Fall 2021
Doctors Metro MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
ADVOCACY beyond the CLINIC
In This Issue: • Announcing new TCMS CEO • Physicians Share their Passion for Advocacy • Future Physician Leaders
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Contents VOLUME 23, NO. 3 FALL 2021
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In this issue
A Physician and an Advocate By Richard R. Sturgeon, MD and James Pathoulas, MS4
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President’s Message
Building a New Kind of Medical Society By Sarah Traxler, MD
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TCMS in Action
A Conversation with TCMS’s New CEO, Annie Krapek, MPH
Physician Advocacy and Volunteerism
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• Colleague Interview: A Conversation with David Hamlar, Jr., MD, DDS
• Listening to Learn and Learning to Listen By Calla Brown, MD, MHR
13 • Best Practices for Physicians Looking to Grow Their Advocacy Voice By Pamela Gigi Chawla, MD, MHA 15
Page 5
• Building Racial Equity into Health Policy
By Nathan T. Chomilo, MD
16 • Building Healthy and Sustainable Communities: Physicians’ Roles Outside of our Clinical Settings By M. Etienne Djevi, MD
Physician Leaders Page 28
19 • Cross-Sector Collaboration: Physician Activism Within Community By Janna Gewirtz O’Brien, MD, MPH, FAAP 20 • Harm Reduction and Low Threshold Addiction Support By Ryan Kelly, MD 21 • You Cannot Give to Others, That Which You Cannot Give to Yourself By Michael B. Koopmeiners, MD 22 • Physicians in Public Office: Advocating for a Healthy, Thriving Minnesota By Rep. Kelly Morrison, MD
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future
17 • Creating and Sustaining Healthy Communities By Alex Feng, MD, MBA
Doctors Metro MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
ADVOCACY beyond the CLINIC
23 • Looking Within: Equity in Medical Education is Foundational Toward Achieving Health Equity By Taj Mustapha, MD 24
• The Invisible Tool in Our Black Bag
By Marvin So, MPH, MS4
27 • Environmental Health— Reflections on Being a Volunteer By Dave Hunter, MD Page 8
Career Opportunities
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MetroDoctors
One Year Since George Floyd: Lessons Learned from the UMN Medical Education Reform Student Coalition By Kriti Prasad, Zarin I. Rahman, Alexandria Kristensen-Cabrera and Malavika Suresh
The Journal of the Twin Cities Medical Society
In This Issue: • Announcing new TCMS CEO • Physicians Share their Passion for Advocacy • Future Physician Leaders
As TCMS transitions into an organization focused on advocating for improved health and health equity for our communities, MetroDoctors invited colleagues to share their personal stories of advocacy and where their passion drives their volunteerism. Articles begin on page 8.
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Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
Physician Co-editor Peter J. Dehnel, MD Physician Co-editor Thomas E. Kottke, MD Physician Co-editor Robert R. Neal, Jr., MD Physician Co-editor Richard R. Sturgeon, MD Medical Student Co-editor Zineb Alfath Medical Student Co-editor James Pathoulas Managing Editor Nancy K. Bauer Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Amber Kerrigan MetroDoctors (ISSN 1526-4262) is published quarterly by the Twin Cities Medical Society, Broadway Place East, Minnesota Medical Joint Services Organization, 3433 Broadway Street NE, Suite 187, Minneapolis, MN 55413. Periodical postage paid at St. Paul, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 2355 Fairview Ave, #139, Roseville, MN 55113. 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 reflect the official position of TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 2355 Fairview Ave, #139, Roseville, MN 55113. E-mail: nbauer@metrodoctors.com. For advertising rates and space reservations, contact: Betsy Pierre phone: (763) 295-5420 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 Nancy Bauer at (612) 623-2893.
Fall Index to Advertisers TCMS Officers
President: Sarah Traxler, MD, MSPH President-Elect: Zeke McKinney, MD, MHI, MPH Secretary: Cora Walsh, MD Treasurer: Alex Feng, MD, MBA Past President: Ryan Greiner, MD At-large: Matthew A. Hunt, MD
Advanced Brain & Body Clinic....................... 6 Advanced Brain & Body Clinic....................... 7 Children’s MN.................. Outside Back Cover COPIC..................................................................18 Crutchfield Dermatology...................................... Inside Front Cover
TCMS Executive Staff
Annie Krapek, MPH, CEO (612) 362-3715; akrapek@metrodoctors.com
Deaf & Hard of Hearing Services.................25
Nancy K. Bauer, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893; nbauer@metrodoctors.com
Edina Eye Clinic.................................................18
Kerry Hjelmgren, Executive Director, Honoring Choices Minnesota (612) 362-3704; khjelmgren@metrodoctors.com
MedCraft..............................................................11
Lakeview Clinic..................................................27 Minnesota Department of Health..................... Inside Back Cover
Lynn Betzold, Program Coordinator, Honoring Choices Minnesota (612) 362-3703; lbetzold@metrodoctors.com
Orthopedic Trauma Department, Regions Hospital....................................14
Lucy Faerber, MPH, Program Manager lfaerber@metrodoctors.com
Philando Castile Community Peace Garden..................25
Amber Kerrigan, Program Coordinator (612) 362-3706; akerrigan@metrodoctors.com
Physicians Wellness Collaborative.................25
Kate Feuling Porter, MPH, Senior Program Manager (612) 362-3724; kfeuling@metrodoctors.com
Superior Wealth Management Group........... 2 U.S. Army.............................................................26
You. We only have one thing on our mind. GJ Lempe – Steve Powers – John Soukup (952) 885-5605 Securities Offered Through LPL Financial, member FINRA / SIPC
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MetroDoctors
The Journal of the Twin Cities Medical Society
IN THIS ISSUE...
A Physician and an Advocate
T
his issue of MetroDoctors focuses on the roles and opportunities for physicians to be advocates within the community. The collection of essays submitted by our colleagues represent their activities, interests, and passion in optimizing the health of all. The privilege we have as physicians comes with a duty to serve. Our authors exemplify specific individual advocacy efforts that put our state on a path toward a more promising and equitable future for all. This issue highlights the experience of physicians who looked beyond their hospital or clinic to promote positive change, many following a framework laid out by Dr. Gigi Chawla: focusing on issues you are most passionate about, considering how advocacy can be something that recharges you, and utilizing your personal skills and professional training to translate the clinical context and patient priorities to others. The interactions in our clinic or hospital setting focus our attention on our patient and their loved ones. Interactions with the community outside the immediate care setting have additional meaningful health implications for our patients. As Dr. Djevi notes, physicians are seen as community leaders, and they play a key leadership role in shaping and influencing policy agendas for the betterment of society. Dr. Alex Feng shares, one is humbled by the roles we as physicians can play in public health and inspired by the meaningful changes we can influence. Other authors describe the need to listen to the community voices and the importance of collaboration and mentorship in advocacy. Another lists a benefit of participating in advocacy initiatives to reduce the threat of burnout. We are proud to feature the voices and experiences of physician advocates in our community and are excited to share the following voices in our reoccurring sections:
By Richard R. Sturgeon, MD and James Pathoulas, MS4 Members, MetroDoctors Editorial Board
MetroDoctors
The Journal of the Twin Cities Medical Society
Richard R. Sturgeon, MD
James Pathoulas, MS4
• Colleague Interview: Dr. David Hamlar’s informative interview describes his personal experiences of growing up Black, his training, and his ongoing commitment to serving the Black community. Note his answer about our responsibilities outside the exam room. • Environmental Health Task Force: Dr. David Hunter details his journey into retirement and the joy he’s found from volunteering his time. • And please note that MetroDoctors is featuring a new medical student page: Future Physician Leaders. In this issue, we hear how students are working with medical school leadership and others, to modify the medical school curriculum with a focus on antiracism and health equity. Changes to the admissions process and faculty development are also underway. Physician advocacy has been central to meaningful change in Minnesota. The authors in this issue share how they felt called to serve their community in a variety of ways including non-profit work, addressing health disparities, and serving in elected office. In doing so, they have improved the health and wellbeing of our state. We hope that you enjoy these personal essays and find inspiration to join your physician peers in advocacy. Fall 2021
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President’s Message
Building a New Kind of Medical Society sarah traxler, MD, MSPH
As we round the corner on 2021, I’m thinking about the work that lies ahead for TCMS as we reimagine ourselves and our role as a professional association. One thing is abundantly clear: none of us can realize our vision of healthy, whole communities if we continue with the status quo within our practices, our organizations, and health care at large. When we don’t have the right resources and the right environment to educate and influence behavior, even the best clinical care won’t help our patients achieve their best health. Our colleagues at the Physicians Wellness Collaborative often talk about moral injury as the “challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control.” Our healthcare systems continue to cause moral injury by creating mutually reinforcing cycles that result in poor health for our patients, and for ourselves as well. I’m afraid the soft approach won’t work if we plan to move forward at an accelerated pace to make real change. I’m sure all of you share my own clinical practice experiences, a combination of real rewards mixed with strong frustration. Frankly the system we have today places limitations on us as providers that force decisions we would never make on our own. You’ve shared so many of these stories with me over the past year, from discharging homeless patients who have no safe space to recover, to counseling others on the dangers of tobacco and sugary sodas, only to see advertisements for both flooding our neighborhoods. It’s time to do something dramatic. This fall we’ll transform TCMS into a medical society wholly focused on supporting and educating physician and medical student advocates, and providing physicians with opportunities to advocate for healthy, equitable and thriving communities beyond their clinic walls. We plan to make real change now by building momentum in several ways including: • Creating deeper relationships between our physicians and students so that your work can become even more impactful. • Advocating within our government to influence and shape healthcare policy and public health initiatives. • Working with other organizations to build a strong, common voice around our shared goals and vision for Minnesota’s communities. Like you, I became a physician because I wanted to help people live healthy lives. It’s time to change health care so that we can all return to our true calling as healers, not only within our practices but within our communities and the world. Stay tuned for more information as we continue to evolve here at TCMS. Rest assured, you’re going to be with us on this ride. Healthy communities can’t wait. We need your voice to make this change.
