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The Direct Admit Program at The University of the Incarnate Word By Adam V. Ratner, MD, FACR and Amanda Galán-Davila, PhD 15 Six-Year Combined Baccalaureate and MD Programs By John J. Seidenfeld, MD 16

San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All ex pressions of opinions and statements of sup posed 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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Graduate Medical Education: The Physician Pipeline for Bexar County and South Texas By Woodson “Scott” Jones, MD 12

Expanding Graduate Medical Education Programs in San Antonio and Laredo By Michael J. Mohr, DO, MS and Brenda Treviño 18

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Book Review: Dr. Mutter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine By Cristin O’Keefe Aptowicz, Reviewed by Teresa C. Hayes, MD 33

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SAN ANTONIO MEDICINE is published by SmithPrint, Inc. (Publisher) on behalf of the Bexar County Medical Society (BCMS). Reproduction in any manner in whole or part is prohibited without the express written consent of Bexar County Medical Society. Material contained herein does not necessarily reﬂect the opinion of BCMS, 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 re sponsibility for accuracy, errors or omissions. San Antonio Medicine does not knowingly accept false or misleading advertisements or edi torial 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 in tention to make such preference limitation or discrimination. COUNTY SOCIETY WWW.BCMS.ORG $4.00 JULY 2022 VOLUME 75 NO.7

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What You Need to Know About COVID-19 and Pets From the CDC 34 Expression in Medicine: By Divya Chandramohan, MD; Reflections from the Margins By Sammar Ghannam, MD; Snowdrift at the Frozen Lake By Richard Marlow Taylor, MD 35 BCMS Donates an Estimated $26K of PPE to the Government of Namibia, Africa 39 Purchasing Directory 40 Review: 2022 BMW M440i and i4 M50 By Stephen Schutz, MD Dealers

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SAN ANTONIO 4 SAN ANTONIO MEDICINE • July 2022

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UIW Graduates Latest Class of Osteopathic Medicine Physicians By The University of the Incarnate Word School of Osteopathic Medicine 30

BCMS BOARD OF DIRECTORS

ELECTED OFFICERS

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

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

Taylor Frantz, Alliance Representative Ramon S. Cancino, MD, Medical School Representative Lori Kels, MD, Medical School Representative Ronald Rodriguez, MD, PhD, Medical School Representative Carlos Alberto Rosende, MD, Medical School Representative BCMS

Vincent Fonseca, MD, MPH, Member Woodson "Scott" Jones, MD, Member Lubna Naeem, MD, Member Lyssa N. Ochoa, MD, Member Jennifer R. Rushton, MD, Member Raul Santoscoy, DO, Member John Shepherd, MD, Member Amar Sunkari, MD, Member Lauren Tarbox, Member Col. Tim Switaj, MD, Military Representative Manuel M. Quinones Jr., MD, Board of Ethics Chair George F. “Rick” Evans, General Counsel Jayesh B. Shah, MD, TMA Board of Trustees Melody Newsom, CEO/Executive Director

Kristy Yvonne Kosub, MD, Member Louis Doucette, Consultant Alan Preston, PhD, Member Rajam S. Ramamurthy, MD, Member Adam V. Ratner, MD, Member David Schulz, Community Member Faraz Youseﬁan, DO, Member Neal Meritz, MD, Member Jaime Pankowsky, MD, Member Moses Alfaro, Student Member Winona Gbedey, Student Member Tue Felix Nguyen, Student Member Cara J. Schachter, Student Member Niva Shrestha, Student Member Danielle Moody, Editor

PUBLICATIONS COMMITTEE

6 SAN ANTONIO MEDICINE •

July 2022

John Joseph Seidenfeld, MD, Chair

SENIOR STAFF Melody Newsom, CEO/Executive Director

Under this program 1,000 Medicare funded physician residency slots will be distributed to qualifying hospitals, phasing in 200 slots over the next five years. The challenge is how many of these slots will come to Texas, and will it be a significant drop in the bucket of Texas GME residencies – likely not!

Medicare has had a near static funding support for residencies since the Balanced Budget Act of 1997. After 25 years, the Center for Medicare and Medicaid Services (CMS) Fiscal Year (FY) 22 Inpa tient Prospective Payment System (IPPS) implemented the largest in crease in residency funding by $1.8 billion over the next 10 years.

To address this shortage, we need to increase the number of physi cians in Texas by supporting an adequate number of graduate medical education (GME) residencies in Texas. The aim is to hit a 1:1.1 med ical school graduate to GME residency position goal. However, we are far from that goal due to lack of adequate GME residency funding sources, forcing many Texas medical school graduates to complete their residencies out of state. When Texans complete their medical school and residency training in Texas, there is an 80% chance they will practice in Texas. When they do only one or the other in Texas, that chance of practicing in Texas decreases to 60%. Texas spends at least $180,000 of state funds for each Texas medical school graduate. When those graduates are forced to go out of state for a residency and don’t come back, we lose more than $180,000 in Texas funds invested in that Residencyphysician.training costs approximately $150,000 per resident per year of residency. Medicare is the largest funder for residency programs in the US since 1965, however, it pays for fewer Texas residents and pays less for Texas residencies than in other states. Medicare pays for 202 residents per 100,000 population in Washington DC, compared to 18 GME residents per 100,000 population in Texas. Medicare pays Connecticut $155,000 per resident per year for GME residencies, while in Texas, Medicare pays an average of $65,500 per year. In addi tion, the direct costs of residencies in Texas average about $89,000 per resident per year. Medicare pays on average about $21,600 per resident per year for direct costs, leaving an average of unfunded direct GME cost of more than $67,000 per resident per year. Due to these signifi cant unfunded costs for graduate medical education from Medicare, it is difficult for teaching hospitals in Texas to reach the 1:1.1 medical school graduate to GME residency position goal.

By Rajeev Suri, MD, MBA, FACR, 2022 BCMS President

While Medicare funds two-thirds of GME funding, Medicaid is the next biggest source. To keep our investment in the health of Texas by supporting current and new residency positions, Texas Human and Health Services and Texas legislative leadership have funded additional residency positions through the Texas Medicaid GME and Texas Higher Education Coordinating Board grant programs. Under this GME Expansion Program, the 83rd Texas Legislature in 2013 appro priated $14 million to support increases in the number of first-year residency positions. In 2015, the 84th Texas Legislature streamlined these efforts and appropriated $53 million to increase the number of first-year residency positions and to establish new residency programs. The 85th and 86th Texas Legislature continued support for the pro gram, and the 87th Texas Legislature recently appropriated $199M for Texas Residency Programs for the 2022-2023 biennium. To continue to provide the best care for our patients and address the physician shortage areas in Texas, we need to continue to aim for the 1:1.1 medical school graduate to GME residency position goal. En suring continued and new GME funding from all sources is critical to the survival of GME and our future physicians. Whether this comes from the local, state or national level for Medicare/Medicaid funding, or requiring alternative options like the VA (federal) or private funding sources or a GME financing overhaul (as described the 2014 IOM re port) – all options need to be on the table to address this GME resi dency funding conundrum. References 1. tion-and-research/https://thotonline.org/thot-initiatives/graduate-medical-educa

Graduate Medical Education in Texas – The Funding Conundrum

PRESIDENT’SMESSAGE 8 SAN ANTONIO MEDICINE • July 2022

Texas has a worsening physician shortage – a ‘shortage area’ being defined as an area with less than one primary care provider for every 3,500 residents. As of July 2021, 249 of the 254 counties in Texas have areas with a primary care physician shortage; in 228 of these, the entire county has a shortage – which has nearly doubled since 2019.

2. Rees L. GME financing system needs overhaul: IOM report July 2014. nancing-system-needs-overhaul-iom-reporthttps://www.ama-assn.org/education/gme-funding/gme-fi

Rajeev Suri, MD, MBA, FACR is the 2022 President of the Bexar County Medical Society, Tenured Professor and Interim Chair of the De partment Radiology at UT Health San Antonio, and Chief of Staff at University Hospital San Antonio.

"Becoming a physician has been a long-held aspiration of mine, but the demanding path comes with necessary hurdles to jump. College and medical school are not cheap endeavors, and living on loans now in my late twenties has been stress-inducing. This scholarship from Bexar County Medical Society Alliance has tremendously decreased my stress, and I am so grateful for this organization recogniz ing medical students’ financial burden that exacerbates an already highly difficult process. I greatly appreciate their generosity and thoughtfulness, and I will reflect on this token when I am able to help in a similar manner. Thank you, BCMSA!”

Evon Rose is a recipient of the BCMS Alliance Medical Stu dent Scholarship. This scholarship supports the medical stu dent in the amount of $1,500. Evon is a third-year medical student at the University of Incarnate Word, School of Os teopathic Medicine, and is a member of the 2024 graduating class.

“I am incredibly honored to be selected to receive this scholarship award to support my journey in osteopathic medicine. With the support of many wonderful faculty, com munity members and peers, I have been fortunate to have opportunities to learn through service and leadership while growing in innumerable ways as a young pro fessional. I have enjoyed making San Antonio my home and am eager to explore con tinued opportunities to learn and study here as an aspiring physician.”

Each year, the BCMS Alliance provides scholarships to students in Bexar County who demonstrate a commitment to academic ex cellence while pursuing a career in Allied Health (e.g. nursing, physical therapy, audiology, physician assistant, speech-language pathol ogy, occupational therapy) and Medicine. We want to recognize our scholarship committee for the 2022 year: Lori Boies; Nichole Eckmann; Taylor Frantz; Celinda Guerra; Julia Halvorsen; Cheryl Pierce-Szender; Virginia Profenna; Jenny Shepherd; Stephanie Stasik; Lisa Uresti-Dasher. Many thanks to the committee for your hard work and dedication!

MaryAnn England is a recipient of the BCMS Alliance His panic Medical Student Scholarship. This scholarship supports the medical student in the amount of $1,500. MaryAnn is a third-year medical student at the UT Health San Antonio Long School of Medicine, and is a member of the 2024 grad uating class.

Evan Caston is a recipient of the BCMS Alliance Medical Student Scholarship. This scholarship supports the medical student in the amount of $1,500. Evan is a third year medical student at the UT Health San Antonio Long School of Med icine, and is a member of the 2024 graduating class.

