By Jaime Pankowsky, MD, FACS

from San Antonio Medicine April 2021

Getting Paid for Your Practice at Retirement

Retirement from Medicine in Stages: Slow Descent From the “Mountain”

By Jaime Pankowsky, MD, FACS

While in training and when in private practice, one does not think of retirement at any time. That thought and feeling enters in our mind as our circumstances, and sometimes our health, begins to change; but not for the better. Alongside the care of patients, duties in the hospitals where we practice and paying off rents and/or mortgages, we are concerned to care for our families and see that our children get the education they can obtain and accomplish.

But sooner or later, events personal, professional, financial and social begin to exert their influence and make retirement a more immediate concern. The “when-and-how” is different for each doctor depending on the physician’s conditions in health, finances, family and age. Early on, when one’s practice becomes stabilized and settled, we begin investing in annuities, IRA’s and/or the stock market, thinking in a very distant future for retirement. Until then we continue humming along. And then, the children are grown up and educated, the house mortgage is paid up and changes are occurring in one’s profession or specialty that we did not expect and for which we were not trained. And then health changes occur and retirement is looking us directly on the face.

I practiced general surgery for over thirty years in San Antonio and then changes began to creep on my complacency. First, general surgery began to be replaced by subspecialties, like colon and rectal surgery, bariatric surgery, breast preservation, etc. One is at that stage, or at an age, when returning to a training program is not an option. Second, I developed cryptogenic tremor in my left hand and this alone made operating less safe for the patient and unsightly for the staff. Finally, a spinal fusion made standing in the operating room for long hours more problematic. So, health issues and changes in the specialty demanded I stop doing surgery. Other than those problems (none of them potentially fatal), I was in good health and condition. But just doing nothing was not in my nature. I took on other activities.

I volunteered as a member of the Committee on Continuous Medical Education of the Texas Medical Association and for a couple of years I used to go with the committee staff to evaluate the educational programs of hospitals in different cities in the state. It was interesting and stimulating, but it required traveling and attending meetings in Austin. At one point they chose to not have me on the committee and I left.

Also, I spent about 18 months evaluating medical claims for the Social Security Administration. I gave it up, because judges seldom had any use for our medical evaluation and it appeared to me to be a waste of time. I also saw how the system was being gamed and cheated by people with false diseases (myalgias) or insignificant injuries. I resigned.

I decided to travel with my wife and, after learning to scuba dive, with a club of scuba divers. Trips as close as Cozumel and as far as

Tahiti and the Red Sea in Egypt were appealing and very interesting experiences. I also made a trip around the world by ship in a program called “Semester at Sea”, which at that time (1998) was sponsored by the University of Virginia (today it is led by the University of Colorado).

Taking advantage of my familiarity with the hyperbaric chamber, I took courses in chronic wound care, one in Minneapolis and two in San Antonio. Our city’s population suffers from obesity and diabetes in large numbers and they, in turn, frequently develop chronic wounds in the extremities very difficult to treat. I joined a couple of clinics as staff and worked in those clinics for about twelve years. Finally, my age was becoming an issue. I was past my 80th birthday, and I was advised enough was enough, (to my family’s relief I quit completely around the year 2008).

If I had to summarize some of the reasons

to retire, I can think of at least three (although I am sure many colleagues could find many more):

First, one’s health. One cannot jeopardize the well-being of patients, family, hospital and office staff by practicing in a state of wobbly well-being, either physical or mental. This does not need further clarification.

Second, family. If in good health, the doctor should try his best to ensure that his family (widow if he dies first) have the means to support and live relatively free of economic distress if possible. Also, one has to see that the children have reached their maximum capacity in learning to lead an independent life on their own.

Third, one should be financially free of major debts and with reserve funds to be able to lead a normal life even if it be a more modest one than when we were at maximum capacity to work.

The United States government has been indulgent and understanding to most middleclass citizens by allowing us to create growth retirement funds that are tax sheltered while growing. For fruitful investment most of us need a financial advisor, but we need to be cautious here, and avoid those who claim they can make us rich in a short time. A steady, diversified plan will work most of the time if we start early and keep the goal of retirement with a peace of mind always in front.

Jaime Pankowsky MD FACS is retired and a Life member of the Bexar County Medical Society.

The COVID-19 Vaccination Game

By Melody Newsom, BCMS Chief Operating Officer, Community Liaison

Vaccinations (and a plethora of questions about them) are all the rage these days! How on earth do I get one? Which brand should I get? Should I even get vaccinated when it’s available? How do I get vaccine for my practice to give to my patients? The list goes on!

