Jan/Feb 2014 Medical Volunteerism - Making a Difference by Advocates for Better Health

CONTENTS VOLUME 16, NO. 1

2 3

JANUARY/FEBRUARY 2014

Index to Advertisers IN THIS ISSUE

“We make a living by what we get, we make a life by what we give.” Winston Churchill By Richard Sturgeon, M.D.

PRESIDENT’S MESSAGE: Physician Satisfaction

By Lisa R. Mattson, M.D.

TCMS IN ACTION

By Sue Schettle, CEO

Letters MEDICAL VOLUNTEERISM

Page 32

Tale of Two NGOs — Volunteering With Two Twin Cities-based NGOs: No Time for Poverty and the American Refugee Committee By Stephen Pomrenke, M.D., MPH, MATS

Helping the Hands that Heal By Kim Dickey

We Are Better Hearing: How Starkey Hearing Technologies Lives its Corporate Mission Through Hearing Aid Production and Philanthropic Endeavors By Ryan Mathre

Mission of Operation Eyesight is Clearly Visible By Elizabeth A. Davis, M.D., FACS

Page 5

Medical Students Hit the Streets By Tobi Olayiwola

The U of M Medical Reserve Corps: Giving Back to the Community By Kathy Berlin, RN, PHN

Physician Volunteerism: Recognizing and Facilitating the Voluntary Service of Physicians By Phillip Stoltenberg, M.D.

Your Voice: The Future of the MMA

MN Statutes: 214.40 Volunteer Health Care Provider Program

By Lyle J. Swenson, M.D.

24 Page 5

CHWs Strengthen Collaborative Practice Linking Care and Communities for Better Outcomes By Joan Cleary, MM

25 26 28 29 30 32

Honoring Choices MN Volunteerism: Physician Perspectives Medical Student Lunch ’n Learn Sessions In Memoriam/New Members Career Opportunities LUMINARY OF TWIN CITIES MEDICINE

Robert W. Geist, M.D.

Page 28

MetroDoctors

Caring Hearts for Homeless People

The Journal of the Twin Cities Medical Society

On the Cover: TCMS physicians and Minnesota-based organizations respond to health care needs locally and globally. Articles begin on page 7.

January/February 2014

Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Richard R. Sturgeon, M.D. Physician Co-editor Charles G. Terzian, M.D. Medical Student Co-editor Katherine Weir Managing Editor Nancy K. Bauer TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at St. Paul, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reďŹ&#x201A;ect the ofďŹ cial position of TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.

January/February Index to Advertisers TCMS OfďŹ cers

President: Lisa R. Mattson, M.D. President-elect: Kenneth N. Kephart, M.D. Secretary: Carolyn McClain, M.D. Treasurer: Matthew Hunt, M.D. Past President: Edwin N. Bogonko, M.D. TCMS Executive Staff

Sue A. Schettle, Chief Executive OfďŹ cer (612) 362-3799 sschettle@metrodoctors.com Nancy K. Bauer, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Andrea Farina, Communications and IT Coordinator (612) 623-2885 afarina@metrodoctors.com Barbara Greene, MPH, Community Engagement Director, Honoring Choices Minnesota (612) 623-2899 bgreene@metrodoctors.com

Coldwell Banker Burnet .............................. Inside Front Cover CrutchďŹ eld Dermatology.................................. 2 Fairview Health Services .................................31 Greenwald Wealth Management ....................... Inside Back Cover Healthcare Billing Resources, Inc. ...............20 Lakeview Clinic .................................................31 Lockridge Grindal Nauen P.L.L.P. ................. 6 Minnesota Epilepsy Group, PA ...................... 8 MMIC ................................ Outside Back Cover Multicare Associates .........................................10 Saint Therese......................................................... 8 St. Cloud VA Medical Center .......................30

Karen Peterson, Program Manager, Honoring Choices MN (612) 362-3704 kpeterson@metrodoctors.com

Tinnitus and Hyperacusis Clinic....................... Inside Front Cover

Terri Traudt, Project Director, Honoring Choices MN (612) 362-3706 ttraudt@metrodoctors.com

Uptown Dermatology & SkinSpa................22

U of M CME........................Inside Back Cover Whitesell Medical Locums, Ltd. ..................31

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For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Advertisements published in MetroDoctors do not imply endorsement or sponsorship by TCMS. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Andrea Farina at (612) 623-2885.

January/February 2014

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The Journal of the Twin Cities Medical Society

IN THIS ISSUE...

“We make a living by what we get, we make a life by what we give.” Winston Churchill AS WE PUT THIS ISSUE TOGETHER, we found it to be espe-

cially uplifting. Tremendous international service and impactful backyard work. The initial plan to highlight several very involved physicians was just not possible. There are scores if not hundreds of our colleagues who deserve individual recognition. We instead have chosen to highlight groups or organizations that involve Minnesota physicians. Stefan Pomrenke, M.D. brings us two NGOs based in Minnesota with whom he personally worked with internationally, No Time for Poverty (NTFP) and the American Refugee Committee (ARC). NTFP and ARC represent two great NGOs that are operationally based in the Twin Cities but enact preventive programs in Haiti and elsewhere. Twenty five years ago, Minnesota doctors saw used and outdated equipment and excess supplies being discarded here that they knew were urgently needed overseas. Global Health Ministries is a Minneapolis-based nonprofit whose many volunteers continue to collect and send medical equipment and supplies to hospitals and clinics in developing countries. Many of the donations for these shipments come from metro area clinics, hospitals and health care systems. Starkey Hearing Technologies began in 1967 when Bill Austin created Professional Hearing Aid Service, an all-make hearing instrument repair service in St. Louis Park. Based on the simple premise, “Alone we can’t do much, but together we can change the world,” Austin started the Starkey Hearing Foundation in 1984. Hearing missions are the primary way Starkey Hearing Foundation realizes its goal: So the World May Hear. Elizabeth A. Davis M.D. tells of the work of Operation Eyesight. Their mission is to preserve, restore and enhance vision through research, teaching and providing the highest quality medical and surgical care to patients. Operation Eyesight candidates are referred through Minnesota Eye Consultants clinics, as well as a network of eye-care professionals throughout the state. Selection is based on lack of insurance and demonstrated financial needs or special circumstances. In addition to the physicians, 40-60 employees are volunteering on this program throughout each year. By Richard Sturgeon, M.D., Member, MetroDoctors Editorial Board

MetroDoctors

The Journal of the Twin Cities Medical Society

Tobi Olayiwola describes the Interprofessional Student Outreach Project (ISTOP), a non-profit, volunteer organization run entirely by University of Minnesota medical students. It can probably be best described as a coordination of outreach to several different sites in the community. Each site (most are blood pressure and glucose checks at soup kitchens, etc.) has a student site leader that is in charge of coordination, and then other students sign up for available volunteer spots. A physician preceptor is always present at the sites. ISTOP’s primary aim is to connect individuals experiencing homelessness in Minneapolis and St. Paul with the health care system. On a day-to-day basis, there are medically underserved and hard to reach populations. Joan Cleary shares progress and strategies to incorporate, when necessary, the utilization of Community Health Workers to extend Patient Centered Care beyond facility walls to meet this need. Minnesota Responds Medical Reserve Corps (MRCs) is managed by the Minnesota Department of Health, Office of Emergency Preparedness and coordinates local, regional and statewide volunteer programs to assist our public health and health care systems during a disaster. There are 43 nationally registered Medical Reserve Corps in Minnesota. Thirty-nine are affiliated with local public health departments. All local public health MRCs actively recruit physicians for their Medical Reserve Corps. There exists justifiable angst about the medical malpractice insurance issue in these volunteer circumstances. Especially for retired physicians who, with joy, dropped their coverage upon retirement. In 2011, Minnesota Statute 214.40 was created, the Volunteer Health Care Provider Program. Licensed physicians, registered PAs and other clinicians are covered for this outpatient (Continued on page 6)

January/February 2014

President’s Message

Physician Satisfaction LISA R. MATTSON, M.D. WE ALL KNOW ABOUT THE IMPORTANCE of patient satisfaction. Many of us receive regular

reports from patient satisfaction surveys and these survey results may be tied into payment or bonus pay for some of us. The Triple Aim strives for high quality care that is cost effective with enhanced patient satisfaction. We talk a lot about patient satisfaction, but what about physician satisfaction? A recent report, sponsored by the AMA and authored by Mark Friedberg and the non-profit research organization RAND, studied physician satisfaction. The study found that physicians who see themselves or their practices as providing high quality of care had greater job satisfaction — confirmation that doctors really do care about their patients and still maintain some of the ideals that led them to a career in medicine. Quality of care was highly dependent on physician autonomy and control over schedules with adequate time to spend getting to know the patient and to focus on details. The availability of well-trained support staff was also positively related to physician satisfaction. Dissatisfaction and increased stress were associated with anything found to be a barrier to quality of care such as electronic medical records, time pressure, or an unsupportive leadership. External barriers could include unfair payment practices, too much regulation, or concerns about litigation. Physician satisfaction should be directly linked to patient satisfaction. Patient satisfaction scores are commonly associated with the physician’s attentiveness to the individual, good communication skills, and compassion. A rushed physician, who is short-tempered, and working with a float nurse from the specialty clinic down the hall isn’t going to get high marks on any satisfaction survey. Negative feedback will only increase physician dissatisfaction and the downward spiral will continue. At some point, there is likely to be an error and then we have to deal with a potential patient complication. Barriers to physician satisfaction need to be addressed. As satisfaction decreases, disengagement and negativity ensue, and eventually we’re left with apathy. One of the saddest days of my career was when a former colleague told me that I should be more like him and just stop caring. When physicians stop caring, the practice of medicine becomes just another job and a paycheck. The trust and respect of our patients and the integrity of our profession is compromised. We cannot let this happen. But we can’t expect other people to break down our barriers. Patients expect us to be their advocates, and that means fighting for the ability to provide the best care possible. Physicians need to be actively engaged in medical decisions. We cannot just send our office managers and staff to take care of our problems; it is imperative that physicians be at the table. This might mean taking time out of clinic hours, coming in early, or staying late. The study above also found that physician meetings with colleagues and leadership often improved physician satisfaction, so this could be an avenue to energize your career. If we forfeit our voice, others will make decisions without us. Physicians need to be proactive and help shape the change that is inherent in medicine. Engagement in your personal clinic setting can help with the internal barriers; however, it is the external barriers that may pose the greatest threat to the future of health care, making it even more important that the physician voice is heard. This can be accomplished in many ways — a simple note to your political representative telling your stories and how their actions can affect you and your patients. Representatives are often surprised that they receive little input/feedback from the physician community. Being involved in organized committees through TCMS and other medical societies may also help us unite as a bigger voice with the potential for an even greater impact. Technology has made involvement even easier. We no longer have to meet face-to-face if that isn’t convenient. Most physicians didn’t go into medicine for money and fame. In fact, most of us are happiest when we can shut the exam door, talk to our patient, and do something that may result in better health. The challenges we face when we open the door again and walk out of the exam room are daunting. We can choose to be the apathetic victims or we can choose to do what we were trained to do — identify the problems, weigh the options (or develop new options), and try to make things better. It may take awhile to achieve the results, but if we try and we try and we try, we may just get some satisfaction… 4

January/February 2014

MetroDoctors

The Journal of the Twin Cities Medical Society

TCMS IN ACTION SUE A. SCHETTLE, CEO

Honoring Choices Minnesota Featured at the Institute for Health Care Improvement (IHI) National Conference

Edwin Bogonko, M.D., Ken Kephart, M.D. and Kent Wilson, M.D. attended the 25th Annual IHI Conference in Orlando, Florida on December 10-11. The Honoring Choices Minnesota advance care planning community engagement model has received a lot of interest from across the country. We were pleased to be selected as one of the featured storyboard presentations at the conference.

