44 minute read
By Garrett Kneese and Samantha Driscoll
Prevention through Health Equity Training at the Long School of Medicine
By Garrett Kneese and Samantha Driscoll
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As medical education continues to advance beyond Flexnerian practices (Flexner, 1910), so does the focus of these educational methods to include the charges of today’s physicians. One of these charges, highlighted by the disparate impacts of the COVID-19 pandemic (Kim et al, 2020) and based in the historical segregations of our American society (NCRC, 2020), is the inequities within the social determinants of health (SDoH).
“As the United States contends with the effects of the COVID 19 pandemic, health inequity, and a long overdue reckoning of institutional racism, transforming primary care is essential to meet the moment…” – V.J. Dzau, National Academy of Medicine
Over the last decade SDoH literature has expanded enormously, beginning at a measurement and identification stage (ie what social factors determine health, and how might we calculate, quantify and measure them?), and continuing onward to where we are today with respect to implication and intervention (ie what do these determinants tells us about our communities and what can medical society do to respond within this newfound lens?).
Reaching back to the educational framework, there are now efforts nationwide at the undergraduate (UME) and graduate medical education levels leveraging this lens to empower medical trainees and those of other health professions as well to work towards not only providing higher quality health services based on a socially-derived understanding of their patient, but also advocating for and working towards reductions in the disparate outcomes that unequal distributions of negative social determinants can cause. Much of this education at the UME level is course-based in pre-clinical years, and occasionally integrated at an elective-only level during fourth-year coursework. Ultimately, we conclude alongside most other global and national health organizations that socioeconomics and health behaviors as influences by social determinants are the primary driving factors that can be modified for prevention of disease across populations (Hood et al, 2016).
At UT Health San Antonio, the Department of Family and Community Medicine’s undergraduate medical education division, led by Dr. Nehman Andry, has been hard at work in the post-pandemic setting to bring SDoH education to all medical students at the university in hopes of facing the challenge of health disparities headon. The teams for this article’s highlighted programs comprise of clinical faculty, students, community health workers (promotores) and consultants with the American Board of Family Medicine. With help from several leaders in the department, they have facilitated both longitudinal and interventional programs at the third-year medical student level to improve SDoH clinical competencies in all students and inspire them to advocate for the communities they serve from a foundational understanding of health equity. With additional time available due to limited clinical scheduling for the third-year family medicine clerkship in intra-pandemic education, an impetus to leverage that time for a novel educational experience arose. The idea to create a longitudinal experience over the 6-week rotation framed the pairing of medical students with both a promotore (community health worker, or CHW) from the Department, and a patient well-established with the promotore for an interactive SDoH community-clinical journey.
Over the course of the rotation, students spend time each week getting to know their patient on a more socially-derived level via independent investigation using both electronic health records and geospatial social determinant data tools such as the American Board of Family Medicine’s Population Health Assessment Engine (PHATE) (Bambekova et al, 2020), direct meetings with their partnered promotore, guided visits to the patient’s community, and ultimately a personal meeting with the patient in their own home. While innovative tools, such as the ABFM’s PHATE, allow for neighborhood-specific understandings of patients’ social vulnerabilities, it also directly links providers to zip code-specific resources and services designed to rectify these vulnerabilities (such as travel vouchers, food assistance programs and other social services). Then, by placing students physically into the environment of their patient, we extract them from the medical education bubble that could possibly detach them from the realities often faced by many of their most vulnerable patients. Finally, these experiences culminate with a report to their peers in the form of an artistic rendition that encapsulates what they’ve learned and the relationships they’ve built along the way (see next column, top). Altogether, this student-patient-promotore engagement experience provides a holistic look at health disparities as SDoH are implicated right here in the San Antonio advanced primary care environment. Additionally, it highlighted the importance of an interprofessional team to fully address complex issues and lower the barriers to care for our patients by leveraging the skills and trust built by promotores and other ancillary service team members. The Long School of Medicine’s Team Care curriculum is a longitudinal experience over the third medical school year that focuses on themes that span across all specialties (UTHSA LSOM, 2022). The Family and Community Medicine Department is charged with one session each spring, which has often focused on topics surrounding pri-
mary care access, health disparities in San Antonio, community engagement practices, etc. that are foundational to family medicine practice. This year’s spring session was inter-professionally designed and delivered by three faculty and one medical student to capitalize on the momentum of the clerkship curriculum previously described, acting as either a capstone workshop session for those who had already completed the clerkship, or as an educational primer for those yet to enter the clerkship that year. Based in competencies of place and equity, a patients circle of support, establishing trust between doctor and patient, and addressing societal challenges to these concepts, this case-based workshop follows the story of a patient in small-group format to bring SDoH-oriented tools to students in a competency-driven and practical manner. BeHealth Disparities 6-Week Curriculum Overview as Developed for 2021-2022 Clerkship Students ginning with a review of San Antonio’s own history of housing segregation that have led to measurable health inequities between neighborhoods of the city, students then learn how to work with patients experiencing these disparities in a relationallycentered way through empathic communicative and psychosocial intervention tools that build trust with patients sometimes considered forgotten by medical society. BATHE Clinical Communication Technique as presented in the Family Medicine Team Care Session, February 2022 While implementing these psychologically-driven approaches, students also learn to establish a circle of care for their patient along the way, possibly consisting of behavioral psychologists, nutritionists, psychotropic specialists and social work to name a few of what are entailed in an advanced primary care model. These competencies are finally framed by the ethical and moral challenges posed by our medical-industrial complex, charging students to recognize the moral determinants of health (Berwick, 2020) in practice and community presence. A final charge to students is made to go beyond the recognition of and attempt to resolve in clinical practice the disparities in SDoH that their patients face, through recognizing the necessity to look upstream at the structures and systems in place that lead to these disparities at-large. Measuring the outcomes of these educational interventions is tancontinued on page 24
tamount to further adoption and integrations at an institutional level, and the Department’s work has shown promise in current evaluation. The SDoH Clerkship experience has significantly increased students’ SDoH knowledge, practical intervention competency and clinical practice intentions per 1st-year data collections, while the Team Care session was met with significant engagement and positive feedback from both students and other clerkship directors. What these results tell us is that with adequate time allowed at an organizational level and a committed and passionate interprofessional team available for initiative development, strides can be made in student SDoH training to meet our community’s needs in reducing health disparities in future practice.
