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MEDICAL SCHOOL

EDUCATION & GRADUATION Medical Student Education in the COVID-19 Pandemic By Deborah Conway, MD ..............................................12 Match Day By The University of the Incarnate Word School of Osteopathic Medicine....................................14 Selecting a Residency Program in 2020 By Joshua T. Hanson, MD, MPH ...................................15 The COVID-19 Graduate Medical Education Pandemic Response: Innovation, Agility and Collaboration By Woodson “Scott” Jones, MD ...........16

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BCMS Alliance President’s Message ......................................................................................................................10 Identifying Common Etiologies of Vaccine Hesitance in Texas By Omar A. Caballero, Travis B. Fenlon and Rebecca L. Sanchez, PhD .................................................................................................................................32 Bearing Witness Through Stories By Kristy Y. Kosub, MD .....................................................................................34 Pen & Paper By Chase Ballard ...............................................................................................................................35 Artistic Expression in Medicine By Kristy Y. Kosub, MD .........................................................................................36 Lessons By Aarushi Aggarwal ................................................................................................................................39 Physicians Purchasing Directory.............................................................................................................................40 Auto Review: Full Size GM SUVs By Stephen Schutz, MD......................................................................................44 SAN ANTONIO: Madeleine Justice madeleine@travelingblender.com Gerry Lair gerrylair@yahoo.com PROJECT COORDINATOR: Amanda Canty amanda@smithprint.net

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SAN ANTONIO MEDICINE • June 2021

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

All in the Family: A Love for Medicine Bridges the Generation Gap By David Henkes, MD and Nichole Henkes ............................................................22

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

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.

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Opportunities in Ophthalmology: Connecting Medical Students and Residents during a COVID-19 Crisis By Christopher Zhu and Brandon Lam .........................................................................30

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VOLUME 74 NO. 6

The Journey After Medical School Graduation By Eesha S. Farooqi, MD ...............................................21

San Antonio Historical Advancements and Developments of Modern Medicine By Noor Wadi and Abdullah Ghali .............................................................................................................29

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Medical School Musings By Neal S. Meritz, MD ...........20

A Lawyer Walks into a Medical School By John J. LoCurto, JD .............................................................28

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JUNE 2021

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Two Sisters in Medicine: Two Roads Less Traveled, One Goal By Chinwe Anyanwu and Nneka Anyanwu ...26

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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

Rodolfo “Rudy” Molina, MD, President John Joseph Nava, MD, Vice President Brent W. Sanderlin, DO, Treasurer Gerardo Ortega, MD, Secretary Rajeev Suri, MD, President-elect Gerald Q. Greenfield, Jr., MD, Immediate Past President

DIRECTORS

Michael A. Battista, MD, Member Brian T. Boies, MD, Member Vincent Paul Fonseca, MD, MPH, Member David Anthony Hnatow, MD, Member Lubna Naeem, MD, Member Lyssa N. Ochoa, MD, Member John Shepherd, MD, Member Ezequiel “Zeke” Silva III, MD, Member Amar Sunkari, MD, 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 Stephen C. Fitzer, CEO/Executive Director Nichole Eckmann, Alliance Representative Ramon S. Cancino, MD, Medical School Representative

SAN ANTONIO MEDICINE • June 2021

Robyn Phillips-Madson, DO, MPH, Medical School Representative Ronald Rodriguez, MD, PhD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative Katelyn Jane Franck, Student Alexis Lorio, Student

BCMS SENIOR STAFF

Stephen C. Fitzer, CEO/Executive Director Melody Newsom, Chief Operating Officer Yvonne Nino, Controller August Trevino, Development Director Mary Nava, Chief Government Affairs Officer Phil Hornbeak, Auto Program Director Betty Fernandez, BCVI Director Brissa Vela, Membership 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 Antonio J. Webb, MD, Member David Schulz, Community Member Chinwe Anyanwu, Student Member Donald Bryan Egan, Student Member Winona Gbedey, Student Member Teresa Samson, Student Member Faraz Yousefian, Student Member Neal Meritz, MD, Member Jaime Pankowsky, MD, Member Danielle Moody, Editor

PRESIDENT’S MESSAGE

Coaching in Medicine: Part 2 - The Executive Coach By Rodolfo “Rudy” Molina, MD, MACR, FACP, 2021 BCMS President and Randi Brosterman Hutchens

In Part 1 of this two-part article, the role of a Physician Coach was outlined and clearly defined. In Part 2, we will discuss the role of an Executive Coach. Both types of coaches I believe are of value to our profession. I talked to Randi Brosterman Hutchens, an Executive Coach who has many years of experience coaching business leaders and a Fellow in the Institute of Coaching affiliated with Harvard Medical School. I gave her the same questions as the Physician Coach in Part 1. The following are her answers: 1. What is a coach? A coach is a teacher who works with a client (student) to help the client improve what he/she does. An Executive Coach focuses on the attributes of leadership that can enable the client to grow and ultimately improve the performance of the individual and ideally, the performance of the organization. As defined in Merriam-Webster, a coach (n.) teaches fundamentals and directs team strategy, as in sports. Coaching (v.) means to instruct, direct, prompt or train intensively. In sports, for example, there are specific types of coaches, e.g., football coach, baseball coach, swimming coach. While they all have common elements, they are each fundamentally different in their domain. Regardless, coaching is a deliberate process where one person helps another get stronger and better in what they do. A coach begins by assessing where the client (again, think student) is in his/her process, and quickly determines the level of understanding that the client has of the elements of leadership. Similar to a professor, a coach needs to adapt the level of teaching based on the level of understanding of the student. Consider a 101-level college class vs. a 401level college seminar. A freshman can take a 401-level seminar and have a good experience, however, without the foundational work of the 101 class, the freshman in the 401-level seminar will likely not get the full benefit of the nuance of the 401 content. In medicine, there are different types of coaches too, each with overlapping areas of focus. An Executive Coach is a coach that focuses on leadership development. Executive Coaching in medicine is interesting to me because while the physician is a leader in multiple domains, my perception is that leadership skills are not taught consistently within the field of medicine, and therefore not applied consistently. It appears to me that Physician Coaches focus on physician burnout. While I per8

SAN ANTONIO MEDICINE • June 2021

ceive that several of the elements of Executive Coaching overlap with Physician Coaching, I see Executive Coaching as having a different scope and emphasis than the domain of Physician Coaching. 2. What are the benefits of having a coach? Physicians play multiple leadership roles in their professional and personal lives. There are times when we don't recognize or think of the role we are in as a leadership role. In the absence of that knowledge, we may not be aware that certain leadership skills and behaviors could improve the outcomes of our work with others. Good planning and effective communication can inform the environment in which we work, motivate others to help us achieve specific objectives and result in desired outcomes. I believe physicians who recognize their role(s) as leader(s) can benefit from working with an Executive Coach. Benefits of working with an Executive Coach include, but are not limited to: enhanced presence, increased self-awareness, effective communication, strategic thinking, improved relationships, effective teamwork, influence of others (leaders, colleagues), better self-care and improved work/life balance. Working with a coach provides a private, safe space to talk and work through challenges at work. A coach introduces new ideas and new ways of thinking. Coaches can encourage you to change behavior, hold you accountable and travel the journey with you on the path to achieving specific goals or objectives. 3. How does one become a coach? My path to becoming a coach may not be the recommended path. I leveraged my 26+ years of management consulting experience to become an Executive Coach. As a management consulting Principal (owner/partner/leader) at a major professional services firm, I had two roles: 1) to work with clients to solve their business problems and 2) to develop the people at the firm from recruitment through partnership. Each of these roles involved working with people on their professional, and at times personal, development. Management consulting follows an apprenticeship model, similar to the way in which

PRESIDENT’S MESSAGE

coaches learn to be coaches in athletics. Many Executive Coaches learn to be a coach by participating in one or more programs that provide training and certification. There are several programs at major universities (e.g., Columbia University) and Executive Coaching industry organizations (e.g., International Coaching Federation or the Center for Executive Coaching) in which to learn to be an Executive Coach. 4. When should I consider seeking out a coach? Ideally, the client has a specific objective or set of objectives, in a planned timeframe, toward which the client commits to working with the Executive Coach. Often people reach out to me when they are experiencing frustration at work, either not being heard by leaders and peers or taking on committee work and needing to influence others (like herding cats!). When someone is frustrated by experiences at work, they may benefit from working with someone who has a more objective eye. Coaching can help to "up our game,” but that can mean different things to different people. My approach to Executive Coaching is through the lens of the management consultant. I start with the questions, “What problem are we trying to solve?” and “If you woke up tomorrow and everything were fine, what would it look like?” The next step is to formulate a working hypothesis and test that hypothesis using a Socratic style of coaching. 5. What should I expect from a coach? Expect that a coach will be a coach. Picture a swim coach: the coach is on the side of the pool. The swimmer is in the pool swimming his or her race. Expect that a coach will take the client through a process. Time is a key element of coaching. The person being coached needs time between coaching sessions, over a reasonable period of time, to try out the concepts being discussed in the coaching sessions and to integrate these concepts into their everyday work. A coach is not a therapist, and coaches must understand and respect this boundary. If a client needs a therapist, it is the coach’s responsibility to tell the client and recommend they seek help elsewhere. One question to consider: Does the coach’s knowledge need to include the industry or profession of the client, in this case, medicine? I believe the Executive Coach has a responsibility to be well-informed about the domain or industry in which he or she is working. An Executive Coach does not need to be a physician in order to coach physicians, however, the coach must learn about the work the physicians do and how they do it. I am not a physician. I am realistic that I will never know as much as my clients do about medicine. I am, however, an organizational and process consultant and a teacher (and student) of leadership. My focus is on how people work together in teams to achieve successful outcomes.

The concept of “team play” is essential in medicine, as doctors work in matrixed teams throughout the day and night. The importance of the physician working effectively with hospital leaders, practice leaders, physician peers, nurses, specialists and committee members cannot be underestimated. The physician’s role as leader of practitioner teams is essential to successful outcomes. Physicians have an opportunity to lead better. In today’s world, physicians are not sole practitioners; they are team leaders. Mistakes tend to happen at hand-offs or shift changes, and clear communication at all levels is needed. The physician plays a pivotal leadership role in the effectiveness of the teams with whom he or she works. I believe the onus is on the coach to learn about their client’s industry. When a coach has worked with multiple clients in the same industry or has worked in that industry, there is benefit of understanding the context, vocabulary and nuance of the conversation and objectives. 6. What is the difference between a coach and a mentor? A coach takes the client through a deliberate process over a specific timeframe to achieve a desired result. A mentor can be supportive, make suggestions and offer advice, however, the deliberate nature of the coaching process may or may not be present. Coaches generally are compensated by the client or the client’s employer. Mentors are not. Once the physician has decided to engage a coach, what kind of coach does it make sense to choose? Working with a coach provides you with an opportunity to work on yourself professionally and personally. Envision a Venn diagram with two interlocking circles. Label one circle “Physician Coaching” and label the other “Executive Coaching.” Both types of coaches share common attributes in their work of guiding clients on a path toward self-improvement. Coaches take clients through a process and help the client establish trust, build relationships, manage stress and embrace self-care. Physician Coaches provide the added benefit of addressing physician trauma and preventing (or relieving) physician burnout. Executive Coaches focus on the physician’s leadership skills, such as effective communication, leading teams, prioritizing, planning, delegating and strategic thinking. Both types of coaches offer value to the physician. When engaging a coach, start by asking, “What problem am I trying to solve?” The answer will help guide you to the most appropriate coach for you. I would like to thank Randi Brosterman Hutchens (https://www.actionabletransitions.com) for her role as a contributing author, and more importantly, for her time helping me, and hopefully you, in the appreciation and value a coach has to offer. Rodolfo “Rudy” Molina MD, MACR, FACP is the 2021 President of the Bexar County Medical Society. Randi Brosterman Hutchens is an Executive Coach, a Fellow in the Institute of Coaching affiliated with Harvard Medical School and the President and CEO of Actionable Transitions LLC. Visit us at www.bcms.org

BCMS ALLIANCE

Congratulations to our Allied Health Scholars! For decades, the BCMS Alliance has rewarded excellence in Allied Health fields in Bexar County. This year, six students were chosen as recipients of our 2021 Allied Health Scholarships, representing the fields of physical therapy, nursing, physician assistant and speech-language pathology.

