31 minute read
The Perspective of a Third-Year Medical Student By Justin O’Farrell
The Perspective of a Third-Year Medical Student
By Justin O’Farrell
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It is no secret that the first two years of medical school are exceptionally challenging. Medical students are expected to consume content at a break-neck pace to prepare 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 suddenly 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 requires 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 physicians. 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.
My time 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 oneself 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 successes 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 attending physicians who each have unique teaching styles and clinical preferences. 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 development of my skills as a healer.
Justin O’Farrell is a third-year medical student at the University of Incarnate Word School of Osteopathic Medicine.
Peripheral Arterial Disease and Its Prevention
By Jeffrey J. Stein, MD
Peripheral Arterial Disease, or PAD, is a disease that leads to the blockages of arteries. These blockages can lead to a reduction, or a complete 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 Antonio 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?
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, tobacco use, diabetes and kidney disease.
What are the symptoms of PAD?
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 severe, 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.
How is PAD diagnosed?
Physicians can detect if a patient may be at increased risk for, or currently suffering from, PAD by asking if they have the risk factors. Additionally, 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 expertly trained at testing, diagnosing and treating PAD The vascular surgeon will order an ultrasound to confirm the diagnosis.
How is PAD treated?
Initial treatment of mild PAD is aimed at modifying the patient’s risk factors, along with walking daily, and the use of antiplatelet medication. Depending on the severity of PAD, further treatment may include taking pictures from inside the arteries, with attempts to open up the blockages in a minimally invasive fashion, or open surgery. How can PAD be prevented?
What steps can patients take to lower their risk and manage their PAD symptoms? • Quit smoking. Smoking significantly increases the formation of plaque in arteries, and is one of the leading risk factors for PAD. • Eat a balanced diet. A healthy diet helps maintain, or improve, overall health. • Exercise regularly. Walking is the simplest form of exercise, and the benefits are life-changing. • Manage other health conditions that increase risk for PAD, such as high blood pressure, diabetes or high cholesterol. • 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.
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-certified, 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.
Jeffrey J. Stein, MD is a vascular surgeon at Peripheral Vascular Associates (PVA). He is a member of the Bexar County Medical Society.
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
Like most “mature” readers, historical subjects, hence nonfiction, are becoming more and more prevalent on my reading list. This book looks ominous but is engaging and quick to finish 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.
The short colorful tumultuous life, 38 years, of the charismatic Dr. Dent Mutter, set in Philadelphia in the middle of the nineteenth century, was filled with accomplishments; “too weird to be true” per a reviewer. Some of his contemporaries were doctors after whom diseases were named, such as Drs. Pancoast and Meig.
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 excerpts are essentially timeless and still apply to today’s graduates.
Incidentally, while reading this book, I had the opportunity of traveling to Boston where I watched the play Etherdome, a timely accompaniment 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.
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.
Teresa C. Hayes, MD is a member of the Bexar County Medical Society.
Artistic Expression in Medicine
By Divya Chandramohan, MD
Illustrated with black Bic pen. A study of ink on paper, inspired by Rembrandt’s etchings, with highlights and lowlights copied from the master.
Portrait of a healthcare worker during the pandemic
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.
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.
The Life of a Physician-Artist
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 Renaissance era. I was observant and was inspired to see the world differently. 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 interchangeably, as I truly believed that growth and change is always preceded by courage to try and fail.
My interest in detail steered me toward learning about each individual 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 adventure 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 conundrum. 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.
As a medical student in India, I spent time during my day sitting beside my end-of-life patients and doing portraits for them and their family. 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 unexpected 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.
Divya Chandramohan, MD, is a Fellow in the Division of Infectious Diseases in the Department of Medicine at UT Health San Antonio.
Reflections from the Margins
By Sammar Ghannam, MD
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 anxieties. 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 community. 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.
Sammar Ghannam is a PGY-1 preliminary resident in the UT Health San Antonio Internal Medicine Residency program and will start Radiology residency in July 2022.
Snowdrift at Frozen Lake
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.
BCMS Donates an Estimated $26K of PPE to the Government of Namibia, Africa
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 Engagement for the Bexar County Commissioner Tommy Calvert Precinct 4 office. Clyde Foster Jr., Community Liaison with the Bexar County Commissioner Tommy Calvert Precinct 4 office and Monica Jones, COO of BCMS unpack boxes of PPE.
Please ask your practice manager to use the Physicians Purchasing Directory as a reference when services or products are needed.
ACCOUNTING FIRMS
Sol Schwartz & Associates P.C. (HHH Gold Sponsor) Sol Schwartz & Associates is the premier accounting firm for San Antonio-area medical practices and specializes in helping physicians and their management teams maximize their financial effectiveness. Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”
ACCOUNTING SOFTWARE
Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”
ATTORNEYS
Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice. Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions” ASSETT WEALTH MANAGEMENT
Bertuzzi-Torres Wealth Management Group (HHH Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres
BANKING
Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Shawn P. Hughes, JD Senior Vice President, Private Banking 210-283-5759 shughes@broadway.bank www.broadwaybank.com “We’re here for good.”
