MICHIGAN MEDICINE Jan-Feb 2020

THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 119 / NO. 1

January / February 2020

ALSO INSIDE January is Cervical Health Awareness Month! Protect Your Patients with HPV Vaccine

PHYSICIAN LEADERSHIP

What it looks like and why it matters.

msms.org

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| JANUARY / FEBRUARY 2020

FEATURES & CONTENTS January / February 2020

08

Good Leadership Can’t be Outsourced JODI SCHAFER, SPHR, SHRM-SCP

10

January is Cervical Health Awareness Month – Protect Your Patients with HPV Vaccine ALYSSA STROUSE, MPH

12

Legal and Regulatory Resources at Your Fingertips STACIE HETTIGER

24

Tackling Physician Burnout Requires Unprecedented Leadership ROBERT D. MORTON, CPHRM, CPPS

COLUMNS 04 President's Perspective

MOHAMMED A. ARSIWALA, MD

06 Ask Our Lawyer

16

DANIEL J. SCHULTE, JD

DEPARTMENTS 22 Welcome New Members 28 MSMS Educational Courses

FEATURE

Physician Leadership: What it looks like and why it matters

BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY

STAY CONNECTED!

Leadership is a lofty ideal worth pursuing and practicing over the course of a lifetime. But what does physician leadership look like in daily life, and why does it matter to physicians, their colleagues, and their patients? Story on page 16.

JANUARY / FEBRUARY 2020 |

michigan MEDICINE® 3

MICHIGAN MEDICINE® VOL. 119 / NO. 1

perspective

Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZÜBERANT! INC. rezuberant.com Printing FORESIGHT GROUP staceyt@foresightgroup.net Publication Office Michigan Medicine® 120 West Saginaw Street East Lansing, MI 48823 517-337-1351 www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast.

Postmaster: Address Changes Michigan Medicine® Trisha Keast 120 West Saginaw Street East Lansing, MI 48823

Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan.

The MSMS Committee on Publications is the editorial board of Michigan Medicine® and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors.

Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine® reserves the right to accept or reject advertising copy.

Products and services advertised in Michigan Medicine® are neither endorsed nor warranteed

by MSMS, with the exception of a few.

Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2020 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110.

Single copies, $10. Printed in USA. ©2020 Michigan State Medical Society

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“With today’s challenges in the house of medicine, the shifting landscape of healthcare and the unpredictable fate of [state and] federal legislation impacting their work, it’s essential that physicians are directly involved in health care leadership to navigate a better way forward for the profession and patients.”

By Mohammed A. Arsiwala, MD, MSMS President

It’s been said that leaders don’t create followers—they create more leaders.

Here at MSMS, we’re in the business of leadership creation. Physician leaders have the power to transform lives through their insight, experiences, and ability to look around corners when it comes to health care policy and practice.

In this issue of Michigan Medicine®, we’ll show how some Michigan physicians who are already working in important statewide advocacy roles are able to advance strategies that support quality patient care, while simultaneously nourishing their own professional growth as leaders, collaborators, and mentors.

Along the way, we will highlight how statewide societies like ours can play a huge role in developing the leaders of tomorrow. In fact, the American Medical Association

MOHAMMED A. ARSIWALA, MD MSMS PRESIDENT

has adopted a policy encouraging physicians to serve on the boards of health care organizations like MSMS. In doing so, the association cited numerous studies showing “significant evidence that the participation of physicians in the governance of many health care organizations is associated with higher business performance, clinical quality and social outcomes.”

A blog post shared by Forbes and The Physicians Foundation shines additional light on the need for statewide physician leadership.

With today’s challenges in the house of medicine, the shifting landscape of health care and the unpredictable fate of [state and] federal legislation impacting their work, it’s essential that physicians are directly involved in health care leadership to navigate a better way forward for the profession and patients.

In other words, you can play a stronger role than you ever thought possible—and, along the way, you’ll grow personally and professionally, safeguard against the growing risk of burnout, and help shape a better tomorrow for all of us.