Our Memorial Scholarships JACOB AARON, a PT student at the UIW School of Physical Therapy, was awarded our Rebecca Christopherson Memorial Scholarship, created in memory of our 2015 President Rebecca Christopherson. Jacob was chosen for his academic excellence, perseverance and passion to serve others and change lives. Jacob entered PT school following a year of service with AmeriCorps and plans to work with children facing challenges or in an acute ICU setting. “As a graduate student with no form of income and so many responsibilities academically, it can get difficult surviving from a financial standpoint. More than the money, what I am most grateful for is what BCMS Alliance stands for. When I reached out to them, my emphasis was not on my grades, or how successful I plan to be in the future. My emphasis was on how important it is to me, as a physical therapist, to help others. That is what sets BCMS Alliance apart: their desire to help others.” RYAN RODRIGUEZ, a nursing student at UT Health SA School of Nursing, was selected for our Sandra Vela Memorial Scholarship which honors our 2017 Centennial Board member. Ryan was chosen for his leadership, resilience and willingness to always step forward and serve. He plans to work as an ICU or ER nurse and eventually become a Certified Registered Nurse Anesthetist. “It is my honor to have been chosen. My educational and personal success has been influenced by many positive role models who each possess qualities that I try to emulate. It is through their actions that I have learned, nurtured and grown. Today, I am 10

SAN ANTONIO MEDICINE • June 2021

pleased to add those special qualities described of Sandra Vela to the list of attributes which fuel my passion to make a difference in the lives of those I have the honor to serve.” ANOOSHA MOMIN was a 2020 honoree chosen for her continued excellence as a nursing student at UT Health SA School of Nursing. Providing quality rural health care and continuing research on diabetes and Alzheimer’s disease are her goals. “I am really appreciative to have received this scholarship, and the support by the BCMS Alliance will surely go a long way in helping me achieve my educational and career goals.” TIMOTHY TRAN is a St. Mary’s University student majoring in Biology with a Chemistry minor. Pursuing a future as a physician assistant, our committee was impressed by Timothy’s deliberate career plan and his commitment to serve others. “I am very grateful for this award and look forward to being able to use it on my path to becoming a physician assistant!” ROBYN HERNANDEZ is a speech-language pathology student at UT Health SA School of Health Professions. A military spouse applauded for her conscientious work ethic, Robyn plans to establish her own telehealth company. “I would like to express my deepest gratitude to the committee for their consideration and selection in awarding me this generous scholarship and supporting me on my journey to helping individuals, families and the community in the future as a speech-language pathologist.” ANDREW DUONG from Trinity University was commended for mentoring his peers and service to others. “I was filled with so much joy when I found out I won the award. The scholarship money will help me continue my journey to graduate with a Biology degree from Trinity University and go on to Physician Assistant school. I am so happy to be recognized by the BCMS Alliance, an organization that is committed to helping the community in Bexar County through different projects and this very scholarship." Special thanks to our 2021 Scholarship Committee: Mary Anne Roman, Amy Mahadevan, Hilary Scott, Cheri Schilling, Lori Boies, Nichole Eckmann, Taylor Frantz, April Chang, Cheryl Pierce-Szender and Chair Danielle Henkes.

MEDICAL SCHOOL EVALUATION & GRADUATION

Medical Student Education in the COVID-19 Pandemic: The Show Must Go On, Safely By Deborah Conway, MD

A tsunami warning system detects an event far away and sends alert signals to those who may be affected so they can respond, prepare and MOVE! In February and early March of 2020, the medical education world began to detect tremors of how the seismic event of the SARS-CoV-2 epidemic would impact our domain. The disease was in the news, of course, having reached U.S. shores. San Antonio received quarantined cruise ship passengers. National medical education meetings scheduled for March began to get cancelled preemptively: the first wake-up call to many faculty that this was a different type of crisis. The alarm bells were sounding, and we didn’t know how big the wave was or when it would hit. How far and how fast did we need to run to keep our students safe while minimizing interruptions to their tightly scheduled four-year curriculum? What critical milestones in the life of a developing physician would we have to “leave behind” as we rapidly moved everyone to safety? In the early days of March 2020, we concluded one first-year medical student course under normal circumstances and sent the students on their scheduled one-week Spring Break. Our second-year students were elbowdeep in United States Medical Licensing Examination (USMLE) Step 1 preparation, with individual scheduled test dates looming. Our third-year students were rotating through core clerkships with our main hospital partners, as well as community practices. Our fourth-year students were eagerly awaiting residency Match Day and graduation activities. At this point, however, the full measure of the infec12

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tious threat, the critical shortage of personal protective equipment (PPE) and the urgent need to “flatten the curve” became apparent. The wave was on the horizon. In the second and third weeks of March, the tsunami hit. During the week the students were on Spring Break, we converted our first-year curriculum, including many team-based, collaborative learning activities, entirely online. Third-party testing centers, where USMLE exams are administered, had closed their doors and cancelled test dates. We pulled clerkship students from clinical environments based on national organization recommendations as well as health system partners scrambling to care for patients in new ways while protecting their workforce. Perhaps most painfully of all, we held a vir-

tual Match Day celebration and committed to a virtual graduation event. No one – staff, faculty, leadership, campus and clinical partners – wavered or flinched during these chaotic days and weeks. Our focus remained on the well-being, safety and ongoing education of our students. By April 2020, conditions had stabilized locally to an extent that allowed us to return our clerkship students to their rotations by the end of that month, and our students were eager to resume their role in patient care and clinical development. Established, strong partnerships between our undergraduate medical education team, clinical departments and hospital affiliates were key to this rapid resumption of clinical activity by our students. To do this safely required additional

MEDICAL SCHOOL EVALUATION & GRADUATION

training in PPE, modification of rotations while still providing sufficient experiences, monitoring systems for symptoms and exposures among students and free-flowing lines of communication among the stakeholders. We further benefitted from a robust community response to COVID-19 that kept our first-wave case numbers manageable by our hospital systems. The current academic year finds us at a new-found steady state, seamlessly delivering classroom content virtually to both first- and second-year students, who continue to learn and engage enthusiastically despite the challenges and isolating circumstances. It is certainly not our preferred way of teaching, because much of our curriculum, like medicine itself, is designed to foster collaborative learning and work. Nonetheless, we are discovering new ways to blend technology into learning in order to enhance student engage-

ment, collaboration and well-being. Clinical students continue to rotate, albeit on shortened clerkships this year. Residency interviews were only held across screens, and we provided our students with campus “office space” and equipment to ensure technical glitches (or barking dogs) didn’t diminish their interview experience or the impression they were making. Again, it is the resilience and creativity of our staff, faculty, clinical partners and the students themselves that have cleared a path for us to continue to educate medical students despite the challenges and dangers. The COVID-19 wave is, hopefully, receding, and we will never be the same. It has changed the medical education landscape in ways we can see right now – such as accelerating the decision to eliminate USMLE Step 2 CS (Clinical Skills) as part of the medical licensing pathway – and surely in ways that

will only become apparent over time. Our current medical student colleagues will have an experience like no other generation of physicians. Because of their unique position during the pandemic, they will gain perspective and wisdom from this time that might differ from ours, but is no less relevant. Our job as medical educators is to teach and support them now, honor their experience of the past year and continue to model what it means to uphold our physician’s oath and commitment to patients. Deborah Conway, MD is the Vice Dean for Undergraduate Medical Education at the Joe R. and Teresa Lozano Long School of Medicine at UT Health San Antonio. She is a board-certified OB-Gyn and Maternal-Fetal Medicine specialist who trained and has practiced in San Antonio for more than 20 years.

Visit us at www.bcms.org

MEDICAL SCHOOL EVALUATION & GRADUATION

Match Day By The University of The Incarnate Word School of Osteopathic Medicine

For 32-year-old Ste’Von Voice, March 19, 2021 was a long time coming on an unusual journey. Voice, originally from Terrell, Texas, started his college career in Corpus Christi with dreams of becoming a singer. He is now living the dream of becoming a doctor here in San Antonio. This reality was about to take another major step forward on the first-ever Match Day for the inaugural class at the University of the Incarnate Word School of Osteopathic Medicine (UIWSOM). “I was very excited to find out if I was going to get into my No. 1 program,” said Voice. “Once I found out that I did match with my No. 1, I was very thankful to God for my blessings and immediately started envisioning my next adventures in life.” Voice joined dozens of his classmates on the UIWSOM campus at Brooks on March 19. Held outdoors due to pandemic restrictions, nothing could contain the cheers and tears of joy as each student learned where they would spend the next three to seven years in residency, depending on their specialty. They then filed one-by-one into an auditorium filled with socially distanced faculty to announce their good news and celebrate their match. What they had to say to the faculty was extraordinary. Fifty-five percent of the inaugural UIWSOM Class of 2021 matched into primary care specialties including Internal Medicine, Pediatrics and Family Medicine. In all, the class matched into 14 different specialties. Eighty-four people matched into programs in Texas and the rest matched into programs in 22 other states, including Alaska and Hawaii. Eight learners are military service members, and all matched into military residency programs in the Army and Navy. UIWSOM continues the tradition of its founding congregation, the Sisters of Charity of the Incarnate Word, to bring quality and compassionate health care to where it is needed most. UIWSOM’s mission is to empower all members of the medical education community to achieve academic, professional and personal success and develop a commitment to lifelong learning through excellence in learner-centered, patient-focused education, justice-based research and meaningful partnerships of osteopathic clinical service. For Ste’Von Voice, March 19 brought clarity. He is exactly where he says he wants to be: on a journey that led him from Terrell and now is headed to his No. 1 choice, Providence Hospital in Anchorage, Alaska to study Family Medicine and Wilderness Medicine. All of it bringing him one step closer to his ultimate dream of one day working for NASA and maybe even becoming an astronaut. Still, he says he will look back on his time in the Alamo City fondly. “I will remember how thankful I am for the opportunity to be a part of the inaugural graduating class at UIWSOM and the training they gave me to become a holistic physician. Another fond memory 14

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will be the many days and nights of studying on campus with colleagues to get through exam weeks together,” said Voice. UIWSOM is proud to announce it graduated 137 learners as its inaugural class in May of 2021. “I am so proud of our inaugural class and everyone in the SOM learning community who worked so selflessly to reach this milestone,” said Dr. Robyn Philips-Madson, Dean of the UIW School of Osteopathic Medicine. “We’re very grateful for the Sisters of Charity of the Incarnate Word, our UIW colleagues, community partners and physician preceptors for their support. The Class of 2021 engaged with grace, a pioneering spirit, flexibility and creativity when faced with the pandemic and the challenges of being the first class. They are compassionate osteopathic physicians who care about the vulnerable and marginalized, and I have no doubt they will change the face of osteopathic medicine, health care and their communities in the future.”