These are exciting times for the health equity movement in the medical education space, providing opportunities for students, faculty, interprofessional team members, and even patients to collaborate towards a brighter and healthier future for the city of San Antonio. Prevention of disease begins with an understanding of the real factors contributing to the development of those diseases, which today are unequivocally distributed largely on the basis of inequity in socially-derived drivers of illness, we find. We hope that this story will inspire others in academia to strive for the same at their institutions, but will also inspire all healthcare professionals in this network to see what the future of physicians is leaning into over the coming decade. As these endeavors continue to expand and improve their impacts on students at the Long School of Medicine, we welcome feedback, partnership and most of all, inspiration in our common efforts. Acknowledgements: -Nehman Andry, MD:
For your incredible leadership, guidance and support to all of the teams, players and patients who have helped build these student experiences and patient support mechanisms. You are an inspiration to all who seek to be champions for innovation in medical education.
-Carolina Gonzalez-Schlenker, MD:
For your wisdom in care ethics, pride in the work of promotores and immense contribution to the moral frameworks of these programs that shaped the entire tone of what needed to be understood in these experiences. You are an inspiration to all who value the difficult and necessary conversations required to transform medical society in the coming decades.
- Yajaira Johnson-Esparza, PhD:
For your empathic expertise and collaborative contributions from clinical psychology that equipped these students to communicate in the direst of circumstances with their patients, and do so from a trustbuilding framework. You are an inspiration to all who seek to highlight the criticality of behavioral health in prevention, treatment and maintenance of wellness.
-Robert Ferrer, MD, MPH:
For your foundational efforts, historical contextualization and vast expertise in health inequities across our city of San Antonio and con-
sistent support for this crucial learning at the medical student level. You are an inspiration to all who seek to be leaders and programmers in health equity and clinical fluency in the next generations of physicians.
References 1. Flexner A. (2002). Medical education in the United States and
Canada. From the Carnegie Foundation for the Advancement of
Teaching, Bulletin Number Four, 1910. Bulletin of the World
Health Organization, 80(7), 594–602. 2. Kim, E. J., Marrast, L., & Conigliaro, J. (2020). COVID-19: magnifying the effect of health disparities. Journal of general internal medicine, 35(8), 2441-2442. 3. Redlining and Neighborhood Health. NCRC. (2020). Retrieved 23 April 2022, from https://ncrc.org/holc-health/ 4. Hood, C. M., Gennuso, K. P., Swain, G. R., & Catlin, B. B. (2016).
County health rankings: relationships between determinant factors and health outcomes. American journal of preventive medicine, 50(2), 129-135. 5. Bambekova, P. G., Liaw, W., Phillips, R. L., & Bazemore, A. (2020).
Integrating community and clinical data to assess patient risks with a population health assessment engine (PHATE). The Journal of the American Board of Family Medicine, 33(3), 463-467. 6. Kneese, G. Andry, N. Gonzalez-Schlenker, C. Johnson-Esparza, Y. (2022). Beyond social determinants | Clinical approaches. UTHSA
Team Care Curriculum Session. 7. Clinical Curriculum | UT Health San Antonio. (2019). Retrieved 23 April 2022, from https://www.uthscsa.edu/academics/medicine/education/ume/curriculum/clinical 8. Berwick, D. M. (2020). The moral determinants of health. Jama, 324(3), 225-226.
Garrett Kneese is a graduating senior medical student at the Long School of Medicine's MD/MPH program and curriculum consultant/researcher for the UT Health San Antonio Department of Family and Community Medicine. He will be entering his Family and Preventive Medicine Residency program this summer and will continue to work towards advances in health equity training at the undergraduate & graduate medical education levels.