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MetroDoctors
The Journal of the Twin Cities Medical Society
TCMS IN ACTION Annie Krapek, MPH, CEO
A Conversation with TCMS’s New CEO, Annie Krapek, MPH
In this issue we talk to Annie Krapek, the newly announced CEO of Twin Cities Medical Society on her previous work in the organization, her plans now and in the future, and her sources of inspiration. Were there any life experiences that drove your choice of career? Did you plan to do something else first? Growing up, I always knew I wanted to find a career that helped others. I was a personal care attendant for children and young adults with intellectual disabilities through high school and college and based on that, I thought I’d become a special education teacher. Along the way, I realized that a career of individual level service wouldn’t be a sustainable career for me and decided to pursue a career where I could impact change at a larger scale. What was your professional experience before TCMS? After a very brief stint as a pre-school teacher I was incredibly fortunate to work as non-partisan staff at the Minnesota House of Representatives where I learned the ins and outs of the legislative process, which I put to work afterwards at the Minnesota Physical Therapy Association. I wanted to learn more about best practices in non-profit finances and governance, which led me to working at Propel for Nonprofits before coming to TCMS in 2016. I also learned a great deal through my past roles as a Board Member for myHealth for Teens and Young Adults and serving on Minneapolis’ Northern Metals Consent Decree Advisory Committee. MetroDoctors
What are the highlights of your work with TCMS before now? A highlight of not just my time with TCMS but my career has been working on the campaign to restrict the sale of menthol tobacco in Minneapolis. I learned how to create policy change that is equitable not just in its outcome, but also in its process. It’s also an absolute joy to build and lead our Public Health Advocacy Fellowship. Why did you accept the position of CEO? What excites you most about your new role? I am very excited to expand TCMS’s grassroots model to new public health issues, and to help create a new model for what a mission-driven medical association can look like. Honestly, a huge reason I accepted the job of CEO was because of our members. My work organizing physician advocates in dozens of cities across the state has made it clear that every doctor is a champion for health in their own right. Their passion inspires me, and I want to support and amplify their work as much as possible. As CEO, explain your immediate goals for the organization. We have a lot of work to do in the last quarter of 2021, not least of which will be launching a new brand identity for TCMS! Two other initiatives already underway include: • Implementing a new membership and fundraising strategy to sustain our work into the future. • Positioning TCMS as a trusted leader
The Journal of the Twin Cities Medical Society
for community partners and lawmakers ahead of the 2022 legislative session. If 2022 was a successful year in your eyes, what would be the organization’s biggest accomplishments? Obviously, the biggest “win” will be expanding our network of physician and medical student advocates throughout the state. We’ll see some real advancement in particular areas including: • Advancing our legislative priorities, including universal school meals. • Creating new partnerships with community organizations. • Providing new advocacy training opportunities for physicians and medical students. This certainly is not an exhaustive list. I’d also like to see us cement our position as advocacy leaders even more firmly within the medical student community. They are medicine’s future leaders, after all. As a leader, what value is most important to uphold? Relationships. Investing in deep, trusting relationships is the only way forward. Name three books you’ve read recently that have been impactful for you? Homegoing by Yaa Gyasi Leading from the Roots by Dr. Kathleen Allen Gratitude by Oliver Sacks
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Paid Editorial
Advocating for Patients with Treatment Resistant Depression, PTSD, and Anxiety The health and social upheaval caused by the pandemic has only exacerbated the mental health crisis and those who work in health care find themselves overwhelmed with more severe cases. That’s why a new clinic, Advanced Brain + Body Clinic (AB+BC), opened recently, specializing in severe depression, anxiety, and PTSD. Through the pandemic, we’ve seen less equitable access to healthcare treatments as lower income brackets were hit hardest with job losses. Working with patients and insurance providers alike, AB+BC’s goal is to make treatments accessible to all. AB+BC’s founding psychiatrists Dr. Stephen Manlove and Dr. Brian Johns have been long-time advocates and early adopters of the latest evidenced-based modalities to treat symptoms of depression, anxiety, and PTSD. Making TMS Accessible
As a pioneer in using transcranial magnetic stimulation (TMS) for the treatment of major depressive disorder, Dr. Manlove was instrumental in getting insurance companies to start covering this highly effective treatment that was FDA approved in 2008. TMS is a noninvasive, outpatient procedure using repetitive, pulsed magnetic fields similar to those in an MRI to stimulate the executive functioning center of the brain, which helps it transition out of the default mode network to stop repetitive, negative thoughts and improve symptoms of depression. Advancing the Use of Ketamine for Depression
Because suicide is the 2nd leading cause of death among people aged 10-34 in the U.S., medical professionals need to bring suicidal thoughts under control quickly. Luckily, powerful treatment options are now available. Dr. Johns performed the first study with a team of researchers at the Minneapolis VA to add a lowdose of ketamine, an anesthetic agent FDA approved in 1970, to outpatient regimens in patients whose
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symptoms of depression didn’t respond to numerous other medications or electroconvulsive therapy (ECT). After 92% of patients improved with only two weeks of treatment, Dr. Johns opened one of the first clinics in the region for treatment resistant depression (TRD) to offer ketamine covered by insurers. Soon after, Dr. Johns consulted with Jansen Pharmaceuticals in the development of Spravato (esketamine), which was FDA approved to treat depression in 2019, and suicidal thoughts in 2020. Both ketamine and esketamine work differently from any other medication for depression, causing rapid neuronal growth within hours of administration, resulting in immediate relief for some patients. AB+BC is the only independent clinic in the region that works with insurers to offer all four routes of ketamine administration plus Spravato and TMS to make these resources more widely available. The response to these services has been so overwhelming that the clinic has doubled in size in its first three months. According to the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study, people with depression who have failed four or more medications have less than a 10% chance of improving with another medication trial. These same people have a 70% chance of responding to ketamine, Spravato or TMS. That’s why the team at AB+BC advocates for innovative treatment options to help provide better outcomes. As part of this work, Dr. Manlove hosts a New Paradigms conference each year to spread awareness about depression, anxiety and PTSD, and the many new options that exist for these patients. You will see Dr. Manlove and Dr. Johns presenting in educational seminars on mental health in the Twin Cities area in their efforts to promote the use of these highly effective modalities, making them affordable for those who need them most. To learn how we can partner with you to help your patients, contact Candi Tucker at candi@advancedbrainbody.com or call 612-682-4912.
MetroDoctors
The Journal of the Twin Cities Medical Society
Physician Advocacy and Volunteerism
Colleague Interview: A Conversation with David Hamlar, Jr., MD, DDS
M
ajor General (bvt) RET David Hamlar, Jr., MD, DDS, attended Dental School at Howard University in Washington DC, aided by a scholarship from the National Health Service Corps. As a commissioned officer in the Public Health Service, he fulfilled a three-year commitment at various locations. He returned to school at The Ohio State University College of Medicine where he completed a residency in Otolaryngology and Head and Neck Surgery. It was during medical school that he joined the Ohio National Guard 121st FW initially as an MSC officer, then dentist, and subsequently a physician. A fellowship in Facial Plastics and Reconstructive Surgery brought him to the University of Minnesota. Eventually he transferred to the Minnesota Air National Guard. His military career has seen him hold several positions within the 133 Air Wing and Medical Group eventually gaining Command in 2001. In 2013 he became the State Air Surgeon. In 2014 he was promoted and assumed the position as the first African American Assistant Adjutant General for the Minnesota National Guard. Dr. Hamlar’s practice is based at the University of Minnesota Department of Otolaryngology/Head and Neck Surgery but takes him to several institutions across the Twin Cities where he treats patients afflicted with congenital anomalies, traumatic injuries, and cancer-caused deformities.