MEDICAL SCHOOL EVALUATION & GRADUATION

Selecting a Residency Program in 2020 By Joshua T. Hanson, MD, MPH

A rite of passage occurs every March. Every year, senior medical students across the nation find out where they will be completing their residency training. Physicians and medical schools refer to it as Match Day. It is a day of celebration for students, their loved ones, their educators and their future program directors. The opening of the letter determines their specialty and their training hospital; for many, it is the major milestone in their professional development and is more meaningful than commencement. The transition from medical school to residency was not always so organized. Residency programs, the programs that train physicians into their particular specialty after medical school, were developed in the 1920s. In that era, offers were made to students as early as the second year of medical school. It was not until the 1950s that the National Resident Matching Program was organized to “provide an orderly and fair mechanism for matching the preferences of applicants…with the preferences of residency program directors.” The initial algorithm that was put into place has been remarkably stable and very successful, with only minor modifications in nearly seven decades. In the 1960s, economists David Gale and Lloyd Shapley described an algorithm that would solve the so-called stable marriage problem: a way to match two sets together while taking into account each element’s preferences. This was applied with great success. Economist Alvin Roth, known for his work in organ donation, contributed with a redesign in the late 1990s. This permitted the introduction

of couples (i.e., two senior medical students wishing to link their preferences) to be introduced into the algorithm. For their work, Shapley and Roth were awarded the 2012 Nobel Prize in Economic Sciences. It had been a time-tested process. As in all aspects of life, the COVID-19 pandemic tested the Match Program and introduced uncertainty. In a usual year, students would travel around the country to interview at programs during the late fall and early winter. This would give them a sense of the program. Programs would be able to host applicants in order to understand how they would fit into the program. Unsurprisingly, that was not to be in 2020. Early in the application cycle, the Coalition for Physician Accountability, an umbrella membership organization for many national medical organizations, issued recommendations that all interviews be conducted online in recognition of the dangers inherent in traveling. Schools, programs and students recognized the value in these recommendations and complied. This meant new support systems would need to be implemented along with the development of new skills. At the Long School of Medicine (LSOM), support programs were created; these programs included sessions on increasing online presence, management of accessible interview rooms and an ability to borrow hardware, such as webcams and ring lights to improve their experience. Additionally, LSOM residency programs greatly increased their online presence to present themselves to applicants that would otherwise not be able to visit.

Still, when March began, there was much concern over what The Match would hold. It remained a resounding success. The total number of positions offered was 38,106: the highest on record. This represented a growth of 2.7% from the previous year. Despite this, the percent of all positions filled also increased to 94.9% from the previous year. After the algorithm was run, 1,927 positions remained unfilled, which was a decline of 3.6% compared to 2020. It was no different at the Long School of Medicine. First and foremost, the overall match rate was consistent with that of allopathic senior medical students, indicating the school’s senior class was very competitive in the national job market. It is also clear that LSOM students love the city and the state. For the class of 2021, 23% have chosen to train in San Antonio and 58% will remain in Texas. Primary care remains very popular for the school’s senior class, with 43% going into a primary care specialty. By matching to these training programs in these ways, LSOM physicians will continue to provide excellent care to the people of Bexar County and Texas for years to come. Despite the numerous challenges 2020 presented, the medical education community proved resilient and adapted to the challenges. While the obstacles were substantial, the established processes with novel adjustments created an environment where students could proceed with training, programs could be filled with capable and preferred applicants and, most importantly, patients could receive excellent health care. Joshua T. Hanson, MD, MPH is Associate Dean for Student Affairs at the University of Texas Health San Antonio Joe R. and Teresa Lozano Long School of Medicine. He is a member of the Bexar County Medical Society.

Visit us at www.bcms.org

MEDICAL SCHOOL EVALUATION & GRADUATION

The COVID-19 Graduate Medical Education Pandemic Response: Innovation, Agility and Collaboration By Woodson “Scott” Jones, MD

At the beginning of the COVID-19 pandemic in March 2020, the Office for Graduate Medical Education (OGME) at the Long School of Medicine, University of Texas Health San Antonio (UT Health) began to plan for an anticipated rapid rise in hospitalized patients at University Hospital. At the same time, the state of Texas restricted elective medical procedures. This significantly reduced training opportunities for some residents and fellows in their assigned medical specialties. The OGME implemented a comprehensive plan to employ residents and fellows outside of their training specialty to support critical patient care needs at University Hospital (UH) and the Audie L. Murphy Memorial Veterans Hospital (VA). The OGME, in close coordination with several GME Program Directors (PD), the

Chief Medical Officer at UT Health physicians and key unit medical directors, administrators and nursing leadership at UH and the VA, developed and implemented the Cross-Department Deployment Program (CDDP) to address COVID-19 patient care needs (i.e., palliative care, intensive care, inpatient wards, etc.). Clinical “Bucket Managers” at the VA and UH were also identified for each of these anticipated care-lines needing additional support. Their PDs classified all residents and fellows according to the level of supervision they would need in each clinical setting, should they be deployed. Department Deployment Managers (DDM), often a PD, were identified to oversee each department's cross-deployments. Further educational resources, a just-in-time training intranet site and shadowing opportunities

UT and UH Leadership on “Clinical Learning Environment Walks” recognizing COVID Deployers.

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were developed. The OGME ensured 100% of residents and fellows received personal protective equipment (PPE) training. OGME conducted virtual “town halls” to discuss the deployment preparations and resources available. UT Health, UH and the VA worked cohesively to develop similar PPE protocols, health care provider participation in COVID-19 patient care, testing and return to work protocols. UH, our largest training site, began to experience a rapid rise in COVID-19 hospitalizations in June, with a 400% increase in admissions, leading to the activation of the CDDP. Palliative care team support began on June 19, followed by ward and intensive care team support within a few days. Our second largest participating site, the VA, likewise saw rapidly rising COVID-19 hospitalizations, activating the CDDP to support additional hospitalist teams on June 22. At its peak, the CDDP supported 16 new patient care teams and existing services that required additional physician support. 197 deployed residents and fellows supported UH and the VA during the duration of the CDDP for the first surge. Internal medicine residents provided over 1,500 hours of additional support through their jeopardy coverage. The Surgery Program provided up to seven residents at a time to provide 24/7 COVID ICU support. UH successfully cared for the surge in patients without exceeding hospital capacity. There was no evidence of COVID-19 transmission to the cross-deployed residents or fellows, which is a testament to the thorough training and equipping of our GME residents and fellows.

MEDICAL SCHOOL EVALUATION & GRADUATION

Banner Celebrating Summer 2020 GME COVID Deployers.

In a post-event survey administered to participating residents and fellows, the overall deployment experience was viewed as positive for two-thirds of residents, and onehalf of the respondents stated they would be willing to deploy again if the need arose. Ninety percent felt their personal safety was important to the care team. We also learned from the feedback that we had insufficiently highlighted the additional COVID coverage our UTHSA physician faculty had provided during the first surge. So, as we entered into a second surge of COVID patients in November of 2020, we better communi-

cated when our internal medicine subspecialists began supporting inpatient teaching teams. Freeing our internal medicine hospitalists enabled them to manage the increased COVID patients. This was before any residents were yet cross-deployed. We also better communicated when our trauma faculty expanded our COVID ICU capabilities by opening up the COVID ICU Green Team for a second time, initially without resident support. We had faculty from at least five different specialties cross-deploy to help with our palliative care services. Finally, beginning mid-December 2020, we activated

Palliative Care and COVID ICU Green Team Rounding: Faculty and residents from 6 different departments.

the GME CDDP again through mid-March 2021. We deployed 187 residents and fellows from 26 different GME programs, as well as the oralmaxilofacial surgery residents from the dental school and physician assistant, occupational therapy, physician therapy and respiratory therapy trainees from the School of Health Professions. The physician support was so remarkable that only a very limited number of locums or other external physicians (i.e., deployed military) contributed to either COVID surge. In the end, more than one-third of our GME trainees deployed from their routine training to help directly to meet the demands of caring for COVID-19 patients. The UTHSA, UH and VA demonstrated remarkable agility, collaboration and innovation during the COVID-19 pandemic. Regarding innovation, new processes for assigning and tracking residents and fellows to support clinical activities at UH and the VA were created as deployments that had never been considered before. Best practices were adopted from our own programs and other institutions and tailored to our unique situation while maintaining compliance with the key tenets and accreditation standards of the Accreditation Council for Graduate Medical Education (ACGME). We were contacted and shared our practices with at least four different institutions during the surges. Our efforts were also presented in an continued on page 18 Visit us at www.bcms.org

MEDICAL SCHOOL EVALUATION & GRADUATION continued from page 17

invited workshop at the ACGME annual meeting in February 2021. While innovation is a domain in which academic medical centers excel, agility and collaboration are not often considered inherent strengths. However, agility was crucial to success. The team worked quickly to implement a process, where none had existed before, to evaluate residents’ capability to support several different areas of patient care. Each resident and fellow who participated in the CDDP utilized skills that were part of their core education and training as physicians. However, these were often outside the scope of their specialty training. Dyad teams were created with UH and VA Hospital Medicine to enhance supervision. Finally, the challenge with managing residents deployed from different programs to multiple teams for varying time periods required on-the-fly changes in the implementation process to create “threads” of program-level ownership. Each program would ensure resident or fellow coverage to a specific team daily until clearly transitioning to another program. There were no reported drops in coverage. Further, 100% of residents reported appropriate supervision on the survey mentioned earlier, unlike reports in the press from other areas of the county. With the varied missions of clinical care, research and education, academic health systems can drift towards operating in silos at times. The Office of GME worked in coordination with over 30 GME Program Directors and the clinical, nursing and administrative leaders from UT, UH and the VA to establish and administer the CDDP. UT GME leadership did COVID Clinical Learning Environment Walks (CLEW) with UH leadership, checking in resident workrooms for wellness checks (i.e., candy, cookies), ensuring they had PPE, hand sanitizer and reminding them about staying masked in the often confined workspaces. Regular meetings (daily during peak) and virtual meetings with CDDP leadership (DDM and Bucket Managers)

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Two residents “Cross-Deployed” to COVID Hospitalist Service with Internal Medicine Attending.

ensured all patient care requirements were satisfied with properly trained and supervised providers. GME attended and reported daily in the COVID response team of UTHSA and within the COVID Bed Management Committee, as well for VA and UH, coordinated by the UT Health Physicians Chief Medical Officer. Faculty set the tone for academic medical centers. Departments and divisions outside of general internal medicine lead by example, stepping forward early to help support the COVID mission, which was critical to our success. For instance, the trauma surgeons leading the COVID-19 ICU expansion efforts set a tone for an “all in” environment within the institution, creating a “culture of engagement” in meeting the needs of Bexar County and the Region. The efficiencies and improved communication and coordination across specialties and with our part-

nering hospitals during this pandemic have provided models for us to build upon to enhance patient care for years to come. Woodson “Scott” Jones, MD is Vice Dean, GME & DIO and Professor of Pediatrics at the UT Health Long School of Medicine. He is a member of the Bexar County Medical Society.