Dr. Kephart shares information on Honoring Choices MN at the 2013 Institute for Healthcare Improvement National Forum in Orlando, FL.

Twin Cities Obesity Prevention Coalition celebrated the success of the project on November 5 at Biaggi’s in Eden Prairie. With over 25 guests in attendance including city leaders, coalition members and staff of TCMS, communities were recognized for passing resolutions while providing current updates on work being done around healthy eating and active living strategies. Savage Mayor Janet Williams and Eden Prairie Mayor Nancy Tyra-Lukens both spoke to the advantages of implementing resolutions and the value it has brought to the communities. The Twin Cities Obesity Prevention Coalition work will end December 31, 2013. We want to thank everyone who was involved MetroDoctors

with the work as well as cities across the metro area for considering the passage of a healthy eating active living resolution.

Two medical student Lunch ’n Learn sessions were held this past fall. See article on page 28.

Celebrating healthy eating/active living success. From L: Rick Getschow, Eden Prairie City Manager; Jay Lotthammer, Park and Recreation Director; and Nancy Tyra-Lukens, Eden Prairie Mayor.

We are sad to see Jennifer Anderson’s role with TCMS end in December. Jennifer served as the Project Coordinator for the Obesity Prevention work. Jennifer has been with TCMS for seven years and we will miss her professionalism and dedication to the public health work of TCMS. TCMS Board of Directors Welcomes a Familiar Face

MDH Commissioner Edward Ehlinger, M.D. was the guest presenter at the November 2013 meeting of the TCMS Board of Directors. Commissioner Ehlinger provided an overview of the State Innovation Model. Commissioner Ehlinger is a past president of TCMS.

The Journal of the Twin Cities Medical Society

Heartfelt thanks to Greg Plotnikoff, M.D. who recently resigned from the MetroDoctors editorial board. Greg has been a great contributor and resource to his fellow editors and our staff; his input will be greatly missed. Please contact Nancy Bauer, managing editor, if YOU are interested in serving on the editorial board. As 2013 came to a close, the terms of service of several physicians also concluded. A special thank you to all who have volunteered their time and energy serving on the Boards of TCMS, East Metro Medical Society Foundation and the West Metro Medical Foundation: Michael Ainslie, M.D. – TCMS Board Ben Baechler, M.D. – TCMS Board Carl Burkland, M.D. – TCMS Board Peter Dehnel, M.D. – TCMS Board Lyle Swenson, M.D. – TCMS Board Carrie Terrell, M.D. – WMMF Board Joseph Tombers, M.D. – WMMF Board Don Asp, M.D. – EMMSF Board Mark Destache, M.D. – EMMSF Board Kent Wilson, M.D. – EMMSF Board

Kent Wilson, M.D. receiving proclamation and gift from the EMMS Foundation board of directors for his work as president for the past six years.

January/February 2014

LETTERS

In This Issue (Continued from page 3)

care delivery. Note this doesn’t cover general anesthesia or surgery, except minor outpatient surgery. The Board of Medical Practice arranges medical professional liability insurance; limited to provision of health care services performed for which the provider does not receive direct monetary compensation. I know some physicians who volunteer in local community free clinics or in various clinical arrangements for under-insured, non-insured or other at-risk communities. I’m convinced other physicians would be interested in volunteering if they had a way to find the right volunteer situation, or even knew where to look. The MMA Foundation is creating a Physician Volunteerism Program, a system to identify likely matches between interested medical volunteers with meaningful volunteer position needs. An oversimplification, but a catalog of community needs identified for our members. Phillip Stoltenberg M.D., MMA Foundation vice president submits information about this project, and soon to be launched pilot efforts. Watch for more information on the Physician Volunteerism Program on the MMAF website. Lastly, Robert Geist, M.D. is featured as our Luminary of Twin Cities Medicine in recognition of his commitment to organized medicine and for his career-long passion to educate and engage his colleagues in dialogue about the business side of medicine. Change in health care finds us all very busy having to do more with less. Who has the time? Volunteers consistently say one gets more back than one puts in; preventive medicine for your emotional well-being. If Third World is not your cup of tea, you don’t have to take a 14-hour plane ride to find people in need. Round up a couple of friends and discover the joy of Medical Mission.

Dear Editors, The issue on The Collaborative Medical Model (Nov/Dec 2013) was informative and presented all sides of an important discussion. Unfortunately, the article by Senator Kathy Sheran was less collaborative in its tone than the others. In her zeal for pushing legislation for independent practice for APRNs, she raises the shibboleth that physicians have a “planned opposition to protect a medical hierarchy model of care with physicians at the top.” She’s raised the equivalent of the “race card” in this discussion; it has no place in this civilized discourse. If this confrontational attitude underlies her legislative motives, Minnesota will be the loser. If she sees physicians as self-serving rather than patient-serving, she demeans all physicians whose reason for being is optimal patient care and service. Let’s agree that we all want what’s best for patients, not what promotes anyone’s selﬁsh interest on either side of the debate. Though she may have a dim view of physicians, Sen. Sheran should dial back her rhetoric if she expects her legislative proposal to be heard. Better that APRNs stand on their own considerable merits than to denigrate the motives of physicians. Sincerely, Richard J. Morris, M.D.

January/February 2014

MetroDoctors

The Journal of the Twin Cities Medical Society

Telemedicine Medical Care Volunteerism Organizations

Tale of Two NGOs Volunteering With Two Twin Cities-based NGOS: No Time for Poverty and the American Refugee Committee

anuary 12th, 2010, the Haiti Earthquake struck. A few days later while attending a fundraiser for a St. Paul-based NGO, No Time for Poverty (NTFP) I met a Haitian born pharmacist who had been working at a local St. Paul hospital. We soon ﬂew down to Florida to start an adventure that would join us with NTFP’s main team. NTFP is led by a St. Paul couple, the Bostons. NTFP’s main goal is to create a clinic in Port Salut, Haiti that is based on a preventive health model that encourages the development of a community-based health team that educates and treats the local population. However, just three weeks after the earthquake, NTFP was in the capitol, Port au Prince, for disaster support. We were providing clinical support to Sean Penn’s J/P HRO (Haiti Relief Organization) while the U.S. Army ran logistics support. Our base of operations was at the Petionville country club that at the time looked more like a military encampment.

Haitian's gather in peace and joy to give thanks to God that their lives were spared during the earthquake.

It sat high atop a hill that overlooked a golf course that was now the grounds for a large Internally Displaced People (IDP) camp of 50,000 people. We had a MASH type tent By Stefan Pomrenke, M.D., MPH, MATS to provide emergent medical care and we birthed several women there; women who either walked or were carried in a stretcher up the rather steep hill to our camp. The camp was large and so to ensure people at the periphery obtained care, we rode with U.S. Army Humvee convoys to temporary clinic sites where we provided basic clinic care. If more difﬁcult clinic scenarios would emerge they would be sent to our MASH unit. The work was rewarding; we knew we were ﬁlling Clinic staff at the American Refugee Committee camp.

MetroDoctors

The Journal of the Twin Cities Medical Society

a daunting health care gap that occurred after the earthquake. We saw follow ups of orthopedic-based injuries now casted from prior medical teams. Most of the illnesses we experienced were directly from living in an IDP environment and we worked in co-operation with other NGOs that solely operated immunization campaigns as well as access to clean water. Several months later a health volunteer opportunity arose with the American Refugee Committee based in South Minneapolis. ARC operates camp management in IDP camps as well as refugee camps. Their normal deployments are three to six months long. However, the ongoing IDP crisis in Haiti created a change in their usual operations. After a thorough information session at the ARC headquarters I ﬂew down to Haiti once again. Medicine continued to revolve around issues speciﬁc to camp living. However, I (Continued on page 8)

January/February 2014

Medical Volunteerism

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Tale of Two NGOs (Continued from page 7)

was seeing a great improvement in the prior concerns related to water used for washing. We lived in a separate neighborhood and each morning we made a ~40 minute car trek winding through Haitian trafďŹ c to our clinic. These commutes provided opportunities for informal meetings where we would discuss clinic quality improvement. They evolved into re-assessing clinic workďŹ&#x201A;ow and potential efďŹ ciencies. Concrete change occurred with the start of morning clinic meetings in which the clinic staff discussed how things were going and changes were made. This empowerment of the local staff was particularly rewarding. The ARC is primarily involved in longterm IDP and refugee operations in several countries throughout the world. Their main program areas are gender-based violence, and to build the capacity of the community. The focus on women reďŹ&#x201A;ects the larger development communityâ&#x20AC;&#x2122;s recognition of the importance of womenâ&#x20AC;&#x2122;s health to further overall community health. ARC has also participated in the University of Minnesotaâ&#x20AC;&#x2122;s Global Health Course during the very realistic refugee camp training. The NTFP and ARC represent two great NGOs that are operationally based in the Twin Cities but enact preventive programs in Haiti and elsewhere. At times crisis calls for more short-term based operations, something I was privileged to be a part of. The greatest learning and question was how to work in an NGO alongside local government based operations. How do we empower the local health care organizations within a country to create a robust preventive system that is not dependent upon wavering USAID funding that may change from one election season to the next? These organizations are windows into how we physicians can create education exchange mechanisms so that we can learn from local leaders and we can aid in training the trainers in another country. When other communities suffer, our community mobilizes. Stefan Pomrenke, M.D., MPH, MATS is a family physician in East St. Paul who gained much of his passion for preventive medicine from work experience in Haiti, Tanzania, and Kenya. He continues to be active in his local community as a result of his overseas experiences.

January/February 2014

MetroDoctors

The Journal of the Twin Cities Medical Society

Helping the Hands that Heal

lobal Health Ministries is a Minneapolis-based nonprofit that supports Lutheran health care systems around the world. Twenty-five years ago, Lutheran medical missionaries were being called home from service in the developing world — many of them returning to the Twin Cities and going to work at various clinics and hospitals in the region. While they enjoyed equipment that actually functioned and ample supplies to treat their patients here, they remembered former colleagues in Madagascar, Tanzania, Papua New Guinea and other countries who were not so fortunate. One overseas doctor wrote at the time, “We are trying to do a first-rate job with inferior and worn out equipment. We are still doing surgery with the same instruments you had 20 years ago. Sometimes I try to clamp a bleeding artery with an instrument and it just falls off.” These Minnesota doctors saw used and outdated equipment and excess supplies being discarded here that they knew were urgently needed overseas. So they decided to do something about it. Former missionaries gathered parts and equipment for the medical work being directed in Madagascar by a Minnesota doctor, and sent them to him in the suitcases of people traveling there. That work continues, with one traveler recently bringing a refurbished patient monitor in his luggage to a 110bed hospital in Cameroon. It’s the only patient monitor at the hospital and within a week had saved at least one life, someone lucky enough to be in the one room that had that piece of equipment, according to the doctors in Cameroon. By Kim Dickey

MetroDoctors

Today, Global Health Ministries continues to collect and send medical equipment and supplies to hospitals and clinics in developing countries, but most are sent overseas in 40' containers, packed to bursting by volunteers in their warehouse in Fridley. Many of the donations for these shipments come from metro area clinics, hospitals and health care systems. One wall in the warehouse is covered with forceps, another with scissors. The warehouse ﬂoor is crowded with containers of otoscope speculae, dressings, surgical lubricant, nebulizer supplies, respiratory supplies, suction supplies, radiology supplies, catheters, syringes, syringes with needles, drapes, gowns, feeding tubes, tourniquet pumps, a ventilator, an EKG machine, wheelchairs, exam tables, dental chairs, gloves, and more sutures than you can count. Walking through the warehouse, you’ll see boxes from Allina, HealthEast, Fairview, local pediatric clinics, Owens & Minor, Unimed and other names familiar to us in the Twin Cities. Last year’s shipments included many of these basic supplies as well as special requests to set up an operating room in one hospital, an expanded delivery area in another. 14,750 Newborn Kits and 5,224