“Thank you so much for making the BCMS Alliance Hispanic Medical Student Schol arship possible. I am thrilled that I was selected for this honor, and I am deeply ap preciative. This scholarship plays a large part in making my medical career goals possible, and for that I express the sincerest gratitude. ”

Elia Muzquiz receives the Sandra Vela Memorial Scholarship. This scholarship supports the prospective allied health stu dent in the amount of $750. Elia attends Texas A&M Uni versity San Antonio, and is seeking a Bachelors of Science in Kinesiology with a concentration in pre-physical therapy. Elia is in the class of 2024.

“Thank you for this opportunity! I will continue to serve my community as best I can.”

“I am so honored to have received the 2022 BCMS Alliance Hispanic Medical Student Scholarship. I wanted to become a doctor in the first place because I noticed huge healthcare disparities throughout my community. I saw how hard it was for my mom to communicate with doctors, being that she was only Spanish-speaking. I saw the lack of healthcare education provided to the Hispanic community because of this language gap and the devastating chronic health problems and mistrust that resulted. It is my goal as a future doctor to take the time to build trust with my patients and the best way to do so is to speak with them on their own terms, in their own language. I hope that as a future doctor I will be able to bridge that language and knowledge gap to create a more trusting environment for the Latinx community. Thank you again for this generous award and the support to guide me to achieve my goals.”

Stephanie expresses a strong desire to remain in San Antonio to serve our local community, and has special interests in physical therapy for neurologic conditions.

“I am honored to be a recipient of the Rebecca Christopherson Memorial Scholarship. I'd like to take this opportunity to thank the Bexar County Medical Society Alliance for your consideration and your generosity in funding this. This scholarship will di rectly support my educational pursuits by helping me pay for my last year of under graduate tuition. Thank you so much! Also, thank you for providing me with background on who Rebecca was. It is a privilege to be recognized for exemplifying characteristics similar to that of someone like her. I am deeply touched by her story and hope to also build meaningful relationships with the people I will one day serve as a prospective PA.”

10 SAN ANTONIO MEDICINE • July 2022 BCMS ALLIANCE

“I wanted to show my gratitude for having the privilege of being chosen by the Bexar Medical Society Alliance Scholarship Committee for the Sandra Vela Memorial Schol arship. I am very thankful that I had the qualities for this amazing scholarship that will help me through my journey in getting my Bachelor’s Degree in Kinesiology at Texas A&M University - San Antonio and continuing my education at a graduate program for Physical Therapy. I give special recognition to my sister Carla Muzquiz and my advisor Dr. Malin Lilley for all the support and advice they have given me throughout this long but alluring passage. By being awarded the Sandra Vela Memo rial Scholarship, you have lightened my financial burden which allows me to focus on what is most important, my education, and have inspired me to give back to my com munity when I accomplish my goals in becoming a DPT.”

Amanda Tran receives the Rebecca Christopherson Memorial Scholarship. This scholarship supports the allied health student in the amount of $750. Amanda attends St. Mary’s University, studying toward a Bachelors of Arts in Biology with a minor in Psychology. Amanda is also part of the Marianist and Leadership Programs, while being a member of the 2023 graduating class.

Stephanie Deocampo was awarded a BCMS Alliance Schol arship. This scholarship supports the allied health student in the amount of $750. Stephanie attends the University of the Incarnate Word, School of Physical Therapy, and is graduating in the Class of December 2022. Stephanie has shown a dedi cation to service, working in free clinics and as a peer tutor.

2022 BCMS Alliance Medical Student Scholarship funds were matched by the TMAF Medical Student Scholarship and Grant Trust Fund of Dr. Roberto J. and Agniela (Annie) M. Bayardo, in memory of Agniela (Annie) M. Bayardo.

Honoring Our 2022 Scholarship Awardees

Miguel Saldana is a recipient of the BCMS Alliance His panic Medical Student Scholarship. This scholarship supports the medical student in the amount of $1,500. Miguel is a third-year medical student at the University of Incarnate Word, School of Osteopathic Medicine and is a member of the 2024 graduating class.

Graduate Medical Education: The Pipeline for Bexar County and South Texas

12 SAN ANTONIO MEDICINE • July 2022 UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

UT Health San Antonio (UTHSA), with its two major partners, University Health (UH) and the South Texas Veterans Healthcare Sys tem (STVHCS), have been the central Graduate Medical Education (GME) pipeline in South Texas and the Rio Grande Valley since 1968. We currently have over 85 GME Programs and over 900 interns, resi dents and fellows, 55% with funding support from UH and 26% from the STVHCS. We train throughout the city with support from mul tiple partnerships, including the San Antonio Military Health, Methodist, Baptist and Christus Santa Rosa sys tems. GME truly is a city-wide collaborative effort. UTHSA was the initial sponsoring institution for the UTRGV launch of GME programs that have now grown to 19 residencies and fellowships. A review of Doximity alumni data demonstrates ex cellent retention to practice in the region and State (Table 3). Of UTHSA graduates from core resi dency programs, 64% (3301) are located in Texas and 33% (1,716) in the San Antonio area. 36% of UTHSA faculty were trained in our res idency and/or fellowship programs. UTHSA is truly the predominant source for physicians in Bexar County. In the last decade, the region has benefitted from the other institu tions starting and growing GME positions. Christus Santa Rosa has had a Family Medicine Residency for many years. In partnership with the Children's Hospital of San Antonio, Baylor began a new Pediatric Res

Physician

By Woodson “Scott” Jones, MD M

Figure 1: Texas Physician Shortages 2030 By Region2 Table 1: Texas Health and Human Services South Texas Projected Shortages 20302

ultiple organizations have projected a growing shortage of physicians over the next decade. The Association of American Medical Colleges (AAMC) projects a national shortage of between 37,800 and 124,000 physicians by 2034.1 Further, Texas is ranked 41st of the 50 states in the number of active physicians (231) per 100,000 population.2 We have close to the most elderly physician workforces, ranked 49th of the 50 states. Given the aging Texas physician workforce and the COVID Pan demic leading to physicians choosing the leave the work force sooner, Texas physician shortages may be greater than current projections.1 Texas Health and Human Services (HSS) project South Texas will be short 745 physicians by 2032, 10% short of the need (Figure 1).3 The Rio Grande Valley, despite the growth of the University of Texas Rio Grande Valley (UTRGV) School of Medicine GME pro grams, is projected to meet only 61% of the physician de mand. Specialties with Texas HHS projects shortages in the Texas South Region, which includes San Antonio, are in Table 1. More granular Bexar County data also indicates physician shortages by 2026 (Table 2). Our region and county have projected physician workforce shortages in pri mary, specialty and subspecialty care.

idency in 2012 and ex panded to a few pediatric subspecialty programs. The Texas Institute for GME and Research (TIGMER) is the GME arm of the University of the Incarnate Word School of Osteo pathic Medicine. They now have six accredited pro grams in Laredo and San Antonio. Methodist also plans to expand GME pro grams, beginning with an Internal Medicine program in 2023. As crucial as these expansions are for our re gion, the capacity to train the number and breadth of subspecialists remains a challenge. In particular, many subspecialty residen cies and fellowships require a mix of both volume and complex patients, multiple other specialties and subspecialty GME programs, and research expectations with the associated teaching and research faculty typically found in larger teaching institutions. Even as Texas has been growing the GME pipeline, its population is growing as fast or faster and also aging. Texas has successfully brought in physicians from out of state, partly due to tort reform.4 However, the projected shortages remain despite substantive investment into starting new and growing existing medical schools and GME programs.

SG2

Doximity Residency Navigator continued on page 14 UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

Table 2: Bexar County Physician Shortages 2026 Table 3: UT Health San Antonio GME Alumni Practice Locations

The good news is that the State of Texas and the Federal Government have taken several steps to address the GME funding challenge. The State recognized it must keep as many of the growing number of medical students in the State as possible for GME. Texas routinely ranks in the top 2-3 states, keeping 81% - 83% of physicians who do both UME and GME in the State to practice.2 The desired ratio is 1.1 GME positions for each UME graduate. The Texas Higher Education Coordinating Board (THECB) GME Expansion Program, started in 2013, has been a significant factor in sustaining this ratio and will fund almost 1,400 GME positions each year by July 2023.5 The UTRGV and TIGMER have particularly benefited from this funding due to their fortunate tim ing of starting new programs that also aligned with the THECB fund ing priorities for primary care and mental health. However, this funding is under scrutiny for potential cuts each legislative session, mainly since the spending has grown to nearly $100 million annually.6 The other chal lenge is the GME expansion grants do not address the increasing needs for specialists and sub-specialists. Another GME funding initiative was expanding a Medicaid DME matching program for residents from only the State-owned teaching hospitals to include non-state owned and op erated government teaching hospitals.7 Therefore, two new state-lead programs have enhanced GME funding to both the medical schools and teaching hospitals.

Beginning in 2016, CMS allowed some hospitals to reclassify to a rural geographic designation, resulting in a 30% increase in their IME "cap" and a substantive increase in CMS funding for GME. 8 Additionally, Congress passed landmark legislation in 2021, imple Visit us at www.bcms.org 13

While state formula funding to the medical schools has stagnated for Undergraduate Medical Education (UME) and GME for many years, the GME state formula funding is about a tenth of the UME funding. This challenges educational institutions that sponsor GME programs as the most significant proportion of GME funding goes to the teach ing hospitals. For reasons to follow, the teaching hospitals may not have sufficient funds to support the educational institution's GME infra structure, such as program directors, coordinators and faculty educa tional time. Established teaching hospitals have been constrained because the Centers for Medicare & Medicaid Services (CMS) "capped" or froze the number of positions they would pay for at the number of residents and fellow FTEs in 1996. Hospitals are not reim bursed for trainees over these "caps," limiting GME expansion by estab lished teaching hospitals.

Source:

References 1. Association of American Medical Colleges (AAMC) The Com plexities of Physician Supply and Demand: Projections from 2019 to 2034. https://www.aamc.org/media/54681/download?attach

6. Price S. Texas Medicine "Medical Education: Lawmakers invest in Texas' future." August 2021. com/publication/?m=55178&i=714147&p=40&ver=html5https://www.qgdigitalpublishing.

grams-in-texas-fy2020/for-graduates-of-texas-medical-schools-to-enter-residency-prouate-medical-education-report-an-assessment-of-opportunities-

5. The Graduate Medical Education (GME) Report: An Assessment of Opportunities for Graduates of Texas Medical Schools to Enter Residency Programs in Texas A Report to the Texas Legislature per Texas Education Code, Section 61.0661 October https://reportcenter.highered.texas.gov/reports/legislative/grad2020.