The hardest one for the physicians, their staff and other medical professionals in the Phase 1A category is the “How on earth do I get one?” Physicians that do not have privileges at a hospital along with their staff were left out of the mix during the initial rollout of the vaccine in Texas. This became even more of an extreme challenge when the State of Texas opened up the vaccination priorities to the 1B population, leaving the doctors and other medical professionals in the same boat as the rest of the community, having to struggle to find an opportunity to get vaccinated! H-E-B had been designated as the place for Phase 1A’s to get vaccinated, yet they only received 100 doses at each pharmacy in San Antonio for a total of 1,400 doses for our entire medical community.

I have dedicated nearly all of my time at BCMS, since the pandemic was declared, focused on all things COVID-19. I’ve served on various pandemic related committees such as the BCMS COVID Task Force, Metro Health Testing Task Force, Testing and Lab Reporting Workgroup, the Community Response Coalition, the Regional Medical Operations Center (RMOC) and monitored multiple conference calls each week such as UT Health, Southwest Texas Regional Advisory Council (STRAC) and the Department of State Health Services (DSHS).

At each of these committees on which I participate I continually mention the plight of our physician members who, along with their staffs, are without hospital privileges and therefore have no path to get the vaccine. So, when a hospital has a small quantity of vaccine available, they would call me –“there are 300 doses at this location for doctors only; 200 doses at that location for doctors and medical staff; 35 doses RIGHT NOW at this location”, and so on! (I have likened the situation to a game of “Whack-A-Mole” on steroids!)

As you recall from previous articles in San Antonio Medicine, BCMS in conjunction with H-E-B held a 1st dose vaccine event at the BCMS building on Sunday, January 10 and the follow-up 2nd dose event Saturday, February 6.

I knew that was still just a drop in the bucket of the medical community needing to be vaccinated, so the vaccine Whack-A-Mole game continued. Vaccine opportunities became few and far between. UT Health reached out and had a limited number of vaccine doses to dedicate to the 1A group. I collected names and phone numbers and UT Health personnel called to schedule appointments. Still a very cumbersome scenario for all involved, but it was still progress. Finally, on Thursday, February 25 at 4 p.m., UT Health called to let me know they were going to designate 1,000 doses for the doctors and other medical professionals on Saturday, February 27. Wow! Short notice again but, hey, “We’ll see what we can do”. UT Health had been internally testing a program that would allow the ability to upload the contact information for those needing to be vaccinated so they could self-schedule. BCMS became the beta test to the large population of physicians. Despite a few glitches, we were able to get over 700 uploaded into the system by Saturday. The glitches seem to be minimal now and, the great news is, UT Health has been designated a vaccine hub and continues to make vaccination appointments available to our physician members and other medical professionals. I want to say I finally won at the Whack-a-Mole game. (At least for now!) “Which brand should I get?” With three vaccines receiving the Emergency Use Authorization (EUA) – the Pfizer and Mod-

erna mRNA vaccines and the newest vaccine from Janssen/Johnson & Johnson – discussions, phone calls and questions abound. The consensus from experts is you should get whichever COVID-19 vaccine is offered to you. Each of the three currently authorized COVID-19 vaccines prevents severe disease and death.

Now that the Johnson & Johnson one-dose vaccine is out, the main question I receive now is, “How do I get vaccine for my practice?” If this is you, links to all the information you need are available on the BCMS COVID-19 Resources page under the COVID-19 Vaccine Resources section on the BCMS website www.bcms.org. This includes the COVID-19 Pandemic Vaccine Provider Registration as well as links to COVID-19 Vaccination Training Programs and reference materials for healthcare professionals. We have worked throughout the pandemic to make the BCMS COVID-19 Resources page an all-inclusive place to go for information.

According to the DSHS website, vaccine supply remains limited as manufacturers build capacity. It will take time for Texas to receive enough vaccines for priority populations. Supply will increase in coming months. More vaccines are in clinical trials now and may be authorized for use soon. If you are interested in seeing where the vaccine allocations are going each week, the information is available on the DSHS COVID-19 Vaccine Allocations webpage. Both State and Federal Allocations are available on that page.

Throughout the pandemic, the Bexar County Medical Society team has worked diligently to communicate valuable information, provide easy to access needed resources, distribute FREE Personal Protective Equipment (PPE), and gain access to vaccinations for our members and the medical community!

Always know, we are here for you and want to help you and your practice during the difficult as well as the good times.

Melody Newsom is the BCMS Chief Operating Officer and Liaison with Community, Emergency Preparedness Entities.

