Local Physicians Look Toward the Future of Health Care
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Medical record
A Quarterly Publication
To provide news and opinion to support professional growth and personal connections within the Berks County Medical Society community.
Berks County Medical Society MEDICAL RECORD
D. Michael Baxter, MD, Editor
Editorial Board
D. Michael Baxter, MD
Lucy J. Cairns, MD
Daniel Forman, DO
Shannon Foster, MD
William Santoro, MD, FASAM, DABAM
Raymond Truex, MD, FACS, FAANS
T.j. Huckleberry, MPA
Berks County Medical Society Officers
William Santoro, MD, FASAM, DABAM President
Ankit Shah, MD President Elect
Daniel Forman, DO Treasurer
Jillian Ventuzelo, DO Immediate Past President
T. J. Huckleberry, MPA Executive Director
Berks County Medical Society
2669 Shillington Rd,, Suite 501 Sinking Spring, PA 19608 (610) 375-6555 (610) 375-6535 (FAX) Email: info@berkscms.org www.berkscms.org
The opinions expressed in these pages are those of the individual authors and not necessarily those of the Berks County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Berks County Medical Society.
Manuscripts offered for publication and other correspondence should be sent to 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501. The editorial board reserves the right to reject and/or alter submitted material before publication.
The Berks County Medical Record (ISSN #0736-7333) is published four times a year by the Berks County Medical Society, 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501. Subscription $50.00 per year. Periodicals postage paid at Reading, PA, and at additional mailing offices.
POSTMASTER: Please send address changes to the Berks County Medical Record, 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501.
12 Local Physicians Look Toward the Future of Health Care
Berks County Medical Society 1824 Club Part IV 20 The Power is in Tower –A Look at Tower Health’s Road to Recovery and Beyond
22 Penn State Health Predicts Bright Future in Berks County and Beyond
24 The Next Pandemic –Not If, But What and When
26 Advocacy Update
27 Message from the 2024 Outgoing PAMED President Kristen Sandel, MD
28 Over the Barbed Wire: Healthcare in the Za’atari Refugee Camp
30 Eye MDs Look to the Future of Ophthalmology
31 Summer 2025
Berks County Medical Society’s Pat Sharma President’s Scholarship
34 In Memoriam: Chris J. Beetel, MD Thaddeus J. Tomkeiwicz, MD
President’s Message
Compass Points 8 Editor’s Notes 17 Resident Rounds 18 Student Vital Signs
32 Community Anchors
Berks County Medical Society –BECOME A MEMBER TODAY! Go to our website at www. berkscms.org and click on “Join Now”
Content Submission: Medical Record magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Berks County Medical Society. Submissions can be photo(s), opinion piece or article. Typed manuscripts should be submitted as Word documents (8.5 x 11) and photos should be high resolution (300dpi at 100% size used in publication). Email your submission to info@berkscms.org for review by the Editorial Board. Thank YOU!
www.Hoffpubs.com
Santoro, MD, FASAM, DABAM Medical Director, Addiction Medicine Services, St. Luke’s University Health Network President
Reflecting on Two Remarkable Years
As my term as President of the Berks County Medical Society comes to a close, I find myself filled with gratitude for the opportunity to lead one of the oldest medical societies in the country during such a momentous time. The 200th anniversary of this esteemed organization was not only a celebration of our rich history but also a reminder of our ongoing responsibility to advance the practice of medicine in service to our community.
Over these two years, I have often reflected on the dual roles we play as physicians: healers of individuals and advocates for systemic change. For me, this has been most evident in my passion for treating patients with addiction. Addiction medicine is not just about treating a disease with a medication—it’s about restoring lives, healing families, and giving hope to those who often feel invisible and stigmatized. As our understanding of addiction grows, so too must our compassion and commitment to evidencebased care.
I am proud of the many events we hosted that brought us closer as an organization and strengthened our connection to the community. Our yearly Drug Take Back Day, coordinated with law enforcement and held at the Fightin’ Phils stadium, is vital in addressing the opioid crisis, providing a safe way to dispose of unused medications and prevent misuse.
The multiple journal clubs we held at the Peanut Bar and the Highlands fostered lively discussion and professional growth among our members. The yearly outing to the Fightin’ Phils baseball game gave us a chance to relax and bond outside of clinical settings. Proudly,
I got to throw out the first pitch, and did not bounce it to the catcher. The New York Yankees fans have been known to boo the President of the United States for doing that, so I was not going to chance it.
And of course, the 200th anniversary celebration held at the Drexel University College of Medicine West Reading campus was a highlight—a tribute to our legacy, but even more importantly, a vision for the future.
One of my favorite initiatives was the series of “Gorilla Events,” small intimate gatherings which reminded us that while we are physicians, we are also people with diverse passions. These small, enriching gatherings included a nature walk led by Dr. Lucy Cairins, who guided us on a bird-watching tour, an ice cream social where we shared stories and laughter over sweet treats, and a cooking class at the Wyomissing Restaurant and Bakery, where we learned to make sticky buns and Brazilian carrot cake. These moments of connection reaffirmed the importance of nurturing our interests outside of medicine. It is my hope that the “Gorilla Events” continues and expands.
Personally, I have worked to find balance and inspiration through my own passions: family, long-distance running, writing, and cooking. After 43 years with Reading HospitalTower Health System, I joined the St. Luke’s University Hospital Network to help create and expand Addiction Services while working less hours each week. My hope is that this move will allow me to devote more time to family and my outside passions while still creating a program that will outlast my time as a physician.
William
Running teaches me perseverance, the value of pacing myself, and the clarity that comes with stepping away from daily demands. Cooking, on the other hand, is my creative outlet—a way to connect with family and friends to celebrate the joy of the kitchen. Writing has always been an added way to reduce my stress level, and I hope I can get up the courage to publish a book of my stories.
These pursuits remind me that as much as we give to our patients, we must also nurture ourselves to remain effective and fulfilled.
The Berks County Medical Society has always been a beacon of collaboration, innovation, and resilience. I am proud of the strides we’ve made together, the journey we have travelled together, from supporting public health initiatives to fostering camaraderie among our members.
While I am stepping away from the presidency, I look forward to continuing to contribute to our shared mission in new ways.
To my colleagues, thank you for your support, dedication, and friendship. It took me many years to realize that joining organized medicine as a member and then serving in leadership was mutually beneficial. To the leaders who guided me through my time in office, thank you for sharing your wisdom and experience to help me grow and make my term in office easier and more successful. To our community, thank you for trusting us with your care.
This may be my final “President’s Message” for the Medical Record, but I assure you, it will not be the last time you hear from me. As I pass this baton to our next leader, Ankit Shah, MD, I am confident that the future of the Berks County Medical Society is bright and will remain bright.
Bill
William Santoro, MD, FASAM, DABAM
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RIP (Run in Peace)
T.J. Huckleberry, MPA Executive Director
“thank you”
It seems like from the first day I started as Berk County Medical Society’s Executive Director in 2015, I was asked by friends and family, “What do you do exactly?” And for basically the past decade, I have provided multiple answers. Depending on the year, the Board, or the circumstances, my job responsibilities seemed to vary.
When I placed an order last month for four dozen balloons for our 200 Year Anniversary Gala, I finally reached a moment of unprecedented professional clarity.
For those who remember the day of our anniversary event, the weather was somewhere between gale force winds and a Category 1 hurricane. When I stepped out of Party City with the balloons, the balloons and I nearly went airborne. As I was taking helium-filled right jabs to the face, I was thankfully able to get these $#&^@! balloons into the back of my car and safely to our venue at the Drexel Medical School. Unfortunately, these balloons became a tangled mess of strings.
Sitting in the middle of the Medical School Lobby, and under the watchful eye of a very interested security guard, I began to untangle this puzzle. It was an amazingly challenging, sometimes difficult, and thoroughly enjoyable exercise in patience! So much so that I lost track of time and was forced to leave the balloons half tangled and move on to other tasks.
When I returned, I was more than slightly surprised and a little saddened to see our President, Dr. Bill Santoro already in the same focused stance, mindlessly weaving strings up and over other balloons to untangle the remains of the great puzzle. It became clear that Bill was equally invested in getting the job done….and I was never going to get another crack at them!
Thankfully all balloons were untangled. They were beautifully placed throughout the lobby, and no one ever knew what an insane amount of time and mental stamina it took to get them there.
Which leads me back to my “moment of unprecedented professional clarity.” My role and duty as Executive Director is untangling balloons. In organized medicine, our Society’s role is to see the hurdles and issues facing physicians and to do our best to untangle them. Some are easier than others. Some demand time and patience. Others need more finesse than force. But in the end, nothing gets unraveled unless there is a partnership with the physician.
My job, like unraveling those balloons, was an amazingly challenging, sometimes difficult, and thoroughly enjoyable exercise in patience!
This leads me to the second part of what will be my last Compass Points article. As of January 1, 2025, I will be stepping down as your Executive Director. I am moving on to the Philadelphia Medical Society. My family and I will continue to live in Berks County, and I am committed to ensuring a smooth transition as I pass the balloons to the next lucky executive director!
In the meantime, I would like to respectfully leave you with three heartfelt closing points for our membership.
