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Features

The Gluten-Free Diet Craze It’s Not for Everyone

Daniel T. Dempsey, MD, MBA, FACS PRESIDENT

Cadence Kim, MD, FACS PRESIDENT ELECT

Michael DellaVecchia, MD, PhD, FACS IMMEDIATE PAST PRESIDENT

Max E. Mercado, MD SECRETARY

10 You’ve Seen and Heard Hillary Clinton and Donald Trump — Now What? Maybe It’s Time to Get Past the Noise and Look at Health Issues in the Party Platforms

J. Q. Michael Yu, MD, FRCPC TREASURER

BOARD OF DIRECTORS Angel S. Angelov, MD

13 PAMED’s House of Delegates Physicians Shaping the Future of Pennsylvania Medicine

Martin Brown Enrique Hernandez, MD Harvey B. Lefton, MD Henry Lin, MD

16 Overbrook School for the Blind Enriching the Lives of Visually Impaired Students for 184 Years

Curtis T. Miyamoto, MD Ricardo Morgenstern, MD Natalia Ortiz, MD, FAPA, FAPM Anthony M. Padula, MD, FACS

Stephen R. Permut, MD, JD Andrew B. Roberts, MD Dane Scantling, DO John Vasudevan, MD

Doctors Without Borders A Philadelphia Doctor Lends a Helping Hand to War-torn South Sudan

FIRST DISTRICT TRUSTEE Lynn Lucas-Fehm, MD, JD EXECUTIVE DIRECTOR Mark C. Austerberry EDITOR Alan J. Miceli The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals. The placement of editorial opinions and paid advertising does not imply endorsement by the Philadelphia County Medical Society. All rights reserved. No portion of this publication may be reproduced electronically or in print without the expressed written consent of the publisher or editor.

In Every Issue Letter From the President. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 careers in medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 PAMED updates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 PCMS & Community News. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Upcoming Events & Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

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Fall 2016

Contents

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Letter from the president

his is my first issue of Philadelphia Medicine while serving as president of the Philadelphia County Medical Society. It happens to be the last issue before our nation elects its next president. We have been paying attention to health issues related to the election. In our summer edition we examined the Affordable Care Act. This edition looks at how the Democratic and Republican platforms differ on some important health care issues. We hope the article gives you additional insight into how the parties would govern on these key issues, while also giving you a break from the hand-to-hand combat exhibited by the candidates.

Daniel T. Dempsey, MD, MBA, FACS President

We Welcome Your Comments! They should be sent to our email address at editor@philamedsoc.org. If you would like your comments considered for publication, please include your name, town, and phone number.

In this issue we also show several dramatic faces of the medical profession, and at least one compelling hand. The man’s hand on the cover of this issue belongs to Dr. Pak Leung of the Einstein Healthcare Network. The small hand of a South Sudanese child is resting in Dr. Leung’s hand. The photograph was taken while the Philadelphia surgeon worked in that African country as a volunteer for Doctors Without Borders. His account of the challenging nature of the job – he was one of only three surgeons in a war-racked country of 11 million people – is a story of diligence and courage. This issue may very well give you new insight into the sometimes overwhelming pressures of the job of a physician. Those pressures are being blamed in part for a shocking number of suicides in the profession. Lacey Kohlmoos, wife of Jason Heckert, a fourth year medical student at Temple University, gives us a very personal account of what she has seen. She also took part in the PCMS conference on physician suicide that we report on, in this issue. There is research that indicates that pressures in the medical profession have also caused fertility problems for women who are in medical school and residencies. In her article on the problem, Laila Muallem, fourth year medical student at Sidney Kimmel Medical College, describes the pressures and their consequences, and urges some changes in how medical schools deal with female students. We take a look at the gluten-free diet fad. Local gastroenterologist Sidney Cohen, of Jefferson University Hospital, talks about who should not be eating wheat and other gluten-laden foods, and whether such a diet is healthy for most people. Philadelphia Medicine is part of our effort to inform our members and be an advocate for them. We also speak on your behalf on legislation that will affect the medical profession in our state. This issue reviews several proposed bills in “PAMED (Pennsylvania Medical Society) Updates.” You can also stay current on these issues by visiting our website at www.philamedsoc.org. Hope you find this issue enlightening. We welcome your comments. If you’re not a member, join us. We have a lot to offer you. EDITORIAL BOARD • Michael DellaVecchia, MD, PhD, FACS • William S. Frankl, MD • Corina Graziani, MD

Philadelphia Medicine : Fall 2016

• Alan Miceli, MA • Susan Robbins, MD, MPH, FAAP • Paul D. Siegel, MD

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Feature

THE GLUTEN-FREE DIET CRAZE – IT’S NOT FOR EVERYBODY

Alan Miceli, MA

ll you have to do is walk into a grocery store to see that gluten-free foods have become the bell bottom jeans of 2016. Stores often reserve an entire aisle for them. A recent survey conducted by the market research group NPD found that about one in four U.S. consumers believe that the hot new food fad is good for everyone. The study also found that 11% of U.S. households eat gluten-free. Many of the gluten-free converts think that spurning wheat, barley and rye will help them lose weight and lead healthier lives.

A prominent local gastroenterologist isn’t biting. “I don’t see the benefits of a gluten-free diet for people who appear to be healthy,” Dr. Sidney Cohen told Philadelphia Medicine. He’s a professor of medicine and director of research programs at Thomas Jefferson University. Dr. Cohen doesn’t even recommend the diet for people who say it clears up gastrointestinal discomfort. “Now, if a patient comes in and does not have celiac disease, but says they feel better on a gluten-free diet, we just tell them to stay on it. But I don’t personally tell patients who have bloating and diarrhea to go on a gluten-free diet.” Some have nicknamed healthy people going on the gluten-free kick “celiac wannabes” – people who don’t eat grains containing

Philadelphia Medicine : Fall 2016

gluten even though they will not suffer the intestinal damage that celiac patients get from those grains. Then there are people like Jenine Lawton, who are clearly not celiac wannabes. Avoiding gluten is not a luxury for her Chester County family, it’s a necessity. Her daughter Shea has a wheat allergy that became apparent soon after she was born. “When she was three months old, she was covered with eczema from head to toe. I was nursing her and thought, what am I eating that’s causing this?” Shea tested positive for major allergens in wheat. From that moment, Lawton declared gluten off limits in her home. The only time her husband and son get to eat wheat is when they are out of the house. Lawton always carries epinephrine with her in case Shea accidentally eats something containing wheat or barley and goes into anaphylactic shock. “Even a fruit tray is suspect. I don’t know what else the knife that cut the fruit was used for. Whether it cut bread, for example.” She said her eight-year-old daughter has a big problem receiving communion at their Catholic church. The Vatican requires all hosts to contain some wheat, to give at least a hint of the bread used by Jesus at the Last Supper. “Our church gets low-gluten hosts for parishoners who can’t eat wheat. The hosts have no more than 100

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The Gluten-Free Diet Craze – It’s Not for Everybody

parts of wheat per million. But that’s still too much wheat for Shea. She needs hosts that have fewer than 20 parts. I eventually found a German company that makes them.” (The Catholic Church, by the way, believes that both the consecrated host and wine are the real presence of Jesus, so celiac and wheat allergy patients can pass on the host and opt for the consecrated wine.) It’s a challenge to get the proper nutrition from a gluten-free diet. Gluten-free foods on store shelves are often filled with white rice flour, tapioca and potato starch, and contain little or no fiber or B vitamins. Many of the products are high in sugar and fat, and low in nutrients. Lawton says she went to a nutritionist for help. “We eat a lot of whole grain rice, quinea, gluten-free oats, fresh fruits, vegetables, fish and meat, and we take multi-vitamins.” About one-half of one percent of the U.S. population is like Shea, and has to avoid gluten because of an allergy to wheat. Another one percent of Americans – around three million people – has celiac disease. That number has jumped in recent years. “It used to be one person in 100,000 had celiac disease,” Dr. Cohen said. “One reason for the jump is increased detection, but another reason appears to be the hygiene hypothesis. As our environment gets cleaner we have less bacteria in our intestinal tract – bad bacteria – allowing other diseases to emerge. “We’re too clean,” Dr. Cohen added. “Celiac disease is on the rise in our country because our environment is too clean. I jokingly say in Philadelphia we don’t get these diseases as often because we buy pretzels from street vendors.”

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There is a third group in the gluten mix that has been in a medical state of limbo for decades. It’s made up of people who say they have a gluten sensitivity. Unlike celiac disease and wheat allergies, a biomarker has not yet been developed to identify the condition. It’s estimated that about six percent of the population – about 18 million people – appear to have a gluten sensitivity. They’re people like Melinda Arcara. She doesn’t eat gluten, even though she does not have a wheat allergy, and has not been tested for celiac disease. Arcara, the author of the book Three Steps to Gluten-Free Living, says she is one of the people doctors have traditionally viewed with suspicion. “If you don’t have that celiac diagnosis,” she said, “doctors don’t really have any way to support you. If you have a sensitivity you’re kind of left on your own.”