The Journal of the Twin Cities Medical Society

Hospice Kits, including items donated and packed by groups from across the Twin Cities area, were sent overseas in 2013. Palliative care teams in Tanzania, Zimbabwe and Cameroon are grateful for the hospice kits, which provide basic supplies for patients struggling with terminal illness. Newborn kits are often used by doctors in these countries to encourage new or expecting mothers to visit their clinic. If they can just get them to come, these women can be screened for pre-term and post-delivery complications, and provided information to help them care for their newborns, helping address high infant and maternal mortality rates in these remote places. From those ﬁrst couple of suitcases sent to Madagascar in 1987, Global Health Ministries now sends about 13 20' and 40' containers overseas every year to support the work of Lutheran health care systems in a dozen developing countries. The containers will get about $1.5 million worth of medical equipment and supplies to colleagues providing health care to some of the world’s poorest people. Global Health Ministries’ warehouse hums with activity when groups of volunteers are in the building. And that’s often. Walter Argueta, Medical Missions Program Manager at Fairview Health Services, brings a group once a month. One November evening about 25 volunteers from Fairview locations across the Twin Cities gathered to hear about the mission of Global Health Ministries, and to help sort, check and pack medical supplies. Walter comes because “I love it, and I’m passionate about it. What do I love about Global Health Ministries? I love their heart (Continued on page 10)

January/February 2014

Telemedicine Medical Care Volunteerism Organizations Helping the Hands That Heal (Continued from page 9)

for helping the needy.” Most of the Lutheran hospitals, clinics and dispensaries that are supported by GHM primarily serve the poor. Throughout their history, these mission hospitals have been known for serving all people, regardless of ability to pay. Global Health Ministries’ many volunteers are helping these important hospitals survive, by sending supplies and equipment they can’t source themselves and can’t afford to buy. So this ministry continues, and is even more important in 2014 than it was 25 years ago. Increasingly, Global Health Ministries’ focus has shifted to sharing other important resources with overseas partners to create sustainable improvements to the delivery of health care in these countries. Global Health Administration Partners (GHAP) sends teams of health care administration professionals to work with partner health systems to enhance administration and management practices. Too often these physicians and nurses are expected to go outside their ﬁeld and

perform administration functions without the benefit of training or supporting infrastructure. GHAP works by invitation from leaders of overseas health systems, and assembles a team of volunteer consultants to conduct a 5–10 day on-site assessment with follow-up recommendations. After they return, the GHAP consultants continue to develop relationships with their overseas colleagues in what usually involves a multiyear consultation process. Through email, phone and Skype, they evaluate progress, encourage leaders and answer questions, assisting in the implementation of the improvement plan. GHAP consultants have lent their expertise and experience in the areas of finance, pharmacy logistics, supply chain management, human resources and more, helping health care systems in Madagascar, Cameroon and Tanzania find revenue streams and improve their capacity to deliver health care to their communities. Plans are underway to send teams to Nigeria, Ethiopia and Liberia in 2014. Global Health Ministries is always looking for health care professionals interested in volunteering for short-term projects and

longer-term mentoring relationships with partners overseas. Other groups of Twin Cities health care professionals have volunteered to train village health workers in such places as El Salvador, where building skills in health assessment, preventive care and hydration therapy empowers villagers to improve the health and well-being of their communities. One student shared a story the second day of her training. “I just have to tell you something,” she stood up and shouted at the opening of the second day “I have to tell you. When I came to my village yesterday afternoon, I passed by the house of a woman whose daughter had been sick the night before. I stopped there and asked how her daughter was, and her mother told me that she had vomiting and diarrhea all day.” I said, “I know what to do about that!” And the woman acted like she thought I couldn’t possibly know anything about it, but I said, “really, I know what to do.” And I told her about the training I had just come from and how if she mixed the right amounts of salt and sugar and clean water, her daughter could get better. Well, she knew as well as I that her child couldn’t live through two nights like that, and so she said she would try. I stayed with her, and we boiled the water, and mixed in the salt and sugar, and when it cooled, we began to give it to her by spoonfuls through the night, and I’m here to tell you that the little girl is alive this morning! Thank God we are here!” Thank God, indeed. If you’re interested in ﬁnding out how you might be involved with the work GHM does, they can be reached at (763) 586-9590, or go to www.ghm.org. Kim Dickey recently joined Global Health Ministries as director for Mission Development. Her connection to GHM began several years ago when she volunteered to direct senior high students from Minneapolis in gathering and personally delivering supplies to a mission hospital in South India, a project supported by Global Health Ministries. She and the students had an opportunity to tour the GHM warehouse, pack supplies and see ﬁrst hand the impact of their small gesture. Kim can be reached at (763) 586-9590, or kimdickey@ghm.org.

January/February 2014

MetroDoctors

The Journal of the Twin Cities Medical Society

We Are Better Hearing How Starkey Hearing Technologies Lives its Corporate Mission Through Hearing Aid Production and Philanthropic Endeavors

s the only privately held and American-owned company in its industry, Starkey Hearing Technologies is recognized across the globe as a premier provider in hearing health care. But for those familiar with the company, Starkey Hearing Technologies is much more than the hearing aids it produces. Guided by the ethos, “Hearing Is Our Concern,” the company believes each hearing life deserves special treatment. This is evident through all of its operations including nearly 50 years of innovation in hearing aid manufacturing and philanthropic efforts via the Starkey Hearing Foundation. History

An Oregon native, Bill Austin came to Minnesota in 1960 to study pre-med. To pay tuition, he took a job making ear molds for a hearing aid dealer in Minneapolis. Watching customers grow frustrated by the large and bulky hearing aids of the era, Austin sensed a potential business opportunity. “After six months in Minnesota, I decided I wasn’t going to do medicine. I was going to do hearing,” he told USA Today in a 2006 proﬁle. In 1967 Austin created Professional Hearing Aid Service, an all-make hearing instrument repair service in St. Louis Park, Minn. Then, in 1970, Austin purchased Starkey Laboratories, a small ear mold company for $13,000. He merged Professional and Starkey and retained the Starkey Labs name. It was when an Intra V series hearing aid was ﬁtted on then President Ronald By Ryan Mathre

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Sir Richard Branson gives the gift of hearing at Virgin Unite¹s Bhubezi Healthcare Clinic in South Africa.

Reagan that the demand for hearing aids — and Starkey’s business — took a dramatic upturn. As a powerful influencer and one of the first public figures to be fitted with a hearing aid, President Reagan increased the acceptance of hearing devices and marked a monumental turning point in the hearing industry. Starkey Hearing Foundation

Based on the simple premise, “Alone we can’t do much, but together we can change the world,” Austin started the Starkey Hearing Foundation in 1984. Hearing missions are the primary way Starkey Hearing Foundation realizes its goal: So the World May Hear. Starkey

The Journal of the Twin Cities Medical Society

Hearing Foundation fits and gives more than 100,000 hearing aids annually, and as a member of President Clinton’s Global Initiative, it has pledged to fit one million hearing aids this decade. In the last year alone, the foundation’s team of audiologists and staff fit more than 165,000 hearing aids through international and domestic hearing missions in 21 countries, including Rwanda, Madagascar, Malaysia, Papua New Guinea, Peru, Philippines, Lesotho, Kenya and Honduras — expanding its reach to more than 100 countries since its inception. (Continued on page 12)

January/February 2014

Telemedicine Medical Care Volunteerism Organizations We Are Better Hearing (Continued from page 11)

Through its work, Starkey Hearing Foundation has amassed an impressive list of support, ranging from world leaders, celebrities and professional athletes — many of whom have been on missions themselves. In recent years, former Presidents Bill Clinton and George W. Bush, British business magnate Sir Richard Branson, and NFL MVP Adrian Peterson have all participated in mission trips abroad to help give the gift of hearing. “I admire the Starkey Hearing Foundation for its tireless effort to transform lives with the gift of hearing,” said Branson. “I hope it will inspire others, businesses and nonproﬁts alike, to seek new, innovative and entrepreneurial ways of making a difference in people’s lives.” The foundation changes lives through more than just hearing missions. Research shows that teens are at an increased risk for hearing loss — a reality that is growing and in most cases is 100-percent preventable. Studies show that one in ﬁve teens in the United States has hearing loss — a 30 percent increase over the last decade. To reverse this alarming trend, Starkey Hearing Foundation created its Listen Carefully campaign to educate young people on the importance of protecting their hearing. To date, the Listen Carefully teaching guide has been distributed

to more than 17,000 teachers across the country, including Minnetonka Public Schools. During the 2013–2014 school year, the foundation will be rolling out its Listen Carefully campaign across the Minnetonka district to encourage students to adopt better listening habits through small daily actions, like turning down the volume on headphones and wearing earplugs around loud sounds. Starkey Hearing Foundation provides hearing help domestically through Hear Now, its program for low-income people in the United States. Started in early 1988 by Dr. Bernice Dinner, Hear Now ofﬁcially became part of the Starkey Hearing Foundation in 1999 to meet the growing demand for hearing help. Since then the program has provided top-of-the-line hearing aids to more than 50,000 people who otherwise would not be able to afford them. The foundation also collects and recycles used hearing aids through its recycling program and recycled its 500,000th hearing aid earlier this year. This program helps

give the gift of hearing to those in need and also helps to contribute to a healthy environment. While Starkey Hearing Foundation gets most of its notoriety for its hearing missions abroad, it has also provided significant help to those locally in need of hearing assistance. In April, along with Minnesota Twins Justin Morneau and Scott Diamond, the foundation hosted 20 children from the Faribault School District and provided them with free hearing aids. In September, 22 Minnesota Special Olympics athletes were fitted with top-ofthe-line, customized hearing aids during a visit to Starkey Hearing Technologies’ Center for Excellence. Special Olympics president, Dave Dorn, said the partnership with the foundation would make a huge difference in each of the athlete’s lives. “It’s a confidence builder,” Dorn said. “They can be engaged in conversations and hear the world around them. All of a sudden they are much more participatory and active in their surroundings because they can hear what’s going on.” And in October, the foundation provided free hearing aids to more than 50 people ranging from children to senior citizens, with help from Adrian Peterson, Greg Jennings and several other members of the Minnesota Vikings. Since its beginning, Starkey Hearing Technologies has been driven by the single purpose of providing better hearing. Through its continuous efforts to offer better hearing aids that sound, look and perform better than any other in the world, to its tireless work to provide free hearing aids both here and across the globe, the company has stayed true to this mission nearly 50 years later. Ryan Mathre is a Public Relations Associate with Starkey Hearing Technologies, where he helps manage the company’s PR and communications programs. Previously, Mathre managed PR and social media for the University of Minnesota and Milestone AV Technologies. He holds a Bachelor of Arts from St. John’s University in Collegeville, Minnesota. He can be reached at: Ryan_mathre@starkey.com.