To Vaccinate or Not to Vaccinate?

By Jaime Pankowsky, MD, FACS

Often in the news media one reads of people refusing or doubting whether to be vaccinated against COVID-19 or not. Reasons given appear at first sight reasonable enough, including worry about allergic reaction, fear of secondary infections (because of or in spite of the vaccine, etc.), or that vaccines may cause Autism. These and other reasons given varied from the improbable to the outlandish.

Ever since Dr. Jenner introduced the cowpox vaccine at the end of the XVIII century and the British Parliament passed a law to vaccinate school children, the news media has come out with questions and even opposition to such vaccine obligation. “Punch”, the sarcastic magazine, published a number of cartoons showing people growing cow tails behind their bodies, or horns on their heads as a consequence of being vaccinated. Other dreadful consequences to vaccination were presented and in response many Britons tried to refuse the vaccination lest they develop such complications. In the meantime, smallpox epidemics were still killing or deforming millions of people, a fact that was waved away as part of life like rain and snow. Today, because of this effective vaccine, smallpox has all but disappeared.

Since the times of the invention of smallpox vaccines, we have seen the development of vaccines against rabies, diphtheria, tetanus, influenza, poliomyelitis, etc. In other words, vaccines have had an enviable record of success in preventing or reducing the effects of infectious disease that in the past were scourges of humanity. It would be safe to dare any business enterprise or world government to match similar successes in all their decisions. And yet, some people will trust the advertisements and propagandas placed in newspapers and on television before they would trust the COVID-19 vaccine.

Joseph Goebbels, Hitler’s minister of propaganda, is reputedly to have said that “a lie, repeated frequently and persistently enough, will be believed more than the truth”. And the regime he represented was an example of perhaps he being right since it happened in Germany, a country that prior to the Nazis was the most educated, most scientifically advanced country in Europe. That said, those were bad times in Germany. It was suffering terrible post-war inflation and bad economic times after World War I, when they also felt the humiliation of defeat and the people were in the mood to receive the messages of those false Messiahs.

Today, and since the end of World War II, the United States has been at the apex of scientific advancement while at the same time enjoying an enviable economic position in the world. Our medical centers are a Mecca for medical education and new scientific discoveries and developments. So, why are some of our people showing such stubborn disregard for true science and embracing persistent ignorance?

In times past, newspapers like “Punch” and many other more serious publications, were the purveyors of news, some factual, some speculative, some dubious and some flat-out lies. But, the public had the choice of buying them or not. With the inventions of the telephone, radio, television, movies and now, the internet and the electronic platforms to cast opinions, speeches and ideas up into the clouds to be captured (willingly or unwillingly) by the public, we are now inundated with unverified opinions, voices, fantasies, conspiracies and, yes, some verified facts as well. The goal is not always evil as with Herr Goebbels’, but nevertheless, the spread of unverified information can cause what our military calls collateral damage or unintended results.

As an example, we learned that no less than a representative to Congress from Georgia, postulated that the fires in California were caused by a laser ray projected from outer space by Monsieur Rothschild, who happens to be French and, of course Jewish, and normally is known to be more interested in producing high quality wines. What caused Monsieur Rothchild to want to burn California is not explained.

My problem is this: that there are enough people in the state of Georgia who thought this person, who probably should be under psychiatric care, should be elected their representative to Congress. The only explanation is the diffusion of outlandish stories, pseudo facts, and conspiracies in the media mentioned above. It is worrisome, because Americans think of themselves as practical, factual individuals. However, since the appearance of unverified, mis-information in the media and its persistent repetition, it has begun to appear believable to a portion of our citizens. Even television commercials seem to be promising fantastic possibilities that seldom if ever come true, but their constant repetition are making them believable.

One should not be surprised, therefore, that vaccinations have also been endowed with mysterious evil properties. Even minor reactions to injections are magnified by the news media, making them appear as dreadful complications by their televised megaphone. The media thrives financially and politically in panic mongering. When children receive routine vaccinations, and coincidentally, some of those children turn out to autistic, it is immediately assumed that one caused the other, instead of just coinciding with one another.

I think its time to teach more science to our children in school, at least it should be given the same importance we now give to sports and social activities…perhaps more.

Jaime Pankowsky MD FACS is a retired physician who is a life member of the Bexar County Medical Society.

Ten Things to Know to Administer COVID-19 Vaccines

By David Doolittle

State health officials have begun distributing COVID-19 vaccines across the state, based on guiding principles that prioritize essential health care workers and vulnerable populations.