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She says when she eats something with wheat in it, she gets discomfort in her right shoulder and a migraine, along with other symptoms. “When I first got the symptoms I thought I was having a stroke.” She spent decades going to doctors for treatment of eye issues, bladder infections, headaches, achy joints and GI problems. “At one point a doctor wanted to put me on anti-depressants. I’m a very happy person. I knew that was not going to solve my problem.” She decided to try the naturalpathic route. A nutritionist told her she might have a gluten sensitivity. So, Arcara went off gluten, and soon felt much better. She then went to her doctor who suggested that she be tested for celiac disease. But that would’ve meant returning to a gluten diet for two weeks – something she wasn’t willing to do, now that she had a couple of small children and was feeling fine. (Arcara is not a classic gluten sensitivity case, since she was never tested for celiac disease, and could have it.) After Arcara went gluten-free, her husband was diagnosed with celiac disease. Now, they both avoid foods with gluten in them. Their gluten-free diets have eliminated the symptoms they had when eating wheat and other foods containing gluten. For many years, doctors believed that people who claimed to have gluten sensitivity had a psychological or emotional issue, not a physical one. “When I started out,” Dr. Cohen said, “most of these patients would’ve been diagnosed with psychosomatic disease — a condition related to stress, for example.” But he said there has been a big change in medicine in recent years when it comes to what used to be considered psychosomatic causes of illness. Dr. Cohen said patients who say they have a gluten sensitivity are usually young women. They often have symptoms of diarrhea and bloating, similar to irritable bowel syndrome. “The mechanism is not clear. There’s no antibody in these patients. All bowel biopsies are normal. “They often say they feel better on a gluten-free diet. Other treatments for people with irritable bowel syndrome have been increasingly effective – treatments involving the taking of non-absorbable antibiotics and probiotics.” But he added, “Many in this particular group of patients also seem to feel they are better off on a gluten-free diet.” Dr. Cohen added, “Now maybe I may change in coming years because it has become so trendy that I may recommend it. But right now I don’t.” A recent study seems to support the argument that a significant number of people who think they have a gluten sensitivity, may not. The University of l’Aquila in Italy conducted a clinical trial of 392 patients who believed they had gluten sensitivity. 8

Philadelphia Medicine : Fall 2016

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The Gluten-Free Diet Craze – It’s Not for Everybody

The group ate foods with gluten for two months, then were tested. Almost seven percent of them ended up being diagnosed with celiac disease. Two other people in the trial had a wheat allergy. But the vast majority of the study’s participants – 86% – 337 people -- did not show any gluten sensitivity, even though before the trial they were certain that they had such a problem. The study, however, did give more support to the theory that there are people who have a real gluten sensitivity. The researchers concluded that 27 patients demonstrated a gluten sensitivity that was not caused by celiac disease or a wheat allergy. But is a gluten-free diet simply better for everybody? Not according to an Australian study of 3,200 food products. The study found that a gluten-free diet did not offer any nutritional advantages. And so far, there isn’t any scientific research that supports the claim that such a diet will help someone lose weight. Dr. Benjamin Lebwohl, assistant professor of medicine and epidemiology at Columbia University’s Celiac Disease Center, summed it up this way – “for the general population, there’s no evidence that a gluten-free diet has any beneficial effects.”

Fall 2016 : Philadelphia Medicine

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Feature

You’ve Seen and Heard Hillary Clinton and Donald Trump — Now What?

Maybe It’s Time to Get Past the Noise and Look at Health Issues in the Party Platforms Alan Miceli, MA

eality TV buffs should have been more circumspect about what they wished for this political season. In the 2016 presidential election, they’re arguably getting way more than what they want. Instead of bickering housewives and searches for the next great pop star – they’re being swamped by waves of never-ending political soundbites.

The cable news channels can’t give enough air time to Donald Trump, the billionaire Republican candidate who nurtured his presence on reality TV (The Apprentice), or Democrat Hillary Clinton, who has been something of a media magnet since her husband was elected president in 1992. It’s hard to find someone who doesn’t have a strong opinion about these two. But it can be challenging in this age of

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constant tweets and overlapping layers of breaking news, to find out just where the candidates stand on the issues. At the time this article was completed, we were just out of the starting gate for the general election, a couple of weeks beyond the political conventions – a time littered with personal attacks from the candidates. Many voters witnessing the verbal carnage couldn’t be faulted for quoting an ancient TV ad — “where’s the beef?” One way to hazard an answer to that question is to read each party’s platforms, even though they’re unenforceable messages that are usually ignored by the candidates almost as quickly as they’re approved. But the platforms haven’t entirely lost their luster. Bernie Sanders thought the Democratic Party platform was so important, that he withheld his endorsement of Clinton until

she agreed to add several of his planks. The platforms are just meaningful enough. They signal the general beliefs of a party and the direction it wants to take the country. With all of these caveats, Philadelphia Medicine decided to highlight a couple of the most obvious health issues in the platforms as a way of getting at least a feel for the philosophies and beliefs of each party, and a sense of some of the things their candidates would do, if they ended up moving into that stately mansion on Pennsylvania Avenue. The Affordable Care Act Health care is certainly a flash point for both parties. Under the leadership of President Obama, the Democrats passed the Affordable Care Act over the united

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objections of the GOP. Democrats have vowed to fight any effort to repeal the ACA, and since its passage Republicans have promised to repeal and replace it. The Democratic platform outlines some of the highlights of the ACA – “Young Americans entering the workforce can stay on their parents’ plans. Insurers can no longer refuse to cover kids with pre-existing medical conditions; insurance companies can no longer arbitrarily cap and cancel coverage, or charge a woman more simply because of her gender.” Democrats say Republicans threaten to end a program that has added 20 million Americans to the health insurance rolls. The Democratic platform calls for every citizen in America to have affordable, effective health insurance, and adds that Americans should be able to sign up for public coverage through a public option. Democrats also want to expand Medicare coverage to include anyone 55 and over who would like to opt for that coverage. The party platform pledges to make premiums more affordable, deductibles lower, and cap prescription drug costs.

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The Republican platform calls the ACA “a Euro-style bureaucracy” that it claims has driven up prices for all consumers. The GOP wants it replaced with a system “that encourages genuine competition, patient choice, excellent care.” Republicans want to return to the states the authority to regulate local insurance markets, and they want to block-grant Medicaid, the health insurance program for low income individuals and families. The GOP also wants tax-free health savings accounts expanded, along with health reimbursement accounts. Republicans say they will save Medicare by modernizing it. Democrats counter that the Republican plan will drive Medicare out of business, deprive millions of Medicaid, and close the books on millions of the newest health insurance consumers.

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k a u t t e r k e l l e y. c o m Abortion Perhaps the clearest and most dramatic difference between the two parties is their approach to abortion. The latest Gallup poll on the issue shows why. More than 43 years after Roe v. Wade, the Supreme Court decision legalizing the procedure, abortion is still a contentious issue. The Gallup survey conducted in May shows that Americans are still deeply divided over abortion. Forty-seven percent call themselves pro-choice,

while 46% say they’re pro-life – a statistical dead heat. The same poll found that 29% of voters believe abortions should be legal in all circumstances, 19% think they should always be illegal, and 50% say they should be legal only under certain circumstances. Forty-three percent believe abortions are morally acceptable, while 47% think they’re morally wrong. Continued on page 12

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The parties have been far apart on this issue since the 1980s, but the differences have never been greater than in this election year. Republicans don’t mince words about what they believe is growing inside the uterus during pregnancy. “Accordingly, we accept the sanctity of human life and affirm that the unborn child has a fundamental right to life which cannot be infringed.”

You’ve Seen and Heard Hillary Clinton and Donald Trump — Now What?

Pain Capable Unborn Child Protection Act, prohibiting abortion after 20 weeks, “when medical research indicates the unborn child can feel excruciating pain.”

Dayle Steinberg, vice chair of the Board of Planned Parenthood Pennsylvania Advocates, told Philadelphia Medicine that Republicans have banged the personhood drum relentlessly, in an effort to try to drive a wedge Some in the GOP argue that the Demo- into the abortion debate. “That has been crats point to science when it involves, for basically their mantra for years. They have example, global warming, but shelve science introduced dangerous, so-called personhood and opt for politics when it comes to the legislation – bills that could interfere with life growing inside the uterus. medical decisions in regard to birth control

Dr. Karl Benzio, a psychiatrist in Doylestown and Pennsylvania director of the American Academy of Medical Ethics, thinks that the science of pregnancy is irrefutable. “That life possesses all the genetic endowment of the species. It has the inherent, active biological disposition for ordered growth and development in a continuous, seamless, mature process. “To me, that’s a human being. We can see the body parts growing. We can see the heart beating. We can see the ultrasound. The human embryo is not a potential human being. It’s a human being with potential.” The GOP continues to call for nominating judges to the Supreme Court who would overturn Roe v. Wade, and send the issue back to the states. The party promises not to fund or subsidize health care that includes abortion coverage. The platform also calls for programs that “affirm our moral ability to assist rather than penalize women who face an unplanned pregnancy.” The party supports informed consent, parental consent, waiting periods and more clinic regulations. It also wants Congress to approve the

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poor have the same right to an abortion as everyone else, the Hyde Amendment, which prohibits the federal government from paying for most abortions, should be repealed. “We will continue to oppose – and seek to overturn – federal and state laws that impede a woman’s access to abortion, including repeal of the Hyde Amendment.” Steinberg said the GOP platform is a concerted effort to deny reproductive health care for women. “We believe unequivocally that everyone should have access to reproductive health care, including safe, legal abortions, regardless of her zip code, income, or what kind of insurance she has.” The Hyde Amendment has to be renewed by Congress every year. It first passed in 1976, shortly after the Roe v. Wade decision. Before the Hyde Amendment, Medicaid paid for about 300,000 abortions each year. After Hyde, that number dropped to a few thousand.

This year the Democratic Party Platform calls for an and access to safe, legal abortions. It has end to the Hyde Amendment. The most been pretty much unsuccessful.” recent poll on federal funding for abortion seems to indicate that Democrats are out of Democrats say the emphasis in the abor- step with most voters on this issue. A poll tion issue should be on pregnant women, conducted in July by the Marist Institute especially those with crisis pregnancies – the for Public Opinion found that 62% of the victims of rape or an abusive partner. Preg- more than one thousand voters surveyed nancies in which the woman does not feel opposed taxpayer funding of abortions. she has the ability to raise a child because Hillary Clinton supports an end to the of poverty, threats from the partner, or Hyde Amendment, while her running mate, personal health. Republicans respond that Tim Kaine, does not. adoption could be a workable solution for many of these pregnancies. Democrats argue that the best way to cut the number of abortions is to provide afBut Democrats believe that adoption fordable health care for women that includes should be just part of the woman’s choice, birth control and prenatal and postnatal along with abortion. The party platform care – something they say the Affordable proclaims that the government should Care Act has done. They accuse Republicans not have the right to interfere with a of failing to support federal funding for the woman’s decisions about her pregnancy. care women often desperately need during And Democrats say that to make sure the crisis pregnancies.