Has the practice of medicine for a Black physician, in terms of patient care, medical education, and diversity more broadly, changed since the start of your career? Tremendously and yet very little! Data supports that patients are more compliant when treated by caregivers who look like them. Thus, outcomes are improved. (https://bit.ly/JAMA_1999) Many of the physicians and dentist I frequented as a youth were in my neighborhood with private practices. We would go to their offices if not a “Black” hospital for care. Costs and overhead being what they are today have almost eliminated that possibility. The same can be said about a path toward medical education. Those and hosts of other factors have taken us out of the communities we wish to serve. However, there is intentionality to bring back these clinics. The Howard University College of Dentistry, an Historically Black University and College (HBCU) which I attended, has continued its mission to produce Black professionals. Cato Laurencin, MD, PhD, and supported by Montgomery Rice, MD, Dean of Morehouse School of Medicine, noted that there 8
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is an American Crisis finding Black males in medical school. (https://bit/ly/NBCI_2017) And in 2018, the AAMC noted the number of Blacks matriculating in medical school in 2014 are fewer than in 1978. (https://bit/ly/AAMC_2014) Therefore efforts have increased to correct that disparity as well as all who are underrepresented in medicine (URIM). Despite the Flexner Report’s calling for the removal of Black medical schools, they still remain the primary source of Black male physicians in the US. (https://bit.ly/Flexner_2011) Therefore, I have dedicated my career to administratively work to increase the number of students who are underrepresented in medicine.
Reflect on the advantages and disadvantages of attending a Historically Black College and University. I spoke to the HBCU Medical School issue above. That extends to the undergraduate level as that is where the majority of medical and dental students have applied. The advantages are immediate acceptance of your place at the institution, the familiarity, the warmth, and the understanding MetroDoctors
The Journal of the Twin Cities Medical Society
of circumstances. Having attended majority schools since high school this is a rare experience for most of our Black or other URIM populations. Often the professors have walked in their student’s shoes and are patient with their course of development or in certain aspects social needs and support. In contrast, when I attended Tufts University I was pledging a Black fraternity and my Dean of Students called me into his office fearing I had joined a cult. My PI of my research project at Ohio State thought the lack of Blacks in medicine was because we were “lazy.” You only have to look at private, parochial, and suburban public schools to see the lower percentage of future URIM candidates. Since graduation from Howard University I have amassed an extensive network of Black professionals who reach out to me, and I to them. I cannot say the same for my undergraduate and medical schools. The obvious disadvantage to attending an HBCU is money. That translates to resources for facilities and infrastructure, tuition and grant support, and of course salaries. Though access to government tuition programs exists, there are not the vast monetary reserves for student support from the schools themselves. I was just speaking to a graduate of Cheyney University, an HBCU in Pennsylvania, who is constantly struggling to keep its doors open. (https://cheyney.edu/)
What is different — good or bad — about practicing medicine for a Black physician? I would not say there is a difference; the connection we make with our patients is always rewarding. However, I would say I get comments from my Black patients that they are glad they have “someone who understands them,” or “looks like them.” Early in my career I used to hear, “I want to introduce you to my daughter!”
What drew you to practice in the Twin Cities? I came to the Twin Cities as a Fellow in Facial Plastics and Reconstructive Surgery at the University of Minnesota under Peter Hilger, MD in the Department of Otolaryngology and Head and Neck Surgery. After completing my fellowship, I immediately accepted their job offer and never left. I mention Dr. Hilger as he extended the opportunity to be his Fellow long before the Medical School was thinking about diversity and inclusion. In fact, at that time, I am not sure there were any other Fellows of color in the nation.
You’ve had a very successful career in the National Guard. What did you find attractive about service? What advice would you give a physician who is considering serving? The most attractive aspect is that they paid for my education. The military and specifically the National Guard has been MetroDoctors
The Journal of the Twin Cities Medical Society
and continues to be a tremendous influence in my life. I am old enough to have a Vietnam draft card and saw the unfair practice of sending Black and Brown young men to the front line while those I matriculated with at my white high school got deferments. Despite that, the meritocracy provides some semblance of fairness to ascend the leadership ladder. It is not perfect but there are persons to be held accountable. I would encourage anyone to join the military, not just the young. Our country would benefit from those already blessed with skills. But as I alluded, your education will be paid for if in training. In medicine we always talk about a life of service. Well… serving in the military is the ultimate. To this day I continue to serve as a retired general officer at the local and national level. The rewards for such a career are fulfilling.
How has your work in the military affected your approach to patient care in a civilian setting? To tell you the truth, my civilian trauma experience was more beneficial to the military. Having deployed six times, I was an asset not only as a surgeon but also as an instructor. As a Flight Surgeon we are considered Occupational Medicine physicians in the military. Of course it is more aligned with flying, but holistically I tend to consider the downstream effect of my interventions and what they may cause, than what I was trained to consider from my ENT training. Years ago, I also developed a pre-surgical checklist just as we did for flight planning and pre-flight. Those have now morphed into having briefs and time-outs. Overall patient care is patient care. The military has always used physician extenders, mainly physician assistants, which has also increased in our civilian practices. Maybe we should look to the military for innovation.
You continue to provide care in both the VA and community settings. Are there differences in the types of patients or problems you see? Patients at the VA are older, wiser, and loyal — which translates to compliant. I love hearing their stories which is a large part of their coming to see you in the first place. We need to give them that time. Yes, it cuts down on productivity, but it does help with outcomes. We are losing our WWII and Korean Vets; it is an honor to treat our “greatest generation.” Our Vietnam Vets faced many difficulties as well that may have some relationship to Otolaryngology. Same as the Gulf War and our Afghanistan and Iraqi Vets. We are now looking at Burn Pit Exposure that may be just as important as Agent Orange and Gulf War Syndrome.
(Continued on page 10)
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Physician Advocacy and Volunteerism Colleague Interview (Continued from page 9)
What do you find most rewarding in treating pediatric patients? Fortunately, a majority of the kids I have treated have facial deformities that could be corrected or at least improved. I was at a MN Wild game and a mom walked up to me with her 13-year-old son who I corrected coronal synostosis. Talk about rewarding! There are some cancer- and trauma-related deformities that encompass the entire family and you and your team are committed to the best outcome possible. But you have to be honest about the situation which hurts you as much as them.
You’ve had an interesting career — DDS, ENT, Major General, MN National Guard. What drives your passion? I would say the desire to learn combined with service. I usually joke about being a slow learner. But that is one of the characteristics we ask our medical applicants to demonstrate, “lifelong learning.” That was instilled in me from my mother and father. I was fortunate to have their support to try things, make mistakes, learn from them, and eventually make my way. The service part is easy. What else are we to do in life if it is not to serve others?
What responsibilities do physicians have to the community, outside of the exam room? That is all about service again. There is a saying that you should always leave a place better than you found it. That is colloquialism for whatever your responsibility is or was, improve upon it so those who follow on will be successful. Our communities are an example of that. There are many organizations that being a physician lends credibility to help in several different spaces, not just health care but that is an easy one to build upon. Be it at churches, the YMCA, Big Brothers, area high schools, or neighborhood clinics, having someone who looks like them can make a big difference in a child’s life. Especially one who has not seen what he can be. At this moment there is a significant blood shortage. This affects our entire metro, but it especially affects the Black community, and more specifically our sickle cell population. We are promoting blood drives at several of the facilities mentioned above. With the murder of George Floyd, one of my fraternities has created a liaison with the business community to improve many of the disparities that are so prevalent across our country, health care to name one.These are time commitments that do not register as RVU’s. This is an important issue. As an Assistant Professor at the University none of this work is credited toward 10
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productivity within your department. This work is usually left to the interested party where important advances can be attained but because it is not academic no credit is gained. Over the past years I have seen admissions criteria change, AOA is now invitational, so it is only a matter of time until promotion will be more inclusive.
You have served on the Board of Directors for several community organizations throughout your career. How has your experience as a physician prepared you to serve in these roles, and what skills did you have to develop to successfully serve as a board member? What advice would you give to a physician who is considering joining a Board of Directors for the first time? Currently I serve on four Boards of Directors, all non-profits, and Chair a capital campaign. Most Boards reach out to you for your network. I will be the first to admit my business acumen is not my strength. In fact, I was rejected from a CEO search because of that. Subject matter expertise is probably second. Then they may be looking for a niche that you cover. The obvious one is medical. But teaching may be a part of it as well. To help with my deficits I attended several prep courses that were not business schools. An example is BoardSource (https:// boardsource.org/board-support/training-education/). They give you the basics and you can apply them to your particular situation. If you are truly interested and have the time, then look into business schools, many of which are online. Two pieces of advice: don’t get in over your head and go where your passion drives you.
What role do you see for health professional associations that serve physicians of Color, such as the Minnesota Association of Black Physicians, in addressing racial health inequities and other pressing health issues? I am a meber of the Minnesota Association of Black Physicians (MABP). The organization has been around approximately 60 years and is an affiliate of the National Medical Association (NMA). It was formed when the AMA and its affiliates did not allow Black physicians membership. So, we had to form our own. Their mission was to provide care for the Black community since Black physicians were not allowed to practice in white hospitals. That is why we are committed to improving health care in our communities today. Things have changed but not enough. It is well documented how Minnesota has some of the worst healthcare disparities in the country. (https://bit.ly/MNCM_2020) So besides providing care we are advocating wide-ranging needs from getting tested for COVID-19, vaccine hesitancy, addressing food deserts, poor nutrition, chronic care and regular doctor visits, and volunteering for clinical studies. MetroDoctors
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A natural partner would be the majority medical organizations in the state. And I assume that is why Drs. Zeke McKinney, Nate Chomilo, Dionne Hart, and myself have been recruited. As I stated earlier, networks are important but so are many other entities such as medical organizations and insurers, in addition to the legislature.