There are numerous requirements and steps physicians and health care facilities must adhere to in order to administer vaccines.

Below are 10 things to know about administering the vaccines that have received an EUA from the FDA so far. • State Registries: In order to administer a vaccine, you must be enrolled in Texas' immunization registry, ImmTrac2. Enrollment in

ImmTrac2 is part of the registration process at EnrollTexasIZ.dshs. texas.gov. • Ordering and Inventory: You will be required to submit requests, accept your allocation, and report inventory for the COVID-19 vaccine via the Texas Vaccine Allocation & Ordering System (VAOS). Be sure to check your email spam folder and accept your allocation within 48 hours. Resources: o COVID-19 VAOS – How to Access the System (PDF) o COVID-19 VAOS – Provider User Training Guide (PDF) o More Department of State Health Services (DSHS) Resources and Video Demonstrations • Records and Reporting: You will need to report patient information for each vaccine administered to ImmTrac2 within 24 hours of administration. COVID-19 vaccination records must be preserved for at least three years following vaccination, and will need to be made available to any federal, state, local, or territorial public health department to the extent authorized by law. You also need to submit a daily report of the doses administered into the Texas Department of Emergency Management (TDEM) Therapeutics and Vaccine

Reporting Portal and report any unused or wasted doses specifically into VAOS. • Payment: You cannot sell or seek payment for COVID-19 vaccine and any accompanying supplies provided free by the federal government. Administration fees may be applied; however, you must administer the vaccine regardless of whether the recipient can pay the fees. If you are enrolled in Medicare or plan to enroll to administer the vaccine, you need to keep up to date on coding, billing, and payment requirements from CMS. • Temperature Monitoring: You must have a digital data logger to closely monitor and record the refrigerator and freezer temperatures that store the COVID-19 vaccine. These records must be preserved for at least three years. Find more information on the requirements of digital data loggers on the DSHS website. • Ancillary Supplies: COVID-19 vaccine shipments will come with

all ancillary supplies, including needles, syringes, alcohol prep pads, surgical masks, face shields, diluent (if applicable), and COVID19 vaccination record cards for patients. For the Pfizer/BioNTech vaccine, you may receive these supplies in a separate shipment. • Time Limitations: The vaccines come in multi-dose vials and need to be completely used within a limited period of time after the vial is removed from the refrigerator or freezer. The Pfizer/BioNTech vaccine requires reconstitution with saline. More details on administration, dilution (if applicable), and time limitations are available in these Pfizer/BioNTech, Moderna, and Janssen/Johnson&Johnson fact sheets. • Patient Education: Before you give the shot, you have to provide to the patient an approved Emergency Use Authorization (EUA) fact sheet or vaccine information statement (VIS). The current EUA fact sheets for recipients of the Pfizer/BioNtech, Moderna, and Janssen/Johnson&Johnson vaccines are available on the BCMS website. After the first dose, you must give your patient a COVID19 vaccination record card, which is included in your vaccine shipment. For Pfizer/BioNtech and Moderna, the card is to ensure the first dose and second dose are from the same vaccine manufacturer.

If the patient’s card is lost, you can look up which first dose the patient received in ImmTrac2. You cannot give a patient doses from different vaccine manufacturers. • Safety: You must administer a COVID-19 vaccine in accordance with all requirements and recommendations of CDC and

CDC’s Advisory Committee on Immunization Practices (ACIP). The ACIP’s recommendations for the Pfizer/BioN

Tech,Moderna, and Janssen/Johnson&Johnson vaccines, as well as

CDC’s Interim Considerations for Use of mRNA COVID-19 Vaccines are available on the BCMS website. • Adverse Events: You must input any moderate and severe adverse events following vaccination to the Vaccine Adverse Event Reporting System (VAERS). Note that you should report adverse events only to VAERS, which is co-managed by the CDC and the U.S.

Food and Drug Administration (FDA). You also must promote to recipients V-Safe, a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins.

CDC also has published Interim Considerations: Preparing for the Potential Management of Anaphylaxis at COVID-19 Vaccination Sites.

Find more tools, resources, and information on TMA’s COVID19 Resource Center, which is continually updated.

Melody L. Newsom

Distinguished Service Award Recipient

For tireless, successful efforts during the COVID-19 crisis organizing the distribution of donated personal protective equipment (PPE) to medical professionals in Bexar County;

For creating and maintaining awareness of the need for prioritization of Phase 1a vaccinations and arranging, in combination with other community organizations, COVID-19 vaccinations for medical professionals throughout Bexar County;

For continuing loyalty to the Bexar County Medical Society and its physician members;

Melody L. Newsom, you are recognized with this Distinguished Service Award from the Bexar County Medical Society, its leaders, members and staff.