8. Bazakas A. Declassifying the GME Reimbursement Benefits of Rural Reclassification. January 2018. benefits-of-rural-reclassificationthought-leadership/blog/declassifying-the-gme-reimbursement-https://www.ecgmc.com/

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ment 2. Association of American Medical Colleges (AAMC) State Physi cian Workforce Data Report. ports/workforce/report/state-physician-workforce-data-reporthttps://www.aamc.org/data-re

7. Texas Health and Human Services Supplemental programspayment-directed-payment-programs/supplemental-payment-https://www.hhs.texas.gov/providers/medicaid-supplemental-Programs

9. Graduate Medical Education Final Rules Published for FY 2022 IPPS AAMC Jan 7. 2022. rules-published-fy-2022-ippsicy/washington-highlights/graduate-medical-education-final-https://www.aamc.org/advocacy-pol

14 SAN ANTONIO MEDICINE • July 2022 menting processes to grow 1,000 new GME positions over five years.9 The number of positions at 200 per year for the nation was not a "landmark" but represented the first time since 1996 that Con gress approved increases in the DME "cap." Unfortunately, the im plementation process defined by CMS proved unfavorable for us. Finally, new hospitals and hospitals that have not had residents are another potential way to expand CMS-funded GME training posi tions. As UTHSA opens its Multispecialty Research Hospital, there will be a few new GME programs and positions.10 However, CMS rules limit new funding in new hospitals to only new GME pro grams, a challenge for UTHSA with 85 GME programs. Therefore, new CMS or State funding for expanding our outstanding, estab lished specialty and subspecialty training has been and will likely re main a challenge. In summary, UTHSA has had a long history of supplying a substan tial portion of the workforce to Bexar County, the region, and the val ley, primarily with its two major partners in University Health and the STVHCS. The expansion of GME by TIGMER, UTRGV and oth ers is vital to the region's rapidly growing population needs for primary care. While medical school growth is welcomed, GME growth must keep pace in this region to ensure we meet the healthcare needs of our future. Continued support of the THECB GME Expansion Program, use of new CMS or other identified funding for increasing GME spe cialty and sub-specialty positions, and capitalizing on starting new GME programs in new hospitals in the county and region will be nec essary to meet our future physician workforce needs.

10. Garcia L. Express-News Exclusive: First look at UT Health San Antonio's $430M hospital. March 29, 2021. at-UT-Health-16059475.phpnews.com/news/local/article/Express-News-Exclusive-First-look-https://www.express 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 and on the Board of Directors of the Bexar County Medical Society.

4. Berlin J. Coming of Age: Celebrating 15 Years of Texas Tort Re form. Texas Medicine Sept 2018. https://www.texmed.org/Tem plate.aspx?id=48427

3. Texas Department of State Health Services Texas Workforce Sup ply & Demand Projections, 2019 - 2030. texas.gov/dashboard/health-care-wf/wf-sup-and-demand-projhttps://healthdata.dshs.

Adam V. Ratner, MD, FACR, is Professor of Radiology, Health Pol icy, and Medical Humanities and Assistant Dean of Strategic Initiatives at UIWSOM. He is the 2019 Past Presi dent of the BCMS. He is also an active member of the BCMS Publications Committee.

Finally, as seniors, Direct Admit applicants must successfully interview with SOM faculty. This pathway allows pre-medical learners to avoid the pain of taking the MCAT and filling out more than one medical school application. Because the UIWSOM Direct Admit pro gram is relatively new, the most advanced learners are now finishing their second year of medical school. This program is not for all smart and driven high school seniors. For the select few who know this early in life that they want to become osteopathic physicians, this program offers a straightforward and support ive pathway toward this professional career.

he University of the Incarnate Word (UIW) serves learners from around the world but focuses on those from central and south Texas. Arising from the founders’ healing mission, UIW has estab lished health professional schools offering de grees in nursing, optometry, pharmacy, physical therapy, and, most recently, osteo pathic medicine. To encourage highly qualified and moti vated high school graduates to pursue careers in these professions, UIW has established a Direct Admit program to allow select learners a more straightforward admission process to obtain advanced degrees from the UIW schools of optometry, pharmacy, physical ther apy and osteopathic medicine. The Direct Admit program was launched in 2016, one year prior to the DO inaugural class. UIW continues to focus on building pipeline pro grams which identify future healthcare profes sionals, and supporting their progression from high school to professional school.

A Direct Track for High School Seniors into Medicine and Other Health Professions

By Adam V. Ratner, MD, FACR and Amanda Galán-Davila, PhD

The

To be admitted into the UIW School of Osteopathic Medicine (UIWSOM) Direct Admit program, high school seniors dedicated to becoming physicians must be admitted to the UIW undergraduate school with a mini mum cumulative high school GPA of 3.7, four years of math and science with a minimum GPA of 3.7 and demonstrate community serv ice involvement. Candidates must also success fully interview with UIWSOM faculty.

Amanda Galán-Davila, PhD is As sistant Professor of Cellular and Mo lecular Biology and Biochemistry at the University of the Incarnate Word School of Osteopathic Medicine and serves as the faculty advisor for the UIWSOM Direct Admit learners. Direct Admit Program at University of the Incarnate Word:

During their undergraduate education, Di rect Admit learners are supported by UIW SOM faculty, staff and learners through a variety of experiences to prepare them for medical school and foster the development of their career skills. Workshops are offered yearly to develop skills related to academic and career success such as resume and professional statement writing, collaboration strategies in the classroom and professional environment, and public speaking. Direct Admit learners also experience components of the DO cur riculum including participating in simulations at the UIWSOM Center for Interprofessional Experiential Learning and Observation (CIELO) simulation laboratory and osteo pathic manual manipulation/technique (OMM/OMT) demonstrations.

UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

Visit us at www.bcms.org

Once admitted to the program, Direct Admit learners are awarded conditional ac ceptance to UIWSOM. Learners must main tain a 3.5 GPA each academic year, maintain a math and science GPA of 3.5 and success fully complete medically relevant upper divi sion electives.

The

Learners enroll in a professional develop ment seminar which addresses issues related to medicine and the transition to medical school. In addition, they must complete the UIW community service requirement with a focus on health education. These curricular activities contribute to the well-rounded academic expe rience and prepare the learners for successful matriculation into the DO program.

Six-Year Combined Baccalaureate and MD Programs

UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

A US (United States) literature review reveals no difference between traditional and abbreviated programs in attrition, withdrawal, perform ance on licensing examinations, matching to residency programs and performance in medical school examinations. In studies where the two groups were compared by entry SAT scores, the abbreviated program participants did as well as matched controls but better than the rest of their classmates on most performance measures.5

16 SAN ANTONIO MEDICINE • July 2022 he cost of a medical education continues to spiral out of reach for many, particularly underrepresented minority students. For those who matriculate, the debt load is a cause of great anxiety. Fourth-year students in the UIW (University of the Incarnate Word) SOM (School of Osteopathic Medi cine) Business of Medicine course often choose to research debt and stu dent loan repayment as their sole topic of study. The concern has wors ened as tuition continues to rise over $70,000/year at many schools. Even if debt cancellation programs are eventually enacted, they usually only pay a minor fraction of medical debt. Since the 2010 Patient Protection and Affordable Care Act, consterna tion over individual and societal costs of medical education has increased for all learners and their parents. To pay back debt, many learners seek graduate medical education (GME) programs (medical and surgical spe cialties) that will lead to higher paying jobs and accelerated debt repayment.1 At the same time, we see data which show an educational system that pro duces poorer quality medical out comes than most other industrialized countries.2 In addition, we produce significantly fewer doctors per 100,000 people than in many coun tries. We need more doctors, more training slots after graduation (GME) and more primary care doctors. This discussion will focus on studies which have looked at shortening the duration of training.1

Most European countries such as France, Germany, the Netherlands, Italy, Sweden, UK, Denmark, Austria and Finland have shortened pro grams after learners demonstrate competence through testing. Learners receive only a medical degree, have a six-year training period, and pro ceed to clinical rotations and specialization. Combined degree paths are the exception. All these programs require learners to demonstrate dedication, hard work, proficiency in complex subjects and mission orientation to care for patients.1

A review in 2012 by Eaglen et al. found that of learners in combined baccalaureate and MD programs (BA-MD), 20% pursue a truncated course taking less than the usual eight years to complete both degrees.3

By John J. Seidenfeld, MD T

Concerns are raised about the quality and maturity of graduates. Ac cording to Carrothers, “An essential way for medical schools to help restore public trust is to select and nurture professionals who see med icine in a broad social context, who have learned to listen to feedback, who are capable of responding and communicating clearly and honestly in those areas and about those issues where they are uniquely qualified to contribute.” This group developed an emotional maturity question naire for applicants to help in acceptance decisions that is applicable for traditional and accelerated programs.4

In 2021, Gonnella reviewed data from a review of 723 men and 411 women who attended the combined Penn State and Jefferson Medical College shortened program. The six-year program was compared to class year matched controls of those learners in the regular program with acceptance after a four-year baccalaureate degree and a four-year medical degree. Study participants were matched by year of entrance to school, gender and scores on the Medical College Admission Test (MCAT). The authors conclude after assessing decades’ worth of edu cational and professional outcomes of an accelerated combined BS–MD program that began more than 50 years ago that it is feasible to reduce the cost and time required to obtain an MD degree without

Visit us at www.bcms.org compromising educational outcomes and professional compe tence. Additional benefits include avoiding redundancies in the baccalaureate and medical school curricula and graduating younger physicians with longer career spans to serve the public greater good.5 Greene et al. reported similar findings after examining out comes for abbreviated versus eight-year programs at Northwestern University.6Itistimeto consider abbreviated programs for medical graduates in the United States. We need more doctors, more primary care doctors, more doctors from underserved minorities, lower educa tion debt, more GME training slots, and less pressure on medical graduates to seek high pay specialties and urban practices to repay loans. The two medical schools in San Antonio would be ideal test ing sites for such programs. Texas and the federal government would benefit from a greater supply of physicians, and lower train ing costs. Governmental groups have authority over public univer sity systems and should exercise it for the health of the states and country at large.1