January/February 2014

MetroDoctors

The Journal of the Twin Cities Medical Society

Mission of Operation Eyesight is Clearly Visible

ision is our most prized sense. Cataracts are one of the most common causes of treatable vision loss in the United States. Approximately 3.2 million cataract surgeries are performed each year, with those numbers increasing as the population ages and people live longer. When cataracts start to interfere with daily functioning and activities, then cataract surgery is warranted. Cataract surgery is one of the most successful procedures performed in the United States. Not only is it typically fast (4-20 minutes in uncomplicated cases) but it is most often painless with a fairly fast visual recovery. Although complications can occur, the rates of vision threatening problems are fortunately low. Innovations in the field of cataract surgery have greatly improved the safety and efficacy over the past decade. For those thousands of Minnesotans without medical insurance coverage or Medicaid benefits the prospect of cataract surgery is, quite simply, out of reach. Whatever their circumstances — financial, employment-related or otherwise — these individuals have special needs or circumstances that disqualify them from important, sight-saving cataract surgery. Twelve years ago, the increase in the number of patients who had no financial resources to obtain cataract surgery prompted me to encourage my By Elizabeth A. Davis, M.D., FACS

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Drs. Elizabeth Davis and Sherman Reeves, of Minnesota Eye Consultants, with an Operation Eyesight patient prior to surgery.

partners at Minnesota Eye Consultants, with ﬁve clinics in the Twin Cities area, to begin an initiative — Mission Cataract. A joint effort with the Minnesota Eye Foundation, the program name was changed to Operation Eyesight in 2008 when demand grew for access to other critical eye procedures, like cornea transplants, glaucoma procedures and pterygiums. Over the past 12 years, more than 240 Operation Eyesight surgeries have been performed, serving patients of all ages from the Twin Cities, throughout greater Minnesota and Wisconsin — truly changing lives by restoring vision through cataract surgery. It has really been rewarding to serve more patients each year by engaging the entire team — surgeons, physicians and clinic professionals — in this volunteer effort.

The Journal of the Twin Cities Medical Society

This year’s Operation Eyesight program spans two full surgical and two post-operative exam days (February 1-2 and March 1-2, 2014) at Minnesota Eye Consultants’ Bloomington surgical center and clinic, located at 9801 Dupont Ave S. Anywhere from 40-60 employees are working/volunteering on this program throughout each year. Beyond the volunteer efforts of the surgeons and medical/professional teams at Minnesota Eye Consultants, all supplies, equipment and medications are donated to Operation Eyesight patients from organizations such as Allergan, Bausch & Lomb, Merck, MN Lions Eye Bank, and Precision Lens. The translators from Garden and Associates

(Continued on page 14)

January/February 2014

Telemedicine Medical Care Volunteerism Organizations Mission of Operation Eyesight (Continued from page 13)

donate their time on the surgical day as well for patients who do not speak English. Operation Eyesight candidates are referred through Minnesota Eye Consultants clinics, as well as a network of eyecare professionals throughout the state. Selection is based on lack of insurance and demonstrated ďŹ nancial needs or special circumstances. Everyone beneďŹ ts in this effort by ensuring that these patients receive the medical attention they deserve, especially in light of the ďŹ nancial difďŹ culties or special challenges they face every day. Itâ&#x20AC;&#x2122;s Minnesota Eye Consultants way of giving back to the community and supporting Minnesotans whose lives can be improved from the care and attention of others. Each year, family, friends and doctors refer over 50 applicants to the program. A vetting process takes place during which 10-20 of these patients are chosen to receive treatment. Minnesota Eye Consultants also offers free pre-operative history and physical, done by on-staff Physician Assistants, and the postoperative eye drops at no-charge. Many patients will have two surgeries (one on each eye), after which theyâ&#x20AC;&#x2122;ll be cared for post-operatively, also at no cost, for a period of six months. Since its inception, the program has become an invaluable service for patients who would not otherwise receive this specialized care. One of the wishes of the

physicians and surgeons of Minnesota Eye is to inspire other practices, medical providers and volunteers to help serve the growing needs of these patients. Quick Reference Guide for the Referring Doctor:

s s s

s s

)DEAL PATIENTS HAVE VISUALLY SIGNIlcant cataracts or other serious eye conditions. !LL APPLICANTS MUST APPLY FOR AND BE denied, Medical Assistance. !LL APPLICANTS MUST HAVE SIGNIlCANT ďŹ nancial encumbrances. !PPLICATIONS ARE ACCEPTED IN THE FALL )T is a needs-based program that operates on ďŹ rst come, ďŹ rst-served terms. 0ATIENTS NEED TO BE DIAGNOSED AND IN need of surgery before being referred. )DEALLY PATIENTS WILL HAVE HAD A COMprehensive eye exam in the last six months. ! NO CHARGE PRE OPERATIVE CONSULTAtion, which includes testing, is required. These visits are done at our Minneapolis location. !LL PROCEDURES ARE PERFORMED AT -INnesota Eye Consultantsâ&#x20AC;&#x2122; Bloomington ofďŹ ce, located at 9801 Dupont Avenue South.

Any questions should be directed to Stefanie Johnson, Operation Eyesight Program Coordinator. Stefanie can be reached at (952) 567-6086. The surgical team at Minnesota Eye Consultants is comprised of sub-specialty

Dr. Sumitra Khandelwal performs cataract surgery, while MN Eye partner and surgeon, Dr. David Hardten, steps in as a scrub tech to allow the volunteers a break.

January/February 2014

trained, board-certiďŹ ed physicians with years of experience in the ďŹ eld of ophthalmology. Focusing on Laser Vision Correction, Cornea Disease, Cataract Surgery, Glaucoma Treatment and Eye Plastic and Reconstructive Surgery, the practice serves as a teaching facility â&#x20AC;&#x201D; training ophthalmologists and clinical professionals throughout the world. Their mission is to preserve, restore and enhance vision through research, teaching and providing the highest quality medical and surgical care to patients. The Minnesota Eye Foundation is committed to continuing education and research in the ďŹ eld of vision care. The foundation was created to support: s $ELIVERY OF EYE CARE TO THE NEEDY s 6ISION RESEARCH s %DUCATION OF /PTOMETRIC AND Ophthalmology students and post-graduates s %DUCATION OF INDIVIDUALS REQUIRING Low Vision Aids The Minnesota Eye Foundation (MEF), a 501 (c) (3) non-proďŹ t organization, was created by the partners of Minnesota Eye Consultants in a continuing effort to enrich the publicsâ&#x20AC;&#x2122; quality of life through innovative methods including vision research, outreach and education. References: Olson, Jeremy (10/17/13). â&#x20AC;&#x153;MNsure: 3,700 Minnesotans enrolled in health exchange plansâ&#x20AC;? Retrieved from: http://www.startribune.com/politics/statelocal/227976661.html

Elizabeth A. Davis, M.D., F.A.C.S. is an ophthalmologist with subspecialty training in corneal, cataract, and refractive surgery and is currently managing partner of Minnesota Eye Consultants, P.A. Dr. Davis completed her doctor of medicine degree at Johns Hopkins University School of Medicine. She completed four years of cardiac surgery residency at Johns Hopkins before changing specialties to ophthalmology where she also completed a two-year immunology research fellowship. She completed an ophthalmology residency at Massachusetts Eye and Ear InďŹ rmary, Harvard Medical School. Dr. Davis is an Adjunct Clinical Assistant Professor, University of Minnesota and can be reached at (952) 888-5800; info@mneye.com.

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The Journal of the Twin Cities Medical Society

Medical Students Hit the Streets

ndividuals experiencing homelessness are faced with a myriad of concerns that are often taken for granted by most people. They constantly worry about food, shelter and safety. Additionally, those experiencing homelessness live daily with socially isolating stigma. As these immediate necessities of life require so much effort and time to acquire, individuals experiencing homelessness often put off important things like health care until it is severe. This is where the Interprofessional Student Outreach Project (ISTOP) steps in. ISTOP is a non-proﬁt, volunteer organization run entirely by University of Minnesota medical students. Started in 2008 with the help of Dr. John Song, an associate professor in the Department of Medicine and Graduate Program Director in the Center for Bioethics, ISTOP’s primary aim is to connect individuals experiencing homelessness in Minneapolis and St. Paul with the health care system. Homelessness is increasing in the United States and here in Minnesota; a statewide survey in 2012 found that homelessness had increased by about 6 percent since the last survey in 2009. With so many barriers to health care, a wide gap exists between many, if not most, homeless individuals and better health. Some of these barriers are personal, such as the lack of income, insurance, or trust in the health care system. Others are structural and institutional, such as the lack of personal identiﬁcation, transportation, or coordinated and social support services. Unfortunately, one of the longstanding institutional barriers is the discrimination and prejudice homeless persons face By Tobi Olayiwola

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when seeking medical care. ISTOP intentionally stands in this wide gap to serve as a potential point of entry for this medically underserved population. Through street outreach, ISTOP aims to forge meaningful relationships and work diligently to repair any apprehensions individuals experiencing homelessness may have toward the health care system. Another aim of ISTOP is that the medical student volunteers will gain a better understanding of the challenges Collins, MS1 attends to a patient at Holy Rosary, an facing the homeless popula- Eric ISTOP site. tion and other underserved communities in the Twin Cities. By forgsuch as detox and emergency departments. ing these relationships early in medical ISTOP volunteers provide education training, we are helping cultivate an enabout health issues that group members vironment in which health care education have questions about, as well as emphasis is drawn from the needs and wants of the on the risks of substance abuse. Women local population. In doing so, we hope to of Nations is a St. Paul shelter for women contribute toward developing conscienand their children who have been victims tious and compassionate physicians. of domestic violence. Several students act ISTOP currently has four sites: St. as site liaisons that help cultivate strong Mark’s Episcopal cathedral, Holy Rosary, relationships between ISTOP and local St. Stephen’s and Women of Nations. Both homelessness providers. St. Mark’s and Holy Rosary provide dinner ISTOP is unique from other studentfor low income and under-housed individrun clinical organizations in the Twin uals. The client population at St. Marks is Cities because of its emphasis on street mostly young homeless individuals, while outreach. Student volunteers and phyHoly Rosary primarily consists of Native sicians go out into the community and American and Hispanic family units. At bring medical care and support directly St. Stephen’s Human Services, volunteers to underserved populations. Visiting sites meet with the “Chemical Health Housing consistently reduces large barriers to health Project” on Thursday mornings. Many of care, such as transportation and other esthe participants are referred to the group sential needs (such as the need for child because of frequent use of public services (Continued on page 16)

The Journal of the Twin Cities Medical Society

January/February 2014

Telemedicine Medical Care Volunteerism Organizations Medical Students Hit the Streets (Continued from page 15)

care). A typical team consists of two or three medical students and a physician, who set up a table at St. Mark’s and Holy Rosary during dinnertime. Clients receive free essential giveaways, basic medical care, and education on their own terms in a comfortable and familiar environment. Each shift is well equipped with ample giveaways, which include hygiene supplies that most people take for granted, such as soap, lotion, shampoo, toothbrushes, razors, socks and condoms. However, most of the clients are familiar with ISTOP and come weekly with speciﬁc medical questions and concerns. Students perform blood glucose and blood pressure checks, and other simple medical exams. If a client has a complicated question or concern, they are referred to the preceptor on site, and preceptors can perform sensitive and more involved exams away from the table if necessary. The team is also equipped to perform otoscopic and ophthalmologic exams as well as attend to basic wounds. Additionally, the preceptor is able to prescribe and dispense over-the-counter medications and basic antibiotics to our clients. However, without a preceptor present, medical students cannot perform any of the basic care provided and are limited to giveaways and medical education only. Between June and May 2013, over 500 people visited the ISTOP tables at the different sites. A majority was estimated to be repeat clients. A diverse group of ethnicities were represented overall at all the sites, with the most represented age group being between 20 and 29 years old. However, the age range was wide. Most people were concerned about diabetes and their blood pressure. Other concerns included fever, ﬂu and other upper respiratory infections, sexually transmitted illness and pregnancy concerns, injury and musculoskeletal pain, and skin concerns. A small percentage also came for education and referrals. Although basic, the care and support ISTOP provides are crucial for our clients. For example, socks are the most popular giveaway and we run out almost every shift. While providing socks is not a direct medical care, it is especially critical for 16

January/February 2014

Preceptor Recruitment

ISTOP is only possible because of the dedicated work of the medical students and preceptor physicians who volunteer and guide us. However, the organization is currently experiencing a shortage of preceptors. Without a physician present onsite, medical students cannot perform any of the much-needed health checks or basic, but crucial, health care. We are a group of dedicated and energetic medical students, and we ask for your help so that we can continue our mission of providing hope, engagement, and care to fellow Minnesotans experiencing homelessness and poor health. Please contact ISTOP leadership at istopleadership@gmail.com if you interested in volunteering or learning more about the organization. You can also contact Dr. John Song at songx006@umn.edu or (612) 624-8936 if you have any questions, concerns, or suggestions.