1. In 2025, the first priority of our medical society needs to be addressing and reaching out to our early career physicians, our residents, and our medical students. In short, we not only need to get younger members, but we need to grasp the values that drive these new physicians. The only way to gauge what the next decade of medicine will be is to engage those who will be at its forefront.
2. PLEASE read Bowling Alone by Robert Putnam. This book illustrates just how invaluable joining social and civic groups is to you and our community. We are steadily becoming a nation of islands where we can’t understand our neighbor because our focus is solely on ourselves. As physicians, you especially need more than just a routine of work and home; you need an outlet. You need opportunities like our 1824 club events where you can go out and blow off steam with colleagues and their families. If you don’t believe me…read Bowling Alone.
3. I cannot truly put into words just how much Berks County Medical Society means to me. The friendships and opportunities I have made while serving you have been invaluable. Waking up every day knowing I was working for the individuals whose sole goal and agenda is the health and well-being of others has been nothing short of inspiring. As I move on to untangle balloons in Philadelphia, my heart and appreciation will remain here in Berks County.
With all that said, I would like to close this article the same way I closed my first Compass Points article. A quote from the TV show, Parks and Recreation:
When we worked here together, we fought, scratched, and clawed to make people’s lives a tiny bit better. That’s what public service is all about, small incremental changes every day. Teddy Roosevelt once said, “Far and away the best prize that life has to offer is a chance to work hard at work worth doing.”
Adam J. Altman, MD
Angela Au Barbera, MD
Helga S. Barrett, OD
Jennifer H. Cho, OD, FAAO
Christine Gieringer, OD
David S. Goldberg, MD, FAAP
Marion J. Haligowski III, OD
Dawn Hornberger, OD, MS
Y. Katherine Hu, MD, MS
Lucinda A. Kauffman, OD, FAAO
Christina M. Lippe, MD
Barry C. Malloy, MD
Michael A. Malstrom, MD
Mehul H. Nagarsheth, MD
Abhishek K. Nemani, MD
Amy M. Olex, OD
Tapan P. Patel, MD, PhD
Jonathan D. Primack, MD
Kevin J. Shah, MD
Michael Smith, MD
Anastasia Traband, MD
Monica Wang, OD
Denis Wenders, OD
Linda A. Whitaker, OD, MS
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“Thank
“HISTORY IS NOT A BURDEN ON THE MEMORY BUT AN ILLUMINATION OF THE SOUL.”
by D. Michael Baxter, MD, FAAFP
2024 was quite a year, one that historians will dissect for generations. For the Berks County Medical Society (BCMS), it was also a memorable year, one marked by reflection and celebration. It was indeed an “illumination of the soul” as we explored the proud tradition of medical care in our community over the past 200 years. Through several events including our historical 1824 Journal Clubs, Berks History Center dinner, and finally our 200th Anniversary Celebration at the impressive Drexel University Medical School West Reading Campus, we transcended two centuries of proud history from our founding by Dr. Isaac Hiester and his peers to our new Drexel/Tower center of medical education and all of the promise that holds for our area.
The history of medicine is a fascinating story and the exploration of our own BCMS history has been equally engaging. From the efforts of our outstanding forebears, we can learn lessons that will help us navigate what will no doubt be a challenging future. And as we close out 2024, it is time to look ahead to those opportunities and challenges which lie before us. In this Winter 2025 edition of the Medical Record, we do just that with our cover story, “Local Physicians Look Toward the Future of Health Care” by area health writer Sue Shelly. These physicians offer their insights (and best guesses) regarding what we may face over the next decade, both opportunities and challenges. In addition, our local health systems, Penn State Health St. Joseph Medical Center
Lord Acton, 19th Century English historian, politician and writer
and Reading Hospital/Tower Health, provide us an update on their status and what they see ahead as they too navigate an uncertain future.
We can be optimistic about the possibilities already evident for tremendous advancements in the treatment of many chronic diseases, e.g., cardiovascular care, diabetes mellitus management, oncology therapies, and new developments in the treatment of neurologic and genetic diseases. However, we also realize that there will be great challenges, e.g., the role of artificial intelligence (AI) for better or worse, fiscal restraints on health care from financially strapped government bodies, as well as private insurers, and the uncertain impact of political forces and even climate change influences. Navigating these forces will require intelligent, wise and ethical decisions by leaders in many fields, including medicine.
In 1824, a group of physicians here in Berks County saw the value of joining together to share their knowledge, community awareness, and professional ideals which helped them circumvent the challenges that they faced then in a much different world. We can still learn from their example to maintain the skill, professionalism, and compassion that have long been the foundation of medical care. Let us embrace our proud legacy and look ahead with guidance from the four points of our BCMS “Compass”—Education/Knowledge, Advocacy, Professionalism, and Collegiality—that will help us navigate this future together.
Celebrating YEARS OF EXCELLENCE
200th Anniversary Celebration
November 8th, 2024
Drexel University College of Medicine
West Reading Campus
by D. Michael Baxter, MD, FAAFP
The Berks County Medical Society (BCMS) formally celebrated our 200th Anniversary at an evening ceremony, Friday, November 8th at the impressive setting of the Drexel University College of Medicine West Reading Campus. It was a delightful evening with music by a string trio from the Berks Sinfonietta, food and beverages by Bravo for Rose and much great socializing among a mix of the “old and new” in the Berks County Medical Community.
Evening events were opened with a welcome and reflections on our 200-year history by BCMS President, William Santoro, MD. Expressions of recognition for the 200 years of excellence and medical service provided by BCMS were made by Berks County Commissioners’ Chair, Christian Leinbach, and Reading Hospital President and CEO, Charles Barbera, MD.
In addition citations of recognition for the 200th Anniversary by the Pennsylvania Senate and House were presented by representatives of State Senator Judy Schwank and House member Johanny Cepeda-Freytiz.
A highlight of the evening included the presentation of the William Alexander, MD, Community Service Award to individuals who made outstanding contributions to our community efforts to overcome the COVID-19 Pandemic. While many individuals contributed their energy and talents, this group was seen as representative of these efforts:
Debra Powell, MD
Reading Hospital/Tower Health
For her selfless service and medical expertise COVID-19 Pandemi 2020—2023
Brian Gottschall, MPA, CEM Director of Emergency Services/ Berks County
For his dedication to the health and safety of our community COVID-19 Pandemic 2020--2023
David Mowery, Editor
David Mekeel, Senior Reporter
For Reading Eagle factual and thorough coverage COVID-19 Pandemic 2020--2023
Local Physicians Look Toward the Future of Health Care
by Susan Shelly
Members of the Berks County Medical Society (BCMS) spent much of 2024 looking back as they reflected on two centuries of growth and change while celebrating the 200th anniversary of the organization.
At the close of this anniversary year, BCMS has decided to change its focus and look to the future, speculating what the next 10 years might look like for the field of medicine and the health care industry, in general. While what is to come is uncertain, there is no doubt it will bring many changes—some welcomed and others met with skepticism and doubt.
Predicting the future of health care is not an easy task; however, some area physicians agreed to share their thoughts regarding the potential for breakthroughs in the prevention and treatment of major diseases, the impact of artificial intelligence (AI) in health care, the biggest challenges facing the health care industry, and other issues with the potential to affect patient care, how physicians work, and the economics of the industry.
Responding to questions posed by Medical Record editor Dr. D. Michael Baxter were Dr. Ankit Shah, emergency medicine physician, clinical informaticist, and president-elect of the Berks County Medical Society, Dr. Shannon Foster, an acute care surgeon and owner of an independent consulting firm, and Dr. Anthony Donato, an internal medicine physician and vice chair of the Department of Medicine at Reading Hospital/Tower Health. Also participating were Dr. Priyanka Raju, a member of the Reading Hospital Obstetrics and Gynecology residency program, Dr. Karen Wang, chief medical officer at the Berks Community Health Center, and Dr. Kristen Sandel, an emergency department physician and past president of the Pennsylvania Medical Society and the Berks County Medical Society.
Here are some of their responses to questions regarding the field of medicine over the next decade.
What do you see as major challenges facing the practice of medicine over the next decade, and do you feel that physicians will be able to prepare and respond proactively to those challenges?
Answers to these questions varied significantly, with doctors citing major challenges including staffing, high costs for tools needed to implement precision medicine and artificial intelligence (AI), fragmentation of the health care system, scope of practice challenges, and mergers of health care systems that result in hospital closings.
Other challenges noted were data security and patient privacy, disparities in access to advanced medical technologies, strain and burnout among the medical workforce, lack of resources, public skepticism regarding medical science, and a shortage of health care professionals to treat all patients.
As for the ability for physicians to prepare for these challenges and respond proactively, most of the replies were skeptical.
Sandel said she believes doctors recently have accomplished small steps toward being more proactive, but that serious challenges coming at physicians from many directions make it difficult.
“We have been forced to react to these pressing challenges rather than be strategic in our initiatives to move medicine forward from a physician perspective,” Sandel wrote in an email.
Raju said the response of physicians to the challenges facing them will depend on the collective efforts of government, health care organizations, academia, and developers of technology.
“While we have the tools and knowledge to respond proactively, our readiness to do so is uneven and policy level change is often slow and disjointed,” she replied. “Key barriers include fragmented health care systems, competing policy priorities, and insufficient collaboration between stakeholders.”