Samantha Driscoll is a medical student at UT Health San Antonio pursuing Family Medicine.
BCMS staff pose for a picture. Fourteen BCMS Presidents and BCMS Real Estate Chairman, Buddy Swift, MD, were present to celebrate and congratulate Mr. Fitzer on this very special day.
The Bexar County Medical Society (BCMS) on Saturday, May 14 held a ceremony honoring former CEO and Executive Director, Stephen C. Fitzer, who recently retired. The BCMS Board of Directors unanimously voted to name the BCMS headquarters the “Bexar County Medical Society Stephen C. Fitzer Building” after Mr. Fitzer.
Mr. Fitzer served the Bexar County Medical Society for more than 13 years in two different terms. During his tenure, Mr. Fitzer led the efforts of BCMS to provide its 5,600-plus physician members with the advocacy and tools necessary to meet the healthcare needs of the citizens of Bexar County.
Mr. Fitzer first joined BCMS in 2003 when the organization faced serious financial challenges, needing reorientation to better serve its members. Because Mr. Fitzer had 20 years prior experience as CEO of three different companies, including Inspectorate America, Inc., Professional Service Industries, Inc. and Smith Bucklin and Associates, he was able to bring to bear his operational, marketing and financial expertise to the fore to strengthen the organization and put it on solid financial footing. In Mr. Fitzer’s first term with BCMS, the old BCMS building was sold. That left BCMS in temporary offices with the intention of constructing or buying a new building, one that is closer to where physician members live and work. However, Mr. Fitzer chose to retire from BCMS in 2008.
In 2013, Mr. Fitzer was approached by BCMS to return and resume his role as CEO when the position again became available. Mr. Fitzer accepted the role. Besides managing the day-to-day operations, Mr. Fitzer was immediately challenged to find a new home for BCMS. Over a period of 24 months, Mr. Fitzer raised the necessary money, purchased a prime lot on Loop 1604 near NW Military Hwy, and constructed an award-winning building (“Project of the Year” by the American Subcontractors Assoc.) and did it all on budget and on time!
For Mr. Fitzer’s outstanding management of the 8th largest county medical society in the
Rick Evans, BCMS legal counsel for 41-years, praises the leadership, years of service, dedication and successes of Mr. Fitzer with the crowd.
Jayesh Shah, MD; Mayor of Shavano Park, Bob Werner; Buddy Swift, MD; Steve Fitzer and Vijay Koli, MD pose for a picture. Rajeev Suri, MD gives remarks at the building dedication.
United States, bringing financial and management strength to the organization, and for constructing this one-of-a-kind, award-winning building that will be the home of BCMS for the next 100 years or more, this beautiful building is named in his honor, to be known as the Bexar County Medical Society Stephen C. Fitzer Building.
“When I learned about this great honor, I felt a genuine sense of appreciation and recognition for my years of service. I feel a bond with the Society, its members and my colleagues that will endure forever in my heart,” said Mr. Fitzer.
Melody Newsom, the current BCMS CEO and Executive Director, said “By naming our building in honor of our recently retired CEO and Executive Director, Stephen C. Fitzer, we celebrate his leadership, guidance and dedication to the physicians of Bexar County and as such, the patients in our community. The naming of this building in Mr. Fitzer’s honor will serve to remind us all of the past, current and future dedication that we exercise daily to serve our physician members and their practices.”
Dr. Rajeev Suri, the current BCMS President, said “This building naming ceremony also speaks to the vision and mission of BCMS, which is to provide quality healthcare to the patients of Bexar County and make Bexar County a healthier community. Mr. Fitzer truly exemplified the skills of a leader and has laid the groundwork for us to continue to support the future generations of physicians in times to come. Steve embodies the spirit of BCMS in his actions, his professionalism, and his commitment to the Society and for its ideals.”
The Bexar County Medical Society is the oldest county medical society in Texas and eighth largest in the U.S. representing more than 5,600 physicians in and around San Antonio, Texas. The society seeks to promote high standards of medical care in the community, advocating on behalf of physicians and patients while providing beneficial services to its physician members. For more information about BCMS, visit www.bcms.org.
Patient Safety, Burnout and
COVID-19 By Prachi Shah and Desiree “Dez” Ojo
This article will examine how COVID-19 contributes to burnout, the impact of COVID-19 on patient safety and changes that can take place in hospitals to help mitigate burnout and increase patient safety.
What do patient safety, burnout and COVID-19 have to do with each other?
They are intertwined. The pandemic increased the prevalence of burnout among healthcare professionals. Exhaustion and stress impact how patients are cared for in our hospitals and clinics. Recent studies have shown concerning increases in Methicillin Resistant Stahylococcus Aureus (MRSA), Central Line Associated Blood Stream Infections (CLABSI), Catheter Associated Urinary Tract Infection (CAUTI), and Skilled Nursing Facility (SNF) major injury fall rates and decubitis ulcers since the COVID pandemic began.¹ This area of research is especially important because it is likely that we will have to learn to live with COVID-19, new strains and periodic surges for the rest of our lives. Hospital administrators and hospital systems will need to figure out a way to take better care of their healthcare workers while also making our patients feel safe, happy and cared for in their hospitals.