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PAMED’s House of Delegates - Physicians Shaping the Future of Pennsylvania Medicine

PAMED’s House of Delegates

Physicians Shaping the Future of Pennsylvania Medicine

his year’s Pennsylvania Medical Society (PAMED) House of Delegates (HOD) and Annual Education Conference will be held at the Hershey Lodge in Hershey, Pennsylvania, from October 21-23. The HOD is the legislative and policymaking body of PAMED. It is comprised of delegates and alternate delegates, chosen and certified by the county medical societies, specialty societies, and PAMED’s special sections that represent medical students, residents and fellows, young physicians, and international medical graduates. The HOD is also charged with filling elective offices, including electing representatives to the House of Delegates of the American Medical Association. The inauguration of the incoming PAMED president is held at the HOD each year. The event offers an opportunity for physician members to honor the accomplishments of the current PAMED president and welcome a new physician leader. This year, President Scott Shapiro, MD, FACC, FCPP, will hand over the reins to President-Elect Charles Cutler, MD, MACP.

Who are the delegates?

Resolution. This is the proposed action or idea that delegates can submit, then debate, and finally vote on.

• Others are chosen to represent one of PAMED’s special sections. • And there are delegates picked to speak on behalf of their specialty. It’s a unique group of over 300 physicians of varying specialties and practice settings from across the commonwealth’s cities, suburbs, and rural communities. They come together every year to debate, discuss, and, ultimately, create policy on the most important issues affecting Pennsylvania physicians and patients. It really is all about the members, since physician members are the driving force behind all of PAMED’s policies. At the HOD, member physicians have developed policies on a wide range of topics, including costs of health care, prescription drugs and physician reimbursement.

What Happens at the Meeting: • Delegates are chosen in a few dif- How a PAMED Policy Is Born ferent ways:

• Some are selected by their county medical society to be part of the county’s delegation.

Here are a few key terms to keep in mind that can help you get a feel for what happens at the meeting and how policy is made:

Caucus. A smaller group of delegates in the same region or special section meet and discuss resolutions, typically on Saturday and Sunday mornings before the entire group of delegates meets in an official House session. This gives delegates a smaller venue to discuss and hear feedback on each resolution. Reference Committee. After the resolutions are officially accepted by the House of Delegates on Saturday morning, delegates go to reference committees to debate the merits of each resolution. Each reference committee divides resolutions by topics. There are five topics and five reference committees. This is where any changes to resolutions will occur. Each reference committee addresses a specific set of topics: • Education & Science/Public Health • Managed Care and Other Third Party Reimbursement • Mcare Fund/Tort Reform/Other Legislation/Regulation • Membership/Leadership/Subsidiaries • Organization Bylaws Continued on page 14 Fall 2016 : Philadelphia Medicine 13

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PAMED’s House of Delegates - Physicians Shaping the Future of Pennsylvania Medicine

How PAMED Policy Makes a Real-World Impact

Networking and CME at Annual Education Conference

Let’s take a look at two recent examples of resolutions from a recent House of Delegates that have had an impact on medicine.

A recent addition to the House of Delegates is PAMED’s popular Annual Education Conference. This year’s conference will be held on October 21 and 22.

Maintenance of Certification: A 2014 resolution centered on MOC and physician concerns that the American Board of Internal Medicine’s (ABIM) MOC program fails to provide a meaningful, evidence-based and accurate assessment of clinical skills.

While resolutions must be submitted by a voting delegate, there are opportunities for all PAMED members to weigh in. Even if you’re not a delegate, you can participate in policymaking through two channels: 1. Have an idea for a resolution? Contact your county medical society, and it will put you in touch with a delegate who may be able to introduce the resolution on your behalf (all resolutions must be submitted by a delegate or come through one of PAMED’s special sections). Keep in mind that the deadline for submitting resolutions is Sept. 22. View the Resolution Drafting 101 video on PAMED’s website at www.pamedsoc. org/HOD for more information. 2. Once the resolutions have been submitted, PAMED members can share their thoughts via the Virtual Reference Committee. It’s an online forum that allows all members to read the resolutions, discuss the issues with colleagues, and offer ideas for changes or additional considerations. Reference committee members review all of the feedback submitted in the Virtual Reference Committee prior to the HOD.

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PAMED has taken a national leadership role on this issue, most recently announcing at the 2016 AMA Annual Meeting in June that PAMED’s Board had voted a position of no confidence in the leadership of the ABIM’s Board. Learn more about PAMED’s MOC efforts at www.pamedsoc.org/moc. Telemedicine: The 2014 HOD also saw the adoption of a resolution to evaluate and define telemedicine in Pennsylvania and identify standard policies for payment of telemedicine services. This led to the creation of PAMED’s Telehealth Task Force, comprised of representatives from a number of specialties and primary care physicians, and the creation of telemedicine draft legislation. Rep. Marguerite Quinn (R-Bucks) has introduced a telemedicine bill, House Bill 2267, and a companion telemedicine bill (Senate Bill 1342) is expected to be introduced soon in the Senate by Sen. Elder Vogel (R-Beaver). These bills aim to improve health care access in Pennsylvania. PAMED’s Telehealth Task Force was actively involved in the drafting of the legislation. Get the latest news on telemedicine initiatives at www.pamedsoc.org/telemedicine.

All physicians—members and non-members alike—can attend the education conference in order to earn CME toward meeting this year’s licensure requirements, network with peers, and learn skills that will help them succeed in their daily practice and the ever-changing health care environment. The Annual Education Conference is free for all members. Our courses this year aim to offer solutions to many of the challenges that Pennsylvania physicians are experiencing—guidance on managing patients with chronic pain, help navigating MACRA requirements and new payment models, or information on leading your practice, hospital, or health system through the maze of health care reform and transformation. This is the one conference relevant to all Pennsylvania physicians regardless of specialty or practice setting. We hope to see you at the PAMED’s House of Delegates and Annual Education Conference! Online registration for both the HOD and the education conference is available at www.pamedsoc.org/hod. If you have questions, don’t hesitate to call PAMED’s Knowledge Center at 855-PAMED4U (855-726-3348). This article was written in collaboration with the Pennsylvania Medical Society (PAMED) and Michael DellaVecchia, MD, PhD, who just finished his term as president of the Philadelphia County Medical Society (PCMS).

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OVERBOOK SCHOOL FOR THE BLIND

Overbrook School for the Blind

Enriching the Lives of Visually Impaired Students for 184 Years Gerald Kitzhoffer, Executive Director and CEO

The Spanish Renaissance architecture of Overbrook School for the Blind

Photos by: Denise Mihalik

Early in the 19th century, a young teacher from Germany named Julius Friedlander came to Philadelphia determined to establish a school for the blind here. With help from several prominent Philadelphians, Mr. Friedlander opened his school in 1832 in a rented building and called it “The Pennsylvania Institution for the Instruction of the Blind.” The mission of the school and the system of instruction were set by Friedlander based on successes achieved by similar institutions in Europe, especially Paris. So successfully did the school proceed that a new building was built in 1835 at the Northwest corner of what is now 20th and Race streets in Philadelphia. Mr. Friedlander died only six years later, but his school was already well established by then. In 1899, the school moved, this time to its present location at 6333 Malvern Avenue. Designed by the architectural firm of Cope and Stewardson in the Spanish Renaissance style, the school was re-named in 1946 to comply with the vernacular name in use since its relocation to the Overbrook community of Philadelphia.

OSB students in the classroom For 184 years Overbrook School for the Blind has offered a range of educational programs designed to provide comprehensive support to any child with blindness or visual impairment (20/70 or less, as corrected). Each student’s Individualized Education Program (IEP) is followed to educate the whole child. An entire related services team is employed for students in the areas of Occupational Therapy, Physical Therapy, Speech and Language Therapy, Counseling, Orientation and Mobility, and Audiology Services. Faculty members Continued on page 16

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Feature are also trained to work with students who have been diagnosed with a variety of eye conditions including retinopathy of prematurity, septo-optic dysplasia, optic nerve hypoplasia, myopia, glaucoma, coloboma, amblyopia, and nystagmus. The school is also continuing to develop its expertise in and reputation for educating students with cortical visual impairment. OSB also serves children with deafblindness in all of its outreach and educational programs. All of the educational programs at OSB focus on the National Agenda’s Expanded Core Curriculum, in which skills such as braille, orientation and mobility, communication and technology, social skills, and life skills are emphasized so that students with blindness can live as active and independent members of their communities. “The proper assistive devices, the correct educational programs, and appropriate staff expertise give our students with blindness and visual impairment access to a high quality comprehensive education that prepares them well for their future endeavors,” says Gerald Kitzhoffer, Executive Director and CEO of OSB. “Our new technology initiative, focusing on mainstream and specialized devices, further enhances and supports our efforts to provide access to the world through our educational programs.”

EARLY CHILDHOOD

HIGH SCHOOL

The Early Childhood Program is the campus-based component of the Early Intervention Outreach Program. Designed to give children between the ages of three and five a fun and educational preschool experience, the Early Childhood Program prepares children to enter school programs that are appropriate to their abilities and needs.

College, career, and community-ready is the goal of the High School Program, which typically provides services to students 15 to 18 years of age.

OSB PROGRAMS

ELEMENTARY AND MIDDLE SCHOOL

EARLY INTERVENTION OUTREACH

The Elementary Program serves students six to ten years of age. Along with academics, instruction also includes mobility, communication and technology, social skills, leisure and recreation skills, and prevocational skills. Students are challenged in a joyful and supportive way, discovering their own unique talents and potential.