Betty Fernandez –

New Director of Operations

Bexar Credentials Verification, Inc.

The Bexar County Medical Society is pleased to announce the appointment of Ms. Betty Fernandez as the new Director of Operations of its subsidiary, Bexar Credentials Verification, Inc. (BCVI).

Ms. Fernandez was previously trained and worked as a credentialing specialist under Mary Jo Quinn, the departing Director of Operations at BCVI. After 11 years of service as a credentialing specialist under Ms. Quinn, Ms. Fernandez left BCVI and accepted an opportunity to work for a neuromonitoring practice for 3 years where she gained the experience of how primary source verification information is used by a medical practice. This completed her training/exposure and made Ms. Fernandez the right candidate to assume the role formerly held by Ms. Quinn.

Ms. Fernandez expressed her acceptance of the new position by declaring “I am truly honored and excited to accept the position of Director of the Credentialing Department at Bexar Credentials Verifications, Inc. (BCVI). I am very thankful for being given this opportunity. Ms. Mary Jo has been the director for 20+ years and has paved the road for me to come and continue her legacy. I am proud to return to be part of such a great organization and it is my deep belief that working together with physicians’ medical practices, our clients and staff, we will meet our mutual goals.”

In order for a medical provider or allied professional to be able to practice at a hospital, clinic or surgery center they need to be credentialed. BCVI is a credentialing authority organization (CVO) certified by the National Committee for Quality Assurance (NCQA) that provides direct contact with primary sources for the verification of healthcare providers’ qualifications. Primary Source Verification (PSV) is the process of making sure to verify where the provider received their degree in medicine and had their training to confirm their credentials, including the PSV of boards, licensing, sanctions, medical staff and work experience.

Thank you, Mary Jo Quinn!

God be with you in your retirement

After more than 20 years of service to the Bexar County Medical Society and Bexar Credentials Verification, Inc. (BCVI), its subsidiary, Ms. Quinn has decided to begin officially enjoying the journey as a retired person.

Mary Jo Quinn is a native of San Antonio and has worked in the health care field for over forty years in Texas, Kentucky and Ireland. She worked in San Antonio area hospitals (Christus Santa Rosa, University Hospital, and Humana Hospital) and for health care plans. For eighteen years prior to joining BCVI, Ms. Quinn was directly involved with credentialing and compliance for hospitals, health care plans and CVO’s.

Ms. Quinn was the first Director for Bexar Credentials Verification, Inc. when it started up in the 1990’s. Ms. Quinn felt a higher calling and left the company for three years to be a missionary with the Presentation Sisters of the Blessed Virgin Mary in Zambia, Africa for two years, living with the people and teaching reading and English to children and setting up a special needs class for Zambian children who had never been able to attend school.

Upon return home to San Antonio, Ms. Quinn worked with the Incarnate Word Sisters as Director of Volunteers at Sisters Care, a personal care agency. Then in 2005, she returned as the Director of Bexar Credentials Verification, Inc.

Ms. Quinn will be sorely missed by her staff, Bexar County physicians, and all the companies with which she has worked in her many years of service. Ms. Quinn leaves us with this comment, “Working for BCMS has been a delight.”

GOLF is a Four-Letter Word

By John J. Seidenfeld, MD

It pains me to say this, but my younger self sees my older self as elderly. Though some people start golf at a younger age to enjoy the game for a lifetime, even those who start later should look forward to camaraderie, a nice walk and help with tracking errant balls. Two years ago, a friend asked me to join him on the links. Some history of our relationship is important to better understand my response. We were once a tennis doubles team and always had an enjoyable time playing. We also played softball and made a formidable shortstop to first base connection. This was mostly because of his excellent fielding at shortstop and pinpoint throws to first base. Occasionally I connected well with pitches while at bat and would drain the bases. I still remember, fondly, patients we cared for as doctors over the years. For these reasons one could only say yes to his invitation. A few words of caution as to why you should or should not say yes to such a proposition.

Reasons to say “yes” are that when we play golf, we walk for one-totwo hours and pull carts with our clubs around a par three, nine-hole city course. We discuss life events and plans, ask questions about all aspects of life, speak spontaneously without inhibition, suggest new streaming shows and books, marvel at good shots but do not keep score unless we are doing well, often drop another ball if we mishit or lose one, and never feel the need to lie or cover up if many shots are taken. The formula we use to rate the day is that the walk and talk get a grade of 85% and any good shots add to the total. Anger and frustration are discouraged, and we agree that this is a difficult game. My friend is a good golfer, and this beginner is open to his suggestions.