What forces do you feel will have the greatest negative effect on the practice of medicine in the future,
and how
will those forces affect physician work
satisfaction?
Again, answers to these questions were varied.
Shah cited lagging reimbursements and public distrust in the medical field as forces with the greatest negative impact, but added that lack of work-life balance, pressure to do more with less, and less money for each unit of time worked also negatively affect physician work satisfaction. All those factors have caused morale among physicians to plummet and placed health care in general in a precarious position in the coming years, he said.
“We can get through this, but the system will need to be fundamentally altered to help us survive and succeed for the next century,” Shah said. “Our current system is just not sustainable as it is.”
Other respondents said administrative burden, health care costs, workforce shortages, lack of work-life balance, and competing priorities for doctors are some of the forces that will have the greatest negative effect. Nearly everyone said work satisfaction among physicians is low and things will need to change for it to improve.
A notable response came from Donato, who wrote that “physician work satisfaction is exactly what one makes it.”
He acknowledged that the current speed of change within the profession is having an unsettling effect on many who work within it, resulting in uncertainty and the potential for lowered work satisfaction. However, he said, the satisfaction of treating patients keeps him on track and well satisfied with his work.
“The core of this profession—the ability to use your gifts and skills to abate suffering of others—will always be there,” Donato wrote. “And if that is why you are in practice, you will never be dissatisfied.”
Local Physicians Look Toward the Future of Health Care
continued from page 13
How might the consolidation of health care systems affect practice options and job satisfaction for physicians?
Addressing the issue of consolidation in the health care market, our respondents predicted they will have fewer practice options as independent practices and smaller health care organizations are absorbed into larger systems.
Foster said physicians are already experiencing fewer practice options as they are pressured to switch to large group or hospital/ health system-based employment models. That consolidation affects access and availability of physicians in certain environments, with patients in rural, safety net, or limited coverage areas most affected.
Meanwhile, Foster noted, the number of health care administrators has risen dramatically, a sign that health care operates as a business, not a physician-driven system of care.
Most doctors responding to Baxter’s questions predicted that continuing consolidation will result in less job satisfaction, but Raju expressed that it is likely to have both negative and positive effects.
Consolidation, she asserted, could lead to greater financial stability with access to better technologies and support services, interdisciplinary collaboration opportunities, and reduced administrative and financial responsibility.
“Ultimately, the impact on job satisfaction will vary based on individual preferences and the policies of the health care systems,” Raju said.
What do you expect will be the impact of Artificial Intelligence (AI) on medical practice and patient care? Both positive and
negative?
While many of those responding to Baxter’s question about AI said they believe it has the capacity to dramatically move health care forward, some expressed reservations.
Donato indicated concerns regarding algorithmic bias that could potentially compound inequities that already exist within the field of health care.
“Artificial intelligence can only learn from available data sets, and if those data sets have biases, so will its answers,” Donato said. “We will have to be on guard for biases and correct them when found.”
On a positive note, Donato expressed optimism for the role of AI in the development of drug discovery and testing and in the area of genomic analysis to help identify patterns, make predictions, and classify genetic variations based on training from large data sets.
Wang views an upside of AI as enabling physicians to more fully focus on patients, as listening and charting tools record conversation and create office notes, eliminating the need for providers to enter patient information on a computer during office visits.
“This has the promise of letting us step away from the keyboard and potentially focus more on the patient in the room,” she wrote.
Shah predicted AI will be valuable in charting medical discoveries and keeping providers informed about rapidly changing guidelines they must adhere to. He also is hopeful AI will alleviate the need for
physicians to attend to tasks such as ordering refills for medications and dealing with hurdles connected to prior authorization.
“AI can and will be a huge help,” Shah said.
Do you anticipate significant breakthroughs in the prevention and treatment of major chronic diseases over the next decade? Do you think that patient care will improve, and if so, will that improvement impact all patients, or just some?
Everyone who responded to this question expressed optimism regarding medical breakthroughs in the prevention and treatment of major chronic diseases such as cardiovascular disease, including stroke; diabetes; dementia; various forms of cancer; and others.
Those breakthroughs, according to Raju, will be largely driven by advancements in precision medicine, genomics, and biotechnology. Wearable health monitors can provide early detection of stroke and cardiovascular diseases, while AI-driven risk assessment tools can improve prevention.
Her greatest area of optimism, however, is the advances being made in the areas of cancer and diabetes. She praised immunotherapy, which she said has transformed treatment for several cancers and will likely become more personalized and effective as understanding of tumor biology deepens. And, she noted, patients with diabetes will greatly benefit from innovations in glucose monitoring, automated insulin delivery systems, and regenerative therapies such as beta-cell replacement.
“These could revolutionize disease management and potentially lead to functional cures,” Raju said.
Sandel said that while a tremendous amount of work is being done to improve the care of chronic diseases, more work is needed to find solutions that are cost effective and available for all patients.
“This is a journey, not a destination,” she said. “An emphasis on preventative health care, especially in the areas of obesity and chronic diseases, will improve the overall health and life expectancy in the population as a whole.”
Wang is hopeful that creative use of technology, such as remote monitoring and telemedicine, can improve care for all patients, but feels that health care disparities are likely to widen if significant steps are not taken to address them.
She said it will be important to work on public policy that addresses issues such as food and housing insecurity and access to high quality primary care and medications if the needs of all communities are to be addressed. And, Wang noted, work toward increasing the diversity of health care providers must continue.
“Working to make our physician and advanced practice provider workforce more diverse will help us better serve our patients,” she said.
As economic and practice pressures on physicians increase, what do you think their best responses might be? Is there a role for medical societies and perhaps even physician unions to provide support to physicians as they face such challenges?
Health care is a very complicated arena, Foster observed, and those in it who hope to thrive must learn to navigate the complex system. Physicians can try to influence industry policy by taking on management positions, Foster suggested, and by being aware of and actively participating in all aspects of the larger field of health care.
“We need to force the conversation about how issues such as job descriptions, non-compete eradication, and the standard of care should be set by front-line care providers—not the insurers, legal community, or management,” she said.
Raju agreed, saying it is important for physicians to engage in advocacy efforts at institution and government levels to influence health care policies and reduce administrative burdens, promote fair compensation, and prioritize patient care over profit.
Respondents’ thoughts regarding medical societies and physician unions were a mixed bag. Sandel said that medical societies play an integral role in supporting physicians by helping to find practice environments that are favorable to them.
Shah observed that medical societies are struggling and will need to work on engaging younger members who may not live in the communities in which they practice.
“Medical societies need to adapt or will face extinction,” he said.
Regarding physician unions, Shah said they could be beneficial by amplifying the voices of members, but expressed reservations that patient care could be negatively affected by strikes or other actions.
Donato also was uncertain about the value of physician unions but believes that medical societies will continue to be valuable to providers.
“I believe organizations such as local and state medical societies will have an important voice to carry forward to legislators to help guide future rules that will improve the health of all who work in the medical field, as well as benefit our patients,” Donato said.
Editor’s Note: Indeed, as these physicians describe, there is a great deal of uncertainty facing us over the next decade and beyond— challenges that will require scientific, ethical, professional, fiscal, and political responses, some which we may not yet have foreseen. One clear point they emphasize is that physicians must fully engage in these efforts for the preservation of our profession and for the wellbeing of our patients. If you have thoughts on this topic, feel free to send them to the Medical Record: www.berkscms.org and click on “contact” for possible inclusion in a future edition.
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TBerks County Medical Society 1824 CLUB PART IV
he final 1824 Journal Club of 2024 was held on November 21st at the Peanut Bar in Reading. The topics covered key medical developments in the years 1960-2000, including several landmark articles which have had a most significant impact on the practice of medicine.
Berks County Medical Society Journal Clubs will continue in 2025 with a focus on the most significant and provocative topics. Stay tuned for timely updates.
The November topics included:
The Epidemic of Addiction in America (1960-2000)
Olapeju Simoyan, MD (and William Santoro, MD)
The Epidemiologic Detective Work that Solved the Mysterious Illness and Deaths of “Legionnaires” in Philadelphia in 1976. (MMWR, January 18, 1977: “Special Issue of Epidemiologic Notes And Reports Follow-up on Respiratory Illness–Philadelphia”)
Michael Baxter, MD
The Tragedy and Triumph of AIDS (1981-2000)
(MMWR, June 5, 1981: “Pneumocystis Pneumonia—Los Angeles”)
Debra Powell, MD
Advances in Gastroenterology Including the Discovery that an Infectious Bacteria was an Etiology for Peptic Ulcer Disease (The Lancet, June 4, 1983: “Unidentified Curved Bacilli on Gastric Epithelium in Active Chronic Gastritis.” Warren and Marshall.)
Seth Rosenzweig, MD
From the ER to the ED: Advances in Emergency Medicine 1960—2000
Ankit Shah, MD
Advances in Cardiology: Cardiac Catheterization, Bypass, Transplants and more
Nicola Bitetto, MD
The ACE (Adverse Childhood Experiences) Study and Its Impact on The Epidemiology of Leading Causes of Death in Adults (American Journal of Public Health, May, 1998: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults)
Michael Baxter, MD
MResident Rounds: Hobbies, Doctors, and Shattered Glass
by Deba Osaghae, MD, MPH, Internal Medicine Resident, Tower Health/Reading Hospital
ost of my high school years have faded from memory, but some moments still stand out vividly. One of these is from my senior physics class, where my teacher demonstrated the concept of thermal stress. He held up a glass cup and explained that if you poured hot water into it, the inner part of the glass would expand faster than the outer part. This uneven expansion would create stress, eventually causing the glass to crack and break.