The Early Intervention Outreach Program provides specialized services to children who are visually impaired ages birth to five and to their families. We encourage these children to explore their environments through play and functional activities, and we empower their families with the knowledge and resources needed to be advocates for their children. Birth to three services are typically provided in the home, and three to five community based services are provided in preschool or daycare settings.

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Students between the ages of 11 and 14 in the Middle School Program are immersed in classroom learning, lessons in daily living skills, assistive technology, communication and more, all with a goal of functional independence. Self-awareness skills and appropriate behaviors are emphasized to make the transition into adult life easier.

For students with an Academic focus, schedules are structured to provide a traditional high school experience and to prepare the student for college, technical school or competitive employment. Students with a Functional Academic focus attend core curriculum classes where real life situations help them become as independent as possible. Students with a Life Skills and Experiential focus work on increasing independence through classes centered on activities of daily living, communication, and orientation and mobility. A variety of activities are provided to help develop the whole student. The social challenges of students with visual impairment are addressed and support is provided to help students form relationships with others, increase social connections, and participate in more activities.

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Overbrook School for the Blind

A fully accessible and adaptive greenhouse is planned for the Spring of 2018. Offering a Upon completing their high school skills rich sensory experience, the OSB Greenhouse requirements, students (ages 19 to 21) enter will teach students how to identify the shapes, the School to Work Program to enhance smells and textures of various plants and their skills for adult life. how to care for them. There will be room for year-round planting, making crafts, and Transition goals and readiness are a large practicing science studies, and students will part of the School to Work Program. Effec- one day sell herbs, flowers, and vegetables, tive transition involves purposeful planning for experience with retail work. among the student, his or her family, and school-age services and program providers, Over the years, OSB has updated the use to identify what services and supports he and flow of many areas on campus which or she will need in the future. SCHOOL TO WORK

has transformed learning spaces, enhanced the campus walkability, and created open spaces that unify important buildings and landscapes. While the Overbrook School for the Blind colors may be red and white, the campus in the City of Philadelphia is definitely green. For more information about Overbrook School for the Blind, please visit www.obs. org.

THE INTERNATIONAL PROGRAM Since 1998, Overbrook School for the Blind has been collaborating with the Nippon Foundation to make access technology more widely available to people who are blind and visually impaired in Southeast Asia. Training, technical assistance, and material support is shared between countries to increase educational access and expand employment opportunities for low vision and blind individuals. With support from the former John Milton Society, OSB International also works with special education schools in China.

At Overbrook School for the Blind, learning continues outside of the classroom. An array of programs is offered including student government, music, art, and a full sports program, which includes cheerleading, wrestling, track and field, goalball, and swimming. The OSB Residential Program is available to those students who live too far away to commute every day. Many older students live in the White Hall on-campus independent living apartments during the week, learning independence, and enjoying a variety of social and recreational activities. More than 20 acres of spacious grounds surround all of the buildings on campus and provide ample areas for play and recreation. Fall 2016 : Philadelphia Medicine 17

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Doctors Without Borders A Philadelphia Doctor Lends a Helping Hand to War-torn South Sudan Alan Miceli, MA

he evidence was crystal clear to Dr. Pak Shan Leung, that he was no longer in Philadelphia. There was the mud-hut he lived in, the war-ravaged countryside, the 110-degree heat, and of course, the patients with landmine wounds.

One of those patients was an 11-year-old boy who was brought to the South Sudan hospital where Dr. Leung was a surgeon for five weeks in March and April of this year. The physician worked as a volunteer with the international medical aid organization, Doctors Without Borders. Dr. Leung had never seen injuries like the ones the boy had. The violence inflicted on the child had its own unique horror, different even from the gunshot wounds Dr. Leung worked on in North Philadelphia as the associate chair of the Division of Critical Care at Einstein Healthcare Network.

Dr. Leung

The child had stepped on one of the thousands of mines buried in South Sudan’s fields and dirt roads. Gunfire from the civil war may have been silenced by a shaky truce while Dr. Leung was in the Agok region of the country, but the landmines made sure that the ceasefire didn’t stop the maiming and killing. The boy had life-threatening gashes to his left leg, right hand, and skull. “I had to do traumatic amputations to those extremities,” Dr. Leung said, “and I had to do a craniotomy for his traumatic brain injury.” The hospital didn’t have a blood bank, so staff members combed the streets for donors for the boy. And the hospital didn’t have a ventilator. When the two hours of surgery ended, and the boy did not regain consciousness, the anesthesiologist, a nurse, and Dr. Leung, took turns bagging the youngster for 15 straight hours. The effort paid off. The boy woke up and now journeys on a road without landmines — the road to recovery. Dr. Leung was one of only three surgeons in a country of 11 million people. Not surprisingly, that meant he did just about anything a surgeon has done with a scalpel – from operations on landmine injuries, to C-sections and broken bones from car accidents. “On average I did about 10 surgeries a day there, while at Einstein I’d do about 10 trauma cases a week.” He also did a lot of perinatal work, and treated people for infections and a wide range of diseases. Continued on page 20

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FEATURE

The lull in the fighting in South Sudan produced a certain irony. Dr. Leung has treated more gunshot victims in North Philadelphia. “We see more penetrating trauma here in North Philly than I did in South Sudan. The caliber of weapon here is usually small caliber, while over there it was pretty much high velocity. I was told that there would’ve been no comparison had the war still been going on.” The civil war laid waste to much of South Sudan. The conflict forced millions of residents to flee their homes, and left the country with little infrastructure, cities without basic services, and only a handful of schools and hospitals. At the hospital where Dr. Leung worked, the staff was not trained in triage. “They had no formal knowledge of how to assess patients in a systematic and organized manner.” So, while doing emergencies and other field hospital-type work, Dr. Leung trained the staff in triage. Dr. Leung expected to meet a cynical, hostile population in South Sudan, hardened by the horrors they confronted each day. What he found, instead, made him reassess some important biases he clung to before making the trip. “They’re very nice, very helpful. They are the nicest, greatest, most innocent people. They have an innocence that we tend to not have any more in America.”

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DOCTORS WITHOUT BORDERS

Dr. Leung and a national staffer, Dang, taking a break outside the OR between surgeries. Breaks with Dang also included lessons from Dr. Leung on being a scrub nurse.

But that kindness does not materially ease the monumental task a doctor has in the country. Early on, Dr. Leung was almost overwhelmed by the job. It became clear to him that on any given day he took care of dozens of people, knowing full well that thousands needed him. He spoke about his sense of helplessness to a fellow doctor who has done the work for years. “I asked him why he comes here, and he said, ‘Pak, every time I save a kid in Africa, I tell myself he is going to be the Ghandi of Africa.’” The comment drove home to Dr. Leung a belief in the significance of every life. “It’s not just what I do or what my colleague does that’s going to change the world. It’s the patients we touch. It’s the family members we show compassion to. Those are the people who are going to make an impact on the country. “My job is not so great that I can change the whole situation in Africa, but I hope by saving that kid who stepped on the landmine, he will someday change his country for the better, or his brothers or sisters who might be moved by what we did, will.”

Dr. Leung believes that the time in Africa has had a profound effect on what kind of a doctor he has become. ”Now, every patient I treat in North Philly, I say, yes, this might be gang-related violence, but one day this patient might turn things around, might become someone who will change the world for the better.” The physician recommends the work in Africa to any doctor who can do it, but he understands that not everyone can steal the time from residencies, surgical teams and families. “It’s definitely a commitment. My girlfriend is very supportive. I wouldn’t be able to do it, without her support.” Dr. Leung intends to go back, even though he was never able to fill a basic craving in the country for a cold Diet Coke. The first thing he did at a stopover in Geneva, Switzerland, on his flight home, was buy two bottles of the soft drink. “It was the only thing I missed. People who know me would not be surprised.” He said he was honored to help the people of South Sudan – and to be part of the dedicated team of volunteers who work in the Doctors Without Borders program. “They are like crazy people. They think they can just go to Africa and change the world. They truly believe that.” You could say Dr. Leung is also now a believer.

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CAREERS IN MEDICINE

Infertility

in Female Physicians:

A Side Effect of the Medical Profession Laila Muallem Fourth-Year Medical Student, Sidney Kimmel Medical College

s a medical student going into obstetrics and gynecology, I find infertility to be a subject of strong personal interest. Although it’s a common concern among many couples, few physicians ever seem to consider themselves to be potential patients. We medical professionals often form a barrier in order to protect ourselves from the emotional pain experienced by empathizing with patients. We acknowledge that patients’ problems are their problems, ignoring the possibility of the condition in ourselves. As common as infertility is, we tend to live in denial to prevent ourselves from fully experiencing the fear, the disappointment, the sadness that our patients bring with them to the clinic. As I’ve grown closer to residents and attendings through my clinical years, it has become apparent to me that many female physicians are struggling with conception. With more women going into medicine than ever before, the issue of infertility in female physicians as a result of the demands of the career has become a quiet topic of discussion among professionals and a rising area of investigation in medical literature.

factor, and 20% unexplained or achieved pregnancy before the cause could be determined4. Female infertility can be caused by ovulatory dysfunction, fallopian tube damage, endometriosis, uterine or cervical causes, clotting disorders, genetic abnormalities, or an unknown etiology5. Although female physicians can experience infertility from any of the above causes, they are at an especially increased risk of infertility as a result of ovulation disorders — either decreased ovarian reserve as a result of waiting until advanced maternal age to attempt to conceive, or hypothalamic dysfunction from chronic physical and emotional stress6.