References 1. The case for shortening medical education. Robert Orr and Anuska Jain, 6.5.4.3.2.https://www.commonwealthfund.org/publications/fund-refor-shortening-medical-education/ Anuskahttps://www.niskanencenter.org/the-case-ports/2014/jun/mirror-mirror-wall-2014-update-how-us-health-care-system Acad.Med.2012:87:1600-1608.Thescopeandvarietyofcombinedbaccalaureate-MDprogramsintheUS(UnitedStates).RHEaglen,LArnold,JAGirotti,etal. Acad.Med.2000;75:456–463.MeasuringEmotionalIntelligenceofMedicalSchoolApplicants.RobertM.Carrothers,MA,StanfordW.Gregory,Jr.,PhD,andTimothyJ.Gallagher,PhD Acad.Med.2021;96:101–107.PreparingfortheMD:HowLong,atWhatCost,andWithWhatOutcomes?JosephS.Gonnella,MD,ClaraA.Callahan,MD,JamesB.Erdmann,PhD Acad.Med.2016;91:256–261AcademicPerformanceofStudentsinanAcceleratedBaccalaureate/MDProgram:ImplicationsforAlternativePhysicianEducationPathways.MarianneM.Green,MD,LeahWelty,PhD,JohnX.ThomasJr,PhD,andRaymondH.Curry,MD

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

he University of the Incarnate Word (UIW) was established in 1881 by the Sisters of Charity of the Incarnate Word. The university has a long tradition of training healthcare work ers with outstanding schools of nursing, pharmacy, optometry, physical and occupa tional therapy, and kinesiology. The Univer sity of the Incarnate Word School of Osteopathic Medicine (UIWSOM) was es tablished in 2017 to train osteopathic physicians with a focus on primary care and service to those most in need, training students in community-based, rural and underserved urban clinical sites in San Antonio, Laredo, Abilene and several small communities.Postgraduate programs have also been developed to complete the training for graduates of any DO or MD school who wish to serve South Texas communities in a manner consistent with UIW’s commit ment to social responsibility.

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Expanding Graduate Medical Education Programs in San Antonio and Laredo

Psychiatry Residents at Texas Vista Medical Center

18 SAN ANTONIO MEDICINE • July 2022

In 2016, The Texas Institute for Graduate Medical Education Re search (TIGMER) was established as a 501(c)(3) non-profit corpora tion in San Antonio, with Dr. Thomas Mohr serving as the founding Designated Institutional Official and Ms. Marsha Sellner as the found ing Director of Graduate Medical Education Research.

By Michael J. Mohr, DO, MS and Brenda Treviño

TIGMER’s goal is for these residents and fellows to remain in the community and continue serve the residents of South Texas beyond residency and fellowship training.

Michael J. Mohr, DO, MS is the Designated Institutional Official and Associate Dean for Graduate Medical Education at the Texas Institute for Graduate Medical Education and Re search (TIGMER). He is board-certified in family medicine. To learn more, please visit tigmer.com. Dr. Mohr is a member of the Bexar County Medical Society.Brenda Treviño is the Director of Graduate Medical Education at TIGMER. Ms. Treviño has worked in graduate medical education for over 20 years.

Visit us at www.bcms.org 19 UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

Altogether, TIGMER will train 169 medical residents and fellows in San Antonio and Laredo by 2024.

Internal Medicine at Texas Vista Medical Center Family Medicine at CommuniCare Health Centers

• July 2017: Community-Based Family Medicine at CommuniCare Health Centers in San Antonio • July 2018: Family Medicine and Internal Medicine at Laredo Medical Center

• July 2020: Hand Surgery at The Hand Center of San Antonio

Mohr was appointed as Designated Institutional Offi cial in April 2021, with Ms. Brenda Treviño joining the department as Director of Graduate Medical Education in August 2021. Five of the seven programs have achieved a status of continued accreditation by the ACGME, with two programs awaiting their site visit in the 20222023 academic year.

TIGMER partnered with UIWSOM, local community clinics and hospital sys tems to successfully launch the following residency and fellowship programs accred ited by the Accreditation Council for Grad uate Medical Education (ACGME):

•

July 2019: Psychiatry at Texas Vista Medical Center in San Antonio and Sports Medicine at Sports Medicine Associates of San Antonio

• July 2021: Internal Medicine at Texas Vista Medical Center in San Dr.AntonioMichael

20 SAN ANTONIO MEDICINE • July 2022 UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL Help Protect Yourself & Others | COVID-19

Visit us at www.bcms.org 21

UNDERGRADUATEW

By Jon Courand, MD

AND GRADUATEEDUCATIONMEDICAL

Beyond the Kale: Wellness 2.0 and the Move Toward the Wider Systems of Care

22 SAN ANTONIO MEDICINE • July 2022 hen I first physicianinterestedbecameinwellbeing in the fall of 2014, there was very little conversation about burnout, stress man agement, work-life balance and resilience building. Two years earlier in 2012, Tait Shanafelt and his group at the Mayo Clinic had released their first published article about levels of burnout in the physician workforce as com pared to the general popula tion, finding levels of burnout at 45% and satisfaction with their work life at 48%. The conversation on levels of burnout and work life satis faction increased consider ably when just three years later, in 2014, the rates of burnout had climbed to 54% while satisfac tion with work life had fallen to 41%. The realization that over one half of all physicians who completed the study were experiencing burnout reverberated nationally, this caught the attention of national healthcare organizations and leadership, including Dr. Tom Nasca at the Accred itation Council of Graduate Medical Education (ACGME), Dr. Victor Dzau at the National Academy of Medicine (NAM) and Dr. Darrell Kirsch at the Association of American Medical Colleges (AAMC). At this same time, it was noted that there were higher rates of suicide among physicians than in the general population. Currently, approximately 400 physicians die by suicide per year, more than one physician death each day. In 2014, the deaths of two residents just weeks from each other in New York City raised the alarm even higher about physician mental health and well-being. A lot of progress has been made since this time. Both the ACGME and Liaison Com mittee on Medical Education (LCME) have included requirements for medical student and resident mental health screening and counseling, while also helping them discover the true meaning in their work in medicine. The Federation of State Medical Boards continues to work with state medical boards to limit or remove licensure questions related to physicians accessing past or current mental health care. Nationally, healthcare organizations are building infrastructure to support Wellbeing Champions in both focused and organizational roles to drive wellness initiatives within those healthcare systems. Such a focused approach made progress when, in early 2020, we saw the rates of burnout fall to 40%, lower than in 2011. Of course, months later, the COVID pandemic would reverse all those gains and push rates of burnout, moral injury and compassion fatigue to their highest levels. Thankfully, the well-being infrastructure was already in place to intervene actively and to aggressively support our faculty physicians,

As a way of moving this new paradigm forward, myself and a group of physicians in wellness leadership positions across the country pub lished a report through the AAMC in November of 2021 entitled, “The Rise of Wellness Initiatives in Health Care: Using National Survey Data to Support Effective Well-Being Champions and Wellness Programs.”3

UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

Simple changes like replacing slow computers, allowing badges to serve as touch cards in accessing the EHR rapidly or letting physicians test out of required educational modules like Bloodborne Pathogen Training provide incremental but noticeable changes in their daily workload. It is clear now that while we must continue to address provider well-being on the individual level, the road to true provider well-being and opportunity to flourish in the practice of medicine lies along the path to better systems of care. Thankfully more and more leaders are joining us on the Wellness 2.0 path.

Visit us at www.bcms.org 23 trainees, medical students and staff through the series of pandemic surges over two years.

At the end of 2020, the ACGME published their report on their Clinical Learning Environment Reviews (CLER) of Healthcare Sys tems and Hospitals across the country from 2017 until February of 2020.1 One primary focus of these CLER visits is provider well-being. This report entailed the visit of over 9,700 individual training pro grams, with interviews of over 100,000 clinical faculty, residents and fellows. Nationally, this report’s data showed that generally well-being programs were focusing only upon wellness initiatives aimed at the in dividual rather than the system. Early on, wellness initiatives looked at burned out providers as in trinsically susceptible to the challenges of medicine, assuming that if they could just be made more resilient, they would do well and even flourish in medicine. In this view, it was the individual physician or trainee who was to blame for their stress, burnout and mental health concerns. Given this incomplete understanding, the last five years have focused upon building resilience for providers and providing support when they “broke down.” Along the way however, those who worked and published in this field began to see these physicians and trainees as products of their environment. A common phrase was “you don’t blame the fish for the polluted water.”

CF, Courand J, Neuman SA, et al. The Rise of Wellness Initiatives in Health Care: Using National Survey Data to Support Effective Well-Being Champions and Wellness Programs. Wash ington, DC: AAMC; 2021 Jon Courand, MD is a Professor and Vice Chair in Pediatrics and the Assistant Dean for Well-being in Graduate Medical Education at UT Health in San Antonio. He is actively in volved with Physician well-being on a local, state and national level, and chair-elect of the AAMC Council for Faculty and Academic Societies’ Committee on Physician Resilience. Dr. Courand is a member of the Bexar County Medical Society.

With this new understanding, providers on all levels were then told, “it’s not your fault, it’s the environment, but since health care is not going to change anytime soon, we need to continue to work to make you resilient.” This was the average level of progress published in the ACMGE report. Of the many recommendations that have come from this report, one has had great impact: “CLEs that address well-being primarily through activities aimed at building resilience may be miss ing the more urgent system-level issues such as inefficient workflows, inadequate staffing and sub-optimal designed EMRs.” This report and others have recognized that building resilience is no longer sufficient to address the burnout and wellness crisis affecting our physicians, trainees and staff. In fact, another recent study showed that even the most resilience physicians, those who scored the highest on a validated measure of resilience, still burned out at a rate of 30%!2 This updated approach to provider wellbeing has been called Wellness 2.0 by Tait Shanafelt and others.

References 1. Koh NJ, Wagner R, Newton RC, Kuhn CM, Co JPT, Weiss KB; on behalf of the CLER Evaluation Committee and the CLER Program. CLER National Report of Findings 2021. Chicago, IL: Accreditation Council for Graduate Medical Education; 2021. doi: 2.10.35425/ACGME.0008ColinP. West, MD,PhD2; Liselotte N. Dyrbye, MD, Chris tine Sinsky, MD et al. Resilience and Burnout Among Physicians and the General US Working Population. JAMA Netw Open. 2020;3(7):e209385. doi:10.1001/jamanetworkopen. 3.2020.938Pipas

This report describes the current state of well-being programs and lead ership of those programs nationally, and provides a roadmap for advanc ing provider well-being through 10 recommendations. The overarching theme includes the creation of an organizational wellness champion po sition, like a Director of Wellness or Chief Wellness Officer, to align ex isting hospital or institutional well-being efforts while considering the effect new policies and programs have on provider well-being during their inception. The second major focus is to address wellness interven tions with a system-based, quality improvement approach. Within our Long School of Medicine Wellness Council and our Office of GME Wellness and Work Life Action Committee, we are devoting increas ingly more time to system-based issues that affect workflow, efficiency of care and reduction in administrative burden.