Reasons to say “no” to the golf proposition include other things you might do with your time, the cost of equipment and greens fees, the long learning curve, frustration and anger as emotions that arise in some, and physical maladies which a grandfather explained as complaint categories after forty years of age, “asses and elbows.” We might have our new car columnist write about the costs of golf equipment depending on how seriously one is about the game. These might be anywhere from a used Chevy to a new Beemer in his parlance.

The way to get from a used Chevy to a new Beemer might include regular lessons from a professional for many years, the latest clubs by tailor made (Taylor Made?), golf tourism once the pandemic abates although this is what we sometimes imagine as we play at all San Antonio’s courses, shoes and outfits to match the course and weather, golf carts and other paraphernalia, psychoanalysis to work on swings and competitive urges, and public courses known as the Alamo Golf Trail versus country club membership and fees.

Some describe golf as “a good walk spoiled” (attributed to Mark Twain and John Feinstein) but your frame of mind and reasons for playing temper a hasty condemnation. Medical professionals do serious work and need down time to balance the difficult encounters. Because of our historically mild weather in South Texas, we have played almost each week in 2020 and plan to continue in 2021 despite the one week of winter in February this year. Other four-letter words to consider are “love” of the “game”, “mate” to share the day with, and the “walk” that is part of it. I hope your outing brings you more joy than pain.

John J. Seidenfeld, MD is the Chair of the BCMS Publications Committee.

Pandemic Story Telling

Internal Medicine residents at UT Health San Antonio participated in Project 6 -55, a guided reflective writing workshop, during which they wrote and shared 6-word and 55-word stories about how the COVID-19 pandemic has impacted their clinical work. Sharing with their peers offered a powerful understanding of the experience of caring for patients during a pandemic and some collective healing. Here are their stories….

Learning to smile with my eyes. Emotions hidden underneath a mask. It has changed human interaction, challenging us to adapt. Non-verbal communication has always prevailed over words. Now, how can I tell a patient, I’m happy? How can I tell them, I’m sorry? When can we go back to seeing a smile and smiling back? ~ By Ariadna C. Perez Sanchez, MD, PGY-1

Transferred from an outside hospital hanging on to your life. On a nasal cannula, switch to comfort care, away from home. His wife said she can only come the next day. He said, “Please, help me, Doctor.” Morphine ordered. But before it got there, he was gone. Family never got a chance to say goodbye. ~ By Jane Lee, MD, PGY-2

Agony while waiting for a phone call. Hours are longer, waiting. For every ring, my heart skips a beat; hoping to hear the doctor’s voice. Hoping for good news, yet any news will suffice. It’s difficult to hang up. Time shortens. So much to ask. I forget everything I planned to ask during that call. ~ By Juan Carlos Ulloa-Rodriguez, MD, PGY-2

Lying in bed, a painstaking three months now. Ventilated, hypotensive; a victim of the pandemic. Family and physicians holding on to hope, no visible light on the horizon. He lays there, visibly struggling, appearing emaciated and fatigued. All options explored, losing faith. His last breath; he gives a sigh of relief. Now, finally at peace. ~ By James Gnecco, DO, PGY-2

You can’t see the microscopic. The apolitical plagues that baffle us. Empathy is the oracle that reveals the unseen suffering. Fake news. The previously healthy gentleman. Now plugged into a new reality. Winner of an unfortunate lottery, where attention is the consolation prize. Someone needs to call the family. Ignorance is bliss. Especially when sedated. ~ By Andrew Gonzalez, MD, PGY-3

Overwhelmed being an adult and doctor. I love the hospital, COVID and all. It’s when I come home that I cry. I’m not alone at work, find comfort in sickness. Surrounded by friends and family for years. Suddenly being an adult, a doctor, and alone is overwhelming. I’m growing, but it is exhausting and lonely. ~ By Saatchi Kuwelker, MD, PGY-1

Another month passes. 200,000 dead. Surrounded by ventilators and isolation. Yet, some still pretend. “I heard it’s like the flu.” “I want things to be normal again.” The more time passes, the less things change. We could have been there by now. We tried to warn you. If only you had listened. It marches on. ~ Anonymous Palliative care during COVID. MICU full. Calling to update their families daily. I dread picking up the phone. Always bad news to give. The hopefulness in their voices fades with each call. Husbands, wives, sons, and daughters. All wanting to see their loved ones one last time. I have nothing but kind words to offer. ~ By Edward Pierce, MD, PGY-1