Recently, a conversation with a friend reminded me of that physics lesson. She’s an internal medicine intern in New York and described what she called her “triangle pattern” of living; a routine of moving between work, home, and the library. This pattern had helped her stay focused through her studies and previous training, but now, with more responsibilities, she felt her life was becoming monotonous and unfulfilling. As she spoke, I pictured her as that glass cup, holding in intense pressures that could lead to a breaking point.
I shared this analogy with her, and we came to a realization; she needed an outlet. Just as steam escaping might relieve stress on a glass, a hobby might help her release some of her tension and avoid burnout.
The value of hobbies is backed by research. MerriamWebster defines a hobby as “a pursuit outside one’s regular occupation engaged in especially for relaxation.” Engaging in hobbies has been shown to help people de-stress, as one study in the Journal of the American Art Therapy Association found; participants had significantly lower cortisol levels (a marker of stress) after leisure-based art activities. Similarly, a large study of nearly 100,000 adults across 16 countries found that people who pursued hobbies reported greater life satisfaction, happiness, and better health, along with fewer symptoms of depression.
The National Institutes of Health (NIH) estimates that 9.5% of American adults will experience depression each year, and for some, this can lead to severe outcomes. Perhaps hobbies are a missing link, a simple practice that could help alleviate the pressures of modern life and prevent years of unhappiness.
Doctors are more vulnerable to depression than the general population, likely due to the high levels of stress they face in their work environments. According to the CDC, mental health issues among healthcare workers have increased between 2018 and 2022. Therefore, incorporating regular stress-relief activities could be highly beneficial for physicians and other healthcare workers.
Not long after our conversation, my friend sent me a picture of herself dressed for her first barre class, smiling wider than I’d ever seen. “Best decision ever!” she captioned it. It was a beautiful moment; I knew she’d found her escape. For now, the pressures she feels may be more manageable, and she’s less likely to break.
References
1. Hobby Definition & Meaning - Merriam-Webster [Internet]. [cited 2024 Nov 12]. Available from: https://www.merriam-webster.com/dictionary/hobby
2. Kaimal G, Ray K, Muniz J. Reduction of Cortisol Levels and Participants’ Responses Following Art Making. Art Ther. 2016 May 23;33(2):74.
3. Fancourt D, Noguchi T, Bone JK, Wels J, Gao Q, Kondo K, et al. Moderating effect of country-level health determinants on the association between hobby engagement and mental health: cross-cohort multi-level models, meta-analyses, and meta-regressions. Lancet Lond Engl. 2023 Nov;402 Suppl 1:S41.
4. Mental Health Disorder Statistics [Internet]. 2024 [cited 2024 Nov 12]. Available from: https://www.hopkinsmedicine.org/health/wellness-andprevention/mental-health-disorder-statistics
5. Hobby Definition & Meaning - Merriam-Webster [Internet]. [cited 2024 Nov 12]. Available from: https://www.merriam-webster.com/dictionary/hobby
6. Outhoff K. Depression in doctors: A bitter pill to swallow. South Afr Fam Pract. 2019 May 15;61(sup1):S11–4.
Student Vital Signs
ALooking Ahead: Medicine in the Next Decade
by Amogh Nagol MS ll, Drexel University College of Medicine West Reading Campus
s a medical student, I often reflect on the incredible changes we are witnessing in healthcare today and ponder what the next decade will bring. The journey through medical school provides a unique perspective—we see the challenges and opportunities emerging in real time, both in classrooms and in clinical settings. Looking ahead, three significant shifts stand out, shaping not only how we practice medicine but also how we prepare for it.
Technology is revolutionizing the way we learn and deliver care. Artificial intelligence (AI) is no longer just a concept; it is already assisting in diagnosing diseases and predicting patient outcomes. As students, we are introduced to tools like advanced imaging software and telemedicine platforms, which are redefining patient interactions. Telemedicine, in particular, has demonstrated its value in increasing access to care for underserved communities.
Yet, these advancements raise questions: How do we maintain empathy in a digital age? How do we ensure all patients benefit from these innovations, regardless of socioeconomic status? Medical students and physicians alike must advocate for the ethical and equitable use of these tools, ensuring technology enhances rather than replaces the human touch in medicine.
From lectures on the impact of socioeconomic status on health, to the rising prevalence of chronic diseases like diabetes, it is clear that the next decade will demand a shift toward preventative care. As students, we see the impact of social determinants of health during clinical rotations, where patients’ environments and lifestyles profoundly influence outcomes. Addressing these issues will require more than individual action—systemic change and interdisciplinary collaboration are essential.
Physicians and future physicians must work together to champion public health initiatives. Whether advocating for vaccine access or tackling health inequities, our role extends beyond the clinic into policy and community engagement.
The changes ahead are profound, but they are not insurmountable. As medical students, we are learning not just the science of medicine but also the importance of collaboration. By working together, sharing knowledge, and advocating for our patients, we can shape a future where medicine continues to advance without losing its humanity.
Looking ahead, I am inspired by the resilience and determination of the medical community. Together, we can face the challenges of the next decade and build a healthcare system that is innovative, equitable, and compassionate.
IThe Possibilities, Probabilities, and The In-Between
by Peter Aziz MS ll, Drexel University College of Medicine West Reading Campus
am tasked with writing about “looking ahead at the next 10 years of healthcare and the relevant foreseen changes, for better or worse.” Frankly, I have no idea how to expand on this prompt, especially considering the current political and global turmoil.
As medical students, we are often taught to embrace the “unknown.” This comfort with uncertainty forms the foundation of the concept of differential diagnoses, where a list of potential diagnoses is developed, each correlating with the constellation of symptoms presented. The medical toolbox is then utilized to assess and adjust this list, moving diagnoses up or down based on findings. In essence, we are being trained to start with the unknown, generate possible explanations, and then evaluate evidence—or the lack thereof—to identify the most probable diagnosis.
I find myself applying this principle of comfort with uncertainty not only during patient encounters but also when contemplating the trajectory of my medical career. There are countless unknowns that my colleagues and I must accept: board exams, residency placements, and numerous other variables that could disrupt our plans. If it is challenging to envision a clear future for the few undifferentiated stem cells that are us medical students, then forecasting the future of the entire body that is our healthcare system is an even greater challenge. Yet, even if predicting the trajectory of healthcare is difficult, there must be possibilities, probabilities, and something in between.
In treating diseases, “empiric treatment” is based on extensive evidence of efficacy without a definitive diagnosis—just a probable one. Once again, physicians operate with an element of the unknown, using tools that the medical community has collectively deemed effective. These treatments are guided by a history of benefits outweighing risks, supported by a shared wealth of experiences. Similarly, a unified front among medical practitioners will likely drive the evolution of healthcare in the years to come, particularly when the realm of policy can potentially hinder rather than help our efforts. In the next 10 years, it is very possible, as has been the case historically, that our healthcare system may not always put the patient first. However, a unified medical community that advocates for the patient above all else can significantly counter this possibility, preventing it from becoming a high probability. At the same time, scientific advances—such as breakthrough treatments, artificial intelligence, robotic surgeries, and innovations across medical subspecialties—will help push upcoming changes for the better. One can hope for a positive trajectory for our healthcare system and that changes will lead to improvements, but uncertainty is also okay.
POWER
is in
A LOOK AT TOWER HEALTH’S ROAD TO
AND BEYOND TOWER the
As Abraham Lincoln once said, “The best thing about the future is that it comes one day at a time.” During the past four years, Tower Health has maintained a solid focus on the future, taking it one day at a time and diligently following a strategic financial plan that is now helping our system show signs of healing.
Led by the CEO P. Sue Perrotty, who will return to our Tower Health Board of Directors in late February, and Michael Stern, our incoming CEO, we have rounded the corner and started our comeback. If we are being honest, it has not always been easy, as you can expect. We had to dig in and work together to successfully complete a remarkable financial turnaround.
Many of you are aware that Mrs. Perrotty assumed the CEO role at an extremely difficult time for Tower Health after several years of significant losses – more than $400 million in 2021 – due to aggressive expansion and the impacts of the pandemic. The outlook was bleak, but, with her financial background, she assured us it was possible to overcome. She and Mr. Stern will be the first to share that the road to recovery has been a challenging one. Our executive leadership team had to make tough decisions to “stop the bleed” and reshape our market footprint while never compromising our clinical quality.
RECOVERY
With substantial support from our clinicians and staff, we have successfully accomplished our goals of rebuilding internal and external confidence in Tower Health, creating an environment of colleague collaboration, and positioning the organization on a path to financial viability. In the spring, we achieved profitability for the first quarter in five years. And, in the fall, we reached an agreement to refinance our debt obligations. This strategic refinancing initiative allowed Tower Health to increase our cash balance and secure more flexible payment terms, providing a solid foundation and ongoing, multiyear runway for our turnaround efforts. This was not just another step forward; it was a significant milestone that displayed the strength and resilience of Tower Health and our entities, including Reading Hospital.