Dr. Badam is trained and Board-certified in Internal Medicine, Wounds as well as Under-Sea and Hyperbaric Medicine.

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VAYU communicates frequently with primary care physicians, specialists, community resources, managed care organizations and others to develop patient-centered care plans.

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Recently retired USUHS President, Major Gen eral Richard "Tom" Thomas, MD, DDS, commented that, “One thing I emphasized at the university was our leadership development program. I think we can all agree that that’s kind of a void in professional ed ucation.”Sinceleadership is integral to all military organi zations, so leadership development is baked-in across all years of the curriculum. “We institutionalize lead ership development programs for our students, so they graduate with those management skills needed to go along with their great clinical skills,” he said.

By David Alex Schulz, CHP T

UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

he cost of education has rarely been as news worthy and more in public debate. Medical school is no exception. The Association of American Medical Colleges (AAMC) reports the median 4-year cost of attendance for the class of 2022 is $263,488 (public school) and $357,868 (private school), and the debt of graduating medical students averaged around $207,000.

USUHS is unique, says Dr. Kevin Chung, Chair of Medicine. “We’re a fully accredited university med ical school with a second primary mission of training military medical providers and physicians, so our emphasis from day one is to create physicians who are hyper-focused on service.”

PRN: Take As Needed Medical School” Offers Unparalleled

Students pay no tuition or fees and receive the full salary and benefits of an O-1 for all four years at the USUHS. This includes free medical care for stu dents and your eligible family members, a housing allowance and 30 days paid leave each year. Books and lab equipment are also included at no charge. Following matriculation, graduates begin their ca reer with base pay, a housing allowance, and food al lowance around $100,000.

One needn’t already be in uniform to apply: The school accepts both civilian and military applicants for commissioning into the Army, Navy, Air Force and U.S. Public Health Service. Only about onethird of the students have had some form of prior of ficer or enlisted military experience—but join the military ranks once accepted. Once enrolled in the School of Medicine, students serve on active duty as commissioned officers, either as a Second Lieu tenant in the Army or Air Force, or Ensign in the Navy, or Public Health Service.

These skills, honed over years of collaborative combat-arena medical practice, where nothing is de pendable but chaos, provide a unique professional blend making military service doctors, if they retire the uniform, among the most sought for hospital leadership posts. Listening to their experiences, the

“America’s

Yet, students can avail themselves of a world-class medical education without spending any money at all by committing to a term of national service. Both military and public health services need highly trained medical professionals and provide opportu nities for anyone seeking to serve both medicine and society at large.

One path is through the Health Professions Scholarship Program (HPSP) to attend the student’s medical school of choice (given their acceptance) with tuition fully paid by the U.S. Government, and with a monthly stipend. The other route is by attend ing “America’s Medical School” – the Uniformed Services University of the Health Sciences (USUHS), now celebrating its 50th Anniversary.

26 SAN ANTONIO MEDICINE • July 2022

Students in USUHS graduate with a seven-year active-duty service commitment (or 10 years, if in the Public Health Service). But more than the obli gation of time, and more than the education itself, there is an added value in an educational framework devoted to service and leadership that bespeaks an uncommon quality of commitment to teamwork.

David Alex Schulz, CHP is a community member of the BCMS Publications Com mittee.

Opportunity UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

Visit us at www.bcms.org 27 word “I” is eschewed, and emphasis on teamwork overwhelming.Applicantsto USUHS must be at least 18 years old at the time of enrollment but no older than 36 as of June 30 of your enrollment year; a U.S. citizen; and meet the physical, medical and security require ments for becoming a commissioned officer in the military. Academic requirements include a Baccalau reate from an accredited school, completion of the required math and science courses and an MCAT no more than three years old. The average MCAT for those accepted is 509. USUHS will not accept MCAT scores below 496. Applying for the Health Professions Scholarship Program (HPSP) is a different track and has differ ent obligations. Just like USUHS, tuition is paid for by the U.S. Government, and students get a monthly stipend. Medical training is the same as your civilian peers, but an HPSP recipient undergoes a modified form of basic military training during the second year of medical school. During the third- and fourthyear clinical years, students get the chance to rotate at military hospitals if they choose. Graduating stu dent service obligations are a 1:1 payback in military service for every year of scholarship, up to four years. You can apply to any of the four schools (Nursing, Medicine, Dental and Allied Health Sciences) at USUHS through the American Medical College Application Service (AMCAS) online portal using designation code 821. Applying for the HPSP Scholarship simply involves contacting the recruiter for the chosen service, and a candidate can apply to just one or to all three — Army, Navy and Air Force.

“The university continues to produce healthcare providers who are culturally competent to serve the large Hispanic population of San An tonio and South Texas,” said Chiquita Collins, PhD, appointed by Dr. Henrich this year to serve as the inaugural, full-time Vice President for Diversity, Equity and Inclusion and Chief Diversity Officer at UT Health San DesignatedAntonio.asaHispanic-Serving Institution by the U.S. Depart ment of Education, UT Health San Antonio consistently ranks among the top schools in the nation for graduating Hispanic healthcare providers. Will Sansom

After conferring the May and summer degrees, UT Health San An tonio has produced more than 41,100 graduates. “Most healthcare providers and scientists in South Texas have graduated from or work with our academic health center,” Dr. Henrich said.

“Amid the reports of high healthcare worker burnout during the COVID-19 pandemic, it is heartening to see each of these committed graduates moving out to serve society as physicians, nurses, dentists, scientists and health professionals,” said William L. Henrich, MD, MACP, President of UT Health San Antonio.

UT Health San Antonio Graduates 1,000 Healthcare Providers and Scientists Submitted by

28 SAN ANTONIO MEDICINE • July 2022 ore than 1,000 students — 807 in May and 224 this sum mer — are new graduates of The University of Texas Health Science Center at San Antonio, also referred to as UT Health San Antonio. The university’s Institutional Research Office provided these preliminary figures.

UNDERGRADUATEM AND GRADUATEEDUCATIONMEDICAL

Dr. Henrich welcomed graduates, parents, family, friends, and UT Health San Antonio faculty and staff to the Alamodome for the May all-schools commencement ceremony, which happened on Saturday, May 21. The keynote speaker was Henry Cisneros, Mayor of San An tonio in the 1980s and former Secretary of the U.S. Department of Housing and Urban Development.

UT Health San Antonio issued degrees and certificates to 369 His panic students and 54 Black students in May and the summer, prelim inary data show. This is 41% of all graduates of the institution, spanning the Joe R. and Teresa Lozano School of Medicine, the School of Nurs ing, the School of Dentistry, the School of Health Professions and the Graduate School of Biomedical Sciences.

Of the May and summer applicants for graduation, 62% (645) are women, further demonstrating the university’s di versity.Inaddition to front-line physicians and nurses, UT Health San Antonio educates and trains a variety of pro fessionals to serve society. The May and summer graduates included:•210candidates for the Bachelor of Science in Nursing (BSN) degree.

• 113 candidates for the Doctor of Dental Surgery (DDS) degree.

• 50 candidates for the Doctor of Nursing Practice degree.

Graduates celebrate at the 2022 UT Health San Antonio commencement ceremony

UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

• 37 candidates for the Doctor of Philosophy (PhD) de gree in several disciplines. PhD and related degree programs provide expert scien tists for San Antonio’s life sciences ecosystem. “UT Health San Antonio students have an opportunity to engage in basic and clinical research with more than 1,000 leading scientists and clinicians, better preparing them to be leaders in the health care and bioscience industry,” said Jennifer Potter, PhD, Vice President for Research at UT Health San Antonio.TheUniversity of Texas Health Science Center at San Antonio (UT Health San Antonio) is a primary driver for San Antonio’s $42.4 billion health care and biosciences sec tor, the city’s largest economic generator. Driving substan tial economic impact with its five professional schools, a diverse workforce of 7,200, an annual operating budget of more than $1 billion and a clinical practice that provides more than two million patient visits each year, UT Health San Antonio plans to add more than 1,500 higher-wage jobs over the next five years to serve San Antonio, Bexar County and South Texas. UT Health San Antonio is the largest research university in South Texas with an annual research portfolio of approximately $350 million. To learn more, please visit The University of Texas Health Science Center at San Antonio on Facebook, Twitter, LinkedIn, In stagram and YouTube.

• 46 candidates for the Master of Science in Respiratory Care degree. • 42 candidates for the Certificate in Emergency Medi cine Technology.

• 41 candidates for the Doctor of Occupational Therapy degree. • 41 candidates for the Master of Science in Speech Lan guage Pathology degree.

Visit us at www.bcms.org 29

• 204 candidates for the Doctor of Medicine (MD) de gree.

30 graduates from the UIWSOM Class of 2022 will remain in San Antonio for residency training.

Top: UIW School of Osteopathic Medicine Dean Dr. Robyn Philips-Madson (left) congratulates graduate. Bottom: UIW School of Osteopathic Medicine Graduates

UIW Graduates Latest Class of Osteopathic Medicine Physicians

30 SAN ANTONIO MEDICINE • July 2022 he University of the Incarnate Word (UIW) is proud to an nounce the conferral of 140 degrees to students of the UIW School of Osteopathic Medicine (UIWSOM) at the 2022 Spring Commencement Ceremony. The ceremony took place in front of family and friends at Freeman Coliseum on the morning of May 7, 2022. The Commencement marked the first time that all the graduates from UIW’s five health professions schools (Ila Fay Miller School of Nursing and Health Professions, Feik School of Pharmacy, Rosenberg School of Optometry, School of Physical Therapy and School of Os teopathic Medicine) graduated in the same ceremony at the same time. It was a historic moment, acknowledged UIW President, Dr. Thomas M. Evans, as he addressed the graduates. Evans recalled the story of the founding Sisters of Charity of the Incarnate Word who were called to Texas from France in response to a pandemic in the late 1800’s. “The parallels of their journey and yours are astounding and they add to the significance of the milestone we are celebrating today,” Evans told the graduates. “Just as our founders began their service in response to a public health crisis, you are graduating in the midst of a global pan demic, into a world that needs your particular set of skills, education and compassion more than ever. Thankfully, we were blessed to be born into this modern era of fast-moving innovation and medical knowl edge. You will not have to travel to your patients by horse-drawn wagon or provide care with little more than your own two hands and faith. However, some truths remain the same. You will encounter patients who are also frightened, ill and, perhaps, short on hope. When you do, I ask you to think about what the care you provide means to them and their families. Just as it was with those first Sisters, to your patients and their families, you represent hope and the potential that tomorrow can be better than today.”