In order to characterize female physician fertility and childbearing histories as well as decision factors in family planning, Stenz surveyed a random sample of 600 female physicians at or near the end of their reproductive years, of which 327 responded. Almost one quarter (24.1%) of respondents who tried to conceive were diagnosed with infertility, of which 29.3% was attributed to diminished ovarian reserve likely secondary to advanced age, 29.3% due to ovulatory dysfunction, and 17.2% due to male factor. The average age of first Infertility is an inability to conceive after one year of regular pregnancy was 30.4 years in comparison to 23 years in the general intercourse without the use of contraception in women under 35 population, demonstrating the delay in childbearing during early years old, and after six months in women 35 years and older1. In- training when female fertility peaks. fertility has an incidence of about 6%2 and an estimated prevalence of 12-18%3, of which a WHO study cites 37% is due to female Retrospectively, 28.1% of female physicians polled wished they factor, 8% due to male factor, 35% due to both male and female would have attempted to conceive earlier and 17.1% claimed they 22 Philadelphia Medicine : Fall 2016

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INFERTILITY IN FEMALE PHYSICIANS: A SIDE EFFECT OF THE MEDICAL PROFESSION

would have pursued a different specialty, indicating the effect that the career had on their family planning. This is also reflected in the fact that those physicians who terminated a pregnancy most commonly reported their career as the deciding factor, with starting a family while in training posing too many challenges. Part of the difficulty of conceiving during training comes from the lack of support from residencies. A 2009 survey of female ENT residents reported that “36% of program directors actively discouraged pregnancy during residency and department chairs viewed pregnancy during residency as a hardship on other residents and an interference on the smooth functioning of a department.”7 This theme is common across many specialties and residency programs. Although no longer allowed, many residency interviews attempt to assess whether female candidates are planning on childbearing during residency, as they prefer to have residents fully committed to the program without disruption from personal needs. During a time when training consumes one’s life and pregnancy serves as a burden on colleagues, female physicians all too often prioritize their careers and delay pregnancy.

day care coverage, and insurance coverage of cryopreservation (egg freezing), while maintaining the same professional and academic respect for physicians who also choose to be mothers. References (1) Kuohung W, Hornstein MD. Overview of infertility. In: UpToDate, Barbieri RL (Ed), UpToDate, Waltham, MA. (2) Centers for Disease Control and Prevention. Infertility. Centers for Disease With four years of medical school, three to seven years of resiControl and Prevention, 16 April 2016. Web. 07 August 2016. dency, and the possibility of one to four years of fellowship, female (3) Thoma ME, McLain AC, Louis JF, et al. Prevalence of infertility in the physicians often delay attempting pregnancy until they reach an United States as estimated by the current duration approach and a traditional age when decreased ovarian reserve limits their ability to conceive. constructed approach. Fertil Steril. 2013;99(5):1324. Additionally, the physical and emotional demands of the job can (4) WHO Technical Report Series. Recent Advanced in medically Assisted deregulate hormonal cycling, preventing ovulation. Conception. 1992; 820(1-11). (5) Kuohung W, Hornstein MD. Causes of female infertility. In: UpToDate, Unfortunately, women won’t know about their fertility until they Barbieri RL (Ed), UpToDate, Waltham, MA. try to conceive, and female physicians often disregard the possibility (6) Stentz NC, Griffith KA, Perkins E, et al. Fertility and Childbearing of future infertility while prioritizing training. Among American Female Physicians. J Womens Health. 2016. (7) Cole S, Arnold M, Sanderson A, et al. Pregnancy during otolaryngology A fundamental change in the training system is required to further residency: Experience and recommendations. Am Surg. 2009;75:411-415. address the needs of female physicians, with improved work hours to

reduce stresses contributing to anovulatory menstrual cycles, residency program support of women in pregnancy and motherhood, extended

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CAREERS IN MEDICINE

BREAKINGthe SILENCE Working Together to Stop the Medical Community’s Suicide Epidemic Lacey Kohlmoos

On May 10, 2016, Cheryl Collier lost to suicide her only son, 25-year-old Sean Petro. He was a third year medical student at the University of Southern California’s Keck School of Medicine, and planned to become a Navy flight surgeon. John and Michele Dietl’s 26-year-old son Kevin died of suicide on April 23, 2015, just weeks before he was to graduate medical school. Kevin’s parents were excited to attend their son’s graduation. Instead they attended his funeral.

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BREAKING THE SILENCE

Stories like these aren’t advertised in school brochures or talked about to students trying to decide whether to go into medicine. But they should be. While the suicide rate of medical students is not systematically tracked in the United States, a 2009 multi-school study found that 1 in 4 students reported symptoms of clinical depression. That’s a rate of depression 15-30% higher than that of the general population. Almost 7% of students who participated in the study said they had thoughts within the last two weeks of ending their lives. Many go into medical school as confident 22-year-olds excited to make a difference, but they often come out depressed and jaded before they even reach the age of 30. Sleep deprivation, intense competition, the weight of crushing student loan debt, and the culture of abuse found within many medical schools and residency programs are just some of the reasons for this decline in mental health. My husband is a fourth year medical student at Temple University, and I have seen firsthand how he and his colleagues have struggled. There was the guy who got a low test score that meant he wouldn’t ever be able to go into his chosen field of medicine. The guy working back-to-back 12-hour shifts who worried about being an absentee father. And the girl who after making a minor mistake during a surgical rotation, was told by her supervisor to take the elevator to the roof, turn left, walk ten steps, and jump off. I am lucky that I have not lost any friends or loved ones in the medical community to suicide. And I am so thankful that my husband has managed to successfully fight his way first through the medical school application process and then through the rigors of his program. But I also worry about what the future will bring for him and for my family. We are expecting our first child in October, and I know the road ahead is only going to get harder. About 400 physicians die of suicide every year. Male doctors are 1.4 times more likely to kill themselves than their peers in the general population. Female doctors are 2.3 times more likely to kill themselves. There is no doubt that a suicide epidemic has taken hold of the medical community. And it is up to us to stop it. Dr. Pamela Wible has been working for years to reform our medical system so that it treats both doctors and patients with respect and dignity. I first became aware of her campaign when she and Dr. Ashley Maltz created a petition on the Care2 website demanding an end to medical training that uses bullying, sleep deprivation, and public shaming to dehumanize students. The petition struck a chord with me, and as Care2’s Online Organizing Strategist, I was able to work with Dr. Wible and Dr. Maltz to ensure that their petition got as much traction as possible. As a result, over 71,000 people have signed the petition to date, with more signing on every day.

But our work hasn’t stopped there. Building off the success of the petition, Care2 organized a National Day of Solidarity to Prevent Physician Suicide. On August 20th, medical students, doctors, administrators, Care2 members, friends, and family came together in 11 cities across the country to raise awareness of the medical community’s suicide epidemic. Together we showed those suffering in silence that they are not alone, and started conversations to create change within our medical schools and hospitals. During the event, speakers ranging from medical students to mental health care experts shared their experiences, observations, and ideas for how to combat the suicide epidemic. Then the microphone was opened to anyone who felt moved to make a statement or share a story. One woman who wished to remain anonymous had the following statement read on her behalf: I am a second year student, and I will be a 4th generation physician. My grandfather was a general practitioner from 1945-1971. He suffered from depression, and committed suicide in 1971. My uncle was a pediatric infectious disease specialist from 19711999. He suffered from depression, and committed suicide in 1999. They didn’t have anyone to turn to, didn’t have effective treatment, and were victims of a stigma that lead them to feel unable to be true physicians if they themselves weren’t “healthy.” The fact these tides are changing and we can acknowledge and support each other’s mental health as physicians will save lives. Thank you for organizing this day of solidarity — I hope it impacts many student doctors, physicians, families, and friends. Each event closed with a candlelight vigil during which speakers read the names of students and doctors we have lost over the past couple of years. Through the National Day of Solidarity to Prevent Physician Suicide, we were able to create a safe space for the medical community to come together, speak out about shared struggles, and begin to find a way forward. But there is still a long way to go. To sign Dr. Wible and Dr. Maltz’s Care2 petition, visit: bit.ly/MedSuicides. To get involved in the movement to reform our medical system, visit: http://www.idealmedicalcare.org/sign-up.php.

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PAMED UPDATES

PAMED Legislative Update:

Bills Face November 30 Deadline

PAMED legislative staff have been tracking about 400 bills for this session of the Pennsylvania legislature. Only a handful of them are likely to get approved by the time the current session ends on November 30. Any bill not passed by that date will die with the session, but many of them will take on a new life and a new bill number in the next session which begins in January. PAMED, however, believes thereâ&#x20AC;&#x2122;s a chance that a few bills may still get approved by the November deadline.

Opioid-related legislation Last year, about 3,400 Pennsylvania residents died from drug overdoses. More than three dozen bills have been introduced to address this opioid abuse epidemic. Senate Bill 1202, which passed the Senate unanimously on June 15, would require licensed prescribers and dispensers in Pennsylvania to complete two hours of continuing education in pain management or in the prescribing practices of opioids for licensure renewal. The education could be completed as a portion of the total continuing education required for biennial renewal, and it would not apply to physicians who do not possess a DEA registration number to prescribe controlled substances. House Bill 1805 is nearly identical to SB 1202, except that it requires the two hours of continuing education to be completed in pain management, identification of addiction, or in the prescribing practices of opioids. HB 1805 was approved by the House unanimously on June 23. The Pennsylvania Medical Society (PAMED) supports both bills.

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PAMED also supports HB 1698, which passed the House on June 23. The bill would require health insurance plans to provide coverage for abuse-deterrent opioids that are harder to crush, cut, dissolve or inject, and apply cost-sharing provisions for these products at the same level as those applied to other brand and generic drugs. HB 1699, which also passed the House on June 23, would impose limitations on the prescribing of opioids within emergency departments and urgent care centers in Pennsylvania. It would limit prescribing to a quantity sufficient to treat a patient for seven days. The Pennsylvania Chapter of the American College of Emergency Physicians (PAACEP) and PAMED first opposed the bill, but have now taken a neutral position, since it was amended to allow more than a seven-day supply of the opioid if a health care professional determines that the patientâ&#x20AC;&#x2122;s condition warrants it. Legislation is in the pipeline that would require medical schools in Pennsylvania to implement a mandatory safe opioid prescribing curriculum. State funding would be dependent on implementation of the curriculum, which would focus on four areas: pain management, multimodal treatments for chronic pain that minimize the use of opioids, identification of risk for addiction to opioids, and management of substance abuse disorders as a chronic disease. PAMED has not yet taken a position on the proposed legislation. On June 23, Gov. Tom Wolf agreed with members of the House of Representatives, that the General Assembly be called into special session this fall,

to confront the opioid crisis. Gov. Wolf also lobbied for $34 million to support 50 Centers for Excellence across the state to treat Medicaid recipients who have opioid addiction. Lawmakers approved $15 million, which, along with $5 million in federal matching funds, will allow for 20 centers to open by October 1.