The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Brandi Vitier 210-807-5581 brandi.vitier@thebankofsa.com www.thebankofsa.com
Synergy Federal Credit Union (HH Silver Sponsor) Looking for low loan rates for mortgages and vehicles? We've got them for you. We provide a full suite of digital and traditional financial products, designed to help Physicians get the banking services they need.
Synergy FCU Member Services 210-750-8333 info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”
BUSINESS CONSULTING
Medical Financial Group (★★★ Gold Sponsor) Healthcare & Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller & past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”
CLINICAL DIAGNOSTICS
Livingston Med Lab (HHHH 10K Platinum Sponsor) High Complexity Clia/Cola accredited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infectious Disease, & Genetics. Robert Castaneda (CEO) 210-316-1792 Email: Robert@livingstonmedlab.com Sean Villasana (Chief Scientific Officer, CSO) 210-237-8557 Sean@livingstonmedlab.com Joey Martinez (Director of Operations) 210-204-7072 Joey@livingstonmedlab.com Dwight Chapman (Account Manager) 210-591-2649 Dwight@livingstonmedlab.com www.livingstonmedlab.com/home “Trusted Innovative, Accurate, and STAT Medical Diagnostics”
CREDENTIALS VERIFICATION ORGANIZATION
Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA) standards for health care entities. Betty Fernandez Director of Operations 210-582-6355 Betty.Fernandez@bexarcv.com www.BexarCV.com “Proudly serving the medical community since 1998”
FINANCIAL ADVISORS
Oakwell Private Wealth Management (HHHH 10K Platinum Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner”
Elizabeth Olney with Edward Jones (HH Silver Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals. Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you. Elizabeth Olney, Financial Advisor 210-858-5880 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"
Bertuzzi-Torres Wealth Management Group ( Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending & estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres
Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”
HEALTHCARE BANKING
First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”
Amegy Bank of Texas (HH Silver Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things. Jeanne Bennett EVP | Private Banking Manager 210-343-4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President | Private Banking 210-343-4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President | Private Banking 210-343-4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership”
HEALTHCARE TECHNOLOGY SOLUTIONS SUPPLIER
Nitric Oxide innovations LLC, (★★★ Gold Sponsor) (NOi) develops nitric oxide-based therapeutics that prevent and treat human disease. Our patented nitric oxide delivery platform includes drug therapies for COVID 19, heart disease, Pulmonary hypertension and topical wound care. info@NitricOxideInnovations.com 512-773-9097 www.NitricOxideInnovations.com
HOSPITALS/ HEALTHCARE FACILITIES
UT Health San Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health San Antonio MD Anderson Cancer Center, is the only NCI-designated Cancer Center in South Texas. Our physicians and scientists are dedicated to finding better ways to prevent, diagnose and treat cancer through lifechanging discoveries that lead to more treatment options. Laura Kouba, Manager, Physician Relations 210-265-7662 NorrisKouba@uthscsa.edu Lauren Smith, Manager, Marketing & Communications 210-450-0026 SmithL9@uthscsa.edu Cancer.uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio MD Anderson Cancer Center 7979 Wurzbach Road San Antonio, TX 78229 Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”
INSURANCE
TMA Insurance Trust (HHHH 10K Platinum Sponsor) TMA Insurance Trust is a full-service insurance agency offering a full line of products – some with exclusive member discounts and staffed by professional advisors with years of experience. Call today for a complimentary insurance review. It will be our privilege to serve you. Wendell England Director of Member Benefits 512-370-1776 wendell.england@tmait.org 800-880-8181 www.tmait.org “We offer BCMS members a free insurance portfolio review.”
Guardian (★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan. Ned Hodge 210-332-3757 ned@nedhodge.com www.nedhodge.com | www.Opesone.com “Take care of today then plan for tomorrow”
Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com
INSURANCE/MEDICAL MALPRACTICE
Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 health care professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society
The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”
MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze 512-658-0262 Kirsten.Baze@medpro.com www.medpro.com
ProAssurance (HH Silver Sponsor) ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group’s rating is AM Best A (Excellent). Mike Rosenthal Senior Vice President, Business Development continued on page 42 Visit us at www.bcms.org 41
800-282-6242 MikeRosenthal@ProAssurance.com www.ProAssurance.com
INTERNET TELECOMMUNICATIONS
Unite Private Networks (HHH Gold Sponsor) Unite Private Networks (UPN) has offered fiber optic networks since 1998. Lit services or dark fiber –our expertise allows us to deliver customized solutions and a rewarding customer experience. Aron Sweet , Account Director 210-788-9515 aron.sweet@upnfiber.com Jim Dorman, Account Director 210-428-1206 jim.dorman@upnfiber.com Tammy Carosello, Account Director 210-868-0420 tammy.carosello@upnfiber.com www.uniteprivatenetworks.com “UPN is very proud of our 98% customer retention rate”
INVESTMENT ADVISORY REAL ESTATE
Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com
MEDICAL BILLING AND COLLECTIONS SERVICES
Medical Financial Group (★★★ Gold Sponsor) Healthcare and Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller and past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier Jones, Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”
Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”
MEDICAL PAYMENT SYSTEMS/CARD PROCESSING
First Citizens Bank (★★★ Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”
MEDICAL SUPPLIES AND EQUIPMENT
Henry Schein Medical (HH Silver Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 to 50 percent.”