Mohammed A. Arsiwala, MD MSMS President

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ASK OUR LAWYER

Enforceability of Covenants Not to Compete

By Daniel J. Schulte, JD, MSMS Legal Counsel

Q:

Several questions have been received lately regarding the enforceability of a covenant not to compete. These questions arise in the context of an employment relationship and the purchase/sale of a medical practice. Some ask whether they

are enforceable at all in Michigan. Others what a time period and geographic scope that they know will be enforceable. Yet others are unwilling to agree to what is being asked of them in an employment agreement or a purchase agreement and are seeking information to use in negotiations with an employer or a buyer/seller.

The short answer is that a covenant not to compete IS enforceable in Michigan if it is reasonable. However, to fully address this issue three points must be considered.

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Is the covenant not to compete considered reasonable?

No one can tell you in advance what a court in the future will consider “reasonable”. Instead, only some general legal advice based on experience can be given.

As to the time period the covenant not to compete applies, 1 to 5 years is what I have seen most often. The specific length will depend in large part on whether the covenant not to compete is contained in an employment agreement v. a purchase agreement or other commercial agreement (read below for an explanation). The reasonableness of the geographic scope usually depends on the distance patients travel to obtain medical care at an office.

The point of a covenant not to compete is to protect a legitimate business interest. If, for example, the farthest a material number of patients of a medical practice travel to receive care at that practice is 10 miles, the practice likely has no legitimate business interest that will be protected by a covenant not to compete extending 11 or more miles away.

Is the covenant not to compete contained in an employment agreement, a purchase agreement or other commercial agreement?

In 2016, the Michigan Supreme Court clarified that only a covenant not to compete contained in an employment agreement must be reasonable. By contrast, a covenant not to compete contained in a purchase agreement or other nonemployment commercial agreement may be enforceable even if it is not reasonable as to a party to the agreement. This is a significant difference. When challenging the enforceability of a covenant not to compete in a nonemployment commercial agreement it is necessary to prove more

than the unreasonableness of the time period, geographic scope and restricted activity. In addition, it must be proven that an adverse anticompetitive effect in the relevant market will occur as a result of enforcement of the covenant not to compete. This added burden of proof is why covenants not to compete in nonemployment commercial contracts are more likely to be enforced that those contained in employment agreements. This also explains why the time periods, geographic scope and breath of activity restricted are usually greater in nonemployment commercial agreements.

“In 2016, the Michigan Supreme Court clarified that only a covenant not to compete contained in an employment

If a covenant not to compete is enforceable, will it be enforced?

agreement must be

Even if a covenant not to compete is enforceable, there is no guarantee that it will be enforced. Enforcement of a covenant not to compete is usually sought in the form of an injunction preventing the part to a covenant not to compete from engaging in an activity. Injunctions are equitable remedies. This means courts have wide discretion in deciding whether to grant them (i.e. a covenant not to compete that is enforceable may not be enforced). For example, a court may take into account the bad acts of the nonbreaching party to a covenant not to compete (even one contained in a purchase agreement) in deciding not to grant an injunction.

a covenant not to

reasonable. By contrast, compete contained in a purchase agreement or other nonemployment commercial agreement may be enforceable even if it is not reasonable as to a party to the agreement. This is a significant difference.”

As you can see, few clear-cut answers can be given to your questions. Instead, the enforceability of a covenant not to compete will depend on many factors.

DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL

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ASK HUMAN RESOURCES

Good Leadership Can’t be Outsourced

By Jodi Schafer, SPHR, SHRM-SCP, Human Resources Management Services, LLC

Q:

I’m struggling with the current dynamics in my

practice. Right now I have a highly effective group of individuals. The work they do individually is bold and outstanding; however they do not work together well. For example, I have a nurse who will not cover for any other clinical staff. To her credit she did not ask anyone to cover for her, so she feels she shouldn’t have to cover for anyone else.

This causes a great deal of resentment.

She is viewed as uncooperative and a bit of a snob. She is not alone; a number of my staff act like divas. My Practice Manager is at a loss for what to do. I’d prefer not to get rid of any of them because of their individual talents, but how do I get them to work as a team?

Y

ou are fortunate to have high performers on staff, but as you’ve learned, high performers can be more difficult to lead.

Expecting a Practice Manager to take sole responsibility for leading your employees is not realistic. They play a supporting role, but ultimately it is up to you to be the leader.

Leadership is mix of inspiration, communication, action, and representation. Let me break down each of these components so you can see where you might be losing ground.

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“As the old saying goes ‘Actions speak louder than words’.