MEDICAL SCHOOL EVALUATION & GRADUATION

Medical School Musings By Neal S. Meritz, MD

There were only four medical school options in Texas when I applied in the summer of 1967. The possible choices included Southwestern in Dallas, the Medical Branch in Galveston, Baylor in Houston and the brand-new addition to the University of Texas System that was opening in San Antonio. I flew down on Braniff Airlines from my home in Dallas to interview in San Antonio, the most appealing of Texas cities. The South Texas Medical Center sprang from the open fields of a dairy farm almost 60 years ago. Oak Hills landowners donated the land and Bexar County voters approved a bond issue. San Antonians at that time disagreed strenuously about whether a medical school should be built Left: Neal S. Meritz, MD as a medical student in the 1970s. Right: The South Texas Medical Center in the 1970s. downtown or on the Northwest Side, far away from the population. There were more cows and human anatomy and physiology, with pathology and disease states deer than people in this area during the 1960s. When the Veterans studied in the second year. Anatomy, physiology, pharmacology and Administration announced their intent to build a massive hospital biochemistry were all covered as a unit according to the various body nearby and Santa Rosa revealed plans for a psychiatric unit, the Medsystem. We started a course on physical diagnosis immediately and ical Center became a reality. we saw real patients from the very beginning. My first rotation in the The offices of the medical school at the time were located at Trinity clinical third year was pediatrics. This was early 1970 at the height of University, so I took a taxi there from the airport. My interviews were the Diphtheria epidemic of San Antonio. It was my introduction to conducted by Dr. Leon Cander, Chairman of Internal Medicine, and dedicated doctors treating really sick children, an experience that imDr. Joe Wood, Professor of Anatomy. Dr. Wood and I drove in his pacted and influenced me enormously in my entire career. VW Bug to the open fields of the Medical Center where the new My interviewers kept their word. I spent the summer between the school was under construction amid the deer and cattle. We wore first and second years in Appalachia. During the fourth year I did a hard hats on our tour. Methodist Hospital existed, the medical school course in psychiatry at the University of Toronto, followed by a 3was partially completed and the new Bexar County Hospital was in month rotation in Ob-Gyn at the University of London. My fellow the beginning stages of construction. Dr. Wood described the vision English medical students gave me my all-time favorite nickname. I of Dean Carter Pannill and the forward-thinking concepts of the was known as “The Colonist.” early faculty. Dr. Wood promised me, among other things, an inteLater, I won a full tuition scholarship for my fourth year: $300. grated curriculum, early contact with real patients and a senior year My father was thrilled. composed entirely of electives. I was impressed. Medical School in San Antonio was truly one of the best experiThe University of Texas Medical School at San Antonio Class of ences of my life. The University of Texas, now UT Health San An’72, which was the first class to attend all four years, began on Septonio, is presently composed of multiple programs and is well known tember 3, 1968. Some students maintained living quarters on the as a nationally renowned institution. The founders of this school 12th floor of the unfinished Bexar County Hospital with one wing were courageous and wise. The city of San Antonio has been a terfor female nursing and medical students and the other three wings rific place to practice medicine, raise a family and spend a lifetime. for male medical students. I am married to one of those nursing students. The Class of ’72 consisted of 56 students: 52 men and 4 Neal S. Meritz, MD is a retired Family Practice physician women. 54 of us were Texas residents. The eagerness of the students and a member of the BCMS Publications Committee. and the enthusiasm of the faculty were clearly evident. The curriculum was indeed cleverly integrated, and a non-traditional model was utilized. First year studies concentrated on normal 20

SAN ANTONIO MEDICINE • June 2021

MEDICAL SCHOOL EVALUATION & GRADUATION

The Journey After Medical School Graduation By Eesha S. Farooqi, MD

After spending several years on a carved out, step-by-step path of classes, exams and familiar procedure, the post-medical training world becomes quite intimidating. I remember very distinctly when and where this realization had occurred to me, and it has never faded since. It was a few months into our final year of pediatrics residency when a few of my colleagues and I were sitting around my living room after a typical foodie frenzy, holding onto our full stomachs with eyes half open. In that relaxed moment, we began to discuss future plans and what we wanted to do after residency when suddenly we all paused at almost the exact same time. It hit us that we generally knew what we wanted to do (pediatrics of course!) and the overall setting (inpatient vs. outpatient). However, the specifics were entirely blank with large question marks in its place. Which city? Which state? Should we stay here in familiar territory or move and start somewhere new? What type of group/organization should we join, whether private owned or larger? What do we look for in a contract? Suddenly, after years of being guided and told what we needed to do to achieve ‘xyz goal,’ we were now free to do exactly what we pleased and go wherever we desired, but ironically, with very little knowledge about how to do so successfully. Our simultaneous pause that day in my living room summed up a combination of excitement, fear, anxiety and relief — all contradictory feelings which did not sit well with our full stomachs. That day, we discussed various options about job type, location and life goals, and felt a little more at ease as we chipped away at the specifics of our ideal career. For many of us, this was the first true job application and also the first true time where we were not in a desperate "pick me, pick me" posi-

tion. The world was full of options. As a group, our residency class later requested an informational session with a representative from a local hiring company. We were able to learn about contracts, terminology, standard benefits, negotiation, etc. as well as fellowship career paths. All helped to relieve some anxiety, but for many of us that were not doing fellowships, there was still a lingering dread of the unknown awaiting us on the other side of residency. Where would we even start looking for jobs? Luckily, in addition to the typical job sites, the American Academy of Pediatrics regularly conducted virtual job fairs which gave residents access to nationwide job openings and a chance to chat directly with the representative about their questions. I attended a fall session and found my way to ABCD Pediatrics through that platform. I have been truly grateful for that opportunity since then.

The post-training medical world is truly its own challenge, applying technical medical knowledge to a constantly changing world. This first year out, I have realized it requires constant reading, layers on layers of self-confidence, close patient relationships and a lot of patience. However, it becomes significantly worth it when that one family or that one child ends their statement with a genuine “thank you,” and you get that soulful positive boost you needed to keep on moving ahead. I hope to continue to grow as a physician with each patient and with the support of my colleagues, not just in the clinic but in the community as a whole. I look forward to another year of practicing and another year of new experiences. Eesha S. Farooqi, MD is a Pediatrician in Bexar County and is a member of the Bexar County Medical Society.

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ALL IN THE FAMILY

A Love for Medicine Bridges the Generation Gap By David Henkes, MD and Nichole Henkes, MS-II

what was more important was them being happy with the vocation they chose. Never Make Predictions I predicted my son would be most likely to go into medicine. My daughter, Nichole, was smart, but I worried some of the unpleasant experiences in medicine would turn her off: gangrenous limbs, colonoscopies, etc. My son, Daniel, chose another dream—aerospace engineering at NASA. Instead, it was Nichole who stepped forward to follow in my footsteps. Trial by Fire When Nichole said she wanted to go premed in college, I said to myself, “Let’s show her some of the no-glitz and glitter that doctors do and see if she can really cut the mustard.” I set her up to shadow physician friends doing colonoscopies, amputations removing foulsmelling gangrenous limbs and organ transplantation. I thought she might last a day, but instead, she was intrigued. The more she saw the profession, the more her passion grew.

THE BOOMER: David Henkes, MD When my children were in grade school, I wondered how they felt about me being a physician, especially my activities in TMA, AMA and specialty organizations. It meant yearly summer vacations in Chicago or other cities while Dad spent his days in meetings. Would this discourage their interest in pursuing a career in medicine? 22

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My Secret Wish Many years ago, I remember talking with colleagues about their children. Some encouraged and were very proud their children followed them into medicine; others were adamant that their children should not. The differences were striking. Secretly, I hoped my children would go into medicine, but

Competition College pre-med was difficult. Professors discouraged students from pursuing medical school. At that time, it seemed inappropriate, but now I can understand why: At Baylor, nearly 30% of freshmen plan to attend medical school after graduation, but of those, less than 25% complete the medical school application process, with about 18% admitted. Collaboration Time passes quickly: Nichole is nearly an MS-III. She has done well, achieving high honors in every course. I feel proud when she calls to ask me a medical question, especially

MEDICAL SCHOOL EVALUATION & GRADUATION

one dealing with pathology. And just recently, I called her to give me a refresher on some general medical diseases that I had forgotten about. Advice for Parents of Pre-Med Students: • Your student must have a plan to enter medical school. Not just in words, but in actions: forgoing many fun events in college to study and work hard. • They must have drive to achieve that goal. It cannot be your passion: it must be theirs. The road is so long and arduous, your passion cannot be the only fuel for the drive. • The essays required by medical schools are critical. Passion to practice medicine and future contributions to the profession must both be demonstrated. Nichole worked hard on her essays for several months, writing and rewriting them to reflect this. When finished, each essay was unique, personal and inspiring. David Henkes, MD is a Practicing Pathologist, the recipient of our Distinguished Service Award and served as the 2005 President of the Bexar County Medical Society.

THE ZOOMER: Nichole Henkes, MS-II When I tell people that my dad is a physician, I’m always asked, “Did your dad want you to be a doctor?” This question haunts me no matter what stage of education I am in. It’s a pressure hanging over me: the need to prove that I am going into medicine for the right reasons, and not just to please my parents. Of course, my dad is happy to see me in medical school. I believe he sees the same excited passion about becoming a physician that he experienced in medical school. Advantages But there were many advantages of having

a parent in the medical field that I would not have experienced otherwise. I had a sneak peak of the “behind the scenes” personal life of a physician. With many weekends on-call and holidays postponed, I learned firsthand that medicine is a profession that demands a life-long dedication to the service of others. Hesitation Most people are surprised to hear that I was initially met with hesitancy from my father when I chose pre-med at Baylor. He knew about the long hours studying and working, and the delayed gratification physicians face. In fact, I have spoken to quite a few physicians who heavily discouraged their children from going into medicine. Now that I’m in medical school, I see why. Passion You truly have to love medicine in order to endure it. Many days I have struggled and lost motivation, but my passion kept me afloat. Preparing for my first board exam, I could see how burnout is a very real threat. Many students, including myself, are accustomed to high scores and impossibly high standards. We hoard ourselves in the library from sunup to past sundown every day, with the hopeful delusion that workloads will lessen in the near future. Nevertheless, I couldn’t imagine doing anything else.