MILITARY
San Antonio Army Medical Recruiting office (★★Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare professionals for service in the Army Reserves or Active Duty Army, in support of Soldiers and their families. 1LT Thomas Alexandria 210-328-9022 Alexandria.n.thomas12.mil@army. mil https://recruiting.army.mil/mrb/ “Service to Country, Army Medicine, Experientia et Progressus”
MOLECULAR DIAGNOSTICS LABORATORY
iGenomeDx ( Gold Sponsor) Most trusted molecular testing laboratory in San Antonio providing FAST, ACCURATE and COMPREHENSIVE precision diagnostics for Genetics and Infectious Diseases. Dr. Niti Vanee Co-founder & CEO 210-257-6973 nvanee@iGenomeDx.com Dr. Pramod Mishra Co-founder, COO & CSO 210-381-3829 pmishra@iGenomeDx.com www.iGenomeDx.com “My DNA My Medicine, Pharmacogenomics”
PROFESSIONAL ORGANIZATIONS
The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, nonprofit, R&D, healthcare delivery, professional services and more! Kevin Barber, President 210-308-7907 (Direct) kbarber@bdo.com Valerie Rogler, Program Coordinator 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet”
San Antonio Medical Group Management Association (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs and networking opportunities to medical practice managers and support charitable fundraising. Alan Winkler, President info4@samgma.org www.samgma.org REAL ESTATE SERVICES COMMERCIAL
Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Focused on sourcing, capitalizing, and executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand, Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com
CARR Realty (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of healthcare real estate experts assist with start-ups, renewals, relocations, additional offices, purchases and practice transitions. Brad Wilson – Agent 210-573-6146 Brad.Wilson@carr.us www.carr.us “Maximize Your Profitability Through Real Estate”
RETIREMENT PLANNING
Oakwell Private Wealth Management (HHHH 10K Platinum Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner”
STAFFING SERVICES
Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle. Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”
San Antonio Army Medical Recruiting office (HH Silver Sponsor) Mission: Recruit highly qualified and motivated healthcare professionals for service in the Army Reserves or Active Duty Army, in support of Soldiers and their families. 1LT Thomas Alexandria 210-328-9022 Alexandria.n.thomas12.mil@army.mil https://recruiting.army.mil/mrb/ “Service to Country, Army Medicine, Experientia et Progressus”
2022 BMW M440i and i4 M50 Gran Coup
By Stephen Schutz, MD
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).
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.
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. 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 attention it deserves.)
Anyway, the first adjective I thought of when driving the i4 M50 was “fast,” because this car is seriously and relentlessly quick. No matter 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).
Despite impressive driving dynamics, however, the elephant in the room with this car as well as many other BEVs is actually an elephant—the i4 M50 weighs 5,063 lbs, 1,243 lbs more than an M3 Competition and about the same as an adult proboscidean.
On to the M440i Gran Coupe, which, as noted above, is essentially the same car as the i4 M50 but with ICE propulsion.
Naturally, driving the M440i is quite different from its BEV sibling. Pushing the “Start” button results in the sound of an engine starting, and putting the car in “Drive” and motoring away feels very normal. 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.
As alluded to above, the M440i’s engine is a 382HP 3.0-liter inline-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.
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 bigger engine.
Fuel economy figures are 22MPG City/31MPG Highway for the M440i Gran Coupe, 25MPG/34MPG for the 430i and 79MPGe/80MPGe for the i4 M50.
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. 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 extra utility.
All 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.
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.
The BMW 4-series Gran Coupe is a sporty car that can be configured as either a (mostly) ICE or totally BEV car. Which one you select is up to you, of course, but having driven both, I can say there’s no wrong choice. Vive le difference.
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!
As always, call Phil Hornbeak, the Auto Program Manager at BCMS (210-301-4367), for your best deal on any new car or truck brand. Phil can also connect you to preferred financing and lease rates.
Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the US Air Force. He has been writing auto reviews for San Antonio Medicine since 1995.
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