Telemedicine The dramatic expansion of telemedicine technologies has revealed a need for new safeguards and standards to support the coverage of and payment for such services in Pennsylvania. PAMED believes that patient safety and quality of care must be the guiding principles behind any use of telemedicine. For several months, PAMED has been working with other stakeholders to draft legislation addressing the use of telemedicine in Pennsylvania. Senator Elder Vogel (R-Beaver) has introduced a bill that would define what constitutes telemedicine, and force insurers to cover its use. A similar bill has been introduced in the House by Rep. Marguerite Quinn (R-Bucks).

Professional Licensure HB 1619, which passed the House unanimously on June 15, would authorize Pennsylvania to join the Interstate Medical Licensure Compact. The overarching purpose of the Compact is to streamline the licensure process for physicians interested in becoming licensed in more than one state. Supporters of HB 1619 say it would increase access to health care for individuals in underserved or rural areas, and allow patients to more easily consult medical experts

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PAMED UPDATES

through the use of telemedicine technologies. PAMED has not taken a formal position on the bill.

CRNP Independent Practice The Senate Consumer Protection and Professional Licensure Committee approved SB 717 on May 18. The bill was amended by the committee to require nurse practitioners (NPs) to have a minimum amount of post-licensure experience under a collaborative agreement with a physician before they may practice independently. PAMED believes the amendment was well-intentioned, but flawed. The stipulation requires just three years and 3,600 hours of practice experience, and does not contain specifics on what the training would entail. There is no required curriculum for the completion of those hours/ years, no assurance of the quality of mentors and oversight, and — unlike the three to seven years of heavily supervised residency training that a physician must complete — no accreditation or inspection of NP training sites. Requiring a minimum number of years or hours of work experience in an unstructured setting with highly variable experiential learning does not replace the expertise and support that comes with physician oversight. PAMED continues to strongly oppose the legislation and encourages physicians to reach out to their legislators and urge opposition to the bill.

information.

Pennsylvania from another state.

The collaborative agreement serves to ensure that patients have direct access to a physician when their care requires a more highly trained professional. Eliminating this network of support would not only be contrary to proven concepts of team-based medicine, but has the potential to jeopardize patient care.

The DOH created a Safe Harbor Physician Form to be completed by an authorized person and a Pennsylvania-licensed physician. This form must be submitted to the DOH in order for the authorized person to receive a safe harbor letter from the Department. The letter will enable the authorized person to administer medical marijuana to the minor named in the Safe Harbor Physician Form.

Physician Orders for Life-Sustaining Treatment (POLST) After extensive stakeholder meetings led by PAMED, legislative language establishing a state POLST program was finalized in April. PAMED is focusing on identifying legislative sponsors to champion a bill in January 2017.

Medical Marijuana Regulations On June 25, the Pa. Department of Health (DOH) issued temporary regulations regarding the safe harbor provision contained in the medical marijuana law. The safe harbor provision authorizes parents, legal guardians, and caregivers to legally transport medical marijuana into

The safe harbor regulations expire on May 17, 2018, or earlier, if the DOH announces before that date that the Commonwealth’s medical marijuana program has been implemented. In the coming months, the DOH expects to issue temporary regulations regarding other aspects of the medical marijuana law. PAMED will continue to track the development and release of these regulations.

PAMED strongly supports a physician-led, team-based approach to patient care, which emphasizes increased collaboration and integration among health care providers, rather than provider autonomy. The ever-increasing complexity of our health care system demands that both physicians and nurse practitioners coordinate patient care and share Fall 2016 : Philadelphia Medicine 27

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PCMS & Community News

Act 87:

A Call to Action to Scale Up Hepatitis C Testing in Pennsylvania Alex Shirreffs, MPH

n September 18, Pennsylvania’s Hepatitis C Screening Act (Act 87 of 2016) will take effect, requiring every individual born between 1945 and 1965 who receives health services as an inpatient in a hospital or who receives primary care services in an outpatient department of a hospital, health care facility, or physician’s office, to be offered a hepatitis C screening test.1 Unfunded mandates are understandably frustrating. But, as a medical professional, remember that one of the joys of the job is being able offer patients care that will cure their disease and change their life trajectory from grim to hopeful. To that end, Act 87 provides clinicians with a tool to promote awareness of the disease and move towards a more widespread, and much needed, testing scale-up.

In the face of these challenges, eradicating hepatitis C will require collaboration from a variety of stakeholders. Unfortunately, hepatitis C is also a gravely underfunded area of public health. CDC’s Division of Viral Hepatitis has a paltry annual budget of $34 million. With an estimated 5 million people nationwide living with hepatitis B and C, this breaks down to less than $10 per infection for public health services such as surveillance, prevention, or supports like linkage to care. Given the broad prevalence of hepatitis C, we must find – and fund! — cost-effective and innovative strategies in order to reach the goal of eradication. This is where Act 87 comes in. Consider it a necessary call to action. Clinicians, especially primary care providers, are critical partners in eradication planning – which must start by identifying all patients living with the virus so they can be linked to care for a cure. Since baby boomers make up a majority (up to 73%) of hepatitis C cases, and have likely been living with the virus for decades, identifying more cases in this cohort and getting them treated is essential to prevent mortality and morbidities such as cirrhosis, liver failure, and cancer.

legislators for more funding. Furthermore, clinical feedback on Act 87 will help public health officials better understand challenges that exist along the hepatitis C care continuum for both patients and providers. So, as you start implementing Act 87 in your practice, remember – you are moving the state towards a momentous medical milestone. Each additional hepatitis C test performed moves Pennsylvania one step closer to ending hepatitis C! Before you go forth and screen, here are answers to common questions that may arise as your practice considers how to routinize hepatitis C screening among baby boomers. Who needs to be tested under Act 87? A test must be offered to all persons born between 1945 and 1965, regardless of risk factors or symptoms. People with hepatitis C can live for decades without symptoms, so many baby boomers do not even know they are living with an infection that may silently be causing them to develop liver disease, liver failure and cancer.

We are in an exciting era in the field of viral hepatitis, when clinicians can cure most patients of hepatitis C in less than 12 weeks. The new treatments have minimal side effects, especially compared to the Hepatitis C is spread primarily through complications of interferon. So much progcontact with blood from an infected person. ress has been made in the last five years that In case you’re still skeptical of the poten- Many baby boomers were infected from national hepatitis treatment advocates and tial impact of Act 87, consider the experi- contaminated blood and blood products policy leaders are now developing plans for ence of New York State. In the year follow- before widespread screening of the blood eradication.2 Yet this is juxtaposed with the ing the implementation of a similar law, the supply began in 1992 and universal precaujarring statistic that hepatitis C now kills state experienced a 66% increase in hepa- tions were adopted, and most patients do more people in the United States than all titis C screening tests performed and New not know or remember how or when they 60 nationally notifiable conditions, includ- York City reported a 9% increase in linkage were infected. ing HIV/AIDS, combined.3 to care rates.5 While Act 87 focuses on improving In Philadelphia, an estimated 53,000 Increasing screening and identifying new screening of baby boomers, all patients people are living with hepatitis C – more hepatitis C cases isn’t just good medicine for with reported risk factors – including drug than a sold out crowd at Citizen’s Bank Park. the patients receiving treatment. Improv- use, tattoos in an unlicensed setting, unproLess than half of them are aware they have ing our understanding of how many Penn- tected sex with someone who is hepatitis C been infected and less than 5% — a mere sylvanians are infected with hepatitis C is positive, and a blood transfusion or organ 2,600 - have been cured of the virus.4 essential information for advocates asking donation done before1992 — should also 28 Philadelphia Medicine : Fall 2016

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Act 87: A Call to Action to Scale Up Hepatitis C Testing in Pennsylvania

be offered the test as part of standard med- “automatic” hepatitis C confirmatory test. ical care. Clinicians can order a hepatitis C reflex test from several commercial laboratories. Is testing covered by insurance? In 2012, the U.S. Preventive Services Task Force (USPSTF) issued a B grade on screening for hepatitis C among persons born between 1945 and 1965.

• For Quest, search test #91438X www.questdiagnostics.com • For LabCorp, search test #144028 www.labcorp.com. For BioReference, search test #B125-6 - www.bioreference. com.

phillyhepatitis.com. Are there resources to help my practice implement Act 87? The Health Federation of Philadelphia, in collaboration with the Hep C Allies of Philadelphia Coalition (HepCAP), offers one hour, CME-accredited course for primary care providers, bringing area clinicians with an expertise in hepatitis C to practices for an overview of the current landscape of hepatitis C testing and linkage to care strategies. These CME sessions are presented at your clinical site for free, and offer light refreshments. To request a training call 215- 2465212 or email hepcap@healthfederation. org. Find out more about this and other HepCAP activities at www.hepcap.org.