How is COVID contributing to burnout?
Burnout is increasing among healthcare workers due to occupational hazards, systemic inconsistencies, financial instability and an increase in the volume of patients due to the pandemic.² A study that examined burnout among nurses during the pandemic found that 34.1% of the participants experienced emotional exhaustion, 12.6% experienced depersonalization and 15.2% felt a lack of personal accomplishment.³ The AMA Coping with COVID-19 survey administered to assess stress among healthcare workers in the United States found that 25% of physicians experienced anxiety, 37.3% experienced work overload and 47.73% experienced symptoms of burnout.4 In a survey by Medscape, 47% of physicians said they were burned out − a 5% increase from the year before.5
Occupational hazards
In the early stages of the pandemic, there was a lack of personal protective equipment (PPE) availability in many parts of the country and inconsistent data about the reliability of PPE. Healthcare workers were fearful of contracting the disease from work and spreading it to their families.² The AMA Coping with COVID-19 survey found that 61% of the healthcare workers felt fear of exposing the disease to their families.4 This led to many healthcare workers isolating themselves from their loved ones. The toll of having to see patients die from COVID-19 while not being able to have loved ones around contributed to the stress of working on the frontlines during the pandemic. There was also inadequate COVID-19 testing availability, uncertainty about whether healthcare workers would be supported if they contracted the infection and whether there would be access to childcare from the increased work hours. Increased work hours, decreased sleep and disrupted work-life balance led to fatigue and mental distress, which can lead to burnout.6 Systemic inconsistencies
Along with the challenges of working in the hospital with an increased volume of patients during the pandemic, there were rapid changes in protocols and policies varied by specialty and hospital.7 This caused confusion and frustration within healthcare teams. The differences in local and national responses along with inadequate planning for equipment availability, emergency management and triage also contributed to this frustration as the burden falls on healthcare workers. The pandemic put a pause on many parts of the US economy, which increased rates of unemployment and consequently added stress and anxiety on the population.²
Exacerbated by the pandemic, the need for healthcare workers has increased while the supply is decreasing.8 Stress, burnout and more difficult working conditions from the pandemic have led many healthcare workers wanting to leave healthcare partially or completely.9 Hospitals and clinics had a decrease in staffing, more overtime work and decreased time spent during patient visits. Among the healthcare workers that kept their job, it was found that 31% have considered leaving, and 19% said they thought about completely leaving the healthcare field¹¹. Another study found that 55% of frontline doctors have reduced interest or ability to continue working in the field.8 By 2050, the predicted shortage of nurses will exceed 500,000, while the shortfall of physicians will top 139,000.9
How COVID-19 impacts patient safety
To us at the Texas Patient Safety Initiative (TPSI), there are four big contributors to the lack of patient safety in the era of COVID-19: human error, misdiagnosis, delayed patient care and fear of transmission.
Human error
As human beings practicing the art of medicine, physicians are going to mess up. It’s a given. No one is perfect, not even a physician. Medicine has been historically known as a
profession that is above a certain “standard.” Whether it was intentional or not, we have been bred and conditioned to obtain perfection.¹0 From undergraduate science classes to the Medical College Admissions Test (MCAT) and medical school class rankings − we’ve been taught that perfection is what we should strive for.¹0 So, when human error occurs in the hospital, like it inevitably will, people play the name, shame and blame game.¹0 People are punished for their honest mistakes and these honest mistakes increase substantially when our healthcare teams are understaffed and healthcare workers are overworked and burnt out, which has increased due to the COVID-19 pandemic.
Misdiagnosis
According to the Agency for Healthcare Research and Quality,¹¹ the presence of COVID-19 in our communities increases the risk of misdiagnosis in patients with respiratory illnesses. For example, if a patient comes into the emergency room with a respiratory illness presenting with COVID-19-like symptoms and the hospital is unable to see that patient until they get a COVID test, that patient may experience a delayed diagnosis of a nonCOVID-19 condition. The COVID-19 pandemic has shifted the decision-making processes of the healthcare system: if a patient presents with COVID-like symptoms, it is assumed that they have COVID until proven otherwise.¹¹ Patients who present with COVID-like symptoms do not always have COVID.¹¹ Misdiagnosis perpetuated by the magnitude of the pandemic can delay patient care and inevitably lead to increased progression of non-COVID illnesses.¹¹
Delayed patient care/fear of COVID-19 transmission
The COVID-19 pandemic has significantly impacted the delivery of health care in the United States. As we continue to fight to flatten the curve, healthcare administrators, healthcare workers and frontline staff have had to redesign healthcare delivery by prioritizing the most urgent patients with the most acute conditions, and rescheduling patients with chronic conditions and elective surgeries for later appointment times and dates.¹¹ The fear of patient safety and COVID-19 transmission has facilitated delays in preventative care, general checkups and screening procedures.¹¹ We will feel the impact that COVID-19 has had on our healthcare system for a very long time. The effects will pop up in places we least expect. For example, the World Health Organization estimates that over 20 million routine preventive vaccinations will be missed due to the pandemic.¹¹ The fear of COVID-19 transmission and delayed patient care has not only increased the volume of patients in the intensive care unit but will continue to negatively affect patients looking for preventative care and patients with chronic health issues looking for continuation of care.¹¹ COVID-19 has unraveled the structure of our healthcare system and its processes. Without proper mitigation, structural changes and policy updates, our healthcare system and communities could suffer the greatest impact.