AmmarBellalcredit:Photo

By The University of the Incarnate Word School of Osteopathic Medicine

UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

This year’s UIWSOM graduating class had a 99% residency place ment with 81 graduates staying here in Texas for the next step of their medical careers. The others matched to 27 different states including Alaska and Hawaii. The majority of the graduates are going into Family Medicine, Internal Medicine and Pediatrics, while the rest will enter other specialties such as Anesthesiology, Emergency Medicine, Radi ology, Neurology, Obstetrics and Gynecology, and Ophthalmology.

Justin O’Farrell is a third-year medical student at the Uni versity of Incarnate Word School of Osteopathic Medicine. Visit us at www.bcms.org Perspective of a Third-Year Medical Student

By Justin O’Farrell

t is no secret that the first two years of medical school are exceptionally challenging. Medical students are ex pected to consume content at a break-neck pace to pre pare themselves for their first board examination prior to starting their clinical rotations. Transitioning to a clinical setting took some getting used to. Instead of having actors play standardized patients for clinical practice, I was sud denly responsible for interviewing and managing the care of actual citizens of San Antonio. Each patient is unique, and is therefore an opportunity for me to learn how to apply the knowledge I gained over the last couple of years in a clinical setting. Acquiring the knowledge is only half the battle. Learning how to properly manage a patient re quires a very different set of skills. Therefore, it is vital for medical students to be paired with attending physicians who are dedicated to the development of future physi cians. The support of an experienced attending physician is crucial in the progression of the clinical skills of medical students who will soon be interns at hospitals across the country.Mytime working with Dr. Lubna Naeem has solidified my desire to pursue a career in Internal Medicine. Each day, we collaborate to work through her panel of patients. Typically, I will conduct the patient interview and conduct the physical exam with Dr. Naeem in the room to observe the clinical encounter. This hands-on approach allows Dr. Naeem to provide constructive feedback on how to improve my clinical skills. As I reflect upon my clinical experiences thus far, it is difficult not to feel humbled to be able to play a role in the care of these patients. A large portion of internal medicine is managing elderly patients. For each geriatric patient we see, I now understand the importance of comprehensive care in order to fully understand and treat the patient. To holistically care for elderly patients, it requires a physician who takes the time to make sure the patient feels safe in their home and has the support they need to complete their activities of daily living. I have seen first-hand the struggles of aging. The loss of the ability to care for one self can have a profoundly negative impact on the overall health of an individual. I am humbled and inspired by the multidisciplinary effort that is required to both manage a patient’s medical concerns and help them maintain their identity as they continue to age. I have grieved alongside patients in moments of sorrow, and I have shared in the suc cesses of patients in times of celebration. These experiences provide me with the motivation I need to continue to develop my clinical skills in order to better take care of the whole patient, including their mind, body and spirit. Through my six-week rotation with Dr. Naeem, I was consistently inspired by her kindness and respect that she showed to each of her patients. I witnessed first-hand the impact this has in developing a positive and uplifting physician-patient relationship. The third year of medical school is a formative year of our education. We are constantly shuffled through our rotations with different attend ing physicians who each have unique teaching styles and clinical pref erences. It can be challenging to continually learn how to adapt to a new preceptor, but the value they bring to our education is second to none. Each day, medical students are experiencing clinical encounters that impact their career path. In my case, I have fallen in love with the field of internal medicine and look forward to the continual develop ment of my skills as a healer.

I UNDERGRADUATE AND GRADUATEEDUCATIONMEDICAL

31 The

How can PAD be prevented?

The most common symptom is leg pain, especially in the muscles when walking. If caught at this point, the disease is most likely easily managed, and risk factors can be modified. As PAD becomes more se vere, it can cause pain in the tips of the toes at night that improves with hanging the leg over the edge of your bed, discoloration of the lower leg, and open sores or wounds that do not heal due to lack of blood flow and poor circulation.

PAD is a chronic disease that requires lifelong care, and it affects many people in our community. You can learn more with free access to educational articles and videos on PAD provided by the board-cer tified, highly-specialized surgeons who make up my team at Peripheral Vascular Associates (PVA). We offer these resources to our community for free on our website at PVAsatx.com.

What are the symptoms of PAD?

Jeffrey J. Stein, MD is a vascular surgeon at Peripheral Vas cular Associates (PVA). He is a member of the Bexar County Medical Society.

Peripheral Arterial Disease and Its Prevention

• Manage other health conditions that increase risk for PAD, such as high blood pressure, diabetes or high cholesterol.

• Exercise regularly. Walking is the simplest form of exercise, and the benefits are life-changing.

• Quit smoking. Smoking significantly increases the formation of plaque in arteries, and is one of the leading risk factors for PAD.

How is PAD diagnosed?

How is PAD treated?

32 SAN ANTONIO MEDICINE • July 2022 SANMEDICINEANTONIO

By Jeffrey J. Stein, MD

What steps can patients take to lower their risk and manage their PAD symptoms?

• Eat a balanced diet. A healthy diet helps maintain, or improve, over all health.

PAD risk factors are similar to the risk factors for arterial disease in the heart and neck. Risk for PAD is increased for the male sex, and in persons with increased age, high blood pressure, high cholesterol, to bacco use, diabetes and kidney disease.

• Practice good foot care. There is a strong connection between foot health and potential circulation problems. Certain symptoms in a patient’s foot may be an indicator of underlying vascular disease. This is especially common in diabetics. Having the patient check their feet every day is important, and especially for those with diabetes.

Initial treatment of mild PAD is aimed at modifying the patient’s risk factors, along with walking daily, and the use of antiplatelet med ication. Depending on the severity of PAD, further treatment may in clude taking pictures from inside the arteries, with attempts to open up the blockages in a minimally invasive fashion, or open surgery.

Physicians can detect if a patient may be at increased risk for, or cur rently suffering from, PAD by asking if they have the risk factors. Ad ditionally, physicians can perform a physical exam of the patient’s legs, and check for the pulses in their feet. If PAD is suspected, the physician should refer the patient to a vascular surgeon. Vascular surgeons are ex pertly trained at testing, diagnosing and treating PAD The vascular sur geon will order an ultrasound to confirm the diagnosis.

Peripheral Arterial Disease, or PAD, is a disease that leads to the blockages of arteries. These blockages can lead to a reduction, or a com plete restriction, of blood flow to the leg. This concerning circulatory condition can cause a constellation of symptoms, from leg pain to nonhealing wounds, and may result in limb loss, if not quickly and expertly diagnosed and treated. According to the Amputee Coalition, San An tonio does have one of the highest amputation rates in the nation. This makes prevention, early detection and early treatment very important.

What are the risk factors for PAD?

Visit us at www.bcms.org 33 SANMEDICINEANTONIO

Like most “mature” readers, historical subjects, hence nonfic tion, are becoming more and more prevalent on my reading list. This book looks ominous but is engaging and quick to fin ish due to its interesting subject matter that deals with the dawn of modern medicine in this country.

Admittedly, the name Dr. Thomas Dent Mutter had not been in my conscious mind. After reading the book, to me, however, Dr. Mutter is a symbol of perseverance and ingenuity which are the essence of great inventors and entrepreneurs and are scarce currently.

Incidentally, while reading this book, I had the opportunity of trav eling to Boston where I watched the play Etherdome, a timely accom paniment to my enjoyment of this book. A trip to Philadelphia, the City of Brotherly Love, to visit the country’s most famous museum of medical oddities, founded by Dr. Mutter, has also been on my to-do list. I can’t remember any book I read that prompts a field trip too.

Teresa C. Hayes, MD is a member of the Bexar County Med ical Society.

Dr. Mutter’s Marvels: A True Tale of Intrigue and Innovation at the Dawn of Modern Medicine

The short colorful tumultuous life, 38 years, of the charismatic Dr. Dent Mutter, set in Philadelphia in the middle of the nineteenth cen tury, was filled with accomplishments; “too weird to be true” per a re viewer. Some of his contemporaries were doctors after whom diseases were named, such as Drs. Pancoast and Meig.

By Cristin O’Keefe Aptowicz, Reviewed by Teresa C. Hayes, MD

Uniquely, each chapter begins with an excerpt from a speech, entitled “Charge to the graduates,” that Dr. Mutter gave to the graduating class of medical students at Jefferson Medical College in 1851. These ex cerpts are essentially timeless and still apply to today’s graduates.

Note: This hardback book has the publisher price of $27.50. The public library carries several copies of this delightful historical narrative of Dr. Mutter.

34 SAN ANTONIO MEDICINE • July 2022

on page 36

By Divya Chandramohan, MD

Illustrated with ballpoint pens on paper from Johannah Churchill’s photography that surfaced during the pandemic, depicting the isolation, anxiety, fear, frustration and sadness that the pandemic has brought upon us.

Visit us at www.bcms.org 35 ARTISTIC EXPRESSION IN MEDICINE

“Geared up” Portrait of a healthcare worker during the pandemic

“Her”

Artistic Expression in Medicine

Illustrated with black Bic pen. A study of ink on paper, inspired by Rembrandt’s etchings, with highlights and lowlights copied from the master. continued

36 SAN ANTONIO MEDICINE • July 2022 ARTISTIC EXPRESSION IN MEDICINE

continued from page 35 “Mandarin Duck”

Divya Chandramohan, MD, is a Fellow in the Division of Infectious Diseases in the Department of Medicine at UT Health San Antonio.