The USPSTF recommendation ensures that hepatitis C screening among this population will be covered by most public and Reflex testing means that the laboratory private insurance. This is because the Af- will do the hepatitis C antibody test, and if fordable Care Act (ACA) requires that pri- the result is positive, an HCV RNA test will vate insurance plans cover USPSTF A or B immediately be run on the same specimen. recommended services without cost sharing. Only one tube of serum is needed. This reMedicaid Managed Care plans and Medi- flex test provides the information needed care must also cover these services. to determine hepatitis C infection status in one step, without needing the patient to reWhat tests do I need to run? turn for a second blood draw. The National Viral Hepatitis Roundtable The initial hepatitis C screening test — or provides hepatitis C EMR templates, billantibody test - detects the presence of hep- Is separate consent required for ing codes, and testing best practices collectatitis C antibodies in the blood. A reactive hepatitis C testing? ed from clinicians across the nation on their result on a hepatitis C screening test is interNo. Consent for hepatitis C screening website: http://nvhr.org/program. preted as a presumptive positive for hepati- wouldn’t be any different than the methThe Philadelphia Department of Public tis C antibodies in the blood. This means a od your facility uses to obtain consent for Health has educational posters and patient person was exposed to the hepatitis C virus other types of medical services (e.g., testinfo booklets available. Request copies or at some point in time. It does not mean ing, screenings, laboratory procedures, etc.). other hepatitis information through PDPH they are currently infected. Once a person For example, facilities using a general mediat 215-685-6462 or Alexandra.shirreffs@ is exposed to hepatitis C, their antibody test cal consent for medical services would cover phila.gov. result will always be positive, even if their HCV testing. body cleared an acute infection or if they Do I need to report positive tests Alex Shirreffs is the viral prevention coordinator for the Philadelphia Department were cured through treatment. to the health department? of Public Health. Therefore, a positive antibody test must Both acute and chronic hepatitis C are be followed by a confirmatory test to deter- reportable under state and county health mine if someone is chronically infected. codes. Cases of acute and chronic hepa- 1 “Hepatitis C Screening Act,” P.L. 787, No. 87, The hepatitis C confirmatory test (also titis C in Philadelphia residents should be Jul. 20, 2016. Available from: PA Legis, http:// www.legis.state.pa.us/cfdocs/legis/li/uconsCheck. known as a viral load or RNA test) is a lab- reported to the Philadelphia Department cfm?yr=2016&sessInd=0&act=87; Accessed oratory test that detects the presence of the of Public Health. Most HCV cases are re- 8/16/16. hepatitis C virus in the blood. The presence ported to the health department from the 2 National Academies of Sciences, Engineering, of hepatitis C virus in the blood indicates clinical laboratory, and do not require the and Medicine. 2016. Eliminating the public current hepatitis C infection. clinician to call directly. More information health problem of hepatitis B and C in the United States: Phase one report. Washington, DC: The Following a positive RNA test, a patient about reporting is available at https://hip. National Academies Press. phila.gov/ReportDisease. should receive a referral to a specialist for assessment and to discuss treatment options. It will become increasingly more common for primary care providers to give follow up and treatment as hepatitis C therapy continues to improve and become easier to manage.

Where can I refer patients who test positive for care?

In Philadelphia, treatment is available within all of the major health systems through hepatology, gastroenterology, or infectious disease programs. A few Reflex HCV testing is an excellent strat- community health centers are also offeregy for streamlining the follow up of a re- ing treatment in a primary care setting. active hepatitis C antibody test with an A map of clinical sites can be found at www.

3 Ly, K.N., Hughes, E.M., Jiles, R.B., Holmberg, S.D. Rising mortality associated with hepatitis C virus in the United States 2003-2013. Clin. Infect. Dis. 2016.

4 Viner K, Kuncio D, Newbern EC, Johnson CC. The continuum of hepatitis C testing and care. Hepatology. 2015;61(3):783–9. 5 New York State Department of Health. “HCV Testing Law Evaluation Report.” January 2016.

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PCMS & Community News

Pennsylvania’s Prescription Drug Monitoring Program: Time to Sign Up

Pennsylvania’s Prescription Drug Monitoring Program:

Time to Sign Up The Pennsylvania Prescription Drug Monitoring Program (PA PDMP) is now up and running. You can now register for this new tool in the battle against the growing opioid and heroin epidemic. The PA PDMP is designed to help medical professionals identify the warning signs of addiction, doctor shopping, and drug diversion, and refer patients with substance use disorder to treatment. The link to register, as well as tutorials on how to register, is available online at www.doh.pa.gov/PDMP. Prescribers are required by law to query the system in these two clinical situations: 1) If it’s the first time a patient is prescribed a controlled substance by the prescriber. 2) If the prescriber suspects a patient may be suffering from the disease of addiction or is diverting a controlled substance. The Pa. Dept. of Health recommends that health care professionals check the database every time a controlled substance prescription is prescribed or dispensed to a patient. Prescribers are permitted to query the system for a patient to whom they are dispensing or considering dispensing a controlled substance. PA PDMP system users will find a variety of educational resources on www.doh. pa.gov/PDMP on how to effectively used the PDMP in clinical practice. Physician comments on the PDMP registration process can be emailed to stat@ pamedsoc.org. Both positive feedback and constructive criticism are welcome. The Pennsylvania Medical Society (PAMED) will gather these comments and submit them to DOH’s PDMP team. PAMED will share any response received from the Pennsylvania Department of Health.

30 Philadelphia Medicine : Fall 2016

Women Physician Forum Gender Inequalities in Medicine

THE PHILADELPHIA COUNTY MEDICAL SOCIETY

TUESDAY, SEPTEMBER 13, 2016 7:00PM - 8:30PM The Philadelphia County Medical Society 2100 Spring Garden Street, Philadelphia, PA 19130 Our Forum will focus on the experiences of women physicians regarding the key aspects of the culture of Medicine, where men and women are equally engaged in their work and share similar leadership aspirations, yet institutions have failed to create and sustain an environment where women are fully supported to succeed. We hope that this event will be the first in a series of Forums devoted to the practicing women physician. SPEAKERS TO INCLUDE: Cadence Kim, MD, FACS - President Elect, The Philadelphia County Medical Society and practicing Urologist at Aria Jefferson Health Systems Sarah E. Millar, PhD - Professor, Departments of Dermatology and Cell & Developmental Biology; Vice Chair for Research, Department of Dermatology, University of Pennsylvania Rachel M. Werner, MD, PhD - Associate Professor of Medicine, Division of General Internal Medicine; Senior Fellow, Leonard Davis Institute of Health Economics; University of Pennsylvania

2016 Upcoming Events & Programs All programs held at PCMS HQs unless noted

SEPTEMBER 7

PCMS Board of Directors meeting Meets quarterly to make financial decisions on behalf of the Society

5:00 PM to 6:30 PM

Women Physician Forum

7:00 PM to 8:30 PM

PCMS President Installation dinner and Awards night at the Philadelphia Country Club, Gladwyne

PCMS Executive Committee meeting 5:00 PM to 6:00 PM Meets once a month to plan PCMS meeting, agenda; conduct business between quarterly Board of Directors meetings.

Child Abuse Training Program

Public Health Grand Rounds program 5:30 PM to 6:30 PM “The Toll of Tobacco on Philadelphia Health” at the College of Physicians of Philadelphia.

THE CHILD ABUSE REPORTING TRAINING PROGRAM Wednesday, October 5, 2016 6:30 pm - 8:30 pm The Philadelphia County Medical Society 2100 Spring Garden Street, Philadelphia, PA 19130 Physician Licensure New Requirement! All physicians renewing their license are required to submit documentation evidencing the completion of at least two hours of approved continuing education in child abuse recognition. If you are newly licensed you must submit 3 credit hours from an approved course on the topic of mandated child abuse. This program satisfies the licensure requirement, but does not provide Category 1 CME credit. The program will include: Child abuse recognition What you need to know in order to report abuse Penalties for failing to report abuse

6:00 PM to 10:30 PM

OCTOBER

Karen E. Davidson, Esq - Law Offices of Karen E. Davidson, LLC To Register Call PCMS at 215-563-5343 x 101

Discussion on combating gender bias

6:00 PM to 8:30 PM Approved 2 hour courses for child abuse recognition and reporting training for physicians that is required for medical license renewal.

PCMS Executive Committee meeting 5:00 PM to 6:00 PM 19 Meets once a month to plan PCMS meeting, agenda; conduct business between quarterly Board of Directors meetings. 19

Health Care Town Hall- Patient and Physicians Working Together Forum to advocate for a quality sustainable and affordable health system

21-23 Pennsylvania Medical Society (PAMED)

7:00 PM to 8:30 PM

House of Delegates meeting & Annual Education Conference at the Hershey Lodge, Hershey

all Day

NOVEMBER

Adult Type 2 Diabetes Presentation INVOKANA® An Individualized Approach to the Treatment of Adults

7:00 PM to 8:00 PM

PCMS Executive Committee meeting 5:00 PM to 6:00 PM Meets once a month to plan PCMS meeting, agenda; conduct business between quarterly Board of Directors meetings.

DECEMBER

Please RSVP by September 26 To register or for more information, call: (215) 563-5343 x 113 This program is open to ALL physicians!

PCMS Board of Directors meeting

Meets quarterly to make financial decisions on behalf of the Society

5:00 PM to 6:30 PM

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PCMS & Community News

PCMS HOSTS NATIONAL DAY OF SOLIDARITY TO PREVENT PHYSICIAN SUICIDE

PCMS Hosts

National Day of Solidarity

to Prevent Physician Suicide On August 20, nearly 60 medical students, physicians, administrators, friends, and family members gathered at the Philadelphia County Medical Society to take part in the National Day of Solidarity to Prevent Physician Suicide. The Day of Solidarity was organized by Care2.com, which held similar events in 11 cites. The organization circulated a petition urging the Association of American Medical Colleges (AAMC) and Accreditation Council for Graduate Medical Education (ACGME) to take action to prevent medical student and resident suicides. The petition, which was started by Ashley Maltz, M.D., M.P.H., and Pamela Wible, M.D., has gathered more than 71,000 signatures. The American Foundation for Suicide Prevention estimates that about 400 doctors die by suicide in the U.S. each year.

During the open mic portion of the evening, several attendees who hadn’t planned to speak were moved by the presentation, and stood up and shared their stories.