homeless individuals in Minnesota, where cold exposure and injury are common in the winter. Another example is that by providing seemingly simple wound care and antibiotics early, we can prevent severe infections, which are very common among homeless individuals. Another unique aspect of ISTOP is that we have the time to talk and connect with our clients: sometimes, and most importantly, students simply lend an ear. Second year medical student, Lindsey Zhang, recalls meeting a man once who sat down at the table, not for health checks or giveaways, but to talk and grieve. He had recently been diagnosed with cancer and just needed a friend. Although ISTOP strives to provide multifaceted care to our clients, we are limited in what we can provide and do not see ourselves as the clients’ primary care provider. We provide referrals should a client need and desire more care to the free or sliding-scale clinics in the Minneapolis and St. Paul area. We especially try to connect clients to clinics near their homes or shelters. Additionally, we are hoping to collaborate with University of Minnesota students from the School of Social Work in the future, so that we can provide our clients with any additional support and resources that ISTOP may be lacking at the moment. We are humbled by our client population, and therefore continue to grow, expand and learn so that we can meet the needs of our clients. A project we are currently undertaking is providing ﬂu

vaccines at all the sites next fall. Last year, ISTOP was able to provide flu vaccines at one of the sites with the help of pharmacy students at the University of Minnesota, who are trained early to give vaccines. Our current goal is to create the infrastructure necessary to maintain a cost-efficient and sustainable vaccine program in the future. Many clients have numerous reservations about getting vaccinated, which is why this program is a great opportunity to educate and dispel incorrect popular assumptions about vaccines. Additionally, per requests from clients, we’re looking into providing reading glasses and bus passes this year if our budget allows it. In writing this, I have had an opportunity to reflect on my involvement with ISTOP. I first became interested in the group during my first semester in medical school after one of Dr. Song’s lectures about the importance of advance directives and end-of-life planning in homeless population because a large number of those experiencing homelessness either die outside or alone. I was immediately drawn to ISTOP’s theme of providing dignified care for a population that has been alienated by the health care system and health care professionals. Although volunteering at ISTOP is a short time commitment, it has been an impactful experience for me and many other medical students. Tobi Olayiwola is a 2nd year medical student at the University of Minnesota Medical School. Tobi can be reached at: olay0005@ umn.edu

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The Journal of the Twin Cities Medical Society

The University of Minnesota Medical Reserve Corps:

Giving Back to the Community

he University of Minnesota Medical Reserve Corps (MRC) Program offers students, staff and faculty members from the Academic Health Center (AHC) and Boynton Health Service an opportunity to be of service to their community during a public health emergency or disaster and is part of a nationwide initiative to pre-register, manage and mobilize volunteers to help their communities respond to all types of disasters. The University’s MRC has 1,200 members, which makes it one of the largest MRC units in the country and one of only a handful of units based out of a university or college. Current MRC members with clinical experience include nurses, doctors, dentists, pharmacists, public health professionals, epidemiologists, veterinary medicine professionals and others. AHC afﬁliated non-clinical individuals with expertise in information technology, communication and administration are also encouraged to join the University’s MRC Program. Since 2004, the University’s MRC has aided in emergency response and public health initiatives on campus and at the local, state and national level in a timely and effective manner and in so doing has provided unique educational and experiential opportunities for its members. The largest and most ambitious deployment to date occurred in 2005 when multiple teams of 15-20 University MRC members were sent to Louisiana following Hurricanes Katrina and Rita. The Hurricane Katrina and Rita missions had four objectives: 1) to provide By Kathy Berlin, RN, PHN

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primary care in the shelters throughout the regions; 2) to provide hepatitis and tetanus vaccinations for the approximately 3,500 evacuees housed in the University of Louisiana-Lafayette (ULL) Cajun dome, a large sports arena in Lafayette; 3) to provide medical and nursing support for a special needs shelter in Lafayette, which had capacity for up to 300 individuals with health needs that precluded housing in a standard shelter; and 4) to collaborate with the Region 4 Ofﬁce of Public Health in developing an ongoing, sustainable system of primary care clinics that would eventually serve the health needs of all uninsured persons, regardless of evacuation status. This last objective was the most important as primary care systems were needed to accommodate the very large population of uninsured people living in the region. When asked about his experience as a long-term member of the University’s MRC, Jon Hallberg, M.D., associate professor in the Department of Family Medicine and Community Health said, “Following Hurricane Katrina in 2005, I felt compelled to help — though I had no idea how to do that in any kind of meaningful, concrete way. Thankfully, I’d registered to be part of the University’s MRC and when the call came for help, I was ready and eager to assist. The experience of providing care to thousands of

The Journal of the Twin Cities Medical Society

evacuees in and around Lafayette, Louisiana changed my life. I’m ready to assist again should the need arise.” In response to requests from the University of Minnesota Medical Center (UMMC) and the City of Minneapolis, the University’s MRC deployed 22 members to aid in medical and behavioral health efforts in the hours and days following the 35W bridge collapse that occurred in 2007. Members of the MRC’s Behavioral Health Response Strike Team responded immediately by providing support at the UMMC emergency room and Family Assistance Center the night of the collapse. The Behavioral Health Response Strike Team continued their response efforts at the City of Minneapolis Family Assistance Center. University MRC physicians and nurses staffed the Family Assistance Center medical station. In June of 2008 and at the request of the Iowa State Veterinarian via the Emergency Management Assistance Compact, the University’s MRC deployed nine members of its Veterinary Medicine Response Strike Team to aid in the medical care of small companion animals housed in an animal rescue shelter following the severe ﬂooding of the Cedar Rapids, Iowa area. Three teams consisting of College of Veterinary Medicine veterinarians, veterinary technicians and students were deployed for periods of three to ﬁve days. As many as 700 small animals were housed and cared for during peak shelter operations. Along with providing daily treatments, the team assessed the animals, inserted microchips and examined incoming animals. (Continued on page 18)

January/February 2014

Telemedicine Medical Care Volunteerism Organizations U of M Medical Reserve Corps (Continued from page 17)

Thirty seven University MRC members assisted Boynton Health Service during the seasonal influenza clinics held in September and October of 2009 and over 100 MRC members assisted Boynton Health Service during H1N1 immunization clinics held from November 2009 through February 2010. Members served as ushers, registrations clerks, supply staff and injectors. Strike Teams have been developed within the University to provide for better alignment with member expertise and interest. Currently there are six strike teams including a Logistics Strike Team, Behavioral Health Response Strike Team, Veterinary Medicine Response Strike Team, Pharmaceutical Response Strike Team, Respiratory Personal Protective Equipment Fit Testing Team, and the MRC Leadership Strike Team. The University’s MRC also established a Pharmaceutical Repackaging Team at the request of the Minnesota State Health Department. This team is designed for rapid deployment in the region should there be a need to repackage medicine during a public health emergency. Over 150 team members have been trained and drilled on specific repackaging procedures. MRC members have the opportunity to participate in campus and regional emergency preparedness drills and exercises. These types of events help prepare local public health departments and emergency response personnel for specific public health emergencies. U of MN MRC members participated in an exercise of the Biohazard Detection System in Hennepin County. One of the primary goals of the exercise was to test the antibiotic screening and dispensing of U.S. postal employees following detection of anthrax at a postal office. The U of MN has agreed to serve as one of Hennepin County’s Points of Dispensing. Points of Dispensing would be utilized to get antibiotics to the general population in a timely, safe and efficient manner should there be a wide-spread 18

January/February 2014

release of a biologic agent or other scenario in which there is a need to provide mass prophylaxis to large numbers of individuals. MRC physicians, nurses, pharmacists and dentists would serve in the critical role of medical form screeners and medicine dispensers. In the nearly 10 years the University of Minnesota MRC has been in existence, feedback received from those MRC members who have had the opportunity to assist communities during a public health emergency has often included the statement that their lives have been enriched by the opportunity to be of service. Membership in the U of MN MRC is

open to University of Minnesota Academic Health Center faculty, staff and students as well as Boynton Health Service employees. To learn more about the U of MN Medical Reserve Corps go to http://z.umn.edu/mrc. Membership in one of the metro area MRC units is based on one’s county of residence. For information on how to join a medical reserve corps unit in your area, go to www.mnresponds.org. Kathy Berlin RN, PHN, Academic Health Center Ofﬁce of Emergency Response, University of Minnesota Medical Reserve Corps Coordinator. She can be reached at (612) 626-4722; Berli034@umn.edu.

Volunteer With Medical Reserve Corps Minnesota Responds Medical Reserve Corps (MRCs) is managed by the Minnesota Department of Health, Office of Emergency Preparedness and coordinates local, regional, and statewide volunteer programs to assist our public health and health care systems during a disaster. There are 43 nationally registered Medical Reserve Corps in Minnesota. Thirty-nine are affiliated with local public health. The four non-local MRCs include the University of Minnesota MRC, Minnesota Veterinary MRC, the Minnesota Behavioral Health MRC and MNHOSA (Healthcare Occupation Student’s Association) MRC. All local public health MRCs actively recruit physicians for their Medical Reserve Corps. There are also two Minnesota Mobile Medical Teams that actively recruit physicians, particularly physicians with emergency medicine experience. Mobile Medical Teams are responder teams that can quickly respond during a health emergency to staff the Mobile Medical Unit (MMU). The MMU is an 8-bed emergency department on wheels that can be deployed to supplement an overwhelmed health care system. It is owned and operated by the Minnesota Department of Health. Other opportunities for volunteering include D-MAT, (Disaster Medical Assistance Team) and D-MERT, (Disaster Mortuary Emergency Response Team). To find out more information on volunteering for medical response teams, visit the MN Responds MRC health volunteer registry at www.mnresponds.org. If you have additional questions regarding volunteering or the MN Responds MRC registry, contact the state MRC coordinator through the MN Responds MRC website.

MetroDoctors

The Journal of the Twin Cities Medical Society

Physician Volunteerism: Recognizing and Facilitating the Voluntary Service of Physicians

hysicians work hard to improve their communities and the larger world even beyond what they do for their patients every day. We all know colleagues who generously volunteer their time in free clinics either here in Minnesota or in medical missions around the world. We know others who serve on boards or task forces. As the Minnesota Medical Association Foundation (MMAF) looked to the future, it considered how to recognize and support this good will of physician volunteers while providing a service that could make it easy for any physician to ﬁnd a satisfying and rewarding volunteer experience. Why Support and Promote Volunteerism Among Physicians?

The MMAF cites several reasons to support and promote physician volunteerism. First, physicians are a valuable and muchneeded resource. As the population ages and more get access to affordable health insurance, the need is only increasing. Furthermore, the number of new physicians coming out of training will not be sufﬁcient to replace those who will retire or otherwise leave practice in the coming years and decades. Volunteering expands the footprint of a practicing physician’s contribution, and prolongs the retired physician’s contribution to society through medicine. Second, we need to increase access to care in underserved urban and rural communities. In addition to the general

population trends mentioned above, medically underserved communities have a particularly urgent need. Minnesota’s health disparities are among the worst in the nation and physicians are the essential resource in providing accessible health care. Third, volunteering embraces some of the key elements of professionalism: ethics and well-being. Two of the Principles of Medical Ethics, adopted by the AMA state the following: s ! PHYSICIAN SHALL RECOGNIZE A RESPONsibility to participate in activities contributing to the improvement of the community and the betterment of public health (Article VII), and s ! PHYSICIAN SHALL SUPPORT ACCESS TO medical care for all people (Article IX). Furthermore, volunteer activities provide meaningful social and community engagement and improve well-being overall. That’s true in the general population, but especially important in medicine where nearly half of physicians (45 percent) are experiencing burnout. (Shanafelt, et al., 2010) As a bonus, volunteers even live longer! Finally, physician volunteerism is not well understood and shining a light on it will help physicians and others understand how physician volunteers are improving not just health care, but our communities and society in general. Building a Program

With a working title of the Physician Volunteerism Program, the initiative got its start in the strategic planning process of the MMAF. One of the guiding principles of

By Phillip Stoltenberg, M.D.