What can be done to prevent and identify burnout?
The following list is suggested from our literature review that expanded on how we can support healthcare workers to prevent and identify burnout. • Hospital systems must integrate mental health services like counseling, chaplain services, accommodations in work schedules and community support for healthcare workers.¹² • Involve healthcare workers in the process of developing, integrating and evaluating measures to help identify burnout.¹² • Encourage reflection and blame-free environments for healthcare workers to share their experiences.¹³ • Eliminate the stigma associated with mental health-related illness.7 • Hospital leadership must show their appreciation, support and spread words of encouragement.¹² • Encourage healthcare team meetings or check-ins to facilitate constant communication, team building, trust and a stronger sense of support.¹² • Monitor fatigue, stress and sleep via mobile health tools. ¹²
The pandemic has caused frustration, burnout and loss of passion among many physicians and other healthcare workers. A change must be made to decrease burnout and optimize patient care and safety. Happy, healthy physicians are more likely to deliver the quality care that patients deserve.
References 1. Lee A. Fleisher, M.D., Michelle Schreiber,
M.D., Denise Cardo, M.D., and Arjun
Srinivasan, M.D. Health Care Safety during the Pandemic and Beyond — Building a System That Ensures Resilience. The
NEW ENGLAND JOURNAL of MED-
ICINE Perspective, 386;7, 609-611 2. Sasangohar, Farzan PhD, SM, MASc*,†;
Jones, Stephen L. MD, MSHI*; Masud,
Faisal N. MD‡; Vahidy, Farhaan S. PhD,
MBBS, MPH*; Kash, Bita A. PhD, MBA,
FACHE*,§ Provider Burnout and Fatigue
During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit, Anesthesia & Analgesia:
July 2020 - Volume 131 - Issue 1 - p 106111 doi: 10.1213/ANE.0000000 000004866 3. Galanis P, Vraka I, Fragkou D, Bilali A,
Kaitelidou D. Nurses' burnout and associated risk factors during the COVID-19 pandemic: A systematic review and metaanalysis. J Adv Nurs. 2021
Aug;77(8):3286-3302. doi: 10.1111/jan.14839. Epub 2021 Mar 25.
PMID: 33764561; PMCID: PMC82 50618. 4. Prasad K, McLoughlin C, Stillman M,
Poplau S, Goelz E, Taylor S, Nankivil N,
Brown R, Linzer M, Cappelucci K, Barbouche M, Sinsky CA. Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study, EClinicalMedicine, Volume 35, 2021,100879, ISSN 2589-5370, https://doi.org/10.1016/j.eclinm.2021.10 0879. 5. Physician Burnout, Depression Compounded by COVID: Survey - Medscape - Jan 21, 2022. 6. Leo CG, Sabina S, Tumolo MR, Bodini A,
Ponzini G, Sabato E and Mincarone P (2021) Burnout Among Healthcare
Workers in the COVID 19 Era: A Review of the Existing Literature. Front. Public
Health 9:750529. doi: 10.3389/ fpubh.2021.750529 7. Song YK, Mantri S, Lawson JM, Berger EJ,
Koenig HG. Morally Injurious Experiences and Emotions of Health Care Professionals During the COVID-19
Pandemic Before Vaccine Availability.
JAMA Netw Open. 2021;4(11) :e2136150. doi:10.1001/jamanetworkopen.2021.36150 8. Cutler DM. Challenges for the Beleaguered Health Care Workforce During
COVID-19. JAMA Health Forum. 2022;3(1):e220143. doi:10.1001/jamahealthforum.2022.0143 9. Wilensky GR. The COVID-19 Pandemic and the US Health Care Workforce.
JAMA Health Forum. 2022;3(1) :e220001. doi:10.1001/jamahealthforum. 2022.0001 10.Classen, David C. MD, MS; Kilbridge,
Peter M. MD The Roles and Responsibility of Physicians to Improve Patient Safety within Health Care Delivery Systems, Academic Medicine: October 2002 - Volume 77 - Issue 10 - p 963-972 11.AHRQ PSNET Annual Perspective: Impact of the COVID-19 pandemic on Patient Safety. Patient Safety Network. (n.d.). Retrieved March 7, 2022, from https://psnet.ahrq.gov/perspective/ahrqpsnet-annual-perspective-impact-covid19-pandemic-patient-safety 12. Rangachari, Pavani, and Jacquelynn
L Woods. “Preserving Organizational Resilience, Patient Safety, and Staff Retention during COVID-19 Requires a Holistic
Consideration of the Psychological Safety of Healthcare Workers.” International
Journal of Environmental Research and
Public Health., vol. 17, no. 12, 2020, pp.