Time Passes Surprisingly, I am already finishing my second year of medical school. Despite some COVID distortion, my class was still able to complete pre-clinical education and practice clinical skills. I look forward to the next two years of medical school and beyond, as I finally get to interact with patients and apply all the knowledge I have learned. My next big decision will be residency, and although I have had plenty of exposure to my father’s specialty, pathology, I have never felt pressured to go into it. I am so grateful to my dad for introducing me to medicine. If he had discouraged it early on, I probably would not have found my passion. Advice for Those Interested in Medicine: • Pay attention to both positive and negative aspects of your parent’s vocation. • Start early, in high school, with a deliberate plan toward medicine. • Be honest with yourself and your parents about what your passion is. • Don’t assume you have an advantage getting admitted to med school — it often works against you. Nichole Henkes is an MS-II at UT Health SA Long School of Medicine and co-chair of the BCMS Student Collaboration Committee. Visit us at www.bcms.org

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Generational Medicine:

When Several Generations of a Family Pursue Medicine as a Career By Rodolfo “Rudy” Molina, MD, MACR, FACP

When I was asked to write about why I thought all three of my children pursued a medical career, I drew a quick blank and thought it best to ask them for their input. The answers I received sent a clear message, at least for me. I must mention, none were pre-med majors when they entered college and both my wife, also an MD, and I were very supportive and excited for them as they pursued their education. I asked them for the why. The following are their answers. Our oldest, Eric, graduated from Stanford with a degree in Cell Biology and then worked in the private sector at Genentech before applying to medical school. I’m proud to say he is graduating as Valedictorian from the MD and PhD program at Baylor College of Medicine (my wife and my alma mater) and is pursuing an Interven-

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tional Radiology residency at Massachusetts General Hospital. He provided this response: “I believe that values will ultimately lead an individual to a profession or vocation if that individual is presented with the right opportunities. My parents gave me any and all opportunities to grow my sense of self and my mind. Respect for my fellow humans, compassion for the suffering, logical rigor and the notion that scientific knowledge and advancement not only can be achieved, but that achievement is a moral imperative in order to prevent the needless loss of human time, life and dignity. These are the principles that I observed at the base of my parents’ motivation. Their values became my own, but I chose to pursue them in a slightly different way by adding a PhD in Bioengi-

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neering to my medical degree. I did this because I wanted to help patients navigate their illness but also believed that science generates the map which makes that navigation possible.” Our second child, Emily, graduated from Massachusetts Institute of Technology (MIT) with a degree in Neurocognitive Studies and then spent the next three years doing medical research at UTHSC, San Antonio. She is presently at Johns Hopkins completing her second year as a medical resident and is pursing a Rheumatology Fellowship program. The following is her response: “It’s honestly hard to remember exactly what happened, or when the lightbulb that told me, ‘this is what I want to do,’ went off in my head, since I had spent so much time fighting the idea. I didn’t like the hours I saw, and I didn’t want to feel torn between work and home. But, honestly, as soon as I stopped thinking of being a physician as ‘having a job,’ and started thinking about it as part of a lifestyle, I eventually just realized that I couldn’t see myself doing anything else. My initial plans of being a teacher are fulfilled (with students, interns and patients), my curiosity on the human body, mind and condition is never satiated, and the relationships and compassion I choose to have for my fellow beings is essential, not only for the sake of my patients and their families, but also for myself and my team. From an ideological perspective, the traits of what I would consider a great physician – compassionate, listener, humble, analytical, good communicator and teacher – are all traits that I aspire to, although I know I can fall short. Plus, seeing how fulfilling you both found your work, and [after more exposure to the field outside of home] understanding how meaningful the work truly is, ultimately helped guide that decision. Regardless, I’m sure it was many things that led each of us down this path, though I also would favor believing that if you (parents) didn’t like your job, we probably wouldn’t either.” Sarah, our youngest and a proud Aggie, is graduating this year from UT Health San Antonio Long School of Medicine and will be entering a Pediatric residency at Baylor College of Medicine.

As soon as I stopped thinking of being a physician as ‘having a job,’ and started thinking about it as part of a lifestyle, I eventually just realized that I couldn’t see myself doing anything else.

“

This was her response: “Throughout college, I seriously considered a few different career choices – marine biologist, teacher, art historian, social worker, the list goes on. I saw the tireless hours that you and mom spent working and was firm about not pursuing medicine because of it. Similar to Emily, it wasn’t until I stopped thinking of practicing medicine as a job and began thinking about it more as a lifestyle that I seriously considered it. As I grew up, I remember countless conversations about different projects and patient cases that you both were working on and I’d be lying if I said that your passion and excitement were not contagious. Ultimately, as I reflected upon my own experiences, I realized that becoming a physician would provide me the opportunity to marry many of my passions: science, teaching, advocating, serving my community (specifically our tiniest members) and learning. Side note: I also remember multiple warnings from you both to not go into medicine unless I was 100% sure – I still appreciate not being pushed into this field because it is demanding (but also extremely rewarding and fun). I joked multiple times with my interviewers who asked about whether or not you and mom played a role in my decision to become a doctor that the best way to get your kids to go into medicine is to tell them NOT to go into medicine. I told them it worked 3 out of 3 times.” From my perspective, the message is clear: if the parents love what they do as physicians, their children will likely consider pursuing the same, if not a similar career. I’d like to thank the Publications Committee for asking me to write this article and mostly would like thank our children for writing the bulk of it. Rodolfo “Rudy” Molina MD, MACR, FACP is a Practicing Rheumatologist and the 2021 President of the Bexar County Medical Society.

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Two Sisters in Medicine:

Two Roads Less Traveled, One Goal By Chinwe Anyanwu and Nneka Anyanwu

Student doctors Chinwe and Nneka Anyanwu aren’t just sisters in medicine. They also happen to be sisters in real life! These two sisters born to Nigerian parents, sometimes referred to by family as, “The Sisters,” because you never see one without the other, took two very different roads to medicine with one same goal in mind: diversifying medicine. Nneka, the older sister by 4 years, fought tirelessly to get into medical school and the road was anything but easy. After being diagnosed with scoliosis as a young girl and having spinal surgery to place rods at the age of 10, her ties to medicine were sealed tighter than a jar of pickles. Learning later in life the medical error that occurred during her surgery, in which adult rods were placed instead of the appropriate growing rods for children, she had spinal reconstructive surgery her senior year of high school. She wheeled across the stage at her high school graduation in a wheelchair to claim her diploma as if it was her birthright and wheeled herself straight into college at Prairie View A&M University in that same chair. She then went on to complete two master’s degrees. Her experiences meticulously fashioned her passion for Physical Medicine and Rehabilitation. She learned then, she had a strength that few had, and it was that same strength that would carry her through her journey in medicine, and apparently right alongside her little sister. Chinwe had a very different path. Never interested by just one thing, she never actually planned to go to college. After high school, she was set on moving to New York to be a creative and fashion designer. Just as many Nigerian parents would feel though, her parents actively dis26

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couraged the naïve idea of being a struggling artist in a place she’d never lived, and of course nudged her into going to college to at least have a “backup plan.” Little did she know that this nudge to college would bring a wind of events strong enough to skid a freight truck and propel her into the field of medicine. Returning home for the first time after her first semester of college to find out her brother passed away from a seizure helped scope much more of her future career than she realized. Sitting there as EMS attempted to save his life and not knowing what to do in that moment to help the one person she admittedly loved most, manifested itself as a deep love for the field of emergency medicine. She then went on to work as an ED medical scribe for the next four years and obtained her Master’s in Epidemiology. In 2018, both Chinwe and Nneka were accepted into medical school at University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) and Meharry Medical College, respectively, and collectively have received over $140,000 in scholarships. Obviously, one sister chose DO, while the other set on pursing an MD. Two very different roads, though admittedly one even less traveled than the other, but have these roads really been so different? As they talk about their medical school experience, there are many similarities, such as both being part of relatively new programs. Nneka’s class had rolled out a new curriculum, so it felt like going to a new program full of lots of trial and error. As many know, UIWSOM is literally a brand-new medical school, with its first class graduating this year and is all too familiar with the trials and errors of a new pro-

MEDICAL SCHOOL EVALUATION & GRADUATION

gram. Both have also entered schools that focus heavily on primary care, with missions that include in part, advancing health equity through service, cultural competency, education and leadership. As an osteopathic medical student, Chinwe has been able to develop an appreciation for the research opportunities, resources and exposures to numerous subspecialties that her sister has had at her MD program. As someone who chose to take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) and United States Medical Licensing Examination (USMLE) licensing exams, she has been able to use aspects of her sister’s curriculum and resources to better prepare for USMLE, since her school has a sole focus on COMLEX. She has been able to use information and skills from both of their experiences to carve out her own path to success and develop ways to bridge the gap between MD and DO training. She has learned that both have an important role to play in the field of medicine. Along with the rigorous curriculum of medical school, Nneka also deals with chronic back/neck pain attributed to her multiple spinal surgeries. Medical school only intensified her pain due to the extensive study hours and workdays. Having her sister perform an Osteopathic Manipulative Treatment (OMT) on her during the holidays, teach her new techniques to use on herself and watching her sister practice has broadened her view of the tools available to treat patients and has

been of particular interest as someone going into the field of physical medicine and rehabilitation (PM&R). Though the additional exam and classroom hours are not the most attractive to someone choosing the field of DO, she has developed a deep appreciation for the skillsets her sister has learned, and these skills have even helped her at times with her pain through medical school. In retrospect, DO may have been a good fit for her specialty interest, however, she is a true believer that everything happens for a reason. She would not have had the opportunity to go through medical school with one of the people she loves most in this world: her little sister. For her, that has honestly been the best blessing throughout her medical school experience. MD or DO, medical school is medical school, and it is to say the least, hard. So, though these sisters have taken very different paths to medicine, it is the similarities that strengthen their bond and have placed them in a position to be each other’s helping and healing hand. Two very different roads, though admittedly one even less traveled than the other, but have these roads really been so different? Chinwe Anyanwu is a rising OMS-IV at the University of the Incarnate Word School of Osteopathic Medicine. Nneka Anyanwu is a rising OMS-IV at Meharry Medical College.