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The Journal of the Twin Cities Medical Society

the MMAF is to improve access to care in underserved communities. “We all know physicians who volunteer in free clinics and we expected that other physicians would be interested too if they had a way to find the right situation” says Michael Ainslie, M.D., who serves on the MMAF Board of Directors. “We thought that a resource to help physicians find volunteer opportunities to match their interests and fit their schedule would be useful, but we needed more information.” So, the MMAF developed a survey to learn more about where physicians volunteer, what kinds of opportunities they look for and how they learn about those opportunities. These and other questions were designed to ascertain whether there (Continued on page 20)

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Telemedicine Medical Care Volunteerism Organizations Physician Volunteerism (Continued from page 19)

was sufﬁcient interest among physicians as well as need and interest by community clinics and other organizations to use physician volunteers, to justify building such a resource. Physicians Respond

In the spring of 2013, 726 physicians, 8 percent of those invited, responded to a survey of MMA members. The response rate alone was gratifying, but the information was striking. Nearly 70 percent had volunteered in some capacity in the last year, 40 percent as physicians. Given that level of volunteerism, one could conclude that physicians had all the information they needed about volunteer opportunities. However, most active volunteers reported that they heard about their volunteer activity by word of mouth. Only 25 percent were aware of any volunteer resources for physicians.

Finally, 85 percent wanted to know about volunteer opportunities for physicians and 87 percent said they would use an online guide or clearinghouse to ﬁnd that information. … And So Do Community Clinics!

The MMAF reached out to community clinics, too, through a survey and in personal interviews with clinic leadership — both administrators and physicians. They, too, see value in physician volunteers serving in either clinical or non-clinical roles. While several potential obstacles were identiﬁed in the surveys, physicians and clinic administrators who convened to discuss the program were optimistic that all could be addressed. What’s Next?

Given the information and positive responses, the MMAF is moving ahead to bring physician volunteers together with three clinics as part of a pilot project. The

clinics are Neighborhood HealthSource in Minneapolis, United Family Medicine and Open Cities Health Center in St. Paul. Dr. Kathleen Macken, director of the United Family Medicine Residency Program will also explore how volunteers can play a role in the training and development of family medicine residents. During the pilot project phase, which is expected to launch in the spring of 2014, clinics will work with the MMAF and physician volunteers to shape the essential elements of the program, remove stumbling blocks, and ﬁne tune the overall experience for both the organization and the volunteer. An advisory panel made up of clinic administrators and physician volunteers will guide the program through the pilot phase and, if all goes as expected, into full implementation in the fall of 2014. The ﬁrst advisory panelists to be named are Steve Knutson, executive director of Neighborhood HealthSource, Kathleen Macken, M.D., director of the United Family Medicine Residency Program, and Carolyn McKay, M.D., Fairview Children’s Clinic, who has served on the board of the MMAF and is a long-time leader in Twin Cities and Minnesota health care. Others are expected to be named soon. Jim Dehen, M.D., president of the MMAF, said “I look forward to a day when we not only post volunteer opportunities, but we help physicians and organizations throughout Minnesota make a great match.” Watch for more information on the Physician Volunteerism Program in publications of the MMA and the Twin Cities Medical Society and on the web at mmafoundation.org. Phillip Stoltenberg, M.D. practices in the Twin Cities with Minnesota Gastroenterology. Among his other volunteer activities, Dr. Stoltenberg serves on the boards of the Twin Cities Medical Society, the Minnesota Medical Association and the MMAF where he is vice-president.

January/February 2014

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The Journal of the Twin Cities Medical Society

Minnesota Statutes: 214.40 Volunteer Health Care Provider Program Subdivision 1. Definitions. (a) The definitions in this subdivision apply to this section. (b) “Administrative services unit” means the administrative services unit for the health-related licensing boards. (c) “Charitable organization” means a charitable organization within the meaning of section 501(c)(3) of the Internal Revenue Code that has as a purpose the sponsorship or support of programs designed to improve the quality, awareness, and availability of health care services and that serves as a funding mechanism for providing those services. (d) “Health care facility or organization” means a health care facility licensed under chapter 144 or 144A, or a charitable organization. (e) “Health care provider” means a physician licensed under chapter 147, physician assistant licensed and practicing under chapter 147A, nurse licensed and registered to practice under chapter 148, dentist, dental hygienist, or dental therapist licensed under chapter 150A, or an advanced dental therapist licensed and certified under chapter 150A. (f ) “Health care services” means health promotion, health monitoring, health education, diagnosis, treatment, minor surgical procedures, the administration of local anesthesia for the stitching of wounds, and primary dental services, including preventive, diagnostic, restorative, and emergency treatment. Health care services do not include the administration of general anesthesia or surgical procedures other than minor surgical procedures. (g) “Medical professional liability MetroDoctors

insurance” means medical malpractice insurance as deﬁned in section 62F.03.

administrative services unit for purposes of administering the program.

Subd. 2. Establishment. The administrative services unit shall establish a volunteer health care provider program to facilitate the provision of health care services provided by volunteer health care providers through eligible health care facilities and organizations.

Subd. 4. Health care provider registration. (a) To participate in the program established in subdivision 2, a health care provider shall register with the administrative services unit. Registration may be approved if the provider has submitted a certified statement on forms provided by the administrative services unit attesting that the health care provider agrees to: (1) receive no direct monetary compensation of any kind for services provided in the program; (2) submit a sworn statement attesting that the license to practice is free of restrictions. The statement must describe: (i) any disciplinary action taken against the health care provider by a professional licensing authority or health care facility, including any voluntary surrender of license or other agreement involving the health care provider’s license to practice or any restrictions on practice, suspension of privileges, or other sanctions; and (ii) any malpractice suits filed against the health care provider and the outcome of any suits filed; (3) submit any additional materials requested by the administrative services unit; (4) identify the eligible program through which the health care services will be provided and the health care facilities at which the services will be provided; and (5) if coverage is purchased for the provider under subdivision 7, comply with any risk management and loss prevention policies imposed by the insurer.

Subd. 3. Participation of health care facilities. To participate in the program established in subdivision 2, a health care facility or organization must register with the administrative services unit on forms provided by the administrative services unit and must meet the following requirements: (1) be licensed to the extent required by law or regulation; (2) provide evidence that the provision of health care services to the uninsured and underinsured is the primary purpose of the facility or organization; (3) certify that it maintains adequate general liability and professional liability insurance for program staff other than the volunteer health care provider or is properly and adequately self-insured; (4) agree to report annually to the administrative services unit the number of volunteers, number of volunteer hours provided, number of patients seen by volunteer providers, and types of services provided; and (5) agree to pay to the administrative services unit an annual participation fee of $50. All fees collected are deposited into the state government special revenue fund and are appropriated to the

The Journal of the Twin Cities Medical Society

(Continued on page 22)

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Telemedicine Medical Care Volunteerism Organizations Minnesota Statutes (Continued from page 21)

(b) Registration expires two years from the date the registration was approved. A health care provider may apply for renewal by ďŹ ling with the administrative services unit a renewal application at least 60 days prior to the expiration of the registration. Subd. 5. Revocation of eligibility and registration. The administrative services unit may suspend, revoke, or condition the eligibility of a health care provider for cause, including, but not limited to, the failure to comply with the agreement with the administrative services unit and the imposition of disciplinary action by the licensing board that regulates the health care provider. Subd. 6. Board notice of disciplinary action. The applicable health-related licensing board shall immediately notify the

administrative services unit of the initiation of a contested case against a registered health care provider or the imposition of disciplinary action, including copies of any contested case decision or settlement agreement with the health care provider. Subd. 7. Medical professional liability insurance. (a) Within the limit of funds appropriated for this program, the administrative services unit must purchase medical professional liability insurance, if available, for a health care provider who is registered in accordance with subdivision 4 and who is not otherwise covered by a medical professional liability insurance policy or self-insured plan either personally or through another facility or employer. The administrative services unit is authorized to prorate payments or otherwise limit the number of participants in the program if the costs of the insurance for eligible providers exceed the funds appropriated for the program.

(b) Coverage purchased under this subdivision must be limited to the provision of health care services performed by the provider for which the provider does not receive direct monetary compensation. Subd. 8. Fee adjustment. The administrative services unit shall apportion between the Board of Medical Practice, the Board of Dentistry, and the Board of Nursing an amount to be raised through fees by the respective board. The amount apportioned to each board shall be the total amount expended on medical professional liability insurance coverage purchased for the providers regulated by the respective board. The respective board may adjust the fees which the board is required to collect to compensate for the amount apportioned to the board by the administrative services unit. History: 2002 c 399 s 3; 2008 c 326 art 1 s 6; 1Sp2010 c 1 art 25 s 12; 2013 c 108 art 10 s 11. Reprinted with permission OfďŹ ce of the Revisor of Statutes.

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January/February 2014

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YOUR VOICE

The Future of the MMA

embers of the Minnesota Medical Association received the latest issue of our monthly journal, Minnesota Medicine, recently, and with this came the 2013 Annual Report. Displayed prominently on the front of the report, and on every subsequent page, are the words “the unified voice of the medical profession.” I am sure that many members will be struck by the irony of this statement after experiencing the discord and divisiveness of the debate over the past few years regarding the governance structure of the MMA. It appears that this is an effort by MMA staff to convince the membership that we have, to some degree, resolved the governance debate, and are again united. While the statement is clearly aspirational, I sincerely hope that it can become reality in the future. The accompanying letter, signed by our new president, states that the MMA has been tackling the tough issues. However, the most important challenges for our profession, in my view, are not mentioned. The growth and consolidation of large health systems and the related rapid shift towards employment of physicians, the increasing difficulties of physicians attempting to remain independent, increasing divisions within our profession, widespread dissatisfaction of American physicians with the practice of medicine, declining membership in our state organization, and other important issues, are nowhere to be found. In addition, the annual report contains very little of what an annual report is usually expected to include. The financial highlights show only broad categories of where dues are spent, and where revenue comes from. There are no details of how much is spent on staff, office expense, information technology, and other important areas. Membership information shows only a geographic distribution, and not how many members are regular members, students, residents or fellows. This is more propaganda than annual report. The above issues are indicative of fundamental concerns that many members have with the MMA. The governance debate has revealed a strong desire on the part of the CEO, supported by some of our physician leaders, to eliminate the House of Delegates, and to concentrate control of the Association, as well as

By Lyle J. Swenson, M.D.

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policy development, in a small board of Trustees that even has the CEO as a member of the Board (although without a vote). Even though the HOD at our annual meeting voted to suspend the HOD for three years rather than completely eliminate the HOD, a strong concern has grown that without the HOD, the BOT has no oversight. Incredibly, there has yet to be any clear and honest explanation of why the HOD should be eliminated, and how this might benefit the MMA. Also troubling is the fact that the issue of how MMA policy is developed and established has been disingenuously deflected into the issue of physician engagement. The efforts to change MMA governance have been staff-driven. This raises the issue of the appropriate role of staff in the organization. Over the past few years, physician leadership has relied increasingly on staff for most of the MMA’s important functions, including formulation of meeting agendas, directing the efforts of committees and task forces and even chairing task forces, providing testimony before government entities, and controlling MMA publications and communications. There is obvious staff expertise in these areas, but there is a growing sentiment that a staff-driven MMA is more about the MMA and less about physicians and our profession. Physician leaders should take a more active role in the functions of the MMA. The economic health of the MMA is also becoming more problematic due to declining dues revenues and increased expenses. The expenses of a large staff, requests for a new computerized management system and upgraded website, and increasing reliance on, and use of, the investment account are issues that must be dealt with, and must be done with a clear vision of what is best for the physicians of Minnesota as well as what is necessary for the organization. I understand that some MMA members will disagree with my views on these challenges. Many, however, will recognize these challenges as significant threats to the long-term health of the MMA. Now that the HOD has been suspended, it is up to our physician leaders and the Board of Trustees to take on these challenges and secure the future of the MMA. I am confident that new physician leaders will emerge and step up to effectively deal with our current challenges, as has been true in the past.