International journal of environmental research and public health. , 2020,
Vol.17(12). 13.Leo CG, Sabina S, Tumolo MR, Bodini A, Ponzini G, Sabato E and Mincarone P (2021) Burnout Among Healthcare Workers in the COVID 19 Era: A Review of the Existing Literature. Front. Public Health 9:750529. doi: 10.3389/ fpubh.2021.750529
Prachi Shah is an OMS-II at the UIW School of Osteopathic Medicine. She is a member of the Texas Patient Safety Initiative, Student Outreach for TDSR Public Health Talks and former Treasurer of the American College of Osteopathic Family Physicians Student Chapter (ACOFP).
Desiree “Dez” Ojo is an OMS-II at the UIW School of Osteopathic Medicine. While pursuing her medical degree, Desiree is a Student Board Member for Texas Doctors for Social Responsibility (TDSR), a member of the Texas Patient Safety Initiative (TPSI), former 2021-2022 Treasurer for the UIWSOM Student National Medical Association (SNMA) and is a member of her school’s Learner Ambassador Program.
Artistic Expression in Medicine
By Ravjot Virdi
For this project, I chose to make a twopart plaster mold of a medicine bottle. After the mold was made, I used it to create wax models of the bottle. My theme for this project was mental health. In society today, mental health is a topic that is not talked about enough. The medicine bottle I used for this project belongs to a close family member who uses it to contain anxiety medication. I have seen firsthand how individuals with mental health often feel the need to hide their illness. Mental health is considered a taboo topic in many societies, especially in South Asian culture. To highlight the topic in this project, each bottle is labeled with a medication used to treat a different mental illness. By creating a display that outwardly portrays this topic, I hope it will spark conversation and promote greater awareness on this important issue.
Ravjot Virdi is a medical student at the UIW School of Osteopathic Medicne.
Contemporary By Winona Gbedey Every three months, it’s the same dance. There’s more to this choreography, but we never advance.
We begin when she tells me my A1c is high. I pretend and tell her I don’t know why.
“Are you taking your meds?” she always says. “Sometimes,” I concede, “but I wish they cost less.”
Then she asks about diet and exercise. We talk about cutting out tortillas and fries.
She concludes with a little encouragement. I smile and nod, yet wonder if this is time well spent. I know what they say about patients like me. “Uncontrolled,” “non-compliant,” and “nonadherence” makes three.
They don’t try to understand my life. They don’t know my triumph, my toil, my strife.
I like her because she knows me and tries To listen and understand why I always buy fries.
So we finish our dance, and then part ways. We work and wish for better days.
Every three months, we do this dance. But at least she tries to give me a chance. Author’s note: “Contemporary” was inspired by a patient interaction I had during my Family Medicine clerkship. Written from the patient's point of view, this poem was made to be a reflection of the unknown social and economic factors that contribute to our patient's adherence to our treatment plans and to serve as a love-letter to practitioners who take the time to take these factors into account.
Winona Gbedey is a medical student at the UT Health San Antonio Long School of Medicine and a member of the BCMS Publications Committee.
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ACCOUNTING FIRMS
Sol Schwartz & Associates P.C. (HHH Gold Sponsor) Sol Schwartz & Associates is the premier accounting firm for San Antonio-area medical practices and specializes in helping physicians and their management teams maximize their financial effectiveness. Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”
ACCOUNTING SOFTWARE
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BANKING
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.”
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Synergy FCU Member Services 210-750-8333 info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”
BUSINESS CONSULTING
Medical Financial Group (★★★ Gold Sponsor) Healthcare & Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller & past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”
CREDENTIALS VERIFICATION ORGANIZATION
Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA) standards for health care entities. Betty Fernandez Director of Operations 210-582-6355 Betty.Fernandez@bexarcv.com www.BexarCV.com “Proudly serving the medical community since 1998” FINANCIAL ADVISORS
Oakwell Private Wealth Management (HHH Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner”
Elizabeth Olney with Edward Jones (HH Silver Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals. Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you. Elizabeth Olney, Financial Advisor 210-858-5880 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"
FINANCIAL SERVICES
Bertuzzi-Torres Wealth Management Group ( Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending & estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres
Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”
SWBC (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Michael Leos, Community Relations Manager Cell: 201-279-2442 Office: 210-376-3318 mleos@swbc.com swbc.com
HEALTHCARE BANKING
First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”
Amegy Bank of Texas (HH Silver Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things. Jeanne Bennett EVP | Private Banking Manager 210-343-4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President | Private Banking 210-343-4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President | Private Banking 210-343-4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership”
HEALTHCARE TECHNOLOGY SOLUTIONS SUPPLIER
Nitric Oxide innovations LLC, (★★★ Gold Sponsor) (NOi) develops nitric oxide-based therapeutics that prevent and treat human disease. Our patented nitric oxide delivery platform includes drug therapies for COVID 19, heart disease, Pulmonary hypertension and topical wound care. info@NitricOxideInnovations.com 512-773-9097 www.NitricOxideInnovations.com
HOSPITALS/ HEALTHCARE FACILITIES
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 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
TMA Insurance Trust (HHHH 10K Platinum Sponsor) TMA Insurance Trust is a full-service insurance agency offering a full line of products – some with exclusive member discounts and staffed by professional advisors with years of experience. Call today for a complimentary insurance review. It will be our privilege to serve you. Wendell England Director of Member Benefits 512-370-1776 wendell.england@tmait.org 800-880-8181 www.tmait.org “We offer BCMS members a free insurance portfolio review.”