In the summer of 1999, I sat in my room analyzing the details of Vermeer's "Woman Holding a Balance." I remember using a magnifying glass to pay close attention to the details of the painting − the tiny light beams made their way through a small window and illuminated a dimly lit room, they enhanced the delicate gentleness of the woman's features and finally bounced off the pearls lying in a casket accentuating them and making their presence known to the admirer. The scale in her hand was precariously balanced by only her index finger and thumb, and the entire image was in perfect harmony with complementing colors and details. I pondered over how Vermeer could have possibly achieved the velvety softness of her attire. I got a sense of the way the fabric would have felt should I have touched it. Every single aspect of the painting was attended to in detail. With the passing of years, I became more and more engrossed in photorealism. I studied the many paintings of old artists of the Ren aissance era. I was observant and was inspired to see the world differ ently. Each new painting was a new adventure to me, and I cultivated the patience to finish each with the intricacy I expected. I took risks on occasion to drastically change the nature of my paintings, sometimes even alternating different mediums, putting down pencil and paint in terchangeably, as I truly believed that growth and change is always pre ceded by courage to try and fail. My interest in detail steered me toward learning about each individ ual patient and practicing the art of a thorough physical exam, all the while finding clues leading up to their final diagnosis. I loved going after the layers in each patient to achieve the depth like I had practiced in my art. I scrutinized each patient with a magnifying glass and put the puzzle together to complete the exciting challenge. The sense of ad venture ingrained in me led me to contemplate factoids and search for the diagnosis, while the calm endurance I had developed as I spent time on a sketch assisted me in patiently sifting through each medical co nundrum. The risks I took while experimenting with my paintings steered me away from fear of failure. My heightened observation taught me to view patients through a different filter. My world of shadows, light, lines and color was now my world of microorganisms, people, environment and their intermingling − still with the same intricacy, depth and complexity.

The Life of Physician-Artista

As a medical student in India, I spent time during my day sitting be side my end-of-life patients and doing portraits for them and their fam ily. With the passage of time, and with more training, this has become hard to continue. I strive to do some part-time work to showcase, to frame and to bring smiles. I truly believe that art brings joy in unex pected times to people who witness it, the same way it brings happiness to the artist through the process. I hope this inspires you to create, do activities that bring joy to your day and enforce a strong mindset filled with positive emotions.

With nature’s array of colors all in one, the mandarin duck is a fascination to behold. The beautiful creature is drawn with six colored ballpoint pens in this art piece.

By Sammar Ghannam, MD

Sammar Ghannam is a PGY-1 preliminary resident in the UT Health San Antonio Internal Medicine Residency program and will start Radi ology residency in July 2022.

Visit us at www.bcms.org 37 ARTISTIC EXPRESSION IN MEDICINE

This work was inspired by my interactions with my patients. In the same way they see themselves in me, I see myself in them. I can tell the difference it makes with my patients when I enter the room and their doctor understands their language, cultural preferences, fears and anx ieties. Alternatively, I know what it feels like to be on the opposite side, to feel misunderstood and overlooked. As a Muslim woman pursuing medicine, I was initially concerned with the lack of representation within my field of radiology, and within the greater medical commu nity. Having this immediate sense of comfort and connection with my patients reminds me of the honor and privilege it is to be in service to them. It makes every minute of hard work worth it.

Reflections from the Margins

By Richard Marlow Taylor, MD Richard Marlow Taylor, MD is a resident in the Department of Psychiatry at UT Health San Antonio. He is a resident member of the Bexar County Medical Society.

Snowdrift at Frozen Lake

38 SAN ANTONIO MEDICINE • July 2022 ARTISTIC EXPRESSION IN MEDICINE

Visit us at www.bcms.org 39 SANMEDICINEANTONIO

Estimated $26K

BCMS Donates an of to of Africa

PPE

On June 2, 2022 the Bexar County Medical Society donated an estimated 15,000 disposable surgical masks and 92,000 KN95s to the citizens of Namibia to help them fight the COVID-19 pandemic. It is an honor to help the citizens of Namibia with our donation of personal protective equipment (PPE) to help fight the COVID-19 pandemic, now that Namibia is under a mandatory mask mandate. Commissioner Tommy Calvert, Precinct 4, will be going to Namibia to deliver the PPE.

Pictured: Clyde Foster Jr., Community Liaison with the Bexar County Commissioner Tommy Calvert Precinct 4 office, Melody Newsom, CEO of BCMS and Ramon Chapa Jr., Director of Community En gagement for the Bexar County Commissioner Tommy Calvert Precinct 4 office. Clyde Foster Jr., Community Liaison with the Bexar County Commis sioner Tommy Calvert Precinct 4 office and Monica Jones, COO of BCMS unpack boxes of PPE. Clyde Foster Jr. and Melody Newsom load the boxes of PPE.Boxes of PPE are prepared for loading.

Namibia,

the Government

ACCOUNTING FIRMS

BUSINESS CONSULTING Medical Financial Group (★★★ Gold Sponsor) Healthcare & Financial Profession als 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 Commu nicare Health Systems. Jesse Gonzales, CEO CPA, MBA information@medicalfgtx.com210-846-9415

Linda Noltemeier-Jones Director of www.medicalfgtx.comlindanj@medicalfgtx.com210-557-9044Operations

STAT“Trustedwww.livingstonmedlab.com/homeInnovative,Accurate,andMedicalDiagnostics”

Jim Rice, CPA 210-384-8000, ext. 112 www.ssacpa.comjprice@ssacpa.com

ACCOUNTING SOFTWARE Express Information Systems (HHH Gold Sponsor)

“Proudly serving the medical com munity since 1998”

“Client-centered legal counsel with integrity and inspired solutions”

HHH Gold Sponsor)

(BroadwayBANKINGBank

“We’re here for good.” The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insur ance for the medical community. Brandi Vitier www.thebankofsa.combrandi.vitier@thebankofsa.com210-807-5581

Synergy Federal Credit Union (HH Silver Sponsor)

CLINICAL DIAGNOSTICS Livingston Med Lab (HHHH 10K Platinum Sponsor) High Complexity Clia/Cola accred ited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infec tious Disease, & Genetics. Robert Castaneda (CEO) Robert@livingstonmedlab.comEmail:210-316-1792 Sean Villasana (Chief Scientific Officer, CSO) Sean@livingstonmedlab.com210-237-8557

"Making Sense of Investing"

Looking for low loan rates for mort gages and vehicles? We've got them for you. We provide a full suite of digital and traditional fi nancial products, designed to help Physicians get the banking serv ices they need.

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Michael L. Kreager mkreager@kreagermitchell.com210-283-6227

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 physi cians and their management teams maximize their financial ef fectiveness.

(ManagementBertuzzi-TorresMANAGEMENTWEALTHWealthGroup HHH Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning.

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BexarORGANIZATIONVERIFICATIONCREDENTIALSCredentialsVerification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the Na tional Committee for Quality Assur ance (NCQA) standards for health care entities. Betty Fernandez Director of www.BexarCV.comBetty.Fernandez@bexarcv.com210-582-6355Operations

“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 www.edwardjones.com/elizabeth-olneyElizabeth.olney@edwardjones.com210-858-5880Advisor

Joey Martinez (Director of Joey@livingstonmedlab.com210-204-7072Operations)

ASSETT

PHYSICIANS PURCHASING DIREC-

Bruce M. Mitchell www.kreagermitchell.combmitchell@kreagermitchell.com210-283-6228

With over 29 years’ experience, we understand that real-time visi bility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimen sional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager www.expressinfo.comranac@expressinfo.com210-771-7903

“Dedicated to working with physicians and physician groups.”

40 SAN ANTONIO MEDICINE • July 2022

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

Shawn P. Hughes, JD Senior Vice President, Private www.broadwaybank.comshughes@broadway.bank210-283-5759Banking

“Once a member, always a member. Join today!”

FINANCIAL ADVISORS Oakwell Private Wealth (Management HHHH 10K Platinum Sponsor) Oakwell Private Wealth Manage ment is an independent financial advisory firm with a proven track record of providing tailored finan cial planning and wealth manage ment services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor SERVICE512-649-8113 @ www.oakwellpwm.comOAKWELLPWM.COM

Mike Bertuzzi First Vice President Senior Financial Michael_bertuzzi@ml.com210-278-3828Advisor Ruth Torres Financial http://fa.ml.com/bertuzzi-torresRuth.torres@ml.com210-278-3828Advisor

Healthcare banking experts with a private banking team committed to supporting the medical community.

“Leaders in Healthcare Software & Consulting” (KreagerATTORNEYSMitchell HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation pos sible in providing industry specific solutions. From business transac tions to physician contracts, our team can help you in making the right decision for your practice.

“Let’s start with Free Evaluation and Consultation from our Team of Professionals”

Lauren Smith, Manager, Marketing & SmithL9@uthscsa.edu210-450-0026Communications

INFORMATION (ExpressTECHNOLOGIESANDInformationSystems

 Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solu tions for discerning healthcare professionals, including asset pro tection, lending & estate planning.

Robert Lindley Senior Vice President | Private robert.lindley@amegybank.com210-343-4526Banking

Ruth Torres Financial http://fa.ml.com/bertuzzi-torresRuth.torres@ml.com210-278-3828Advisor

HOSPITALS/ HEALTHCARE UTFACILITIESHealthSan Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health San Antonio MD Ander son 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 NorrisKouba@uthscsa.edu210-265-7662Relations

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.

“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 www.medpro.comKirsten.Baze@medpro.com512-658-0262 (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).

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 insur ance for the medical community. Katy Brooks, CIC www.thebankofsa.comkaty.brooks@bosainsurance.com210-807-5593

Mike Rosenthal Senior Vice President, Business Development Visit us at www.bcms.org 41

HHHH 10K Platinum Sponsor)

(TexasMALPRACTICEINSURANCE/MEDICALMedicalLiabilityTrust

Mike Bertuzzi First Vice President Senior Financial Michael_bertuzzi@ml.com210-278-3828Advisor

“We offer BCMS members a free insurance portfolio review.” (Guardian ★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan. Ned Hodge www.nedhodge.comned@nedhodge.com210-332-3757

Denise C. Smith Vice President | Private Banking www.amegybank.comDenise.C.Smith@amegybank.com210-343-4502

Stephanie Dick Commercial m/tx/austin/stephanie-dickhttps://commercial.firstcitizens.costephanie.dick@firstcitizens.com210-744-4396Banker

continued on page 42

FINANCIAL (ManagementBertuzzi-TorresSERVICESWealthGroup

First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a re lationship bank. We get to know you. We want to understand you and help you with your banking.