What action should physicians who are not BIPOC take to rectify the health disparities that are present in our community? Stand up and admit the system is unfair. I personally see it as systemic racism and there should be an ICD-10 code for the effects it causes. But we do not have to agree on that. Like so many issues that lay before us, education, housing, employment, equitable policing, and of course health care are areas that need to be addressed. As a Black man I know my limitations. I can complain, bring ideas, seek funding, and on and on but unless they are accepted by non-BIPOC physicians we are standing in the same place.
My wife and I joke about the “epidemic” phrase. Unless you put yourself in another person’s shoes you will never know the realities they face. Years ago, crack cocaine started showing up in the suburbs and all the sudden there was a crisis, an “epidemic” and money was distributed to do something about it. There is no way one of our suburban communities would allow what goes on every day in North Minneapolis. Once again we can blame the people who live there but what resources do they have to fight it?
Please tell us about your personally financed scholarship program. Years ago, the University of Minnesota School of Medicine Admissions Committee dedicated funds for a scholarship in my name. Though I have not been able to consistently fund it, the scholarship is directed to an URM with a military background enrolling into medical school and applying for the scholarship. It was quite the honor for me and my family. Something I am very proud of.
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Fall 2021
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Physician Advocacy and Volunteerism
Listening to Learn and Learning to Listen
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he Minnesota Immigrant Health Alliance was formed in 2019 as a loose coalition of people concerned about the interactions between immigration detention and health. Since that time, my own engagement in the work has narrowed and become focused on solitary confinement in Minnesota jails, in particular those that hold contracts with Immigration and Customs Enforcement, or ICE. Solitary confinement is limited in international law by the UN Standard Minimum Rules for the Treatment of Prisoners, also known as the Nelson Mandela Rules. These rules limit the duration of solitary confinement, explain that it should only be used under very limited circumstances, and not be used in people with mental or physical health conditions or disabilities for whom solitary confinement would exacerbate those conditions. As one physician engaged in the work to reduce and ultimately, hopefully, eliminate the use of solitary confinement as a small piece of the larger pie of the ongoing justice work toward a world in which people’s needs are fulfilled and people’s rights are realized, I have focused on advocacy around this third platform; avoiding the use of solitary confinement for persons such as those with a history of torture, juveniles, and those with a history of severe persistent mental illness. I am an outsider in this work and acknowledge both lived experiences of community members and the incredible By Calla Brown, MD, MHR
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activism of those who have been doing this work for their whole lives, and whose family members have been doing this work for generations. I wrestle with privileged outsider status. I am a cisgender white woman with a US passport and a terminal degree. I do not have a personal history of incarceration. Furthermore, I work in community-based health, not in the carceral system. And yet, I feel very strongly that the immigration system intersects with our criminalization system, and with our ideas of class and gender and race and justice and punishment and crime. I view solitary confinement as the hidden magnifier that sits at the nexus — for example, a report from Minnesota’s Department of Corrections demonstrates the racial inequities in the use of solitary confinement in Minnesota’s prisons, with Black and Brown people who are incarcerated experiencing solitary confinement at much higher rates than their white counterparts.
The mentors who I have met along the way have been pivotal to my own development as a physician advocate, and even more so as a human being. To name a few: Alexandra Tamayo, who taught me that medicine and advocacy should be one and the same project. Jose Ramiro Cortes Argueta, who taught me that our past, while it informs our present, is not our destiny; we have the agency to build the world as a place that is good for our children and our communities. Val Rubin-Rashaad Crutcher, who taught me that seeing people as the sum of their vulnerabilities, as I or the system might perceive them, is a deep form of ignorance; communities are strong, but resources have not been fairly distributed. Mike Aylward and Taj Mustafa, who taught me that values are worth fighting for. Roli Dwivedi, who taught me that compassionate servant leadership, when practiced well in tranquil times, will set the stage for guiding the ship in times of crisis. This list is wildly incomplete. But what I have learned along the way is this: no one operates in a vacuum, and as physician advocates we have the responsibility to listen, step back, engage, and always hold space for the powerful activists who are moving the needle.
Calla Brown, MD, MHR practices Internal Medicine and Pediatrics at the Community University Health Care Center and is an Assistant Professor of Pediatrics, University of Minnesota. She can be reached at: brow3601@umn.edu.
MetroDoctors
The Journal of the Twin Cities Medical Society
Best Practices for Physicians Looking to Grow Their Advocacy Voice
A
s a primary care clinician, my daily work is advocacy. Advocacy looks like talking with an insurance company to get a patient their needed medication. Advocacy is partnering with social work to ensure that community resources are available for families to thrive. Advocacy is conversations that empower patients to overcome challenges. But, beyond one-onone patient encounters are many opportunities for advocacy. There are a few things to consider when becoming an advocate. The first consideration is WHAT to advocate for when there is so much that needs improving. Affordable health care, promoting equality for LGBTQIA+ and ending gun violence are just a few important topics. Reflect on what topic(s) need your particular ideas, voice, and support to advance. Consider that when you advocate from a personal experience, your voice will be heard differently. The second consideration is TIME. Work-life balance and provider burnout are real. During the pandemic, we affirmed the importance of family, small day-to-day interactions, and downtime. Recognize if advocacy feels like work to you and is contributing to burnout, or when it does the opposite and recharges you. Another consideration is HOW to advocate. Do you like structured opportunities like serving on a board? Are your strengths in leading and directing? Will you use social media to reach your audience? For example, if you can dance and teach at the same time, then TikTok is for you! A picture of yours could be worth a thousand words (and Instagram followers). Facebook can connect you to affinity groups and support multi-participant dialog. On LinkedIn and Twitter, you can share your academic and scientific views, reaching very different audiences. With these considerations in mind, here is where I spend my advocacy energy: 1. Leader role. Early childhood development, literacy, and dismantling structural racism are all personally motivating topics. As the Medical Director of the Minnesota chapter of Reach out and Read, I’m given an opportunity to pull these three facets together and elevate how the simplicity of reading and bonding can close the opportunity gap and lead to further desirable outcomes. I amplify my voice on social media in support of Reach out and Read Minnesota (other than By Pamela Gigi Chawla, MD, MHA MetroDoctors
The Journal of the Twin Cities Medical Society
TikTok…no dancing for me!) in a low-stress, positive way. Look for opportunities to lend your clinical voice to organizations centered on work you support. 2. Board work. The structured work of boards is personally fulfilling because I can see the progressive improvements made. I see the Minnesota Board of Medical Practice as an opportunity to impact the health of all Minnesotans by ensuring the collective care of high-quality, licensed clinicians. Check out the Minnesota Secretary of State website for open roles to get involved. I see the Minnesota chapter of the American Academy of Pediatrics as a venue that improves the care for kids by using our collective clinical expertise to influence. Explore opportunities in your field of clinical expertise to voice your experiences. 3. Supportive, educational pursuits. Health equity and mental health are personally important topics. As a person of color and a pediatrician, the disparity in childhood vaccination completion rates between white and Black children is top of mind. My motivation for mental health advocacy is close to home as my extended family has endured two suicides. I am fortunate to have venues to elevate these two topics in my workplace; educate the general population through blogs, articles, radio, and television; learn from experts in the field; and listen to lived experiences through community forums. When topics you advocate for are personal, they don’t feel like work. Clinicians have often left advocacy to public health professionals or to super-specialists. But, voices that translate the clinical context, understand patient priorities, and hold a trusted relationship with patients are needed, too. So, focus on a topic or two that is personally important and let your authentic voice be heard (with or without a TikTok dance). Pamela Gigi Chawla, MD, MHA, is vice president and chief of general pediatrics at Children’s Minnesota and medical director of Reach Out and Read Minnesota. Pamela.Chawla@childrensmn.org or Gigi.Chawla@childrensmn.org. Fall 2021
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Building Racial Equity into Health Policy