Guardian (★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan. Ned Hodge 210-332-3757 ned@nedhodge.com www.nedhodge.com | www.Opesone.com “Take care of today then plan for tomorrow”
Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com
INSURANCE/MEDICAL MALPRACTICE
Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society
The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”
MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze 512-658-0262 Kirsten.Baze@medpro.com www.medpro.com
ProAssurance (HH Silver Sponsor) ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group’s rating is AM Best A (Excellent). Mike Rosenthal Senior Vice President, continued on page 36 Visit us at www.bcms.org 33
Business Development 800-282-6242 MikeRosenthal@ProAssurance.com www.ProAssurance.com
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. Aron Sweet , Account Director 210-788-9515 aron.sweet@upnfiber.com Jim Dorman, Account Director 210-428-1206 jim.dorman@upnfiber.com Tammy Carosello, Account Director 210-868-0420 tammy.carosello@upnfiber.com www.uniteprivatenetworks.com “UPN is very proud of our 98% customer retention rate”
INVESTMENT ADVISORY REAL ESTATE
Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com
MEDICAL BILLING AND COLLECTIONS SERVICES
Medical Financial Group (★★★ Gold Sponsor) Healthcare and Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller and past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier Jones, Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”
Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”
MEDICAL PAYMENT SYSTEMS/CARD PROCESSING
First Citizens Bank (★★★ Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”
MEDICAL SUPPLIES AND EQUIPMENT
Henry Schein Medical (HH Silver Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 to 50 percent.” MOLECULAR DIAGNOSTICS LABORATORY
iGenomeDx ( Gold Sponsor) Most trusted molecular testing laboratory in San Antonio providing FAST, ACCURATE and COMPREHENSIVE precision diagnostics for Genetics and Infectious Diseases. Dr. Niti Vanee Co-founder & CEO 210-257-6973 nvanee@iGenomeDx.com Dr. Pramod Mishra Co-founder, COO & CSO 210-381-3829 pmishra@iGenomeDx.com www.iGenomeDx.com “My DNA My Medicine, Pharmacogenomics”
MORTGAGES
SWBC MORTGAGE - THE TOBER TEAM (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Jon Tober, Sr. Loan Officer Office: 210-317-7431 NMLS# 212945 Jon.tober@swbc.com https://www.swbcmortgage.com /jon-tober
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! Kevin Barber, President 210-308-7907 (Direct) kbarber@bdo.com Valerie Rogler, Program Coordinator 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet” San Antonio Medical Group Management Association (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs and networking opportunities to medical practice managers and support charitable fundraising. Alan Winkler, President info4@samgma.org www.samgma.org
REAL ESTATE SERVICES COMMERCIAL
Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com
CARR Realty (★★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 210-573-6146 Brad.Wilson@carr.us www.carr.us “Maximize Your Profitability Through Real Estate”
Foresite Real Estate, Inc. (HH Silver Sponsor) Foresite is a full-service commercial real estate firm that assists with site selection, acquisitions, lease negotiations, landlord representation, and property management. Bill Coats 210-816-2734 bcoats@foresitecre.com https://foresitecre.com “Contact us today for a free evaluation of your current lease”
RETIREMENT PLANNING
Oakwell Private Wealth Management (HHH Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner” STAFFING SERVICES
Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle. Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”
2022 GMC Yukon
By Stephen Schutz, MD
The 2022 GMC Yukon is an updated version of one of GM’s fullsize SUVs, and it’s very good.
For the record, all of GM’s updated full-size SUVs, the Chevrolet Tahoe/Suburban, GMC Yukon/Yukon XL and Cadillac Escalade/Escalade ESV, are very good, and all have been selling strongly since they were launched in 2020.
In addition to the usual changes you’d expect when a vehicle is updated — refreshed 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 larger. One persistent complaint about the Tahoe, Yukon and Escalade was that, for full-size vehicles, they didn’t provide all that much second- or third-row seating space.
That’s been remedied with the addition of five inches to the wheelbase, which has resulted in much more rear passenger space. In fact, things are so much better in that regard that I would imagine many buyers who would have ordinarily purchased longer wheelbase models like the Suburban will get the shorter versions instead 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.
And it improves the third-row seats as well. In previous generations of the Yukon, the third-row seats were just okay. Now the “way back” in the standard wheelbase Yukon is a comfortable place to be, even for 6’2” me. Instead of feeling like my knees were right in front of my face, in the new third-row seat I felt pretty much like I was sitting in the previous generation Yukon’s second-row seat, which is a significant upgrade from before.