“Will I ever get to see my mom? Why is she coughing so much? Things have been tough. Grandma started coughing too and was taken to the hospital today. I just lost my sense of taste this morning and am having muscle aches. Tell me everything is going to be okay, Doctor. I need it.” ~ By Sanjay Prasad, MD, PGY-1

I told her over the phone, without a ventilator he would not make it through the night. A long hard sob. We both knew his wishes. I told her it was time to say good-bye. They had been in love for 50 years. They cried together through a screen. He passed peacefully in the night. ~ By Grace Hopp, MD, PGY-3

First impression: young, healthy, strong. Yet, fighting for breath. A few hours later: sick, unstable, drowning. Yet, calm and smiling. Photo of her family beside her head. “Need air!” “I will put you to sleep, help you breathe. But first, tell me a good memory.” “Me, my two kids on a beach.” The end, agony. ~ By Mahmoud Samy Ahmed, MD, PGY-2

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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 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

BBVA Compass (HH Silver Sponsor) We are committed to fostering our clients’ confidence in their financial future through exceptional service, proactive advice, and customized solutions in cash management, lending, investments, insurance, and trust services. Mark Menendez SVP, Wealth Financial Advisor 210-370-6134 mark.menendez@bbva.com www.bbvacompass.com "Creating Opportunities"

BB&T (HH Silver Sponsor) Banking Services, Strategic Credit, Financial Planning Services, Risk Management Services, Investment Services, Trust & Estate Services -- BB&T offers solutions to help you reach your financial goals and plan for a sound financial future Claudia E. Hinojosa Wealth Advisor 210-248-1583 CHinojosa@BBandT.com https://www.bbt.com/wealth/star t.page "All we see is you"

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!”

DIAGNOSTIC IMAGING

Touchstone Medical Imaging (HHH Gold Sponsor) To offer patients and physicians the highest quality outpatient imaging services, and to support them with a deeply instilled work ethic of personal service and integrity. Caleb Ross Area Marketing Manager 972-989-2238 caleb.ross@touchstoneimaging.com Angela Shutt Area Operations Manager 512-915-5129 angela.shutt@touchstoneimaging.com www.touchstoneimaging.com "Touchstone Imaging provides outpatient radiology services to the San Antonio community."

FINANCIAL ADVISOR

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"

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!”

Regions Bank (HHH Gold Sponsor) Regions Financial Corporation is a member of the S&P 500 Index and is one of the nation’s largest full-service providers of consumer and commercial banking, wealth management and mortgage products and services. Jake Pustejovsky Commercial Relationship Manager (830)302.6336 Jake.Pustejovsky@Regions.com Blake M. Pullin Vice President - Mortgage Banking Regions Mortgage NMLS#1031149 (512)766.LOAN(5626) blake.pullin@regions.com Fred R. Kelley Business Banking Relationship Manager (512)226-0208 www.Regions.com SWBC (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying; For Your Practice: HR administration, payroll, employee benefits, property insurance, and exit strategies. SWBC family of services supporting Physicians and the Medical Society. Jon Tober SWBC Mortgage, Sr. Loan Officer NMLS# 212945 (210) 317-7431 jon.tober@swbc.com Deborah Marino SWBC Employee Benefits Consulting Group, Insurance Services, SWBC Wealth Management and PEO (210) 525-1241 DMarino@swbc.com

Avid Wealth Partners (HH Silver Sponsor) The only financial firm that works like physicians, for physicians, to bring clarity and confidence in an age of clutter and chaos. You deserve to be understood and wellserved by a team that's committed to helping you avidly pursue the future you want, and that's our difference. Eric Kala CFP®, CIMA®, AEP®, CLU®, CRPS® CEO | Wealth Advisor 210.864.3350 eric@avidwp.com avidwp.com “Plan it. Do it. Avid Wealth”

HEALTHCARE BANKING

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

GHA TECHNOLOGIES, INC (HH Silver Sponsor) Focus on lifelong relationships with Medical IT Professionals as a mission critical, healthcare solutions & technology hardware & software supplier. Access to over 3000 different medical technology & IT vendors. Pedro Ledezma Technical Sales Representative 210-807-9234 pedro.ledezma@gha-associates.com www.gha-associates.com “When Service & Delivery Count!”