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e stand at a once in a lifetime nexus of enhanced societal awareness of our interconnection brought to us by the COVID-19 pandemic and a reawakening of how racism has created vastly different experiences, and opportunities, for us and our neighbors. This preexisting condition, that racism’s past and present legacy has and continues to structure our society, has largely been ignored by our medical institutions and healthcare systems. Instead of doing what they train us as physicians to do, diagnose and treat the underlying disease, they have been addressing only the symptoms. This has been laid bare with devastating effect during the COVID-19 pandemic. To move beyond treating only the symptoms of the illness that plagues our healthcare systems we must see the opportunity in front of us to explicitly build racial equity into our present, and establish a different path for future generations to follow. I believe due to the massive amount of disruption the COVID-19 pandemic created, health care is in a position to lead in how we build racial equity into the walls of our society. Instead of it continuing to be part of the wallpaper, something that is added on later, at a more convenient time. This will require a reimagination of how health care engages with community. Ideas to address structural inequity cannot continue to primarily come from those least directly impacted and those with the least amount to lose. We need to create a system where seeking community co-creation is seen as critical to success. It will help ensure more attention is paid to making the health system more antiracist instead of solely helping patients more efficiently navigate a system that produces racist outcomes. COVID-19 has demonstrated how, when necessary, we can move quickly to address a public health crisis. Racism is a public health crisis. Changing policy, and the environment it is created in, is one way we help the system become more likely to support that the right, antiracist decisions are being made. For me this experience has further demonstrated the need to incorporate community from the very beginning and has led to the framework for my first report as Medicaid medical director which will focus on how to build racial equity for US-born Black Minnesotans into our Medicaid agency. We have met with community leaders from the very beginning of the report development and will be guided By Nathan T. Chomilo, MD
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The Journal of the Twin Cities Medical Society
by community in the questions we ask and the solutions we will be proposing in the report. We also intend that these conversations are iterative and eventually that policy and budget proposals that come from my office will be informed through a similar process, utilizing the relationships and shared goals explored in establishing this report. Opportunity, whether it be economic, educational or health-related, has been tied to structural racism since the founding of our state and nation. The systems our children are raised in lead to gaps between children from different racial and economic backgrounds that start well before they are even in preschool. There is no way to advance family economic mobility, health, and well-being across generations if we do not first dismantle structural racism. To do that across our society we need a blueprint. Health care is an industry that is primed for the revolutionary work it will entail and in building racial equity into the walls of health care we can demonstrate how it can be done across the board. We can demonstrate, as Dr. Camara Jones reminds us that, “racism…saps the strength of the whole society through the waste of human resources,” and therefore realizing racial equity truly is in all of our best interest. Dr. Nathan T. Chomilo is the Medical Director for the State of Minnesota’s Medicaid & MinnesotaCare programs and practices as a General Pediatrician/Hospital Internist with Park Nicollet. He is currently also serving as the State of Minnesota’s COVID-19 vaccine equity director. He is an Adjunct Assistant Professor of Pediatrics at the University of Minnesota Medical School and is a co-founder of the organization Minnesota Doctors for Health Equity. His work has been recognized by the City of Minneapolis Department of Civil Rights which recognized him as a 2019 History Maker at Home recipient and Minnesota Physician which named him as one of the 100 most influential healthcare leaders in 2020. He lives in Minneapolis with his wife and son. He can be reached at: nathan.chomilo@gmail.com. Fall 2021
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Physician Advocacy and Volunteerism
Building Healthy and Sustainable Communities: Physicians’ Roles Outside of our Clinical Settings
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s an infectious diseases specialist from a resource-limited country, it has always been clear to me that preventing a disease is more cost effective than treating it later on. When I see patients in the hospital, I wonder what could have been done to prevent not only the human suffering surrounding illness, but also a costly hospitalization. This is why I look beyond the hospital to promote change wherever I can. For example, we know that flavored tobacco products are just the latest effort to get young people, especially of color, addicted to nicotine. Alongside community organizations, I advocated for the ban of the sale of flavored tobacco products to anyone younger than 21 years old within the city of Roseville. We are proud that the ban became a reality earlier this year. However, for this action to have the desired impact, it needs to be replicated in all cities across the state of Minnesota, and across the country. I urge other physicians to work with local community organizations to seek similar changes in their communities for the desired impact on prevention. For me, another area of focus is the role of government in creating the conditions that are favorable for the perpetuation of poverty in communities of color and the resulting disparities observed in healthcare outcomes. If the government has created these conditions, then the government can and should reverse them to correct the disparities. By M. Etienne Djevi, MD
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This is part of the reason why in 2017, I sought appointment to the Roseville Human Rights, Inclusion, and Engagement Commission. In March 2021, I became the chairperson of this commission. The HRIEC advocates for reversal of city government policies that perpetuate poverty. The COVID-19 pandemic has only confirmed the role of poverty in healthcare outcomes, and my hope is that my work with this commission will ultimately have a positive impact for those living in poverty and other underrepresented members of my community. The city is now using a systemic approach, looking at all of its functions and services through the lens of equity and diversity. The city contracted with an organization that is putting in place a strategic action plan to reverse policies that may contribute to the perpetuation of poverty. The city has also hired an equity and inclusion manager to continue this work going forward. Another effort our commission has recently undertaken is to recommend
to our city council the banning of conversion therapy within the city. The nefarious impact of conversion therapy on the mental health and self-esteem of young victims of such therapy is very clear. An ordinance is being drafted at this moment to ban the practice, and I hope that other physicians can advocate for similar local action. Another major area of concern for me is the relationship between police departments and communities of color. It is one of mistrust, with two seemingly mutually exclusive positions: You are either pro-Black Lives Matter and against police, or you are pro-police and against Black Lives Matter. In reality, these are not mutually exclusive and should not be. To bridge the gap, I have been cultivating a relationship with our local police department. About 10 months ago, Roseville started a Multicultural Advisory Committee (MAC) to have in-depth conversation with our PD to work toward fair policing. We are making some progress, bringing police and community together for better outcomes for all. Physicians are community leaders. We can play a key leadership role in shaping and influencing policy agendas for the betterment of society. Dr. M. Etienne Djevi was born, raised, and educated in Benin, West Africa. He moved to the US in 2006 and completed his internal medicine residency and ID fellowship at the U of M. He joined St. Paul Infectious Disease Associates in 2014.
MetroDoctors
The Journal of the Twin Cities Medical Society
Creating and Sustaining Healthy Communities
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hrough the Twin Cities Medical Society I have been fortunate to engage in a number of public health initiatives since medical school, most and foremost regarding tobacco. Smoking-related illnesses are responsible for hundreds of thousands of preventable deaths per year. Along with my peers, I have testified at city council hearings as well as at state committees and met with local and state representatives to help guide and influence policy development. I have given talks on how big tobacco, including e-cigarette companies, are targeting youth and marginalized communities through shady marketing tactics including utilizing candy-flavored products to attract young users. The wisdom and knowledge I have gained through this work has been indispensable for my personal and professional growth. By engaging closely with community leaders and organizers I have found friends and mentors who inspire and guide me. I learned that I can teach senators and representatives to make well-informed policy. I have a voice that I learned to articulate at legislative hearings. I have colleagues, friends, and institutions that support my endeavors. I am humbled by the roles we as physicians can play in public health and inspired by the meaningful changes we can influence. Our words and work are meaningful for the communities we serve. For instance, as physicians, we often see the medical sequelae of smoking at the clinic or hospital, often after decades of use: vascular diseases, lung cancer, COPD, the list goes on. Through grassroots organizing, I have collaborated with teachers, adolescents, teens, children, parents, and many others, all unified in our goal to create a healthier community to live in. They see the origins of smoking in the classrooms and at home, with their friends and peers. During the Minnesota Medical Association’s Day at the Capitol, I along with several others, testified at a state committee hearing on restricting the sale of flavored tobacco products, surrounded by community members, leaders, and my physician colleagues. Our presence
and narratives keep our government and leaders accountable. Together, we are able to create effective and meaningful public policy that will shape the health of current and future Minnesotans to come. Through my public health work, I have found new meaning and purpose that has strengthened my passion for clinical medicine. As a resident, I am constantly learning, discovering new skills, and finding vulnerabilities that allow me to create a more meaningful and therapeutic relationship with my patients and peers. Fortunately, those same skills are valued far beyond my work at the hospital. Alex Feng, MD, MBA is a PGY-4 interventional and diagnostic radiology resident at the University of Minnesota. He has been involved in both professional and public health advocacy since beginning medical school and has worked at the local, state, and national levels. He currently is a board member at the Twin Cities Medical Society and has served on several committees of the Minnesota Medical Association including chairing the organization’s political action committee MEDPAC. When he finishes residency, he hopes to practice and continue advocacy work here in Minnesota. Email: fengx098@umn.edu.