The exterior design of the new Yukon is evolutionary, not revolutionary, so you’ll be forgiven for not noticing the new versions as they drive by you on Bandera Road. Given the Yukon’s popularity, it’s not surprising that GM took the, “if it ain’t broke don’t fix it” approach to the styling.
Nevertheless, there are changes. The grille is bigger than it was, and the headlight housings are more stylized. And the rear lights are similarly sculpted, switching from rectangular shapes to something kind of oblong and more dramatic. Also, there’s a Range Rover-ish tapering of the rear end of the SUV that wasn’t there before. Maybe it’s “slimming”?
Driving the new Yukon is similar to driving previous versions, but better. The ride and handling − if that’s the right noun when we’re talking about a 6000 lb SUV − are obviously improved thanks almost entirely to the independent rear suspension. And the Yukon’s best-inclass highway manners, which enable the gobbling up of interstate miles, remain unchallenged.
So, the Yukon is noticeably better than it was on school runs, and incrementally improved on the open road.
Two V8 engines are offered: a 355HP 5.3L and a 420HP 6.2L. For Diesel enthusiasts like me, GMC also offers a 3.0L Turbo-Diesel inline-six that pumps out 460 lbs-ft of torque. All models come with a 10-speed automatic transmission operated by a push-button panel on the dashboard, and all can be had with either rear- or all-wheel drive.
Fuel economy is a bummer, as you’d expect. The 5.3L V8 gets you 16 MPG City/20 MPG Highway, the 6.2L V8 drops that to 14/19 and the Diesel makes everyone feel less guilty at 21/27.
For the record, the 5.3L V8 isn’t as comfortable lugging the big Yukon around as the 6.2L. One of my business partners has owned Yukons with both engines, and he told me, “I’d never get the 5.3 again.” As noted above, I’d choose the Diesel.
All Yukon models come with a large infotainment display with GMC's latest user interface, which is nice to look at and easy to use. The base SLE, mid-range SLT, and off-road AT4 models all feature a display that sits in the center of the dashboard and looks good, but the Denali's is embedded in the dashboard and surrounded by chrome for a more upscale look.
Apple CarPlay/Android Auto integration and a WiFi hotspot are all standard; navigation and Bose audio are optional.
I don’t have space to go into all of the options and packages, but the Yukon starts at just over $52,000 and goes up from there. The top shelf Denali costs about $17,000 more and is popular with BCMS members for a reason. It’s a very nice truck.
GM has done an excellent job updating their full-size SUVs, and the 2022 GMC Yukon is proof. If you need the space and can afford the fuel, you’ll love it.
Note for readers: A trauma surgeon friend and I have launched an automotive podcast that may interest you. It’s called, “Cars on Call,” and it features discussions about a myriad of automotive subjects from two physicians’ perspective. It’s available on Apple, Spotify and other platforms, and I hope you give it a listen.
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.
11911 IH 10 West San Antonio, TX 78230 Coby Allen 210-696-2232
Kahlig Auto Group
Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130 Matthew C. Fraser 830-606-3463
Land Rover San Antonio 13660 IH 10 West San Antonio, TX Cameron Tang 210-561-4900
Kahlig Auto Group
North Park Mazda 9333 San Pedro San Antonio, TX 78216 John Kahlig 210-253-3300
Kahlig Auto Group
North Park Subaru 9807 San Pedro San Antonio, TX 78216 Raymond Rangel 210-308-0200
Audi Dominion 21105 West IH 10 San Antonio, TX 78257 Rick Cavender 210-681-3399
Northside Ford 12300 San Pedro San Antonio, TX Marty Martinez 210-477-3472
Kahlig Auto Group
North Park Lexus 611 Lockhill Selma San Antonio, TX Tripp Bridges 210-308-8900
Mercedes Benz of Boerne 31445 IH 10 West Boerne, TX James Godkin 830-981-6000
Kahlig Auto Group
North Park Subaru at Dominion 21415 IH 10 West San Antonio, TX 78257 Phil Larson 877-356-0476
Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216 Charles Williams 210-912-5087 Chuck Nash Chevrolet Buick GMC 3209 North Interstate 35 San Marcos, TX William Boyd 210-859-2719
Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216 Paul Hopkins 210-988-9644
Kahlig Auto Group
North Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX James Cole 210-816-6000
14610 IH 10 West San Marcos, TX 78249 Mark Hennigan 832-428-9507
Kahlig Auto Group
North Park Lincoln 9207 San Pedro San Antonio, TX Sandy Small 210-341-8841
Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX Al Cavazos Jr. 210-366-9600
Cavender Toyota 5730 NW Loop 410 San Antonio, TX Gary Holdgraf 210-862-9769
9455 IH 10 West San Antonio, TX 78230 Douglas Cox 210-764-6945
Kahlig Auto Group
North Park Toyota 10703 Southwest Loop 410 San Antonio, TX 78211 Justin Boone 210-635-5000