We are proud that our medical staff and caregivers never let outside noise impact our focus on patients and our mission to make our communities healthier and more vibrant. Today, I am fully confident that Mrs. Perrotty’s legacy and Mr. Stern’s leadership will guide our organization toward continued growth, success, and service to our communities. Challenges still lie ahead for us and the healthcare industry overall. At Tower Health and Reading Hospital, our focus on exceptional patient care and financial security must remain at the forefront.
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I know I am not alone in feeling optimistic about the long-term future of Reading Hospital and Tower Health. For example, in the past year, our organization’s employee engagement and satisfaction scores increased, and more than 600 employees who left the system to pursue employment elsewhere have returned to work at Tower Health. Our clinical care has been stronger than ever under the leadership of people like Dr. Bernard Boulanger, our Executive Vice President and CEO of Provider Enterprise; Dr. Lisa Lougheed, our Chief Nursing Officer; Michelle Trupp, our hospital Chief Operating Officer; and Dr. Suzanne Wenderoth, our Chief Medical Officer. We have also been able to recruit talented medical professionals, such as nationally renowned Dr. Rohinton Morris, who joined our CT Surgery Team, and to promote others like neurosurgeons Drs. H. Christopher Lawson, Amber Valeri, Brandon Root, and Shahin Manoochehri.
Since my first day at Reading Hospital in 1996, this has been more than just a place of work for me. It is a cornerstone institution in our community, extending care and impact far beyond our walls, and including services at the Reading Hospital Rehabilitation at Wyomissing, the Reading Hospital School of Health Sciences, and Tower Behavioral Health. Reading Hospital has been a vital part of Tower Health’s turnaround efforts, and we are proud to share that in 2024, we:
• Were named among the Top 50 hospitals in the nation.
• Earned a certification as a Comprehensive Stroke Center
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from The Joint Commission – the only hospital in the region to receive certification as a Comprehensive Stroke Center from The Joint Commission.
• Created an additional state-of-the-art cath lab to meet growing demand.
• Opened four full-service retail pharmacies and expanded medication home delivery statewide for patient convenience.
• Celebrated that TowerDIRECT ambulances in the Reading and Phoenixville areas were the first in the state to begin to carry blood products for patient transfusions.
Our recent successes are a testament to the pure grit and dedication of our leaders, clinicians, and staff despite the significant setbacks our organization faced several years ago. Yes, we have more work as we continue to move forward, but we are prepared. We’re teaming up throughout the system to create a new Tower Experience for our patients and peers. Like hospitals nationwide, we are also looking at ways to continue boosting retention and recruitment efforts, implementing additional innovative technology, remaining on the leading-edge of medical care, and maintaining financial viability.
But, as our new mantra declares, “The Power is in Tower,” and, thanks to many lessons from the past few years, both Reading Hospital and Tower Health are now ready to thrive in 2025 – and beyond.
HERE FOR THE FULL CASE STUDY
Penn State Health Predicts Bright Future in Berks County and Beyond
by Susan Shelly
While health care systems nationwide face significant challenges, Penn State Health remains optimistic about expanding its services in Berks County and other parts of Pennsylvania.
Joseph Frank, Penn State Health East Region president, said patients in Berks County benefit from the advanced technologies and resources of Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, which complement highly skilled providers at Penn State Health St. Joseph Medical Center. “Patients at St. Joseph Medical Center receive the same high level of care as patients at Milton S. Hershey Medical Center or any other major hospital,” Frank said. “That’s the advantage of being part of an integrated academic health system.”
Excelling in Three Key Areas
To meet the growing demand for health care, Penn State Health plans to expand its existing facilities and explore new locations. Frank predicted that St. Joseph Medical Center will continue to expand services in three areas of care in which it currently excels: obstetrics and gynecology, heart and vascular care, and oncology.
St. Joseph Medical Center was honored in December 2024 as a High Performing Hospital for Maternity Care by U.S. News & World Report in the magazine’s 2025 Best Hospitals for Maternity Care ratings. The award was based on objective measures of quality, including rates of C-sections in lowerrisk pregnancies, newborn complication rates, exclusive breast milk feeding rates, birthing-friendly practices, and reporting on racial/ethnic disparities. “We’ve long been recognized for our Department of Obstetrics and Gynecology, and we’re well known for our family-friendly birthing practices,” Frank said. “The award affirms our commitment to quality.” St. Joseph Medical Center is also the only hospital in Berks County designated as a Baby-Friendly® USA hospital as part of the Baby-Friendly Hospital Initiative.
Heart and vascular patients have access to some of the most advanced care available anywhere—right in Berks County. Cardiac specialists at Penn State Health Medical Group Berks Cardiology now offer pulsed field ablation, a new technology that uses ultrafast electrical impulses to target heart tissue and break up the electrical signals that cause irregular heartbeats for patients with atrial fibrillation. Other advanced treatments, including trans carotid artery revascularization and endovascular thrombectomy, also are offered.
Comprehensive cancer care is available at St. Joseph Medical Center, which is recognized for its outstanding team of cancer specialists, according to Frank. Patients can expect state-of-the-art technology and innovative treatments with a full range of support services. “We’ll continue working to bring these highly advanced treatments to patients in comfortable settings close to home,” Frank said. “Our goal is to support our patients in every way we can.”
Transforming Health Care through AI
While Penn State Health has used various applications of artificial intelligence (AI) for years, the technology is advancing at a rate that is mind-boggling, Frank said. “We’re on the very cusp of the future of AI,” he said. Among other applications, he predicted AI will have significant value in the field of radiology. “AI-powered radiology tools are able to process vast numbers of images and detect the most subtle abnormalities,” Frank noted. “That not only improves diagnostic accuracy, it also streamlines workflows and lets us better serve our patients, which is always our primary goal.”
Other notable areas where Penn State Health applies AI include stroke detection and treatment, natural language chatbots, patient monitoring, and the analysis of large amounts of data. AI applications will continue to increase exponentially, Frank said, advancing care and providing tools that will enable physicians to spend more time with patients. “The most important work of our physicians is to interact with and care for their patients,” Frank said. “That’s the reason they wanted to be doctors, and we’re excited that AI will be able to help them do that.”
Prioritizing Patient Care and Satisfaction
St. Joseph Medical Center consistently receives high ratings for patient satisfaction, Frank said, and will continue to focus on improving in that area. He anticipates advancements in telehealth, personalized medicine, genomics, regenerative medicine and other fields that will improve the care providers can offer patients and further boost satisfaction.
Penn State Health will continue to meet the needs of urban patients at its St. Joseph Downtown Campus, which provides dental services, outpatient diabetes education and management, a pharmacy, nutrition services, physical therapy, pediatric care, obstetrics and gynecology, family medicine and other services for patients and families. “We want to give all our patients the very best care because that’s what they deserve,” Frank said.
As staff members support patients, they also encourage each other. Frank pointed to St. Joseph Medical Center’s Compassion Project, an interactive photography installation that honors the hospital’s staff and volunteers who embody compassion for patients and one another. “It recognizes the people who demonstrate compassion in unique ways,” Frank said. “Compassion is the driving force behind our care, guiding us to treat every patient and staff member with kindness, dignity and respect. It’s been that way since our beginning more than 150 years ago, and I don’t expect it to change.”
The Next Pandemic Not If, But What and When
by By Debra Powell, MD Chair, Department of Medicine Chief, Division of Infectious Diseases
Reading Hospital/Tower Health
Yes, the next pandemic is coming. We cannot predict when, but microbial evolution is constant, and we should expect more strains to emerge that cause an increase in cases.
As we are entering the winter season, we are watching the evolving respiratory virus season closely. Most seasons follow a similar pattern of increasing influenza A infections that start to increase in late December and then peak in January and February. This is typically followed by cases of influenza B in the spring. RSV showed a significant increase in infections this fall, primarily in children but also in adults, causing an increase in admissions.
PA Department of Health Seasonal Influenza and RSV Comparisoni:
To mitigate the impact of influenza, we monitor the strains of flu that circulate annually to predict the strains that will predominate to formulate the next year’s vaccine. Due to antigenic drift, these strains mutate from year to year, and this is why annual vaccinations are recommended.
Antigenic shift is a larger genetic change, and these larger mutations cause more cases and more severe disease due to lack or decreased immunity in the population. Often these shifts are due to animal reservoirs, such as birds and pigs, that can become coinfected with different strains allowing reassortment and then this virus mutates to infect people.
We have seen 4 major shifts in the past 100 years, causing the 1918 “Spanish flu” H1N1 pandemic, the 1957 “Asian flu” H2N2 pandemic, the 1968 “Hong Kong flu” H3N2 pandemic, and the 2009 “Swine flu” H1N1 pandemic. The 1918 flu pandemic is considered to be the deadliest pandemic in modern history causing 17-100 million deaths worldwide.ii We are due for another significant influenza genetic shift.
Instead of the predicted flu pandemic, in 2020, we experienced the COVID-19 pandemic from SARS-CoV-2, a novel coronavirus. We were very fortunate that SARS-CoV-2 mutated, producing a milder disease over time and that treatments and vaccines were developed very quickly, saving many lives. That said, the COVID-19 pandemic is considered to be the fifth most deadly pandemic in modern history, causing 7-35 million deaths worldwide between 2020 and 2024.iii
Another virus that jumped species, moving from primates to man, causing the third most deadly pandemic, is the HIV/AIDS pandemic causing 44 million deaths between 1981 and the present.iv Of the top 20 pandemics over the past 1500+ years, 6 of them were from bubonic plague (caused by Yersinia pestis), 4 from influenza and 3 from smallpox. Nine of the top 20 were caused by viral agents that constantly mutate and adapt.