By Alex Feng, MD, MBA MetroDoctors
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MetroDoctors
The Journal of the Twin Cities Medical Society
Cross-Sector Collaboration: Physician Activism Within Community
I
am a cis-gendered, thin-bodied, white woman born and raised in New York, now living in Southwest Minneapolis. I am a mother, an adolescent medicine physician, a researcher, and an aspiring physician activist. My clinical work, research, and advocacy are deeply interconnected and focus on promoting the equitable delivery of adolescent health services for youth experiencing homelessness and other historically marginalized populations of young people. I work at the intersection of housing, education and health to facilitate cross-sector collaboration, dismantle systems of oppression, and center youth and community voice, drawing on the tenets of community-based participatory research and youth-participatory action research. My professional work is grounded in frameworks of positive youth development and trauma-informed practice, with the primary goal of promoting health equity for adolescents and young adults. My physician advocacy journey began as a pediatrics resident at the Mayo Clinic when a supportive mentor took me under her wing and welcomed me into a grassroots collaborative that was working to form a school-based health center at an alternative learning center in Rochester, MN. It was through this work that I had the great privilege of working with countless students who generously share their stories of resilience and triumph, often in the face of tremendous hardship and systematic oppression. It was both inspiring and heartbreaking — so many of the systems that were supposed to serve By Janna Gewirtz O’Brien, MD, MPH, FAAP MetroDoctors
them had failed them over and over again, further perpetuating the trauma and inequities they faced. It was also there — at the intersection of school and health — that I witnessed the power of a small but mighty interdisciplinary grassroots team with an immense “capacity for translating idealism into action,” as Charles Mayo put it. This formative experience, among others, led me to pursue adolescent medicine fellowship in the Leadership Education in Adolescent Health (LEAH) Interdisciplinary Fellowship Program at the University of Minnesota, as well as a Masters in Public Health focused on Public Health Administration and Policy. My identities and these personal and professional roots have been formative in my journey as an advocate and aspiring physician activist. I continue to work to expand models of care, such as school and shelter-based health care that meet young people and families where they are — in communities. I have also benefited from the support of several professional organizations that have cultivated my love of advocacy work. I currently serve on the Executive Board of the Minnesota Chapter of the American
The Journal of the Twin Cities Medical Society
Academy of Pediatrics, lead the Housing is Health Workgroup of Minnesota Doctors for Health Equity, serve on the Minnesota School-based Health Alliance and am an active member of the Society for Adolescent Health and Medicine. Through these professional communities of friends and colleagues, I have been able to find my voice as a physician activist, centering equity and the voices of young people in advocacy. In these roles, I have had the privilege of engaging in a range of advocacy efforts, including legislative advocacy at the state and national levels, collaborations with Minnesota Departments of Health and Education, institutional advocacy to improve the care we provide our patients, and community education on a range of child adolescent health concerns. As an early career physician and aspiring physician activist, I have found advocacy work both enriching and empowering. In clinical practice, we bear witness to inequities every day. As physicians, we hold immense privilege and, with it, comes the responsibility to dismantle these inequities and work toward meaningful transformation for a more equitable and just future for the children, youth, and families we serve. “For there is always light, if only we’re brave enough to see it, if only we’re brave enough to be it.” – Amanda Gorman Janna R. Gewirtz O’Brien, MD, MPH, FAAP is an Assistant Professor in the Department of Pediatrics at the University of Minnesota. She provides clinical care to adolescents and young adults at Hennepin Healthcare and to youth experiencing homelessness at The Bridge for Youth. Email: gewir007@umn.edu.
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Physician Advocacy and Volunteerism
Harm Reduction and Low Threshold Addiction Support
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y training in Internal Medicine and Pediatrics emphasized relationships, and that health is more than blood pressure and A1Cs. When working to improve health, I have learned that we must take into context the ways in which people live. Harm reduction is an evidence-based philosophy that takes the following into account: if we don’t meet someone where they are at in any given moment, we are just as likely to cause trauma as we are to help. For example, if I have a patient with insulin dependent diabetes, and I continue to increase insulin doses based on glucoses/A1Cs and miss that the patient has no refrigerator to store insulin, I could cause harm. It is within this framework that I strive to support individuals and communities. We stand on the shoulders of those who came before us. Who I am today and the type of medicine I practice is secondary to the wonderful mentors I have had over the past several years. My mentors, the housing crisis, the opioid epidemic, the COVID-19 pandemic, and now the illicit fentanyl crisis have taught me that it does not matter how smart or how nice your provider is. If you do not have the resources to get to clinic, “survive the waiting room,” and physically sit in front of your provider, most providers are not able to provide health care to you. Yet, people spend most of their lives, and hence the majority of their health, beyond the walls of healthcare centers and clinics. Prior to my experience supporting By Ryan Kelly, MD
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people living at the Wall of Forgotten Natives (the homeless encampment along the Hiawatha Greenway in 2018 and 2019), I felt powerless trying to support folks with the least resources. In addition, in my ignorance, I used to take for granted the number of things that need to go right for a patient to make it to a clinic appointment on time. If a patient has no phone to remind them of their appointment; if a patient needs to stay awake all night to protect their body, if a patient doesn’t have access to hygiene; if their ID was stolen while sleeping outside; making clinic appointments is not a priority — survival takes precedent. However, mentors at Southside Harm Reduction, Hennepin Healthcare For The Homeless, and others, have empowered me to learn to think outside the box. If there is any unseen benefit from the COVID-19 pandemic, the ability to use phone visits to increase access to health care has allowed me to reach those that face barriers physically getting to clinic. With the support of my clinic,
outreach workers who support folks who are un-housed carry with them the documents to register someone at the clinic (including ROIs, phone permission, etc). When they meet someone who is interested in support, the outreach worker can reach out to me via my cell phone. If I am available, I am able to open my laptop, and have the patient call me securely. Once on the phone with the patient, I am able to message a scheduler and get the patient registered and scheduled. By the time I am off the phone, I am able to schedule follow-up and send medications electronically. I have found that this has increased access to life saving medications, decreasing use, and decrease risk of overdose. Over time, this increases stability in one’s life, and eventually, many of the patients are able to make it to clinic for true in person medical care. Access to medications like suboxone and mental health medications are lifesaving, and we, the medical community, need to do whatever it takes to support our patients. Be it becoming familiar with the injection process to decrease risk of sepsis/ endocarditis, learning how to microdose illicit fentanyl users onto suboxone, or understanding that an “on the fly” phone visit is better than no visit, saves lives. Ryan Kelly, MD is an Internal Medicine and Pediatric physician, and practices both hospital medicine at the University of Minnesota Medical Center, and primary care, at the Community University Health Care Center. He practices medicine through the lens of harm reduction.
MetroDoctors
The Journal of the Twin Cities Medical Society
You Cannot Give to Others, That Which You Cannot Give to Yourself Physician, heal thyself. This statement received lip service during my medical training in the 1980s. However, with notable exceptions, self-care was not a high priority by faculty or preceptors. It is not that they did not care about their students, they simply mirrored their training of self-sacrifices for the good of the patients. To save patients’ lives at all personal cost. I completed training with excellent medical skills while being unprepared for the traumatic experiences encountered in practice: how to care for self. Memories of a tragic outcome in my practice stay with me today. Two years into rural practice, a 37-week pregnant patient presented in early labor. Labor continued quickly with no obvious problems except for the nagging thought, why early labor in a primiparous pregnancy? The baby, a little over seven pounds was born early afternoon looking normal in all respects. However, there were no sounds. Stimulation produced no reaction, and respiratory support was begun. Attempts to intubate the baby, showed a laryngeal web. Our anesthetist was called as an endotracheal tube was eventually placed and bagging begun. X-ray showed the baby to have anaplastic lungs with no chance of survival. Explaining the situation to the parents and placing the child on Mom’s chest was one of the hardest experiences I had as a young physician. Trying to help the parents work through their shock and grief required me to acknowledge my own emotional responses. Between grieving for the child and the parents came a flood of other thoughts. Fear — had I missed something? Did I do all I could during the resuscitation? How can I help the parents when I had difficulties looking them in the eye? How could I deliver any more babies with the fear that this might happen again? I experienced what is now described as the impostor syndrome. Reviewing the incident in my own mind, with the nursing staff and anesthetist, I was comfortable that all efforts were appropriate and timely. I had taught airway management in newborns in residency for the neonatal resuscitation course. The anesthetist reassured me multiple times that he could not have done any more than I did. My logical brain told me all of this was true. My emotional brain was still deeply troubled. I needed to somehow resolve my inner turmoil, heal thyself, while helping the parents
By Michael B. Koopmeiners, MD MetroDoctors
The Journal of the Twin Cities Medical Society
and involved staff heal. A friend sent me a quote from Fred Rogers, that encapsulated my dilemma, “Little by little we human beings are confronted with the situations that give us more and more clues that we aren’t perfect.” Confronted with my humanity, trained to be a perfectionist, how could I possibly move on? I sought out a trusted counselor, in secret. (Shame was also present). After several sessions, I realized that my philosophy of medicine was presenting the biggest challenge. I was trained to save lives at all personal cost. Here, despite excellent training, despite using that training well, a baby died. Was I focusing on the wrong approach? My personal approach to medicine, changed from preventing death, to maximizing living. I had fulfilled my personal goal for the baby, despite the sad outcome. There now was a framework to help the parents through their grief and ultimately parenting three other children. That philosophy framework also provided me with the ability for empathy, care, and compassion directed at self. It also gave me a new purpose, to pursue health and wellness for physicians in general. Several times during my career I pursued counseling during difficult times. I began working with Physicians Serving Physicians and with its new initiative Physicians Wellness Collaborative. By example I hope to show residents and young physicians, that acknowledging your humanity is health, as well as necessary, to be the best physician you can be. As the title says, you cannot give to others that which you cannot give to yourselves. I leave with a quote from Willian Olse, “Shut out all of your past except that which will help you weather your tomorrows.” Mike Koopmeiners, MD is a family practice physician, board-certified in addiction medicine and is currently serving as the Medical Director for Physicians Serving Physicians/Physicians Wellness Collaborative. He has a long history of volunteerism with PSP as a confidential peer mentor and leads the monthly substance use recovery meetings. Dr. Koopmeiners is available for individual or organizational consultation through PSP@metrodoctors.com or 612-362-3747. Fall 2021