INFORMATION AND TECHNOLOGIES

INSURANCE

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

OSMA Health (HH Silver Sponsor) Health Benefits designed by Physicians for Physicians. Fred Cartier Vice President Sales (214) 540-1511 fcartier@abadmin.com www.osmahealth.com “People you know Coverage you can trust”

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 is A.M. Best A+ (Superior). Delano McGregor Senior Market Manager 800.282.6242 ext 367343 DelanoMcGregor@ProAssurance.com www.ProAssurance.com/Texas

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 Sales Director 210-693-8025 clayton.brown@upnfiber.com David Bones – Account Director 210 788-9515 david.bones@upnfiber.com Jim Dorman – Account Director 210 428-1206 jim.dorman@upnfiber.com www.uniteprivatenetworks.com “UPN is very proud of our 98% customer retention rate” MEDICAL BILLING AND COLLECTIONS SERVICES

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 PRACTICE

IntegraNet Health (HHHH 10K Platinum Sponsor) Valued added resources and enhanced compensations. An Independent Network of Physicians with a clinical and financial integrated delivery network, IntegraNet Health serves as your advocate and partner. Margaret S. Matamoros Executive Director, San Antonio 210-792-2478 mmatamoros@integranethealth.com Nora O. Garza, MD Medical Director, San Antonio 210-705-3137 ngarza@garzamedicalgroup.com www.integranethealth.com “We encourage you to learn more about how IntegraNet Health can help you “

MEDICAL PHYSICS

Medical & Radiation Physics, Inc. (HHH Gold Sponsor) Medical physics and radiation safety support covering all of South Texas for over 40 years. Diagnostic imaging, radiation therapy, nuclear medicine and shielding design. Licensed, Board Certified, Experienced and Friendly! Alicia Smith, Administrator 210-227-1460 asmith@marpinc.com David Lloyd Goff, President 210-227-1460 dgoff@marpinc.com www.marpinc.com Keeping our clients safe and informed since 1979.

MEDICAL SUPPLIES AND EQUIPMENT

CSI Health (HHH Gold Sponsor) CSI Health is a telehealth technology company providing customized solutions to healthcare professionals, assisted-living facilities, and more. CSI was founded in 1978, it was one of the first companies to move medical testing information from self-service kiosks into the cloud. Brad Bowen President, CEO 210-434-2713 brad@computerizedscreening.com Katherine Biggs McDonald Brand Development Manager 210-434-2713 katherine@computerizedscreening.com Bobby Langenbahn National Sales Manager 210-363-1513 bobby@computerizedscreening.com www.csihealth.net Extend the Reach of Healthcare. Elevate the Level of Remote Care. Enhance the Patient Experience.

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.” 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”

PRACTICE SUPPORT SERVICES

SWBC (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying; For Your Practice: HR administration, payroll, employee benefits, property insurance, and exit strategies. SWBC family of services supporting Physicians and the Medical Society. Raymond Frueboes SWBC Wealth Management, Licensed Client Associate (210) 376-3730 raymond.frueboes@swbc.com Jon Tober SWBC Mortgage, Sr. Loan Officer NMLS# 212945

(210) 317-7431 jon.tober@swbc.com Deborah Marino SWBC Employee Benefits Consulting Group, Insurance Services, SWBC Wealth Management and PEO Relations (210) 525-1241 DMarino@swbc.com

PROFESSIONAL ORGANIZATIONS

The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, 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”

San Antonio Group Managers (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. Tom Tidwell, President info4@samgma.org www.samgma.org

REAL ESTATE SERVICES COMMERCIAL

CARR Healthcare (HHH Gold Sponsor) CARR Healthcare is the nation’s leading provider of commercial real estate services for tenants and buyers.Our team of healthcare real estate experts assist with start-ups, lease renewals, expansions, relocations, additional offices, Purchases and practice transitions Matt Evans Agent 210-560-1443 matt.evans@carr.us www.carr.us Brad Wilson Agent 201-573-6146 Brad.Wilson@carr.us www.InvestmentRealty.com Expect Extensive research, innovative solutions, value added services, unparalleled service." The Oaks Center (HH Silver Sponsor) Now available High visibility medical office space ample free parking. BCMS physician 2 months base rent-free corner of Fredericksburg Road and Wurzbach Road adjacent to the Medical Center. Gay Ryan Property Manager 210-559-3013 glarproperties@gmail.com www.loopnet.com/Listing/84348498-Fredericksburg-Rd-SanAntonio-TX/18152745/

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.”

TELEHEALTH TECHNOLOGY

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 or, sponsor member services please contact:

Development Director, August Trevino august.trevino@bcms.org or 210-301-4366 www.bexarcv.com/secure/ bcms/cofjoin.htm