January/February 2014

CHWs Strengthen Collaborative Practice Linking Care and Communities for Better Outcomes

atient-centered care that is culturally- and linguistically-appropriate takes a team approach. In order to improve health outcomes and effectively address health disparities, Twin Cities clinics are exploring and incorporating CHW strategies as part of their team-based care. As front-line health personnel, community health workers (CHWs) apply their training and unique understanding of the culture, language and life experiences of the communities they serve to provide outreach, health education and care coordination, typically serving low-income, medically underserved, and/or hard-toreach populations. They improve access to coverage and care, promote healthy behaviors, and help manage chronic illness among patients of all ages. Minnesota’s growing CHW workforce reﬂects our state’s diversity with representation from the African American, Native American, Bosnian, Cambodian, Hmong, Karen, Lao, Latino, Liberian, Somali, Vietnamese, Caucasian, and deaf communities. CHWs are known by different titles and encompass multiple roles, including patient navigator, peer advisor, care guide, community health representative, and promotores de salud. The CHW role has deep roots and a long history in the U.S. and around the world. In 2010, the U.S. Department of Labor Standard Occupational Classiﬁcation system recognized CHWs as a distinct profession with key job responsibilities. Leading health authorities support the CHW role such as the American Public Health Association, the Centers for By Joan Cleary, MM

January/February 2014

Integrating CHWs into team-based care helps achieve the Triple Aim, advance health equity and expand and diversify our health care workforce.

Disease Control and Prevention, the Institute of Medicine, the Health Resources and Services Administration as well as the Minnesota Department of Health. The Twin Cities Medical Society recently endorsed CHW strategies for their contributions to better care, better outcomes and lower costs. According to Dr. Paul Farmer, Harvard University professor and founder of Partners in Health, “...the American health care system does not perform as well when you start looking at communitybased care, for example, of chronic disease. When you start looking at people with multiple illnesses at once, which you see very often among the poor and among the elderly as well, then our system doesn’t work well at all. So the big idea that I would give to graduates of medical schools

and nursing schools is that we can only have real impact, and the best impact, when we work in teams. And those teams have to reach from hospitals and clinics, to communities. And that’s where I hope American medicine is going. The big idea, in that case, is we need to learn how to work with community health workers in the United States, just like we do in Haiti, Rwanda, Malawi, Lesotho.” “I see CHWs as an underutilized resource that could expand a primary clinician’s inﬂuence around many conditions and chronic medical diseases within clinic walls and also as a bridge between a clinic and community environments,” states pediatrician Julie Boman, M.D., M.A. “Traditionally, CHWs are trusted and recognized members of the communities they serve, thus provide a link to both

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knowledge about their community, culture and language, and also effectively address the barriers that prevent community members from better care of chronic medical problems and use of available services.â&#x20AC;? Increasingly, CHWs are being hired by hospitals, clinic systems, and local public health agencies to strengthen teambased services to patients and families. They are integral members of clinic care teams at Hennepin County Medical Center, NorthPoint Health and Wellness in north Minneapolis, and HealthEast Care System in the east metro. Beyond the Twin Cities, CHW strategies are in use by CentraCare, Essentia Health and Mayo Clinic Heath System. CHWs reduce demand on overburdened providers by promoting healthy behaviors and helping patients understand how to access and use care appropriately. â&#x20AC;&#x153;Providers appreciate what we do because we can follow-up on a lot of things and make sure they get done,â&#x20AC;? explains CHW Mariela Adremagni-Tollin at HCMCâ&#x20AC;&#x2122;s East Lake Clinic. â&#x20AC;&#x153;In a short visit, itâ&#x20AC;&#x2122;s impossible for the physician to do everything; we need a care team.â&#x20AC;? Minnesota is recognized as a leading state for CHW ďŹ eld development including: s ! DElNED SCOPE OF PRACTICE s ! STATEWIDE COMPETENCY BASED #(7 curriculum in higher education â&#x20AC;&#x201D; the ďŹ rst in the nation â&#x20AC;&#x201D; leading to a certiďŹ cate and offering an educational pathway for those who would like to enter other health careers. s -EDICAL !SSISTANCE PAYMENT FOR diagnostic-related patient education services provided by trained and supervised CHWs â&#x20AC;&#x201D; one of only two states to date with this coverage. s /NGOING TRAINING AVAILABLE THROUGH the Minnesota CHW Peer Network. Growing evidence and recognition of CHW contributions to better outcomes indicate an increasing role for CHWs in our changing health system. For example, studies of CHW programs show signiďŹ cant improvement in patient use of preventive services such as mammography and cervical cancer screening among low income

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The Twin Cities Medical Society supports the role of CHWs in the coordinated delivery of care in multiple health care settings. Integration of CHWs as team members supports improved patient experience, improved health and reducing overall costs of health care services going forward. We encourage any applicable organizations to consider and implement CHWs workforce strategies in their care delivery systems.

and immigrant women. Economic analysis published by Wilder Research Center in June 2012 found that every dollar invested in CHW cancer outreach and prevention results in a savings to society of $2.30. In a comparative study reported in 2012, targeted CHW interventions led to lower use of the emergency room, inpatient care and prescription medications among Medicaid managed care enrollees in New Mexico. â&#x20AC;&#x153;As a best practice for addressing the Triple Aim and tackling health disparities, team-based CHWs are an essential component of Minnesotaâ&#x20AC;&#x2122;s health reform strategies,â&#x20AC;? according to Pete Dehnel, M.D., who serves on the board of TCMS and the Minnesota CHW Alliance. â&#x20AC;&#x153;We see exciting opportunities for CHWs to

The Journal of the Twin Cities Medical Society

make a difference in new structures such as health care homes, accountable care organizations, and MNsure, our stateâ&#x20AC;&#x2122;s health insurance exchange.â&#x20AC;? Joan Cleary, MM, is the director of the Minnesota Community Health Worker Alliance. Joan provides consulting and interim management services to foundations, health care organizations, nonproďŹ ts and government. In a health and human services career spanning 30 years, she has worked in philanthropy, health care and government settings most recently as VP at the Blue Cross and Blue Shield of Minnesota Foundation. For more information, visit www.mnchwalliance.org or contact joanlcleary@gmail.com.

Clinics & Hospitals Needed to Register for Homeless Supply Drive Caring Hearts for Homeless People, the annual supply drive for homeless adults and children in the Twin Cities area, will take place again this winter. Throughout February 2014, clinics and hospitals simply display a collection box and signage and encourage staff and/or patients to donate health and hygiene items. At the end of the month, all donations can be brought to either St. Josephâ&#x20AC;&#x2122;s Hospital in St. Paul or the Twin Cities Medical Society ofďŹ ce in Minneapolis. Have your site representative contact Nancy Bauer at TCMS (612623-2893/nbauer@metrodoctors.com) to express your interest and receive display materials and information electronically. All donated items are distributed directly to the homeless through the following three programs: Health Care for the Homeless, Listening House of St. Paul, and SafeZone Drop-In Center. Caring Hearts for Homeless People is sponsored by HealthEast Care System, Cerenity Senior Care and East Metro Medical Society Foundation.

January/February 2014

HCM Volunteerism: Physician Perspectives

I always wondered why somebody didn’t do something about that. Then I realized I was that somebody. Lily Tomlin As children growing up, many of us were encouraged to volunteer. Whether it was helping someone carry groceries or shoveling sidewalks for someone not mobile, we were taught it was the right thing to do. So decades later, why do we continue to volunteer? There are more than 60 volunteers in the Honoring Choices Minnesota (HCM) Ambassador program. Many of them are physicians. In their spare time, they make the time to discuss Advance Care Planning (ACP) with health care system staff, human service professionals, members of faith groups, assisted living facility staff and residents, and other diverse groups. So why do busy physicians volunteer their precious time for this program? Four physicians were recently interviewed by HCM about what motivates them to take additional time away from their families and loved ones to become change agents for beginning difﬁcult family conversations. This is what we learned.

retired physician with a 34-year career as a primary care internist and later a hospitalist, I have developed these conversation skills. I want to ensure they will be available to current and future caregivers, patients and their families. a hospitalist in your career, you have experienced hundreds Q Asof conversations with patients and families concerning sensitive topics. How does volunteer training in ACP enhance the role of the hospitalist? And how does knowledge of ACP impact the care that hospitalists give their patients? are routinely involved in care situations that could A Hospitalists have beneﬁted from ACP much earlier — or ideally prior to the patient’s illness. Families are commonly asked in an acute care hospital setting to make decisions for a loved one with no prior knowledge of that person’s wishes. I believe that broader availability of community-based ACP discussions will help to improve the hospital experience for both hospitalists and families served.

Perspectives from HCM Ambassador Richard Shank, M.D.

Perspectives from Ambassador Carol Grabowski, M.D., FACRO

recently volunteered to Q You serve as an HCM Co-Facili-

have been an HCM phyQ You sician Ambassador for more

tator for Ambassador Continuing Education. You were trained as an ACP physician Ambassador earlier this year. What motivated you to become involved in a greater HCM leadership position?

than two years. How does being an Ambassador complement your professional radiation oncologist practice?

initiative ﬁlls a signiﬁcant A This community need, as evidenced

being managed for a symptomatic, metastatic problem with a purely palliative intent — and no goal of cure. Most have been heavily pretreated. As a radiation oncologist, sometimes I am the one who gives patients “permission” to stop treatments. HCM is a natural segue to discuss with patients how they want things to go.

by its local growth and increasing adoption across the country. I am delighted to contribute to its continued success. The tools for this discussion were simply not available to me during my preliminary training years ago. As a

one third of my paA Roughly tients receiving treatment are

By Barbara Greene, MPH

January/February 2014

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The Journal of the Twin Cities Medical Society

have worked in large health systems for many years. In Q You your opinion, what infrastructure is most effective in imple-

Is Volunteerism Part of our Legacy?

menting a system-wide ACP initiative?