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Physician Advocacy and Volunteerism
Physicians in Public Office:
Advocating for a Healthy, Thriving Minnesota
I
’m Kelly Morrison, a practicing OB-GYN and a legislator. I represent District 33B, which includes 10 communities in the west metro of Minneapolis. I’m currently serving my second term in the Minnesota State House. I’m also a sixth generation Minnesotan with deep roots in our state. Prior to serving in the state legislature, I was active in running my practice, and served on non-profit boards that advocate for women’s health, the literary arts, and eliminating racism. I ran for office in 2018 because as a Minnesotan, I was concerned about the vitriol I saw infecting our political discourse. And as a physician, I was increasingly aware of the skepticism of science that was creeping into our culture. I wanted to be a voice for constructive problem solving, science, and evidence-based policy making. I won my House race in a very purple district by narrow margins in both 2018 and 2020. Both races produced the only divided legislature in the nation with a Republican majority Senate and a DFL majority House. I’ve worked hard to engage my colleagues on both sides of the aisle in order to pass productive legislation and I’m proud that we’ve had some success in these hyper-partisan times. We crafted bipartisan compromise budgets over the past two bienniums that are good for our state. I prioritized legislation that protects and advances public health. I served on the bipartisan negotiating team to help get the nation-leading Alec Smith Emergency Insulin Act across the finish line. This landmark law will ensure Minnesotans can access affordable insulin if they face an emergency, with insulin manufacturers participating in the solution. In response to soaring prescription drug costs, I co-championed successful legislation to get tough on pharmacy benefit managers who drive up the price of medications. I also carried the Drug Price Transparency Act to improve drug pricing transparency and accountability. I continue to work on measures to lower the costs of prescription drugs so people can access the medicine they need to survive and thrive. Improving maternal and child health is critical, especially with the disparities we have in Minnesota. With that in mind, I carried legislation to expand MA coverage to 12 months postpartum from the current 60 days for new moms. I worked hard to finally get my bill to exempt providers of prenatal care from being By Rep. Kelly Morrison, MD
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mandatory reporters of women who use substances during their pregnancy passed into law. With substance use disorder surging, it is more important than ever to encourage women to get the care they need to ensure the best possible outcome for moms and babies. My bill to provide MA coverage for enhanced asthma care services for children also became law. And I was able to secure funding for tobacco prevention, which is key given the rise of e-cigarettes and vaping. I was also pleased to get the Minnesota Telehealth Act passed into law this year. Telehealth proved to be one of the silver linings of the pandemic in that it enabled patients to safely get the care they needed. Many patients discovered they liked the convenience, while saving them time and money. It will expand access to those without reliable internet in both urban and rural areas. It was an honor to carry and pass the new bipartisan law allowing Minnesota to join PSYPACT, an interstate compact that lets licensed psychologists practice telepsychology across state lines. We don’t have enough mental health providers to meet the need and this will help expand access for Minnesotans. It’s a tremendous honor to represent my district in the Minnesota House. It is enormously satisfying to be able to see the positive impacts of legislation on the lives of my patients. As the complexities of our challenges increase, we need more legislators with backgrounds in medicine and science. I encourage all physicians to engage in advocacy work and to consider running for public office themselves! Rep. Kelly Morrison, MD is serving her second term in the Minnesota House of Representatives, representing House District 33B, and has been a practicing OBGYN physician for almost two decades in Minneapolis. She lives in Deephaven with her husband John and three children. Phone: 651-296-4315. Email: rep.kelly.morrison@house.mn. MetroDoctors
The Journal of the Twin Cities Medical Society
Looking Within: Equity in Medical Education is Foundational Toward Achieving Health Equity “Colorblindness” was the pinnacle virtue when I went through medical training, and minimization of differences continues to dominate conversation when it comes to discussing diversity. You can still hear people saying things like “it doesn’t matter if you’re black, white or green…” or “it doesn’t matter if you’re a man or a woman...” or other such platitudes. If our gender, race, economic background, and other aspects of our personal identity “don’t matter” when it comes to learning and practicing medicine, then those things shouldn’t impact the way we’re treated by our supervisors, colleagues, or patients. But ask any female physician, or physician of color, how many times they were assumed not to be the physician — and compare that to the number of their white and male colleagues who experience that assumption — and you begin to see one of myriad ways that personal identity does affect our experiences. As I progressed through training and began my academic career, I was struck by how little people addressed this simple fact — that difference matters. Indeed, almost all of the conversations people were having about equity looked outside the walls of the institution. Of course addressing bias in patient communication, medical decision-making, and systems of care delivery are critically important, but I knew both from my lived experience and the literature, that a critical part of improving equity in care delivery was having diverse, inclusive, and equitable clinical learning environments. As a woman physician of color, many medical students and residents who shared By Taj Mustapha, MD
MetroDoctors
some aspect of that identity sought me out to discuss their experiences of navigating microaggressions from patients, colleagues, and supervisors, and asking for advice. I quickly realized that my personal toolkit wasn’t sufficient to meet all their needs. To be a better educator, I knew I had to delve deeper and learn more. I quickly learned that providing learners with individual coping skills and mitigation techniques was an incomplete solution. If I wished to address the issue, I needed to shine a light, invite others into problem-solving, and develop and disseminate a broader toolkit to advance culture-change in medicine. At its most basic, advocacy involves education, which is where I began. I educated myself by listening to learners and colleagues with open curiosity, and by reading the pertinent literature within medicine, and also in sociology, psychology, public health, public policy, and business. I am constantly learning still. By listening and exploring perspectives and scholarship outside of medicine, I have had the opportunity to expand my own toolkit. As I did so, I knew I needed to share those tools widely, and engage people in understanding why and when to use them.
The Journal of the Twin Cities Medical Society
As I engaged in advocating for equitable and inclusive clinical learning environments, I realized individual interactions alone would not bring about necessary change. I needed to develop my skills in public-speaking, in pre-emptively addressing common objections or concerns, and in being publicly vulnerable. Doing this work has given me insight into my own strengths and necessary development in order to be effective. It has also made me more comfortable in speaking up in all aspects of my work, when I think we could be doing things better. Equally importantly, engaging in advocacy for equity in medical education has made me more accepting of criticism and suggestions of how I could be a better physician, colleague, and educator. Sometimes advocacy is associated with being unyielding, but I have found just the opposite to be true. Advocating for equity has made me more open to different people’s stories and perspectives, and allowed me to grow in all aspects of my work. Dr. Taj Mustapha received her MD from the University of California San Francisco, and completed her combined Internal Medicine and Pediatrics residency training at the University of Minnesota. She is an Assistant Professor of Internal Medicine and Pediatrics at the University of Minnesota and serves as the Director of Clinical Coaching for the medical school as well as the Lead for Diversity, Equity and Inclusion in the Clinical Learning Environment for MHealth Fairview. Most recently, she was appointed to the H.O.P.E. Commission to help guide MHealth Fairview’s strategy in becoming an anti-racist multicultural institution. Email: must0035@umn.edu. Fall 2021
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Physician Advocacy and Volunteerism
The Invisible Tool in Our Black Bag
W
hat is advocacy anyways? When I think about the word advocacy, the first image that comes to mind is a suited-up lobbyist walking up the capitol steps, on their way to influence government decision-makers. Perhaps holding a fancy portfolio of some kind. Although direct advocacy with our legislators is certainly important, this narrow definition of what advocacy is fails to capture the many other forms we practice with our patients and communities. It also tends to negate the many voices of minority activists who have been historically barred from board rooms and other positions of influence in health care. Still, there is some comfort in unpacking the word as a linguist might. The word originates from the Latin advocatus — “one called to aid.” Considering the term in this most basic sense reminds us that our daily efforts in the clinic, hospital, and beyond fundamentally reflect acts of advocacy. I see these acts of caregiving and support every single day. There was the resident who spent an hour on hold with a county case manager to ensure our patient wouldn’t have to return to the same wasp-infested apartment that brought them to the hospital in the first place. My attending who made sure our patient with substance use disorder could access a local food shelf to address the
By Marvin So, MPH, MS4
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Fall 2021
vitamin deficiencies wrought by his illness. The nurse who led the charge to revamp our clinic’s paperwork to better accommodate our transgender and gender-nonconforming community. The medics brandishing milk of magnesia and gauze at last summer’s protests, righteous anger beneath each step. Taking this view, we can notice that advocacy is not only a “nice thing” for physicians to do — rather, it is central to the practice of high-quality, compassionate medicine. As a learner, I have observed just how beneficial these actions can be, complementary tools in our armamentarium of pharmacology and pathophysiology. Contemplating my role as a future physician through the prism of advocacy has also served as a potent salve against the forces of disengagement and burnout that touch far too many in our profession. Certainly, there
is room to bemoan the broken policies and systems that actively harm our fellow human beings. But advocacy gives us a pathway to channel those frustrations into light — an op-ed, a research proposal, a promise to do things differently with the next patient. So maybe it is time to revisit the image of what an advocate looks like. Beyond the capitol steps are exam rooms, hospital hallways, school board meetings, and city streets where decisions about patients’ lives are made every single day. We can show up there too. Sometimes as a clinical expert, other times as but a humble listener. Always as one who is called to aid. Marvin So, MPH, MS4 is a medical student at the University of Minnesota. Email: so000012@umn.edu.