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A Lawyer Walks Into A Medical School By John J. LoCurto, JD

The title to this article might read like the setup to another lawyer joke. It is not a joke. At least I hope it is not. That is because I am the lawyer, and the medical school I walked into is the University of the Incarnate Word School of Osteopathic Medicine. I joined the SOM full-time in September 2020 as the inaugural Assistant Professor of Medical Jurisprudence and Health Policy. My position gives me the privilege of working with learners across all four years of the medical school curriculum and beyond into residency. Why would a medical school hire a lawyer? You might think that mixing an attorney into a faculty of physicians is like asking dogs and cats to live together in harmony. But the combination is not quite so outlandish. To obtain a license to practice medicine in Texas, each graduate must pass the Texas Medical Jurisprudence Examination. The JP exam, as it is known, is an online, multiple choice test that covers a range of topics drawn from Texas law, administrative regulations and medical board rules. What information does a physician have to report if she suspects elder abuse? Which immunizations must children receive to attend school in Texas? When is a person incapacitated to make medical decisions? These are the sort of questions the JP exam poses, and they are not the traditional fare of medical school curricula. Integrating the law into pre-clinical and clinical education helps learners develop skill spotting legal issues and prepares them more effectively than cramming does for the JP exam. At the SOM, however, incorporating the law and policy is about much more than a licensure examination. It is about preparing learners to practice medicine, to become effective and fulfilled professionals and to become responsible stewards of the public’s trust. A common refrain around the SOM is that structure and function are inextricably linked. Just as the structure of a cell, organ or bone influences how it functions, law and policy provide structure that influences how the health care system functions. The practice of medicine is embedded

in a complex and often contradictory body of overlapping laws, regulations and rules. The requirements these authorities impose and the limits they set are in the exam room with a physician and patient, just like a stethoscope, tongue depressor or sharps disposal. Yet, medical education does not necessarily prepare learners for the realities and demands of the system in which they will deliver care. The SOM is changing that. By threading legal topics into the four years of study – a pinch of informed consent here, a touch of HIPAA there – and creating meaningful opportunities for deeper exploration of real-world issues that arise in the practice, business and regulatory oversight of medicine, the SOM is equipping learners to be physicians in a holistic sense. This approach carries over beyond graduation and into residency when topics such as the basics of medical malpractice insurance and physician contracting are addressed. This fulsome commitment to education is perhaps to be expected at an osteopathic medical school. Osteopathic medicine focuses on the whole person, a sum of more than the genes, cells, organs and systems that comprise the body. The SOM applies the holistic osteopathic philosophy to medical education itself. By adding legal and policy elements to the curriculum and doing so in a way that supplements rather than disrupts the learning experience, the SOM is educating the whole learner. Graduates will emerge from the SOM with the expertise they need not just to be physicians, but to thrive as professionals in a complicated and sometimes bewildering health care system. So, now that I have laid out my case for lawyers in medical schools, perhaps my point can best be made with a lawyer joke after all. What do you call a lawyer on a medical school’s faculty? A good start.* John J. LoCurto, JD is Assistant Professor of Medical Jurisprudence and Health Policy at the UIW School of Osteopathic Medicine.

This joke is a riff on one I have heard many times in many ways: What do you call 100 lawyers in front of a firing squad? A good start. 28

SAN ANTONIO MEDICINE • June 2021

MEDICAL SCHOOL EVALUATION & GRADUATION

San Antonio Historical Advancements and Developments of Modern Medicine By Noor Wadi, OMS-I and Abdullah Ghali, MS-III

The development of accessible health care in San Antonio is due to an exponentially growing population with a vast base of ethnicities that mimic populations throughout the nation. This allows San Antonio to rapidly develop into a city now home to 29 large-scale health care facilities spanning the region and servicing the community. Along with dedication to service, health care development has brought along the advances of multiple research centers invested in creating solutions that impact local and international challenges in health care. San Antonio has grown to develop into the top three Texas cities for funding from the National Institutes of Health in the Fiscal Year of 2021, with the UT Health San Antonio (UT Health) alone receiving $116,658,251 in funding in the year 2021.5 There are over 600 research projects conducted at University Hospital alone, including clinical trials in collaboration with the UT Health San Antonio system. This allows for the development of novel treatments and further understanding of disorders that affect our communities. UT Health holds a legacy in research innovation. It is home to the development of the first clinical estrogen receptor test developed by Dr. William L. McGuire, MD, former Chief of Medical Oncology at UT Health.1 This novel discovery allowed for further depth of understanding of the estrogen receptor, which lead to the development of targeted anti-estrogen receptor drugs for treatment of breast cancer. This development opened the door to current research projects investigating the efficacy of 12 breast cancer management clinical trials led by UT Health for FDA registration. One of the projects that can be highlighted is the development of an antidepressant that functions as an inhibitor of breast cancer proliferation. This was developed by Dr. Manjeet Rao, PhD and colleagues.1,3 These developments were presented at the San Antonio Breast Cancer Symposium, the world’s current largest symposium devoted to breast cancer research nationwide. The UT Health San Antonio MD Anderson Cancer Center established the Mays Cancer Center as the only National Cancer Institutedesignated cancer center in South Texas. Community members seeking clinical trials for the management of certain adult and pediatric cancers can find them exclusively at the Mays Cancer Center. The Mays Cancer Center also developed the Greehey Children’s Cancer Research Institute.4 It remains as one of the few institutes that explores pediatric cancer methods, prevention and treatment options to decrease the instance of cancer prevalence in South Texas.

Among other branches of the institution, The Barshop Institute for Longevity and Aging Studies is now the only aging-intensive research institute in the country to have four designations. The designations are two NIA-funded centers (Nathan Shock and Claude D. Pepper), a testing site of the NIA-sponsored Interventions Testing Program and a U.S. Department of Veterans Affairs Geriatric Research, Education and Clinical Center.1 Their team, along with the collaboration with Sam and Ann Barshop Institute, the University of Michigan and the Jackson Laboratory, developed the anti-aging drug Rapamycin. This is currently in clinical trials and showing promising results in geriatric patients. This key development will lead to further studies assessing its application in treatment for patients with Alzheimer’s and prostate cancer. These are a few among many exciting advances in science and the health care field as San Antonio develops into a health care destination. The accessibility to health care and drive to continue enhancing and widening the depth of knowledge available is felt throughout many of our local institutions. The ability to have access to the latest clinical trials for risk populations is invaluable to those in search of limited treatment options. Abdullah Ghali is a third year medical student at the UT Health San Antonio Long School of Medicine. Noor Wadi is a first year Osteopathic medical student at the University of Incarnate Word School of Osteopathic Medicine. Sources: 1. Honoring a Foundation of Innovation. Magazines of the Schools at UT Health San Antonio. (2020, October 22). 2. Hospitals by County. Txcip.org. Published 2019. Accessed March 28, 2021. 3. Manjeet Rao, Ph.D. - Feature Presentation at 2020 San Antonio Breast Cancer Symposium. Cell Systems and Anatomy 4. Our Cancer Research | UT Health San Antonio MD Anderson Cancer Center. (2021). UTHSCSA 5. “RePORT 〉 RePORTER.” National Institutes of Health, U.S. Department of Health and Human Services 2021 Funding.

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MEDICAL SCHOOL EVALUATION & GRADUATION

Opportunities in Ophthalmology: Connecting Medical Students and Residents during a COVID-19 Crisis By Christopher Zhu and Brandon Lam

As the coronavirus 2019 (COVID-19) pandemic surged in April 2020, unforeseen challenges emerged against the old medical education paradigm, requiring adaptations to address the abruptly altered landscape of student training. Under the guidance of Dr. Lilian Nguyen, Director of Medical Student Education at the Department of Ophthalmology at UT Health San Antonio, our team developed a virtual program to match medical students and ophthalmology residents to address diminished educational opportunities caused by COVID19 in a field with already limited curricular exposure. We then measured the effectiveness of a program matching medical student mentees with ophthalmology resident mentors in the hopes of promoting direct mentorship between mentees and mentors and creating lifelong career impacts. All 22 of our medical students completed program surveys four months apart, assessing attitudes and available opportunities on a scale from 0 (none) to 10 (significant) regarding mentorship, pursuing ophthalmology, research and how COVID-19 impacted these. All 9 of our participating residents likewise completed surveys measuring attitudes towards mentorship in the specialty and expectations regarding time commitment. We found from these surveys that while medical students felt COVID-19 tangibly affected available opportunities in ophthalmology at the outset of the outbreak, their participation in the mentorship program significantly increased their overall access to shadowing and research experiences in the specialty. Confidence among students regarding their knowledge of ophthal30

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mology also rose following participation and overall, the program was deemed valuable. In addition to benefitting medical students, residents maintained their high level of comfort in mentoring students and speaking about ophthalmology as a career before and after the program. Our residents also continued reporting high value regarding mentorship in ophthalmology and medicine at-large. Under novel circumstances plaguing the globe, we were able to create a microcosm allowing for some continuity regarding medical education and mentorship in the relatively small field of ophthalmology. Our team observed student interest in ophthalmology increase as they garnered the opportunity to develop career-long mentors, providing exposure to the field of ophthalmology which otherwise would not have existed during the COVID-19 pandemic. Christopher Zhu is a medical student at the Long School of Medicine, UT Health San Antonio, Class of 2023. Brandon Lam is a medical student at the Long School of Medicine, UT Health San Antonio, Class of 2021 and is an incoming UTHSA Ophthalmology Resident.

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Student Research conducted by Omar A. Caballero, MS, OMS-II and Travis B. Fenlon, OMS-II, Mentored by Rebecca L. Sanchez, PhD

Several years into the Peloponnesian War, one quarter of the Athenian population expired independent of a single Spartan blade.1 The beginning of the conflict that would render the once omnipotent city-state of Athens indistinguishable from that of Sparta was characterized by a rapidly spreading and deadly pustular rash. Athenian historian, Thucydides, writing of this plague made note that those who had been afflicted and survived “had now no fear for themselves; for the same man was never attacked twice—never at least fatally.”2 Thus, a fertile soil for the field of immunology was laid down: a facet of human disease was the potential for immunity. Further investigations into this phenomenon of immunity were limited by etiological theories of disease. Was disease theurgic and immunity merely a reward for righteous behavior? Was disease humoral and immunity only afforded to those with the correct composition of the four bodily humors? Was disease iatrophysical and immunity possible only through proper bodily mechanics? Was disease iatrochemical and immunity only possessed by those with “balsamic blood”?3

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Before those questions were either answered or even fully understood, the advent of variolation was upon us. Long since removed from the intuition of immunity, now came the shared eureka moment of cross-immunity in the late 18th century: English farmer Benjamin Jetsy and physician Edward Jenner independently noted that milkmaids seemed to be unaffected by the smallpox running rampant around them à la 5th century BC Athens.4 Jenner’s work in conferring immunity to the Variola virus from cowpox pustules proved sufficient to kickstart a movement that swept the Western world—the first vaccine was born. Enter the 19th century work of Louis Pasteur, and the composition of a vaccine could not only be more than mere “cow substance,” but also now did not necessitate even a mild illness upon administration. Through Pasteur, the vaccination possibilities for which infectious agents to provide immunity to, and how to go about creating such vaccines, seemed limitless.5, 6 Now that so much of the groundwork of vaccinology had been laid down, the 20th century finally provided an opportunity to

retroactively answer the questions of the origin of immunity. Emil von Behring won the first Nobel Prize in Physiology or Medicine in 1901 for his work on serum therapy, whereby he demonstrated that endogenous antibodies could neutralize infectious agents,4 drawing a stark contrast between Jenner and Pasteur in that immunity was not directly transferred from infectious particles themselves. Von Behring’s work on antibodies would be furthered by the discovery of specific receptorligand binding by Paul Ehrlich,7 and the structure of the antibody itself by Gerald Edelman and Rodney Porter, garnering them the Nobel Prize in 1972. Coinciding with a greater understanding of the mechanism through which vaccines work, as well as their efficacy, came sweeping measures to ensure the population at large were protected against now-preventable diseases. General Washington saw to it that his Continental Army was vaccinated against smallpox,6 while President Thomas Jefferson sought public health vaccination initiatives.5 The Supreme Court of the United States put forth landmark decisions in Jacobson v. Massachu-