We are currently seeing this reassortment in the current avian H5N1 flu outbreak. This virus is causing widespread highly pathogenic disease in birds, including sporadic outbreaks in chickens (125 million affected), and has jumped species to dairy cattle in March of 2024. As of 12/23/24, avian influenza virus A H5N1 has been confirmed in dairy cattle in 16 states.v
As of the start of 2025, sixty-six human cases have been reported. Forty human cases were associated with dairy cattle, 23 from poultry farms, and 3 from other animal exposure (backyard flocks or wild birds) or source unknown.vi Most of the human cases to date have been mild. The first case of severe H5N1 bird flu in the US was
reported on 12/18/24 in Louisiana. This patient had exposure to sick and dead birds in backyard flocks. To date no person to person spread has been reported. The virus is transmissible from birds in their saliva, mucus and feces. Cows can spread the virus through respiratory secretions and unpasteurized milk. Science recently published an article on 12/5/24 that predicts that one mutation in the viral hemagglutinin is needed to make H5N1 more efficient in attaching to human cell receptors in the upper airway which may allow transmission from person to person.vii
What can we do to prevent or mitigate this evolution? Be aware of the trends. Encourage your patients, family and friends to be vaccinated against influenza and COVID-19. With the bird flu pandemic progressing, we need to educate and monitor people in contact with bird flocks, dairy cows, and raw milk, performing appropriate testing to detect cases and initiate appropriate isolation strategies. On the national level, we must invest in more public health initiatives including accurate testing methods, vaccine development for people and animals, treatment options for viral infections, and global collaborative relationships to expedite this work. We have learned many things during the recent COVID-19 pandemic that we cannot afford to forget to mitigate the impact of the next pandemic.
References
i https://www.pa.gov/agencies/health/diseases-conditions/infectious-disease/respiratoryviruses/respiratory-virus-dashboard.html
ii https://ourworldindata.org/spanish-flu-largest-influenza-pandemic-in-history
iii https://data.who.int/dashboards/covid19/deaths
iv https://www.who.int/data/gho/data/themes/hiv-aids#:~:text=Global%20situation%20 and%20trends%3A,people%20have%20died%20of%20HIV.
v https://www.avma.org/resources-tools/animal-health-and-welfare/animal-health/avianinfluenza/avian-influenza-virus-type-h5n1-us-dairy-cattle
vi https://www.cdc.gov/bird-flu/situation-summary/index.html
vii https://www.science.org/doi/10.1126/science.adt0180
Advocacy PAMED Legislative Priorities
PAMED has made a tangible impact on the health care landscape in Pennsylvania this year. By renewing your membership, you can help us continue driving meaningful change. Here’s what we’ve accomplished together in 2024:
Addressing Noncompete Agreements:
PAMED led efforts on House Bill 1633, now signed into law, limiting noncompete clauses in physician contracts and promoting patient continuity of care.
Safeguarding Against Scope Creep: We vigorously opposed legislation allowing non-physician providers to practice independently, safeguarding the integrity of physician-led care.
Advancing Telemedicine:
PAMED supported the successful passage of Senate Bill 739, ensuring health insurers cover telemedicine services. This is a game-changer for patient acc.
Your continued membership supports these efforts and much more!
Message from the 2024 Outgoing PAMED President Kristen Sandel, MD
As we come to the end of the year, I’d like to express what an honor it was to serve as your president. During my tenure, I’ve traveled across Pennsylvania visiting various practices, health systems, medical schools, and county medical societies, to discuss the importance of restoring the joy in practicing medicine. As a practicing emergency physician for over 20 years, I understand how the day-to-day stress and burnout of our profession can overshadow the passion that drives us to deliver the best care to our patients. But this year, we made strides to combat some of the issues that tie our hands in providing the utmost patient care in Pennsylvania. Together we made a difference with several accomplishments this year:
• Made significant progress working with the Department of Health to address emergency department overcrowding in Pennsylvania. We are anxiously anticipating those recommendations being received by the Governor early next year.
• Successfully addressed noncompete clauses that were signed into law to limit this language in physician contracts.
• Safeguarded against scope of practice creep.
• Advanced telemedicine to ensure services are covered by insurance.
• Awarded five Innovation Grant recipients with funding for projects that are creatively addressing issues that have historically marginalized patients in Pennsylvania.
• Recognized 30 talented and innovative physicians as our Top Physicians Under 40 for their unique paths and approaches to patient care.
• Celebrated a dedicated physician rewarded for her decades of international voluntary services.
• Held a webinar with the National Board of Physicians and Surgeons promoting viable alternatives in board certification.
• Worked with the Foundation of the Pennsylvania Medical Society and other stakeholders to successfully advocate for the State Board of Medicine to modify impairment questions on license applications.
The best moments for physicians often come when we are closely engaged with our patients, facing challenges together, and supporting them on their journey to recovery.
Looking forward, I am excited about the continued collaboration within our community. Our shared commitment to advancing our practice in medicine and prioritizing patient safety will undoubtedly lead to even greater achievements. Let’s keep working together to create an environment where both physicians and patients thrive.
Thank you for your unwavering dedication and support. Here’s to a future filled with continued success, fulfillment, and joy in our noble profession.
(Dr. Kristen Sandel is of course a member and former President of the Berks County Medical Society. Dr. Sandel is one of a long line of Berks County physicians who have been President of the PA Medical Society; however, the first in 40 years.
We congratulate Kristen on her many accomplishments and appreciate her strong support for the care of patients and the well-being of her physician colleagues.)
OVER THE BARBED WIRE: Healthcare in the Za’atari Refugee Camp
by Layla Abousaab
This summer, I had the privilege to provide free urgent health care to the largest Syrian refugee camp in Jordan, named Za’atari. Located below the Syrian border, this camp houses over 80,000 Syrians who fled their country due to a 14-year civil war caused by its Assad regime. Many fled south, and the Jordanian government allowed them entry on the condition that they stay confined to a designated camp, barred from the rest of Jordanian society. Within the barbed fences of Za’atari, inhabitants lived under surveillance, and a new generation of children grew up knowing nothing about life beyond the camp. Over time, the population has exceeded capacity, making the camp overcrowded and further underfunded.
Through the Syrian American Medical Society (SAMS), I traveled to Za’atari to provide healthcare to people with limited medical access alongside phenomenal dentists, physicians, and other specialists. In addition to local professionals in Jordan, members came from Lebanon, Greece, Palestine, the United Arab Emirates, and even included Syrians who live in the camp themselves.
Entering the camp required a military checkpoint, where the Jordanian government performed passport checks. While SAMS had prearranged our visit, delays sometimes occurred. One day, our driver wasn’t on the authorization sheet, and we were held outside the entrance for hours. The camp resembled a flat desert surrounded by barbed wire and sand dunes, making it nearly impossible to leave. Passing through was heartbreaking—shacks made from metal and plastic served as homes,
while stray dogs scoured for water and shade. These grim conditions struck me even before seeing or hearing from the people living there. Yet, as we entered, many stopped to smile warmly at us, and children jumped up and down, excited to see visitors.
Inside the clinic, we treated common and severe cases, some rarely seen in the U.S. One was a Stage 4 bedsore on the sacral area of a double amputee, exposing flesh and bone due to lack of care. In the dental clinic, we saw kids with adult molars so decayed they required extraction, teeth essential for digestion and speech. With limited resources, we used sunlight or phone flashlights during procedures. Resourcefulness was vital as we made do with what we had, such as facing chairs toward windows or improvising with ordinary tools in surgery. There were cultural differences in medical practices, too, like Jordanian doctors smoking in their lounges or an anesthesiologist breaking sterile field to use his phone.
One big impression that this experience left on me was the hospitality of the refugees I met. Although a working family’s income is typically 2 dinars a day, people at the camp made sure we were fed and content all week, providing us with fresh falafel, shawarma sandwiches, tea, and Arabic coffee around the clock. Despite having very little for themselves, the children were so happy to have guests in the camp and even more excited that we could make a life for ourselves outside of the camp while representing our Syrian roots. They shared their dreams of becoming doctors, teachers, and professional soccer players. Every day after clinic, the kids would beg to play with us, resulting in a mass soccer tournament that showcased their *intense* competition.
Overall, although hospitality is a big part of our culture, I was amazed that on a trip where I intended to provide more than I could ever receive, I felt welcomed with gifts, food, and genuine love.
Layla Abousaab is a former Berks County Medical Society Pat Sharma summer intern/scholar. She is the daughter of Bassel Abousaab, MD, a Family Physician in the Tower Health Medical Group. Layla is pursuing further studies in anticipation of a degree in dentistry.
IEye MDs Look to the Future of Ophthalmology
n this issue of the Medical Record, we check in with ophthalmologists from Berks Eye Physicians and Surgeons to learn some of the advancements they see upcoming in their field.
Looking to the future, what promising advances are on the horizon that will improve the care available for your patients?