If you say you are going to do something then you have to do it.”

As a leader you need to inspire.

You set the example for behavior you expect from your staff. You should treat all of your employees respectfully, professionally and with kindness. If you want employees to cover for each other you should cover more for them. Even as the leader you are part of the team. They will look to you for direction. Your behavior should model the expectations you have for all the staff members therefore you must act, speak, and be the person you want your employees to be.

As a leader you want to communicate.

You must be accessible and available for your staff. This allows information to flow freely between you and them. Your employees have a stake in the practice.

They may not have ownership interests, but their financial well-being is tied to the financial well-being of business. Therefore they will want to know your vision and plans for the future. Keep them informed as to what you're doing with the practice. Whether it is purchasing software, implementing new procedures, or hiring new staff members, let them know.

If you don’t provide them with the information they tend to fill in the blanks for themselves. Often the end result is more fiction than fact which can create tunnel vision and acts of self-preservation.

You must be honest. Often leaders have to say things that are difficult to say. In order to have their respect you must be honest with your staff. Modeling be-

havior is one of the easiest ways to learn leadership skills (as long as you’re modeling the right behavior).

As a leader you need to act.

As the old saying goes ‘Actions speak louder than words’. If you say you are going to do something then you have to do it. Follow through with your promises in order to get the respect you need to influence others. Provide staff with opportunities for development, both professionally and personally. Dedicate yourself to their growth. Don’t be cheap.

Provide and pay for their training because their development benefits the practice as much as it benefits the individual.

As a leader you represent your staff to the public.

Their behavior is a reflection on you and the practice as a whole. So if they can’t work together as a team, then it’s as if YOU can’t work as part of a team. If a patient feels tension between two employees you may lose the patient. Going to the doctor is stressful enough without having to deal with the practice’s internal conflicts.

In order to change the behavior of your staff you must first identify the weaknesses in your own leadership skills and work to enhance those. It begins and ends with you. You must create an environment where all people feel safe and where cooperation is rewarded. Only then can you truly come together as a team to focus on the needs of the patient.

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MDHHS UPDATE

January is Cervical Health Awareness Month: Protect Your Patients with HPV Vaccine

By Alyssa Strouse, MPH, Adult and Adolescent Immunization Coordinator, MDHHS Division of Immunization

Every year, approximately 34,800 men and women are diagnosed with a cancer caused by the human papillomavirus, commonly known as HPV.1

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C

ervical cancer is just one of six types of cancer caused by HPV, but it is the most common HPV-associated cancer in women.4 Even with effective screening methods, such

as the pap test and the HPV test, HPV causes approximately 10,900 cases of cervical cancer in the United States every year.

Further, nearly 4,000 women die of cervical cancer every year.1

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In addition to cervical cancer, there are an estimated

196,000 cases of cervical precancers each year in the United States.

Treatment for both cervical cancers and precancers can cause additional health issues and can limit a woman’s ability to have children.4 The HPV vaccine is the best and most effective way to protect patients from all HPV-attributable cancers, including cervical cancer. The HPV vaccine is recommended at ages 11-12, but the vaccine can be given as early as age 9. Children who start the vaccine series at the recommended age, prior to their 15th birthday, will only need two doses separated by 6-12 months. Children who start the HPV vaccine series on or after their 15th birthday will need three doses over the course of 6 months. Immunocompromised children will need three doses of HPV vaccine regardless of the age at which they start the HPV vaccine series. Further, HPV vaccination is recommended for males and females through age 26 years, if not previously vaccinated. Although vaccination is not recommended for everyone older than age 26 years, some adults age 27 through 45 years may be vaccinated based on a discussion with their healthcare provider.2 HPV vaccination is safe, effective and provides long-lasting protection against cancers caused by HPV. Since the vaccine was introduced in 2006, over 120 million doses of HPV vaccine have been distributed and ongoing safety monitoring and research by CDC and the U.S. Food and Drug Administration (FDA) continue to