MetroDoctors
The Journal of the Twin Cities Medical Society
Do your patients have trouble using the phone due to a hearing loss, speech or physical disability? The Telephone Equipment Distribution Program offers easier ways to use the phone. Phone: 800-657-3663 Email: dhs.dhhsd@state.mn.us Web: mn.gov/deaf-hard-of-hearing The Telephone Equipment Distribution Program is funded through the Department of Commerce – Telecommunications Access Minnesota (TAM) and administered by the Minnesota Department of Human Services.
MetroDoctors
The Journal of the Twin Cities Medical Society
grow Help grow peace by contributing to the future of the Philando Castile Community Peace Garden, a space for reflection, education, and unity for generations to come. DONATE AT philandocastile-peacegarden.org
Fall 2021
25
PRACTICE YOUR PASSION AS A U.S. ARMY PHYSICIAN
Physicians on the U.S. Army health care team support our Soldiers and their families. They take pride in the fact that their skills and experience will continue to grow, along with their nation’s gratitude. To learn more about the U.S. Army and Army Reserve health care team, call 502-314-6548, visit https://qrgo.page.link/U2dsi, or point your smart phone's camera at the QR code and click the pop up link to learn more about Army medicine today!
©2018. Paid for by the United States Army. All rights reserved.
Environmental Health— Reflections on Being a Volunteer
I
have been a physician. This was my purpose and my existence. It defined me. It was my joy and my inspiration. But, like all demanding professions, it was also my agony and the source of my fears of failure and inadequacy. I slowly retired into a new life that held concerns but also exciting possibilities. I had happy images of new projects and new knowledge. I joined the University of Minnesota Retirees Association and the very next week answered an urgent plea for people to assist with a University-sponsored meeting. I said “YES.” That’s all it took to take me on a new, unplanned and exhilarating trip into the life of a volunteer. One YES led to another, and then many more. I have been an “elderly” subject in scientific studies. I have packed leftover medical supplies for places in need. I have packaged food for the incredible team at Second Harvest and distributed free fresh vegetables in church parking lots. I assisted and judged young people in science programs at the University and the Bakken Museum. And now, together with my marvelous life-partner Janet, I help older adults to be able to stay in their homes by calling them for grocery orders through Help at Your Door; and I drive Meals on Wheels to inner city clients three times per week. I have joined committees and choirs. I have walked sacred water through the streets of St. Paul to support and celebrate the efforts of Native Americans
to oppose the Keystone XL tar sands oil pipeline that is being built through their homelands. I have helped people get vaccinated and vote. I have joined together with the talented and dedicated members of the Health Professionals for a Healthy Climate as we try to push forward a social agenda that will leave our descendants with a cleaner, healthier world. Once you learn the power of saying YES and stepping off into unknown spaces, the rewards are uncountable. Sometimes I use my medical
training but mostly I just use my body, empathy, and common sense and do the task at hand. And every step of the way I listen, watch, learn, and grow. Someday I may get to the projects that I was expecting to enjoy when I retired, but if I don’t it’s because of how much I’m enjoying myself. Dave Hunter, MD. Retired Interventional Radiologist, Professor Emeritus, U of MN. Email: hunte001@umn.edu.
Career oPPortunItIes
Lakeview Clinic has what you are looking for! Join an independent, physicianowned group of 50 providers in the SW Metro. Be a part of a collaborative work environment in a primary care group of family physicians, internists, pediatricians, general surgeons and OB/GYNs. • 4-day work week with 32 contact hours achieving excellent work/life balance • Excellent compensation with a 2-year partnership track to earn in the top 10% in the state • Outstanding benefits including 100% paid family health insurance and dental insurance, 401K and profit sharing • We have 4 sites in the southwest metro: Chaska, Waconia, Norwood, and Watertown
Due to retirements and growth, we are currently looking for: ◦ Internal Medicine
CONTACT: administration@lakeviewclinic.com PHONE: 952-442-4461 ext. 7215 WEB: www.lakeviewclinic.com
By Dave Hunter, MD
MetroDoctors
The Journal of the Twin Cities Medical Society
Fall 2021
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future
Physician Leaders
One Year Since George Floyd: Lessons Learned from the UMN Medical Education Reform Student Coalition (MERSC) After the murder of George Floyd by Minneapolis police, medical schools nationally began examining their curriculums through the lens of anti-racism and health equity.1 As first-year medical students, we identified numerous instances in our preclinical curriculum where content on health equity was either missing or not delivered through an antiracist framework. Our attempt to address this gap led to the creation of the University of Minnesota Kriti Prasad (UMN) Medical Education Reform Student Co(she/her) MS3 alition (MERSC). This student coalition, consisting of 30+ students and 20+ faculty and staff, has organized to advocate for meaningful and sustainable anti-racist changes at our medical school. MERSC was founded in May 2020 when several students drafted an open letter to the UMN medical school administration shortly after the murder of George Floyd. The letter, co-signed by 400+ students and alumni and 26+ student organizations, contained reflections on the magnitude of Floyd’s death and 11 action items centered on anti-racist changes to curriculum, admissions, community engagement, and faculty development. Curricular actions included integration of social medicine curricula, removal of race-based medicine, and inclusion of diverse standardized patients. Admissions action items focused on increasing admission and retention of Black, Indigenous, and people of color (BIPOC) students and faculty and increasing support for pipeline programs supporting BIPOC students. Community engagement requests focused on investing in existing outreach programs and increasing opportunities for student engagement with the local community. Finally, faculty development action items requested that faculty be provided with necessary background to adequately teach race-conscious medicine2 and the history of racism in medicine. Following the published letter, MERSC collaborated with faculty and administrators to establish 11 sub-committees for the 11 action items and maintain specific sub-goals and timelines. Over the last year, MERSC has continued monthly meetings with involved administrators and faculty members to share updates and develop strategies to better coordinate initiatives, identify spaces and resources for change, and sustain long-term momentum. While generations of UMN medical students and faculty have attempted to advance anti-racist curricular changes, MERSC has uniquely managed to capture the attention of powerful administrators at the medical school, coordinate student and faculty efforts under one umbrella coalition, and successfully implement initiatives to advance antiracism within the medical school education. We have asked ourselves: how so, and why now? 28
Fall 2021
Zarin I. Rahman (she/her) MS3
Alexandria Kristensen-Cabrera (she/her) MD-PhD student
Malavika Suresh (she/her) MS3
Our work revealed two key environmental catalysts that contributed to the drive and capacity for administrators to engage students in these efforts. First, the murder of George Floyd elucidated the impacts of structural racism on the Minneapolis community and thrust UMN into the national spotlight. The sociopolitical movement following Floyd’s death further applied pressure to the medical school to demonstrate active commitment to the development of sustainable anti-racist curricula. Second, the United States Medical Licensing Examination’s (USMLE) announcement of a pass/fail Step 1 exam concurrently created opportunities to incorporate non-Step 1 related curricula throughout the preclinical years, in accordance with student demands. Reflecting on these key institutional, local, and national catalysts allowed us to leverage our demands strategically and effectively. Within the coalition itself, we have operationalized strategies of successful grassroots organizations including iterative “power mapping” efforts, which helped us identify key stakeholders within and outside the medical school. We have also sought to maintain institutional knowledge, memory, and accountability through public exposure. Our public-facing website (https://tinyurl.com/ UMNmededreform) details MERSC’s demands, organizational structure, and ongoing progress toward antiracism. Additionally, it allows us to share our work with colleagues, patients, and communities. Ultimately, the collective efforts of MERSC alongside unprecedented calls for social justice in health care have sustained momentum in advancing equity in UMN medical school curricula and, importantly, remind us that students can and should be advocates of their own education. References: 1. Paul DW, Knight KR, Campbell A, Aronson L. Beyond a Moment – Reckoning with Our History and Embracing Antiracism in Medicine. New England Journal of Medicine. 2020;383(15):1404-1406. doi:10.1056/NEJMp2021812. 2. Cerdeña JP, Plaisime MV, Tsai J. From race-based to race-conscious medicine: how anti-racist uprisings call us to act. The Lancet. 2020;396(10257):11251128. doi:10.1016/S0140-6736(20)32076-6.
MetroDoctors
The Journal of the Twin Cities Medical Society
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