One of them was Mike Tzeng, a fourth year medical student at Temple University, who spoke about the mental health issues facing medical students. He read a statement from a former classmate who did not complete medical school due to stress and lack of mental “Like many people, I had no idea that the problem was this bad. health support. Tzeng encouraged med students and physicians to But as the wife of a fourth-year Temple medical student, a soon- talk openly about their struggles. to-be mother, and someone who has had my own struggles with mental health, these statistics scare me,” Care2 organizer Lacey “Don’t just, you know, put on a white coat, smile, and act like Kohlmoos told the group. “That is why I decided to organize the you’re well,” Tzeng told the crowd. “I think it’s important to share Day of Solidarity.” (Kohlmoos has written an extensive description the negatives as well as the positives, and make sure everyone of the physician suicide crisis, in another article in this edition of around you does, too.” Philadelphia Medicine.) Jason Heckert, another fourth-year medical student at Temple After describing the lack of mental health support she received as University, addressed the hesitation that some people and organizaa medical student working in a New York hospital on 9/11, event tions had about getting involved with the Day of Solidarity. “All I speaker Erin Lockard, MD, spoke about why it is so important for have seen tonight are students, residents, and faculty sharing stories. the medical community to come together to support each other. These stories, these words, this is our reality. We are not pointing fingers and we are not rebelling. We love medicine, and we are “I personally cannot accept another medical student, resident, excited to continue in our career no matter how hard the work,” attending physician, nurse or other health care worker dying by Heckert told the crowd. “Together, we are using our collective voice a mental health circumstance that is beyond their control; be it and expressing our desire for change in how our profession deals abuse, burnout, grief, addiction, PTSD or depression,” she said. with the mental health of its practitioners.” “Collectively, I think most health care workers are by nature proactive, solution-based and nurturing people. We need to remind that to The Philadelphia County Medical Society co-sponsored the event. ourselves first, and then to our leadership and the systems within It was filmed as part of the “Do No Harm” documentary being which we work.” produced by filmmaker Robyn Symon.

32 Philadelphia Medicine : Fall 2016

CONSIDER MEMBERSHIP in The Philadelphia County Medical Society

Membership in the Pennsylvania Medical Society and the Philadelphia County Medical Society go hand-in-hand, addressing the many issues facing the medical profession today and preserving the patient-physician relationship. PCMS Membership is available to all opathic (MD) and osteopathic (DO) physicians residing or practicing in Philadelphia County, who are in good moral and professional standing. Membership is also available to residents, fellows, medical students, and practice managers. The PCMS physician leadership and staff are committed to addressing the issues confronting medicine today, and we are pleased to have you as part of that effort. By making the choice to be a part of organized medicine, you are choosing to have a voice in the way you practice medicine every day.

Member Benefits Understand Regulatory, Licensing, & Reimbursement Changes...

Community Health...

We’re here to answer your questions about health system reform, licensure requirements, scope-of-practice, and reimbursement issues. One call could pay for your dues many times over.

PCMS takes an active role in the health of our local community. Our Block Captain Program provides education and access to primary care for residents who cannot afford healthcare. We also work with the Philadelphia Department of Public Health to develop and meet sound public policies.

Stay Current...

Discounted Rates...

Stay up-to-date on local, state, and national issues through our monthly member emails, quarterly magazine, legal and regulatory manuals, regular practice management meetings, and continuing medical education physician seminars.

Members get excellent rates on legal and business reviews of contracts through our legal referral program. We also provide group rates on liability, disability, long-term care, health, term life, and workers’ compensation insurances.

Advocacy...

Networking & Community Improvement Opportunities...

PCMS and PAMED have been committed to being your voice in state and national matters affecting the practice of medicine in our community.

PCMS provides opportunities throughout the year for physicians, residents, and medical students to meet, including a formal Awards Night. Join our speaker’s bureau, or participate in our “Docs on Call” live television program.

Apply Today Join the Philadelphia County Medical Society, and become more engaged in the decisions that impact your livelihood and the future of healthcare. Member Application:

http://philamedsoc.org/index.php/members/ pcms-application/

Resident & Fellows Application:

http://philamedsoc.org/index.php/members/ resident-fellows-application/

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PCMS & Community News

A Conversation

with Our New President Your BA in the classics appears to be an unconventional route to medicine.

You could call Dr. Daniel T. Dempsey a Renaissance man. The 155th president of the Philadelphia County Medical Society is as comfortable with a scalpel in his hand as he is with a copy of The Odyssey in the original Greek. Dr. Dempsey is the chief of the Division of Gastrointestinal Surgery for the University of Pennsylvania Health System, and assistant director of perioperative services at the Hospital of the University of Pennsylvania. He is also a lover of the classics, the discipline that earned him his BA at Princeton. He has written or co-authored 89 original papers on a vast array of surgical and related issues; has helped write dozens of chapters for medical textbooks; has contributed to more than 70 abstracts, and has given more than 125 presentations at hospitals, medical schools and universities. All of that good work has earned him “Best Doctor in America” honors for several years. Why did you want to be a doctor? A surgeon? I liked science and wanted to do something practical that helped people. Growing up in a small rural upstate New York town, our family doctor, Charle Cole, was a strong role model. I went to college with a strong inclination that I would try to go to medical school. When I started med school I was pretty certain that I would do rural primary care. But then I did my surgery clerkship and loved it—the patients and their problems; the surgical residents and attendings; the OR, ward, and clinics. At Rochester I had great role models in surgery, including Charles Rob, Seymour Schwartz and James Adams. And then when I got to Penn for residency I had other great role models and mentors in academic surgery—Jonathan Rhoads, Brooke Roberts, Clyde Barker, Jack Mackie, Ernie Rosato, Jim Mullen. I fell in love with academic surgery and with Philadelphia, so here I am. 34 Philadelphia Medicine : Fall 2016

If I decided late in college that I really didn’t want to go to med school, or didn’t get in, my plan B was to be a classics professor. As is the case today, there was no requirement to be a science major to go to medical school. I took quite a lot of science courses in addition to classics and other requirements. What attracted you to the classics? What did you learn from them? Have they in any way helped to make you a better doctor? I took a lot of Latin in high school and enjoyed the mix of history, literature and philosophy. So I continued the Latin in college and took Greek, too, and really liked the subject matter and the faculty. I think to be a good doctor it helps to be a clear thinker and a humanist. I like to think that studying the classics helped me in that regard, but you should probably ask my patients and colleagues to find out for sure. Reading all that stuff in the original Latin or Greek may stimulate the formation of some additional synapses in the brain, but that’s of secondary importance. If you could recommend one book to medical students from the classics, what would it be? I would recommend two: Homer’s Iliad (Fagles translation) and Plato’s Republic (Bloom translation.) What books do you have on your night stand right now? The Art of Woo (Shell and Moussa), Half Earth (Wilson), The Bully Pulpit (Kearns Goodwin), The Bible. What has helped make you the doctor you are today? Strong faith, loving supportive family, great colleagues and patients. What are the biggest changes you’ve seen in medicine since starting your career? 1) Technology; 2) the expansion of hospital systems; 3) the increase in the percentage of employed physicians, and the decrease in the percentage of private practice physicians. Obviously two and three are related.

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A CONVERSATION WITH OUR NEW PRESIDENT

What does it take to be a doctor today? Is it any different than when you started? I don’t think the fundamentals have changed in ages: genuine care and concern for the patient, good clinical skills, good clinical judgement. What are the things that make it tougher to be a good doctor today?

O C TO B E R 2 0 1 6

Patients are sicker and more complicated than ever, and treatment options are more complex than ever. Logic would suggest that this would require more time per patient. But with decreasing revenue per unit of work and increasing expenses, doctors have to run faster just to stay in the same place. This contributes to less time per patient, increased specialization, lack of patient ownership, and in some cases, physician burnout and patient dissatisfaction.

 Domestic Violence Awareness Month

How are medical students today like you when you started? How are they different?

 Eye Injury Prevention Month  Health Literacy Month  Home Eye Safety Month  National Breast Cancer Awareness Month  National Bullying Prevention Month  National Dental Hygiene Month  National Down Syndrome Awareness Month

In many important ways med students today are the same as when I was in medical school: bright, hardworking, altruistic, motivated. Today’s students are more team oriented and more questioning. They tend to have more real world experience and often have a global viewpoint. All of this is good for patients and for our profession.

 National Physical Therapy Month

If you had one piece of advice for young doctors, what would it be?

 (16 - 22) International Infection Prevention Week

Listen to the patient, and never forget what a privilege it is to be a physician or surgeon. Take time for yourself and your family. Appreciate your colleagues. And advice for doctors in your generation? The same. What do you hope to accomplish as president of PCMS?

 Sudden Infant Death Syndrome (SIDS) Awareness Month  (2 - 8) Mental Illness Awareness Week  (12 - 20) Bone and Joint Health Action Week

NOVE M B E R 2016  American Diabetes Month  Bladder Health Month  COPD Awareness Month  Diabetic Eye Disease Month  Lung Cancer Awareness Month  National Alzheimer’s Disease Awareness Month

I hope to gain a greater understanding of how PCMS can better serve current and future members.

 National Healthy Skin Month  National Stomach Cancer Awareness Month

How has PCMS helped you in your career? It has allowed me to meet and learn from colleagues from a variety of different medical and surgical specialties, some of whom are in private practice and some of whom are employed throughout numerous Philadelphia institutions. PCMS has provided me the opportunity to participate in organized medicine both at the local and state level. It is important for doctors to understand that when legislators in Philadelphia want to know how we feel about a certain issue, they usually call PCMS first; in Harrisburg they call PAMED, and in DC they call the AMA.

DECE M B E R 2016  (1) World AIDS Day  (4 - 12) National Influenza Vaccination Week  (4 - 10) National Handwashing Awareness Week

Fall 2016 : Philadelphia Medicine 35