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HEALTHCARE BANKING

“Get what you deserve … maximize your Social Security benefit!”

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Michael Clark, President www.aspectwealth.commclark@aspectwealth.com210-268-1520

HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visi bility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimen sional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager www.expressinfo.comranac@expressinfo.com210-771-7903

“Leaders in Healthcare Software & Consulting” TMAINSURANCEInsurance 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 compli mentary insurance review. It will be our privilege to serve you. Wendell England Director of Member Benefits www.tmait.org800-880-8181wendell.england@tmait.org512-370-1776

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.

“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 Jeanne.bennett@amegybank.com210-343-4556

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With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) pro vides malpractice insurance and related products to physicians. Our purpose is to make a positive im pact on the quality of health care for patients by educating, protect ing, and defending physicians. Patty Spann www.tmlt.orgpatty-spann@tmlt.org512-425-5932

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Recommended partner of the Bexar County Medical Society

“UPN is very proud of our 98% customer retention rate”

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PURCHASING

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Tammy Carosello, Account www.uniteprivatenetworks.comtammy.carosello@upnfiber.com210-868-0420Director

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MEDICAL BILLING AND COLLECTIONS SERVICES Medical Financial Group (★★★ Gold Sponsor) Healthcare and Financial Profes sionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller and past CFO of (2) Fortune 500 compa nies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA information@medicalfgtx.com210-846-9415

PHYSICIANS DIRECTORY

www.ProAssurance.comMikeRosenthal@ProAssurance.com800-282-6242

MEDICAL (FirstPROCESSINGSYSTEMS/CARDPAYMENTCitizensBank

Most trusted molecular testing laboratory in San Antonio provid ing FAST, ACCURATE and COM precisionPREHENSIVEdiagnostics for Genetics and Infectious Diseases. Dr. Niti Vanee Co-founder & CEO nvanee@iGenomeDx.com210-257-6973

 Gold Sponsor)

“Our Focus is People” Our mis sion is to support the people who propel the healthcare and bio science industry in San Antonio. Industry, academia, military, nonprofit, R&D, healthcare delivery, professional services and more! Kevin Barber, President 210-308-7907 kbarber@bdo.com(Direct)

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INVESTMENT ADVISORY REAL ESTATE Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and de velopment opportunities for our in vestment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and fi nancial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal www.alamocapitaladvisors.comjw@alamocapitaladvisors.com210-241-2036

“People Bank with People” “Your Practice, Our Promise” MEDICAL SUPPLIES AND (HenryEQUIPMENTScheinMedical 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 www.henryschein.comtom.rosol@henryschein.com210-413-8079 “BCMS members receive GPO discounts of 15 to 50 percent.”

Focused on sourcing, capitalizing, and executing investment and de velopment opportunities for our in vestment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and fi nancial restructuring (equity, debt, and partnership updates).

Oakwell Private Wealth (Management HHHH 10K Platinum Sponsor) Oakwell Private Wealth Manage ment is an independent financial advisory firm with a proven track record of providing tailored finan cial planning and wealth manage ment services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor SERVICE512-649-8113 @ www.oakwellpwm.comOAKWELLPWM.COM

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continued from page 41 42 SAN ANTONIO MEDICINE • July 2022

Jim Dorman, Account Director jim.dorman@upnfiber.com210-428-1206

“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 www.cmcs-sa.comhcmiranda@sbcglobal.net210-340-9515

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1LT Thomas Alexandria https://recruiting.army.mil/mrb/Alexandria.n.thomas12.mil@army.mil210-328-9022

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“Service to Country, Army Medicine, Experientia et Progressus” Visit us at www.bcms.org 43

By Stephen Schutz, MD

44 SAN ANTONIO MEDICINE • July 2022

REVIEWAUTO 2022 BMW M440i and i4 M50 Gran Coup

On to the M440i Gran Coupe, which, as noted above, is essentially the same car as the i4 M50 but with ICE propulsion.

A RWD four-cylinder 255HP 430i Gran Coupe is available for $13,000 less, but given the extra power and smoothness of BMW’s classic inline-six, I’d urge potential customers to stretch for the big gerFuelengine. economy figures are 22MPG City/31MPG Highway for the M440i Gran Coupe, 25MPG/34MPG for the 430i and 79MPGe/80MPGe for the i4 M50.

And hats off to BMW’s designers who were able to give the new 4series Gran Coupe the more formal profile of a sedan to go with that extraAllutility.4-series Gran Coupes also get the, ahem, prominent front twokidney grille that’s very much a “love it or hate it” design element. My two cents is: if you hate it, get your 4-series Gran Coupe in a darker color. It minimizes the grille’s visual impact.

As alluded to above, the M440i’s engine is a 382HP 3.0-liter in line-six that’s augmented by a 48-volt hybrid system, and it comes standard with all-wheel drive. The purpose of the hybrid assist is to help with acceleration at low speeds, thereby burning less gasoline.

I’ll start with the BEV i4 M50, which is the more interesting car, but I’ll need to limit my remarks since I was only able to drive it briefly at a BMW event. As the electric age dawns, automotive manufacturers are launching BEVs in one of two ways—with a platform that can accept either an ICE or BEV propulsion system, or a bespoke BEV-only platform. The i4 M50 is the former, and I’m pleased that I was able to drive both the M440i and i4 M50.

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.

The base price of the i4 M50 is $66,895 while the M440i stickers for $59,195. As always with German cars, adding options and option packages can swell the price of your car significantly.

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 car guy physicians’ perspective. It’s available on Apple, Spotify and other platforms. Give it a listen!

REVIEWAUTO

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 45

A quick aside: BMW’s M-division turns 50 this year, and the i4 M50’s name is an obvious tip-of-the-cap to that significant milestone.

All 4-series Gran Coupes are hatchbacks, which is great. Nothing wrong with sedans, of course, but a hatch adds significant utility that you will appreciate every time you go to the grocery store or Lowes.

Despite impressive driving dynamics, however, the elephant in the room with this car as well as many other BEVs is actually an ele phant—the i4 M50 weighs 5,063 lbs, 1,243 lbs more than an M3 Competition and about the same as an adult proboscidean.

Expect to see many more efforts by BMW to highlight M this year. (Space limitations preclude a full discussion of the rich history of BMW M here, but interested readers are encouraged to listen to my Podcast, “Cars on Call”: episode 13, where “M at 50” gets the atten tion it Anyway,deserves.)thefirst adjective I thought of when driving the i4 M50 was “fast,” because this car is seriously and relentlessly quick. No mat ter what speed you’re going, the i4 M50 will catapult you forward in spectacular fashion when you press the throttle. Car and Driver says that the i4 M50 will do 0-60MPH in 3.3 seconds, 0.2 seconds quicker than an M3 Competition, and I believe it. That impressive performance comes thanks to the i4 M50’s 536HP, but there’s no free lunch in life—optimal range is just 227 miles. Handling is reassuringly neutral because of a low center of gravity (the battery pack sits in the floor of the i4 M50 as it does in all BEVs).

While the M440i sounds like a modern BMW turbocharged in-line six, the i4 M50 sounds like the future, with a synthetic electronic sound that’s impossible to describe but pretty cool.

The BMW 4-series Gran Coupe is a sporty car that can be config ured as either a (mostly) ICE or totally BEV car. Which one you se lect is up to you, of course, but having driven both, I can say there’s no wrong choice. Vive le difference.

Naturally, driving the M440i is quite different from its BEV sibling.

I recently drove two versions of the new BMW 4-series Gran Coupe, one of which is completely internal combustion engine (ICE) powered—it actually has a 48 volt mild hybrid system, so I guess we can delete the word “completely”—and the other of which is a totally battery electric vehicle (BEV).

Pushing the “Start” button results in the sound of an engine starting, and putting the car in “Drive” and motoring away feels very normal.

Cavender Toyota 5730 NW Loop 410 San Antonio, TX Gary 210-862-9769Holdgraf Park Toyota 10703 Southwest Loop 410 San Antonio, TX 78211 Justin 210-635-5000Boone Benz of Boerne 31445 IH 10 West Boerne, TX James 830-981-6000Godkin Park 9333 San Pedro San Antonio,

TX 78216 John 210-253-3300Kahlig Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX Al Cavazos 210-366-9600Jr. 9455 IH 10 West San Antonio, TX 78230 Douglas 210-764-6945Cox Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130 Matthew C. 830-606-3463Fraser Northside Ford 12300 San Pedro San Antonio, TX Marty210-477-3472Martinez Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216 Paul 210-988-9644Hopkins 14610 IH 10 West San Marcos, TX 78249 Mark KahligKahlig832-428-9507HenniganAutoGroupAutoGroupKahlig Auto GroupKahlig Auto Group Kahlig Auto GroupKahlig Auto Group Kahlig Auto Group Kahlig Auto Group

Chuck

William

North

Coby

Land Rover

Audi

11911 IH 10 West San Antonio, TX 78230 210-696-2232Allen Dominion 21105 West IH 10 San Antonio, TX 78257 210-681-3399Cavender

North

Raymond

Rick

North

Tripp

North

Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216 210-912-5087Williams Nash Chevrolet Buick 3209 North Interstate 35 San Marcos, TX 210-859-2719Boyd Park Lexus 611 Lockhill Selma San Antonio, TX 210-308-8900Bridges San Antonio 13660 IH 10 West San Antonio, TX 210-561-4900Tang Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX James 210-816-6000Cole Park Lincoln 9207 San Pedro San Antonio, TX Sandy 210-341-8841Small Park Subaru at Dominion 21415 IH 10 West San Antonio, TX 78257 Phil 877-356-0476Larson Park Subaru 9807 San Pedro San Antonio, TX 78216 210-308-0200Rangel

North

Mercedes

Mazda

GMC

Charles

North

Cameron

San Antonio Medicine July 2022

Articles inside

The Perspective of a Third-Year Medical Student By Justin O’Farrell

PRN: Take As Needed “America’s Medical School” Offers Unparalleled Opportunity By David Alex Schulz, CHP

By Woodson “Scott” Jones, MD

School of Osteopathic Medicine

By Michael J. Mohr, DO, MS and Brenda Treviño

Incarnate Word By Adam V. Ratner, MD, FACR and Amanda Galán-Davila, PhD

UT Health San Antonio Graduates 1,000 Healthcare Providers and Scientists Submitted by Will Sansom

Wider Systems of Care By Jon Courand, MD

By John J. Seidenfeld, MD