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setts (1905), which upheld the authority of states to enforce compulsory vaccination laws, and in Zucht v. King (1922), which upheld school districts’ ability to exclude unvaccinated students from matriculation. By the 1980s, all states had compulsory vaccine laws regarding schooling. However, during this time, antivaccination movements widened their scope to include not only an objection to government overreach, but also the government’s proclivity to knowingly administer insidious vaccines.8 And while the antivaccination movement increased momentum in recent years, we also witnessed outbreaks of vaccine-preventable diseases among unvaccinated populations. The pivotal example of adverse effects of decreased vaccination has been several outbreaks of measles in populations with low immunization rates. In 2008, an intentionally unvaccinated child knowingly infected with measles returned to San Diego from a trip to Europe. Subsequently, 850 cases of measles were reported that traced back to exposure to the individual. Of the 850 cases, 75% (637) were intentionally unvaccinated as well, with an additional 48 children who were too young to be vaccinated becoming hospitalized.9 And so, while the scientific field of vaccinology is one that is still fairly new, the fundamental experience of human immunity to disease has been expressed in simple terms throughout recorded history. Over the past two centuries since its inception, our understanding of vaccines has widened such that the mechanisms by which they work are better understood, ultimately improving their efficacy and safety. But despite the remarkable inroads that have been made in the field of vaccinology, there is a growing degree of hesitance to their administration, resulting in a growing number of new outbreaks to many vaccine-preventable diseases. Therefore, as part of a growing public health initiative, our research team sought out to identify and even-

tually combat the etiology of information that yields hesitance to vaccines. To do this, we designed a study for the purposes of establishing correlation with the suspected etiology of vaccine hesitance and its prevalence is a case-control, retrospective study. The groups involved fall under one of two categories: 1. those parents/guardians who choose to vaccinate their children indicating no hesitation and 2. those parents/guardians who choose not to vaccinate their children indicating hesitation. The survey we developed then explores the patients’ history for exposure to the risk factors (anti-vaccination information). This provides four distinct numbers labeled A, B, C and D. A indicates the total sample with vaccine hesitation who have also been exposed to the risk factor. B indicates the total sample without vaccine hesitation who were exposed to the risk factor. C indicates the total sample with vaccine hesitation who were not exposed to the risk factor. D indicates the total sample without vaccine hesitation who were not exposed to the risk factor. The odds ration formula is then applied to determine correlation of risk exposure to prevalence. At this point in time, our research findings are still in their infancy, but our research team hopes to yield its findings within the near future.

Rebecca L Sanchez, PhD is an Assistant Professor of Microbiology at the UIWSOM. Omar A. Caballero, MS, OMS-II and Travis B. Fenlon, OMS-II are second year Osteopathic Medical Students at the UIWSOM.

References 1. Littman RJ. The Plague of Athens: Epidemiology and Paleopathology. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine. 2009;76(5):456-467. doi:10.1002/msj. 20137 2. Thucydides. Book II, Chapter VII, The Plague of Athens. In: History of the Peloponnesian War. 2nd ed. London: J.M. Dent; 1914:132-132. 3. Silverstein AM. Chapter 1, Theories of acquired immunity. In: A History of Immunology. 2nd ed. New York, New York: Academic Press; 2009:5-11. 4. Plotkin SA, Plotkin SL. The development of vaccines: how the past led to the future. Nature Reviews Microbiology. 2011;9(12):889-893. doi:10.1038/nrmicro2668 5. Stern AM, Markel H. The History Of Vaccines And Immunization: Familiar Patterns, New Challenges. Health Affairs. 2 0 0 5 ; 2 4 ( 3 ) : 6 1 1 - 6 2 1 . doi:10.1377/hlthaff.24.3.611 6. Plotkin SA. Vaccines: past, present and future. Nature Medicine. 2005;11(S4):S5S11. doi:10.1038/nm1209 7. Hilleman MR. Vaccines in historic evolution and perspective: a narrative of vaccine discoveries. Vaccine. 2000;18(15):1436-1447. doi:10.1016/s0264-410x(99)00434-x 8. Toward a Twenty-First-Century Jacobson v. Massachusetts. Harvard Law Review. 2008;121(7):1820-1841. www.jstor.org/ stable/40042718. Accessed November 9, 2020. 9. Sugerman DE, Barskey AE, Delea MG, et al. Measles Outbreak in a Highly Vaccinated Population, San Diego, 2008: Role of the Intentionally Undervaccinated. PEDIATRICS. 2010;125(4):747-755. doi:10.1542/peds.2009-1653

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Bearing Witness Through Stories By Kristy Y. Kosub, MD

Medical students at the Long School of Medicine, UT Health San Antonio, continue to engage in Project 6 -55, a guided reflective writing workshop where they write and share 6-word and 55-word stories about patient care experiences during their clinical clerkships. Writing stories gives our students the opportunity to connect more deeply with the illness experience of their patients. Their narratives share themes of vulnerability, responsibility and empathy, as they bear witness to patients’ sickness and trauma and attempt to understand their role… to listen and to be present with the patient in their suffering. ~ Kristy Y. Kosub MD, Professor, Department of Medicine, UT Health San Antonio I only drink 3 or 4 I only drink 3 or 4 a week, I’ve cut down. Yellow, distended belly, puffed up legs. I don’t crave alcohol anymore, I haven’t stopped because my doctor told me it’s dangerous to stop completely. Tremulous, sweat, weakness. Feel free to call my wife and ask her. Hello?..... It’s been this way for 40 years. ~ Gabriela Guerrero

He’s ready to go home now “The bluebonnets at our house are lovely – like heaven.” She wants to move him there, surrounded by everything they grew together. “I love him so much, I’m not ready.” For a second, I see my husband lying there instead of hers. “He said he’s ready to go home, but I don’t think he means Kerrville.” ~ Madison Feng

Sister Beginning of a trauma shift. In yellow gowns, goggles, N95s. What happened? Multiple people MVC. Who’s got the pedi? I volunteer. She rolls in, clutching a Frozen blanket. Assess her head-to-toe. Where’s my sister? I don’t know. Her question echoes in the CT. The resident types into her chart. Today, she is an only child. ~Chelsea Wu

Hello! My name is student doctor… And I’ll be taking a history and… oh, really? Sorry to hear. Sounds like you’ve been through a lot. When did your symptoms… oh ha ha! That’s really funny. I like your outlook. Do you mind if I check your blood… oh, I’m a third year. Your son too? That’s awesome! Okay, see you tomorrow. ~ Rahul Patel

Find the needle in the haystack The patient arrived after his fall. He gazed upon me, frustrated. Before speaking, his eyes communicated the countless workups, years of uncertainty, and moment after moment of disappointment. As I stepped closer, he extended his hand and reached to me. I followed and extended mine, our hands meeting. “Find the needle in the haystack, please.” ~ Frank Jing 34

SAN ANTONIO MEDICINE • June 2021

I have my God, he says A terrible fever, a necrotic ulcer, a veteran staunchly refusing surgery. But you may die, we say. I believe in my God, he says. We want to save your life, we say. I have my God, he says. We’re out of options, we say. Then I suppose we’re done, he says. And he was gone. ~ Anonymous A life saved, but skin flawed I could feel the eyes of the patient even though they slept. It stings to know that out of all the work, all the expertise in that room,

all the patient would see when they wake would be the work of a student. The marks left behind, an everlasting scar for them and for me. ~Ryan Molina I just want to feel normal Narcan brought him back. ESRD and tied to a hemodialysis machine. Necrotic foot with unfathomable pain. He told his story while holding his foot in pain, picking off a chunk of desiccated skin. Abandoned by his loved ones. I just want my mother. I just cannot take it anymore. I just want to feel normal. ~ Jeffrey Xia Young mom with pain, life changed She is just 35 with a 7-year-old at home. Now she’s in a hospital bed, scared, alone. She came in for aches and pain. Doctor said it’s cancer, stage 4. Started in her breast, now in her bones. Too young for screenings, no family history. Who could have guessed this was coming next. ~Kalli Henning He kept reaching for his words Unknown male patient, brought in by EMS. I first met him in the ED, nervous he would tell me to leave him alone or go away. Nervous he would ask me for something I could not give. Most days his prognosis stayed the same; ischemic stroke, damage done. But he kept reaching for his words. ~Brittany Hansen

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Pen & Paper By Chase Ballard

When we have the opportunity to provide health care abroad, it is a transition for us — and also for those who invite us in. We may spend months preparing for the trip by attending classes, communicating with community partners and talking with people who have gone before us to help ease the transition. It is always easier said than done. During my time with the Kisoboka Uganda team, I realized that in knowing everything about a community or culture, it’s the simple things that allow us to break the international ice. Something as simple as a pen and paper can give patients knowledge of their medical histories or serve as a sketchpad for children so they can feel more comfortable with a stranger asking them random questions. I feel as though the simple things allow us to bridge the gap between cultures and help us to provide better care. I took this photo during my pre-clinical years, and now that I am at the end of my clinical year, it’s even more apparent how valuable the connection between physician and patient is. Arguably this could be one of the most critical aspects of patient care, especially for a medical student who still struggles to pronounce Levetiracetam (or remember the brand name!). Throughout my time as a third-year medical student, I have witnessed another gap between ourselves and our patients. We learn about all these different scans and labs that promise more accurate diagnoses to provide treatment for specific diseases. We learn how to navigate through different electronic medical systems, which are supposed to provide effortless communication between providers. Rotation after rotation, we learn the labs, studies, imaging, exam findings, medications and treatment plans in that respected specialty. All of these have allowed us to become more efficient at treating a disease, but it appears to have disrupted the ability to develop and maintain that connection.

Maybe there is a reason a patient can’t recall the names of their medication, which labs or scans were done, or the name on the white coat they saw last week. It does make our jobs more manageable when we can look this all up ourselves, so it may not seem like a big deal. However, seeing all those notes can trap us into thinking about a patient, in the same way, blinding us to something else that may be going on. New information and clues turn up in face-toface conversations, in the initial visit or a followup, not with a quick glimpse at the computer screen. In the few months of my medical “career,” I have had some of the most moving and meaningful experiences with patients when I let them tell their story initially, with only having my pen and paper in hand.

Photograph features Dana Glaser, Class of 2022, talking with a young boy on a global health trip to Uganda.