Kasey L. Pierson, MD: Corneal transplantation techniques continue to advance rapidly. Only 20 years ago, full thickness, sutured transplants were standard care, but now 5-micron thick endothelial transplants are most commonly used. In the next few years, we should be able to simply inject endothelial cells to treat the most common diseases requiring corneal transplantation.
Medical advancements for the treatment of cataracts have started. In animal models, there are studies looking at eye drops to stop cataract formation and the development of presbyopia. Currently in FDA trials there is an eye drop medication known as C-KAD (Livionex), used to treat early cataract formation by limiting calcium aggregation in the natural lens which contributes to glare symptoms and decreased contrast sensitivity in cataracts.
Michael C. Izzo,
MD:
Over the past decade, a group of procedures called Minimally Invasive Glaucoma Surgery (MIGS) has come to the forefront in surgical care for glaucoma patients. Most of these procedures involve bypassing resistance to aqueous humor outflow at the level of the trabecular meshwork with a stent or excising the meshwork itself. These
procedures and their techniques have proven to be highly efficacious at lowering intraocular pressure and preventing visual field loss without taking on the risk and follow-up burden of traditional, more invasive glaucoma procedures.
These procedures are commonly performed at the time of cataract surgery and add minimal risk to cataract surgery alone. I am most excited to see what the future holds for patients who have these procedures and the degree to which we can slow and prevent vision loss long term as many studies are being done to refine the techniques and optimize outcomes for these procedures.
What challenges are Eye MDs likely to face in the foreseeable future inproviding the care patients deserve?
Kasey L. Pierson, MD: Rising costs for devices, medications, and staffing, while at the same time reimbursement continues to diminish. This will likely lead to an increase in cash-based therapies which in turn increase direct costs to the patient.
Access may also be an issue as more than 25% of ophthalmologists are near retirement age while the number of patients requiring eye care is expected to double in the next 10-20 years.
Michael C. Izzo, MD: Many patients with glaucoma are treated with eye drops which require daily use to prevent vision loss. Compliance with these medications has been a longstanding issue in treating this condition, as many patients suffer from varying degrees of irritation and possible adverse reactions to these drugs.
Exciting new advances are being made to deliver drugs into and around the eye to minimize side effects and the reliance on patient compliance with daily dosing. Minimally invasive glaucoma surgery and laser treatment (SLT) have also come to the forefront in improving glaucoma treatment by decreasing or eliminating drop burden for patients.
Summer 2025
Berks County Medical Society’s Pat Sharma
President’s Scholarship
Applications are being accepted now for this paid summer internship. The program is designed to allow college students to explore careers in healthcare through mentorship and clinical observing experiences with practicing physicians and leaders in local government and nonprofit organizations working to advance healthcare in our community.
Time commitment: 6 weeks full-time, Monday through Friday. Exact dates will be matched with those of the 2025 Reading Hospital Student Summer Internship Program, which usually has a start date during the first week of June.
Stipend: $2000 for each of TWO students
Eligibility: Students who will have completed at least 2 years of college at the end of the Spring 2025 academic term and who have demonstrated an interest in a career in medicine or other field in the realm of healthcare, public health, or health policy. Priority will be given to students who are from the Berks County area or who are attending college in Berks County.
Primary activity: Research and write an article on a clinical topic or public policy issue in the healthcare field. The topic will be chosen in consultation with the scholarship program committee, and close supervision and mentorship will be provided by BCMS physicians and community experts. The article will be published in the quarterly magazine of the BCMS, the Medical Record. Articles written by past scholarship recipients can be found on the BCMS website, berkscms.org, in the Fall editions of the Medical Record.
Additional activities will be determined by the intern’s interests and could include:
• Observing clinical practice, including surgery.
• Assisting the Executive Director of the BCMS for a few hours a week to learn about the operation of this nonprofit organization and the many ways it serves our members and our community.
• Participating in panel discussions with practicing physicians and with medical students, to gain insight into the process of becoming a physician and the variety of career paths available.
• Attending didactic sessions at Reading Hospital offered in the Student Summer Internship program.
Application materials:
1) Resume (please include home mailing address)
2) Personal statement of no more than about 500 words, describing your career interests and how this experience would further those interests
3) An example of written scholarly activity (an essay or research paper authored solely by yourself)
4) Letters of recommendation are not required but will be considered.
5) Please indicate whether you are related to a Berks County Medical Society member and let us know how you learned of this internship.
Deadline to submit applications: Monday, March 3, 2025. (Notification will be by March 21.)
Forward applications to Lucy J. Cairns, MD (program coordinator) at ljanetcairns@gmail.com. The BCMS thanks Pat Sharma, MD, and Ray Truex, MD, for their support of this program through gifts to the BCMS Educational Trust.
COMMUNITY ANCHORS: UNITED WAY OF BERKS COUNTY CELEBRATES ITS 100TH ANNIVERSARY
Celebrating a Milestone
For a century, United Way has been a leader in transforming lives and mobilizing the community to help others through its annual fundraising campaign, program investments, and volunteer activities. In April 1925, local leaders and social service agencies united to create a centralized organization aimed at improving the health and well-being of Berks County residents. This organization, originally known as the Welfare Federation of Berks County, is now United Way of Berks County. Though it has undergone a few name changes, its mission has remained the same: to improve lives by inspiring collaboration, volunteerism, and financial support for a stronger community.
express our gratitude to the people and organizations who have fueled our work,” says Tammy White, president of United Way of Berks County.
Throughout the Decades
Sue and Craig Perrotty, long-time supporters and volunteer leaders for United Way, are serving as the 100th Anniversary Campaign Chairs. “We view United Way’s work as all-encompassing. Its funded programs and partnerships represent the safety net for the entire community. The organization has always adapted to Berks County’s ever-evolving needs and will continue to do so in the future,” they share. White agrees, “United Way responds to the community’s most pressing needs. Throughout our history, we have provided help, hope and opportunity to those who need it most.”
“Anniversaries are a time to reflect and celebrate. As United Way of Berks County marks its 100th anniversary in 2025, we
Since its founding, United Way has supported key community needs. Initially, it focused on reducing infant mortality and improving hospital care. In the 1930s, it addressed health concerns related to polio, and in the 1970s, it helped launch the Meals on Wheels program to serve the growing senior population. When the demand for quality childcare increased in the early 2000s, United Way led efforts to support these services.
“United Way is designed to be what the community needs, when it needs it,”
says Carolyn Holleran, 100th Anniversary Honorary Co-Chair, alongside her husband, Jerry. “It has always served as a convenor, responder, and the glue that binds our community together—through the Depression, a pandemic, and everything in between.”
United Way Responds in Crisis
United Way has consistently been there when the community faces crisis. In 1972, after Tropical Storm Agnes devastated Berks County, United Way set up a flood disaster relief fund and partnered with the American Red Cross to assist the hundreds of residents left homeless. Following the tragic events of September 11, 2001, United Way mobilized volunteers to help the Red Cross with local operations and phone bank services. When COVID-19 hit in 2020, thousands of Berks County residents faced hardship. United Way swiftly created the Berks COVID-19 Response Fund to support critical services provided by nonprofits on
the front lines. Through the generosity of Berks County, more than $1 million was raised in record time. United Way awarded 50 grants to help meet emergency food needs, housing, infant and family essentials, safety supplies, emergency childcare, and virtual services. These efforts helped Berks Countians nearly 300,000 times.
In March 2023, a tragic explosion in West Reading resulted in several deaths and injuries, displacing residents. United Way and the Berks County Community Foundation launched the West Reading Disaster Recovery Fund to support the victims. The community’s response was overwhelming, raising over $1 million. Disbursements were made to the families who lost loved ones and those who lost homes or possessions, helping ease their burdens during this difficult time.
Investing in Our Community’s Priorities: Education, Workforce Development, and Leadership
United Way’s annual campaign is where the community comes together in compassion and generosity. The 2024 campaign raised over $10.7 million to fund 80+ crucial programs run by agency partners, alongside grants, to promote school success, job opportunities, and better health. Over 190,000 Berks Countians benefit from United Way-funded programs each year.
“Investing in children’s education is one of the most impactful ways to create greater educational and economic opportunities,” explains White. “Our commitment to early learning and education is evident through our Ready.Set.READ! initiative, which promote kindergarten readiness and earlygrade reading proficiency.”
By third grade, children shift from learning to read to reading to learn. This transition is essential, as children who struggle with reading at this stage often face challenges in other subjects later on.
Research shows that children who read at grade level by the end of third grade are more likely to graduate high school and succeed academically. That’s why United Way’s Ready.Set. READ! initiative partners with schools, parents, and volunteers to provide tutoring for first and second graders in 26 Berks County elementary schools.
The initiative’s Growing Readers program aims to improve the quality of city childcare centers, focusing on coaching, staff development, retention, and business practices.
United Way also collaborates with the Reading School District to implement the
Read Alliance program in nine elementary schools. The program recruits high school students to tutor first graders using a phonics-based curriculum. These teens gain valuable leadership and job skills, while first graders show measurable reading progress. In the 2023/24 school year, 81% of enrolled first graders achieved at least one year of reading growth.
Additionally, United Way is committed to workforce development, creating career pathways through training, placement, and support services. Partnerships with Connections Work, The Literacy Council of ReadingBerks, Tec Centro Berks, and Reading Area Community College help individuals move from poverty to self-sufficiency.