Perspectives from Ambassador Kusum Saxena, M.D.

any health care system, large or small, it is imperative A Into have administrative and physician leader champions for successful implementation. This by no means subordinates the necessity of skilled non-physician team members in nursing, social work, chaplaincy, etc. This interdisciplinary team is effective in introducing patients to the full ACP process. I appreciate the spirit of the Honoring Choices program. Reframing this conversation as a gift for loved ones makes a huge difference. My involvement in the Ambassador program has helped me to build conﬁdence in successfully initiating this conversation. Perspectives from Ambassador Stefan Pomrenke, M.D.

a family physician in a comQ Asmunity clinic environment, how does training in ACP help you to understand the wishes of individuals in decision-making? all have different preferA We ences as to how we want our medical care delivered. As I develop stronger relationships with my patients, I am aware of the importance of these discussions. I explain to patients that this conversation is an extension of chronic and acute care. I need to always keep in mind the importance of normalizing the ACP discussion. addition to being a family practice physician, you have Q Instrong relationships with faith communities and minority populations. How do you prioritize your unpaid involvement? that we are here to use our time and talents to love A Ionebelieve another. We are all motivated by what gives us a sense

For HCM physician volunteers, their community activism surpasses the need to simply make a living. Our fourth interview with physician Ambassador Kusum Saxena, M.D., highlights the need for greater community service. “Raising a family and simultaneously working in my profession did not leave much time for volunteering initially. In 1978 when my husband and I with two other families started the Hindu Society of Minnesota/Hindu Mandir, it required my complete volunteer focus. It was after my retirement that I became involved in Honoring Choices. My intent was really to help our Hindu community with various aspects of end of life medical care.” “As a child, I had a very traditional Hindu family in India. Both my parents helped local poor persons with many things. Once, in the peak of winter, my father gave his woolen coat (a costly item for my family) to a shivering elder. My father then came home shivering himself. I also witnessed the tradition of offering assistance, so that daughters from poor families in our community could ﬁnd the means to marry.” While these four physicians have different stories, they all share a strong motivation to impact others through involvement in HCM. And as Honoring Choices continues its rapid growth on a state and national level, physicians will continue to be a stronghold to increase ACP education and advocacy. For many, volunteering is giving back to their community in a meaningful way. For others, it is spiritually rewarding. And still for others, it’s simply fun. Barbara Greene, MPH, is the community engagement director, Honoring Choices Minnesota.

of meaning. Is it our family, our community, or our larger faith perspective? I have found that my time spent with each of these groups is a rich experience that builds on each other. Working half time gives me this valuable balance.

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The Journal of the Twin Cities Medical Society

January/February 2014

Medical Students at the Lunch ’n Learn.

Medical Student Lunch ‘n Learn Sessions

hat’s the easiest way to attract medical students to attend a forum? Serve pizza of course! TCMS and MMA co-sponsored two Lunch ’n Learn sessions this past fall featuring topics generated by a small group of representatives from the second and third year medical student classes. The lead-off seminar, held on October 29, was a primer on “Cuts to your Graduate Medical Education — What Every Medical Student Needs to Know,” which included presentations by Troy Taubenheim, Director, Metro Minnesota Council on Graduate Medical Education, and Leah Anderson, MS2, member of the TCMS Legislative and Policy Committee. Leah provided testimony on MERCK funding before her legislator last spring. Katherine Holten, president of the Medical Student Section, described her involvement in all levels of organized medicine and encouraged her colleagues to make a difference by getting involved in policy and legislative initiatives through Katherine Holten, MS2, president, Medical Student Section. TCMS and MMA. “Exploring Non-Traditional Medical Careers” was the featured topic for the November 21 Lunch ’n Learn. Susan Alpert, M.D., Principle, SFA Consulting LLC and formerly with Medtronic and the U.S. Food and Drug Administration; Joshua Riff, M.D., Chief Medical Ofﬁcer, Target Corporation; and Peter Dehnel, M.D. Medical Director of Utilization Management, BCBS, each described their education and career path leading them to their current positions. Students were encouraged to explore opportunities through Life Science Alley and Medical Student Leah Anderson other organizations to learn about the business side of medicine, research, and other discusses involvement on TCMS Policy and Legislative Council. non-clinical careers.

Guest Speaker Troy Taubenheim, Director, Metro Minnesota Council on Graduate Medical Education.

January/February 2014

Drs. Susan Alpert, Peter Dehnel and Joshua Riff discuss "Non-traditional Medical Careers" at medical student Lunch 'n Learn.

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In Memoriam PAUL J. BILKA, M.D., age 94, passed away on October 30, 2013. Dr. Bilka graduated from Columbia University School of Medicine in 1943 and completed his residency in rheumatology at the Mayo Clinic. Dr. Bilka started the ďŹ rst rheumatology clinic in Minneapolis in 1950. Dr. Bilka became a member in 1948. JOSEPH J. BUCKLEY, M.D., M.S., passed away at the age of 91 on October 11, 2013. Dr. Buckley graduated from the New York Medical College completing a residency in anesthesiology at the University of Minnesota. He served as head of the Department of Anesthesiology at the U of M until retirement. Dr. Buckley became a member in 1954.

STEPHEN L. LARSON, M.D., age 74, passed away on November 15, 2013. Dr. Larson attended the McGill University Faculty of Medicine, and did his residency at the Mayo Clinic in obstetrics & gynecology. Dr. Larson became a member in 1973. JOHN H. LINNER, M.D., passed away at the age of 95 on November 8, 2013. Dr. Linner graduated from the University of Minnesota Medical School and completed his surgical residency at the University of Minnesota VA Hospital. Dr. Linner became a member in 1947. RAMON P. MENDIOLA, M.D., age 83, passed away in October 2013. Dr. Mendiola attended medical school in Santo Tomas, Manila, and specialized in general surgery. He became a member in 1966.

JAMES A. MUSICH, M.D., age 63, passed away on September 5, 2013. Dr. Musich attended UCLA Medical School and completed his residency training in anesthesiology in 1985. He practiced at Abbott Northwestern Hospital specializing in cardiac surgery anesthesia. Dr. Musich became a member in 1986. LOREN E. NELSON, M.D., passed away October 11, 2013 at the age of 88. Dr. Nelson was a professor at the University of Minnesota Medical School, and past president of the Ramsey County Medical Society. Dr. Nelson became a member in 1956. DOROTHEA P. SOWADA, M.D., passed away October 7, 2013. She graduated from the University of Minnesota Medical School and practiced family medicine. Dr. Sowada became a member in 1973.

New Members Barbara J. Bowers, M.D. Minnesota Hematology Oncology, PA Medical Oncology

John T. Egan, M.D. Specialists in Internal Medicine Internal Medicine

Christopher D. Robert, D.O. Hennepin Healthcare System, Inc. Anesthesiology

Matthew R. Braasch, M.D. Urology Associates, Ltd. Urology

Bjorn I. Engstrom, M.D. Consulting Radiology, Ltd. Radiology, Diagnostic Radiology

Damon D. Shearer, D.O. Consulting Radiology, Ltd. Radiology, Diagnostic Radiology

Kevin N. Brown, D.O. Hennepin County Medical Center Neurology

Kourtney L. Kemp, M.D. Specialists in General Surgery General Surgery

Kellie C. Stecher, M.D. Clinic SoďŹ a OBGYN, P.A. Obstetrics and Gynecology

Annelisa M. Carlson, M.D. Consulting Radiologists, Ltd. Radiology, Diagnostic Radiology

Jason L. Keszler, D.O. Consulting Radiology, Ltd. Radiology

Huy Q. Tran, M.D. Consulting Radiology, Ltd. Radiology

Catherine P. Chadwick, M.D. Partners in Pediatrics. Ltd. Pediatrics

Amy L. McNally, M.D. Minnesota Oncology Hematology, PA Obstetrics and Gynecology, Gynecologic Oncology

Katharine D. Tumilty, M.D. Metropolitan Pediatric Specialists, P.A. Pediatrics

Nicole M. Chase, M.D. St. Paul Allergy & Asthma Clinic, PA Pediatrics, Allergy and Immunology Rebecca A. Doege, M.D. Partners in Pediatrics, Ltd. Pediatrics Rene P. duCret, M.D. Consulting Radiologists, Ltd. Diagnostic Radiology, Nuclear Medicine MetroDoctors

David J. Mills, M.D. Consulting Radiology, Ltd. Radiology, Diagnostic Radiology Jon L. Pryor, M.D. Hennepin Healthcare System, Inc. Urology

The Journal of the Twin Cities Medical Society

January/February 2014

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The Journal of the Twin Cities Medical Society

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LUMINARY of Twin Cities Medicine By Marvin S. Segal, M.D.

ROBERT W. GEIST, M.D. A FRIEND OF BOB GEIST ONCE SAID, “He was born, educated and traveled extensively...in the Twin Cities.” Indeed, that is the case as he was delivered 85 years ago at St. Joseph’s Hospital, schooled in the St. Paul public system, and earned — with honors — bachelors’ degrees and his M.D. from the U of M. After serving in the post WW II regular Army and attending medical school, the early portions of his postgraduate education were at Philadelphia General Hospital, Washington D.C. General Hospital and the Armed Forces Institute of Pathology. His final residency years were spent back at his alma mater followed by a long faculty tenure with the U of M Urology Department — retiring as Clinical Professor Emeritus. Dr. Geist’s professional career helped to shape his strongly held opinions regarding the practice and funding ramifications of medicine. He practiced with Metropolitan Urologic Specialists for nearly 40 years, held presidencies in the Twin Cities and Minnesota Urologic Societies, the Ramsey County Medical Society and the United Hospital Medical Staff. As a long-standing county society and state association trustee and House of Delegates member, he chaired committees dealing with professionalism, medical-legal affairs and ethics. Those activities plus his lengthy service on the Minnesota Patient-Physician Alliance Board formed the basis of his firm beliefs for the medical profession and the protection of patients. He has been described as “the thinking person’s physician and patient advocate.” His prodigious publications and presentations have been a meaningful blend of both clinical and political subjects — ranging from potassium metabolism, the neurogenic bladder, pediatric cystitis and prostatic cancer to legislative public policy, medical economics and a distaste for certain methods of managed care operation. Dr. Geist has for many years engaged in a profound though pragmatic analysis of medical economics and has not been reserved in sharing the 32

January/February 2014

conclusions of those labors with colleagues and populations at large. He has been an outspoken critic of what he believes to be inappropriate cost containment and the rationing of medical care — to the detriment of the patient and medical practice. In a recent op-ed article (Pioneer Press 7/29/13) he boldly stated that doctors were neither the cause nor solution of high health care costs. Whether Bob’s thoughts have been right or wrong, they certainly have been arrived at after a notable volume of experience, research and clear thinking. When asked about the most gratifying portion of his diverse career, without hesitation this father of seven and grandfather of 12 (who states to be married to an angel) replied, “The practice of medicine has been the highlight of my life — I just loved my patients; health care politics as a community obligation are in second place.” When asked about the fondest hopes for his beloved medicine and its future, he responded, “that patients would be empowered to control their care and their own medical budget.” This, he believes, will eventually come about as the insurance and medical delivery marketplaces come into equilibrium. Dr. Robert Geist pursues noble goals. He has the courage of his convictions and continues to demonstrate conﬁdence to act in accordance with his well-intentioned beliefs. A true Luminary of Twin Cities Medicine!

This last page series is intended to honor esteemed colleagues who have contributed signiﬁcantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, managing editor, nbauer@metrodoctors.com.

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The Journal of the Twin Cities Medical Society

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University of Minnesota Continuing Professional Development 2014 CME Spring Activities (All courses in the Twin Cities unless noted)

Maintenance of CertiďŹ cation in Anesthesiology (MOCA) Training Course April 3-4, 2014 Spring Psychiatry Update: Pursuing Wellness Across the Lifespan April 3-4, 2014 Cardiac Arrhythmias: Update for Internal Medicine, Family Practice & Pediatrics April 4, 2014 Integrated Behavioral Healthcare Conference: Building a Framework So You Can Grow April 25, 2014

Pediatric Dermatology April 25, 2014 Annual Surgery Course: Vascular Surgery May 1-2, 2014 Live Global Health Training (weekly modules) May 5-30, 2014

ONLINE COURSES (CME credit available)

Topics & Advances in Pediatrics June 2014

www.cme.umn.edu/online U Global Health - 7 Modules to include Travel Medicine, Refugee & Immigrant Health - NEW! Family Medicine Specialty U Nitrous Oxide for Pediatric Procedural Sedation U Fetal Alcohol Spectrum Disorders (FASD) - Early IdentiďŹ cation & Intervention

Workshops in Clinical Hypnosis June 5-7, 2014

For a full activity listing, go to www.cmecourses.umn.edu

Midwest Cardiovascular Forum May 17-18, 2014 Bariatric Education Days: Decade of Bariatric Education May 21-22, 2014

OfďŹ ce of Continuing Medical Education 612-626-7600 or 1-800-776-8636 U email: cme@umn.edu

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