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

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Artistic Expression in Medicine By Kristy Y. Kosub, MD, Professor, Department of Medicine, UT Health San Antonio

Medical training and the practice of medicine are immensely rewarding, but also rigorous and at times exhausting. Public health crises such as the pandemic, clinician burnout, persistent social and racial injustices and health inequities also challenge efforts to provide whole person care and create a healthier community. Many medical students and physicians are inspired by art as a companion to the study of medicine and a resource for self-expression and finding meaning in their work. The American Association of Medical Colleges (AAMC) has a comprehensive monograph on The Fundamental Role of Arts and Humanities in Medical Education (https://www.aamc.org/what-wedo/mission-areas/medical-education/frah me) that provides an in-depth overview of the importance of the health humanities and art in clinician well-being and understanding of the human condition. In particular, art has been found to improve visual observation skills, communication skills, empathy, reflective skills and tolerance for ambiguity. A core mission of the Center for Medical Humanities & Ethics (CMHE) at UT Health San Antonio is to “nuture empathy and humanitarian values to prepare tomorrow’s healers to act with compassion and justice.” Art and literature have this power. The annual CMHE publication of a literary and visual arts journal, Connective Tissue, allows contributing artists and readers of the journal a shared human experience through art and creative writing. Here are the artistic works of a few of our students. 36

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Rivers and Roots, pen and watercolor by Maggie Carroll, Class of 2021, Long School of Medicine, UT Health San Antonio Creating art is the way I integrate myself into medicine. By engaging with anatomy on an artistic level, I find myself better able to appreciate the idiosyncrasies of the human body as well as deepen my understanding of its complexities. Art feeds the humanistic, creative aspect of my personality and thereby allows me to connect more deeply with my patients and coworkers. In a way, it’s the foundation of the work I do on a daily basis.

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Layers by Amanda Means, Class of 2022, Long School of Medicine, UT Health San Antonio While drawing "Layers" I was inspired by the beauty and complexity found in the study of medicine. The overlap between natural sciences and the humanities is something that I enjoy in this field and have been able to use as a source of creativity.

Still Life: Fresh Summer Figs

by Sammar Ghannam, Class of 2021, Long School of Medicine, UT Health San Antonio This is an oil painting inspired by the beauty in nature that surrounds us in our daily lives. I constantly find myself in awe of the beauty and meticulous organization of colors, textures and patterns in nature. My love for creating and appreciating art led me to choose diagnostic radiology as my medical specialty. I am so fortunate to be able to put my skills and passion for the visual arts to work when I use various imaging modalities to help my patients lead healthier lives. I know that the very visual and artistic field of diagnostic radiology will give me so much meaning, value and purpose in my personal practice of medicine.

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SAN ANTONIO MEDICINE continued from page 37

Spring Flowers

by Jonathan Espenan, Class of 2021, Long School of Medicine, UT Health San Antonio and incoming resident in UTHSA Psychiatry Residency Program; Gabree Torres, Licensed Clinical Social Worker and Therapist at UT Mental Health Transitional Care Clinic Inspiration: We both really enjoy the beauty of flowers and had an idea that doing smaller-sized paintings would be fun. We each did three 4" by 4" acrylic paintings to make a series together. We paint because it is fun, it helps us to relax and when we paint, we connect with beautiful things. We use our experience with art to help our patients find meaningful things in their lives.

Lilac-Breasted Roller, oil paint on 4”X4” wood panel

by Paula Lorena Pérez, Class of 2022, Long School of Medicine, UT Health San Antonio I am interested in pediatric hematology-oncology and palliative care. Born in Laredo and raised in the Rio Grande Valley, I became interested in art through the native ecosystems of South Texas at a very young age. Throughout schooling, I held a strong passion for medicine and further continued studies in biology, chemistry and art at St. Mary's University. I now find art through my anatomy studies, particularly in the cadaver lab, and continue to paint in my spare time as an expressive outlet.

SAN ANTONIO MEDICINE • June 2021

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Lessons By Aarushi Aggarwal

I will readily admit I was ecstatic with the idea of a quarantine: a surmise so perfect for a homebody like myself. It was an opportune reason to shy away from certain encounters and to spend hours wrapped in the embrace of a cozy blanket. It’s as if the world slowed down, so that I could see the value of every minute. Perhaps this was the reason that cabin fever struck at a much later time than those around me. I relished being home, surrounded by loved ones, strengthening existing relationships that had been subdued by both time and distance. I was given the headspace, to finally pursue interests I had only longed to try. Yet even then, there were wisps of time, where I would sit on the porch, whipped coffee in hand and just feel sorry for everyone crushed by the toils of the year, myself included. I thought of those, with no choice but to work in unsafe conditions: those who suddenly had their meals vanish from the table, those who had fallen fifteen steps after climbing ten towards their dreams. People say just surviving is a feat itself, I agree; humbling moments that anchored people to the ground and thousands of lessons learned along the way. So, I’d like to share just one of mine. I have chosen a career in which a patient’s social situation is of equal importance to their health. I thought my eyes were already wide open, yet there was still room to open them further, after witnessing how a crippling blow in the right place, at the right moment, could bring a man on his knees and how a stranger passing by, who carries the remnants of a similar blow could help the fallen man back on his feet, so that he then could do the same for others, down the road. Aarushi Aggarwal is a medical student at the Long School of Medicine, UTHSA, Class of 2022.

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BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country

SAN ANTONIO MEDICINE • June 2021

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.”

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!”

FINANCIAL ADVISOR

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

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!”

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. Mary P. Mahlie Vice President Wealth Advisor (512)787.2488 Mary.Mahlie@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 (210)385.9326 Fred.Kelley@Regions.com www.Regions.com

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!”

HOSPITALS/ HEALTHCARE FACILITIES

HEALTHCARE 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” 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.

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. 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

“People you know Coverage you can trust”

INSURANCE/MEDICAL MALPRACTICE 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”

INSURANCE

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

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.”

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.”

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

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

continued on page 42 Visit us at www.bcms.org

PHYSICIANS PURCHASING DIRECTORY continued from page 41

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 PHYSICS

agnostic 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.”

Medical & Radiation Physics, Inc. (HHH Gold Sponsor) Medical physics and radiation safety support covering all of South Texas for over 40 years. Di-

SAN ANTONIO MEDICINE • June 2021

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

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.

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 (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” 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 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”

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 please contact: Development Director, August Trevino august.trevino@bcms.org or 210-301-4366

The Bexar County Medical Society is proud to welcome a Renewing Platinum Sponsor to our Circle of Friends program.

Please support this sponsor with your patronage, they support us.

Visit us at www.bcms.org

AUTO REVIEW

SAN ANTONIO MEDICINE • June 2021

Full Size GM SUVs

AUTO REVIEW

By Stephen Schutz, MD

GM is hitting their stride with SUVs these days, particularly since they launched their all-new full-size models, the 2021 Chevrolet Tahoe/Suburban, GMC Yukon/Yukon XL and Cadillac Escalade/Escalade ESV last year. All of those vehicles have been selling strongly since they were introduced—in fact, many have found happy homes with BCMS members and their families. Besides the usual evolutionary changes—updated styling, nicer interiors and more efficient powertrains—the big news with this generation of GM’s full-size SUVs is that the “smaller” versions are now bigger. One complaint about the Tahoe, Yukon and Escalade was that, for big vehicles, they didn’t provide all that much second or third row seating space. That’s been fixed with the addition of 5 inches to the wheelbase, which has resulted in much more rear passenger space. In fact, things are so much better back there that I would imagine many buyers who would have ordinarily purchased longer wheelbase SUVs like the Suburban will get the shorter models and be pleased. Another major enhancement for the big GM SUVs is a new independent rear suspension. Not only does that improve ride quality, but it also allows for a lower floor, which further expands storage space. GM has done an excellent job positioning their full-size SUVs to where they’re almost irresistible to a wide swath of upscale parents and grandparents. And now GM’s going to kill them. Ok not right now, but GM has vowed to stop making any internal combustion engine (ICE) vehicles after 2035, so these terrific family haulers are on the clock. What will current (satisfied) owners do then? I think we’ve been given a hint of what’s coming from the Hummer pickup truck due later this year. It’s big and long, like a Tahoe, and it’s electric. Not hybrid mind you, fully electric. My sense is that the electric Hummer pickup’s main objective is to work the kinks out of a platform that is ultimately meant to underpin an upcoming generation of full-size electric SUVs from GM. Vehicles that will do what today’s big SUVs do, but without gasoline powered engines. Current generation batteries aren’t good enough to allow electric SUVs to do what ICE SUVs can do yet, but I would imagine technological improvements will, at some point, give us electric family haulers that we’ll need and want. And since GM currently makes almost all of their profits from ICE-powered full-size SUVs and pickup trucks, the company needs those upcoming electric SUVs to be money makers. Anyway, back to today. Since I wasn’t able to drive one of the 2021 full-size GM SUVs—I wanted an Escalade but one wasn’t available—I drove a much smaller Trailblazer, which actually serves as a

reminder that Chevrolet, like most divisions of GM, has an SUV or crossover for almost everyone. What does that mean? In order of descending size, you can buy these SUVs from Chevy: Suburban, Tahoe, Traverse, Equinox, Blazer, Trailblazer and Trax. The Trailblazer is small and modestly priced—the base MSRP is just under $20,000—and looks like something your medical assistant might drive. But it’s easy to live with and in some ways quite luxurious. How small is it? It’s even smaller than the Honda CRV, and yet I never felt cramped in it despite my 6’ 2” frame. But that’s because I didn’t spend much time in the back seat, where things are less comfortable for adults than they are up front. Driving the Trailblazer was pleasant thanks to a low curb weight and short wheelbase, which generally optimize handling. The 155 HP turbocharged 3-cylinder engine provided sufficient oomph for my regular driving duties, but I could imagine it struggling with a family of four and their gear on board, even if two of them were small children (the 137 HP base engine is not recommended). Of course, if you frequently need to carry four people and lots of stuff, the friendly folks at Chevrolet would no doubt suggest that you consider one of their aforementioned larger family haulers. It’s interesting that many features that were previously available only in luxury vehicles have now trickled down to lower end models. Keyless entry and engine start, Apple CarPlay/Android Auto, adaptive cruise control and more are either standard in the Trailblazer or available as options. And despite its diminutive size, the Trailblazer has earned a 4-star safety rating from NHTSA. Not only are front and rear passengers surrounded by airbags, but important lessons learned over the years, such as positioning the seats farther inboard (and away from the doors) have also been applied in the Trailblazer. Most BCMS members are interested in reading about GM’s new full-size SUVs, and I promise to review one as soon as possible. But spending time in one of Chevy’s much smaller crossovers was an eyeopening experience. The Trailblazer gives you just about everything you want in a family vehicle, except lots of space. 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

San Antonio Medicine June 2021

Articles inside

San Antonio Historical Advancements and Developments of Modern Medicine

Opportunities in Ophthalmology: Connecting Medical Students and Residents during a COVID-19 Crisis By Christopher Zhu and Brandon Lam

A Lawyer Walks into a Medical School By John J. LoCurto, JD

Match Day By The University of the Incarnate Word

All in the Family: A Love for Medicine Bridges the Generation Gap By David Henkes, MD and

The COVID-19 Graduate Medical Education Pandemic Response: Innovation, Agility and Collaboration By Woodson “Scott” Jones, MD

By Deborah Conway, MD

The Journey After Medical School Graduation

Two Sisters in Medicine: Two Roads Less Traveled, One Goal By Chinwe Anyanwu and Nneka Anyanwu

Medical School Musings By Neal S. Meritz, MD

By Joshua T. Hanson, MD, MPH