“As we look to the future, our Leadership United programs help prepare the next generation of organizational
and community leaders,” says White. These programs include:
• Blueprint for Leadership (BFL): A seven-week program that trains individuals for key volunteer leadership positions.
• Emerging Leaders United (ELU): A program for individuals ages 21-45 that connects them with volunteer, philanthropic, and professional development opportunities.
• Leadership Berks: A nine-month program that prepares individuals for nonprofit leadership roles through experiential training and a service project.
“These programs provide developmental experiences that shape community leadership,” White adds.
Coming in 2025
United Way’s signature community volunteer event, the Big Cheese, will be even bigger in 2025 to celebrate the 100th anniversary. The meal-packing event, which helps fight hunger in our community, will draw on the power of 1,000 volunteers to package 500,000 shelf-stable apple cinnamon oatmeal and mac and cheese meals. The event will take place the weekend of June 13th at Penn State Berks, with meals distributed by Helping Harvest to families in need. Registration will open in mid-May.
“Our history and impact are a testament to the donors, volunteers, and partners who show compassion and generosity to connect Berks Countians with the help they need,” says White. “What makes our community special is the people—then, now, and always. It starts with you.”
Learn more about United Way’s history and impact at uwberks.org.
TIn Memoriam Chris J. Beetel, MD
by Tom Beetel, MD
his past September we lost a truly wonderful man. Chris Beetel passed away at the age of 92. He had been in Phoebe personal care for the past year.
Chris Beetel was born in Trenton, NJ, in 1932 to parents who had just endured the Great Depression. He and his older brother, Tom, worked at their dad’s Esso gas station and garage all through high school. Their mom, Catherine, was keen on getting her two sons out of the mechanic business so she made sure their focus was on academics. She was successful.
My Uncle Tom went on to become a superior court judge in Hunterdon County. His little brother, Chris, graduated from Mt. St. Mary’s College and eventually Jefferson Medical College. While serving an internship at St. Francis Hospital back in Trenton, Chris worked alongside another newly minted doctor named Franc Toso. Those two would run into each other again a few years later. Chris spent two years in a MASH unit in Korea as a combat surgeon before returning to the states and completing a fellowship in Thoracic and Vascular Surgery at the University of Maryland. An older colleague he met there, Jim Jewel, would later invite him to join his practice in Berks County. Cohen, Jewel, and Beetel spent nearly three decades in practice together at Reading Hospital, St. Joe’s Hospital, and Community General.
kindness and respect for really anyone who crossed his path. My dad was authentic and people knew that.
My dad did enjoy a few hobbies over the years. He loved pheasant hunting with his partner Jim Jewel, sailing, and tennis. But his real passion was for Notre Dame Football. Saturday afternoons were spent with his two buddies and fellow diehard ND fans, McClenan and Obrien, watching the Fighting Irish. There were always a few surgical journals lying around the house, but they were far outnumbered by volumes of Blue and Gold Illustrated.
My dad told us a couple of times last year that he did not want a big funeral. He didn’t want to make a fuss; it just wasn’t his style. And when he said that, I couldn’t help being a little disappointed. Because I know how many people in this community Dad impacted and what a profound impact he had on all of us. Nearly 60 years ago my dad started working here in Berks County, and he never really stopped.
Dad didn’t spend much of that time just sitting around. He was working. He loved being a surgeon and he loved working. It wasn’t until he retired from his practice and joined me as my assistant and my partner that I fully realized that. He had a genuine respect for his colleagues and for his patients for sure. He demonstrated a type of
My brother, my sisters, and I got lucky. Mentors and role models don’t really come much better than this guy.
There are people who talk about self-discipline and strive for self-discipline, write books about it and so on. But Chris Beetel was the master of selfdiscipline. He didn’t talk about it, ever. He just did it. In all the years I’ve known him, I’ve never once seen him sleep in. Never. Dad loved to enjoy a beer and a little Irish whiskey at night, but I never once saw him drunk. Not even a little. My dad never missed Sunday mass. Even on vacation down the shore, he and my mom always found a church for us to get to on Sunday morning.
And I’ve only seen him unshaven one time in my life. It was the day after his open-heart surgery. He was still intubated in the old BICU. I almost didn’t recognize him because his 5 o’clock shadow looked so foreign on him.
Dad just never let himself off the hook. He refused to go easy on himself. That’s not an easy way to live your life, but he made it look easy.
Retirement was tough for him. Even the idea of retirement, I think he just found kind of offensive. The notion that you had the whole day to just play around seemed crazy to him. Retirement did provide him with a little more time to spend with the only thing he enjoyed more than medicine and that was time with his family. He was blessed with four children and 10 grandchildren, and he absolutely loved the time he spent with all of them.
My mom wasn’t too much different than he was. Their idea of a restful weekend was to have ten yards of mulch and a dozen shrubs dumped off in their driveway and they would spend the weekend getting everything in the ground. When she started to get sick with Alzheimer’s, she became his purpose, and he did a pretty incredible job taking care of her until he just couldn’t do it anymore.
Dad truly had a purpose driven life... up until the end. And when his purpose was gone and his work was finished, he passed away. Not having anything to do just made him so unhappy.
I can’t help but think of my kids who only know him as Pop Pop; the smiling old guy who would shuffle into the kitchen with his walker who couldn’t hear them when they told him about their day at school, or how they did at their game, and who parked his car a little crooked in the driveway.
They never got to know the real Chris Beetel. And that’s too bad because they would have been impressed. As many of us know very well, Dr. Chris Beetel was impressive. And sharing our memories of him; keeping his legacy around, is a good thing to do. It’s a valuable thing to do.
The saying, “they just don’t make ’em like that anymore” has become pretty cliché’ but that couldn’t be more true about Dad. He was one of kind. He was truly a great man.
We were all very blessed to have had Chris Beetel in our lives and we are all very lucky and blessed to be able to keep him in our memories.
Thaddeus J. Tomkeiwicz, MD
by D. Michael Baxter, MD
Thaddeus Joseph Tomkeiwicz, MD, passed away October 3, 2024, at Chestnut Knoll Assisted Living Center in Boyertown, PA. He was born in Reading, the son of Joseph and Karolina Tomkeiwicz, and graduated from Reading High School and Albright College. He then earned his MD degree from Hahnemann University. He was a Captain in the U.S. Army during the Vietnam War and served as the commanding officer of the U.S. Army Dispensary at Fort Indiantown Gap, PA. For his service he was awarded the Silver Star and Bronze Star.
He returned to Berks County and served for many years as Director, Department of Emergency Medicine at St. Joseph’s Hospital. He was a member of the Berks County Medical Society and an Executive Board member of the Pennsylvania Medical Society. In addition, he was a member of the American College of Emergency Physicians, served on the Board of Directors of the Eastern Pennsylvania Emergency Medical Services Council, and as medical coordinator for the Berks County EMS Training Institute.
In addition to his years as an Emergency Medicine physician at St. Joseph’s Hospital, Dr. Tomkeiwicz served as supervisor, coordinator, and instructor for the very earliest Emergency Medicine Services in Berks County. Jim Bova, one of the first paramedics who helped establish those services for the city of Reading in 1975, said they would not have been successful without Dr. Tomkeiwicz. At a time when few people knew who paramedics were or trusted their care, Dr. Tomkeiwicz was always supportive and actually “looked after the paramedic crew.” When paramedics in the field would contact their base at St. Joseph’s with a distressing case, Mr. Bova says, “Dr. Tomkeiwicz was also a calming and reassuring voice providing support and guidance.” He remembers well the monthly sessions when Dr. Tomkeiwicz would sit down with the paramedics to review their cases, discuss outcomes and offer his instructive advice.
Leon Bergstresser, who started the first county EMS office in the Fleetwood area in 1981, also described Dr. Tomkeiwicz as a very compassionate individual who was incredibly supportive of EMS staff and their training. “Without him,” says Mr. Bergstresser, “we would not have had a successful county-wide EMS program.” Another early paramedic who founded the Governor Mifflin/Southern Berks program in the early 1980s also describes Dr. Tomkeiwicz as incredibly caring and supportive of paramedics when they needed it most.
Dr. Tomkeiwicz was predeceased by three sisters and is survived by a niece and nephew. The Berks County Medical Society is thankful for the service offered by Dr. Tomkeiwicz and we offer our condolences to his family.
We are happy to make time for your patients
Eye Emergencies Cataracts
Glaucoma
Diabetic Eye Exams
Macular Degeneration
Yes, we can see your patients same day for emergencies and often same week for consults.
At BERKS EYE PHYSICIANS AND SURGEONS, we are happy to offer state-of-the-art and efficient care. Our doctors provide appropriate diagnosis and treatment, and fast feedback to you. Whether your patient has a sudden change in vision, cataracts, diabetes impacting vision, or even has a family history of glaucoma or macular degeneration, we would be honored to monitor and react to issues related to your patient’s eye health.
Left to Right:
Domenic C. Izzo, Jr., MD, Benjamin Nicholas, MD, Francisco L. Tellez, MD, FACS, Michael C. Izzo, MD, Peter D. Calder, MD, Kasey L. Pierson, MD, Guri Bronner, MD