illustrate that the vaccine is safe and effective. Further, among teen girls, infections with HPV types that cause most HPV cancers and genital warts have dropped by 71% since the vaccine has been in use. Finally, studies suggest that protection provided by the HPV vaccine is long-lasting and there has been no evidence of the protection decreasing over time.2 Although research has illustrated that HPV vaccine is safe, effective, offers long-lasting protection and prevents cancer, the vaccine is still extremely underutilized. According to recent National Immunization Survey-Teen (NIS-Teen) data, nationally, only 48.7% of males and 53.7% of females age 13-17 years have completed their HPV vaccine series.3 In Michigan, according to the Michigan Care Improvement Registry (MCIR) and as of September 30, 2019, only 42.7% of males and 45.3% of females age 13-17 years have completed their HPV vaccine series.5 This data illustrates that approximately half of our adolescents are left unprotected and at risk for developing an HPV infection and/or HPV-attributable cancer at one point in their lifetime. According to CDC, increasing coverage of HPV vaccination at the routine age of 1112 years and catch-up vaccination through age 26 years will contribute to further reduction in cervical precancers.4 It is imperative that all healthcare professionals, including physicians, physician assistants, nurse practitioners, nurses, medical assistants, pharmacists, dentists, dental hygienists and even additional staff in provider offices must advocate for and strongly recommend the HPV vaccine. There are several practical and proven strategies to increase HPV vaccination rates. One strategy is to bundle your recommendation and recommend the HPV vaccine in the same way and on the same day as you do the other adolescent vaccines. Another strategy is to ensure a consistent message

and train all office staff on how to successfully communicate with parents and patients about HPV vaccination. Finally, it is encouraged to provide personal examples on how and why you support the HPV vaccine for your family and friends. The healthcare community must come together to increase HPV vaccination rates and protect all patients from HPV-attributable cancers and diseases.

REFERENCES 1 CDC (2019), HPV and Cancer. Retrieved from https:// www.cdc.gov/cancer/hpv/statistics/cases.htm 2 CDC (2019), Human Papillomavirus (HPV). Retrieved from https://www.cdc.gov/hpv/index.html 3 CDC (2019). TeenVaxView. 2018 Adolescent Human Papillomavirus (HPV) Vaccination Coverage Dashboard. Retrieved from https://www.cdc.gov/ vaccines/imz-managers/coverage/teenvaxview/data-reports/hpv/dashboard/2018.html 4 McClung NM, Gargano JW, Park IU, et al. Estimated Number of Cases of High-Grade Cervical Lesions Diagnosed Among Women — United States, 2008 and 2016. MMWR Morb Mortal Wkly Rep 2019;68:337–343. DOI: http://dx.doi.org/10.15585/ mmwr.mm6815a1external icon.

5 MDHHS (2019). Michigan’s Statewide Quarterly Immunization Report Card. Retrieved from https:// www.michigan.gov/documents/mdhhs/State_Level_ReportCard_621826_7.pdf

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HEALTH CARE DELIVERY

Legal and Regulatory Resources at Your Fingertips

By Stacey Hettiger, Director Medical and Regulatory Policy, Michigan State Medical Society

M

embers of the Michigan State Medical Society (MSMS) have access to a variety of supports and services. MSMS Departments cover a range of areas of interest to physicians,

practice managers, and other medical staff including education opportunities, legislative and regulatory advocacy, legal support, payer advocacy and connections, coding advice, representation on federal and statewide panels, and communication on health care hot topics.

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The Health Care Delivery Department at MSMS deals with payer, regulatory, and system issues that impact the practice of medicine. Health Care Delivery team members are available to help members address individual questions and concerns, as well as to monitor and report on global issues of interest.

As health care law becomes increasingly complex, MSMS’ legal resources are relied upon to help members navigate legal and regulatory constraints and obligations related to care delivery. A list of those legal resources begins on page 13.

“As health health care care law law becomes becomes increasingly increasingly complex, complex, MSMS’ MSMS’legal legal “As resources are are relied relied upon upon to to help help members members navigate navigate legal legal and and resources regulatory constraints constraints and and obligations obligations related related to to care care delivery. delivery. ”” regulatory Legal Services Services Legal

General legal legal questions questions on on aa variety variety of of General issues of of concern concern to to physicians physicians statewide statewide issues (e.g., medical record retention, medical (e.g., medical record retention, medical records charges, privacy issues, Stark, etc.) records charges, privacy issues, Stark, etc.) are answered for FREE as a benefit of are answered for FREE as a benefit of MSMS membership.

MSMS membership.

Legal Checklists Checklists Legal

MSMS checklists checklists provide provide physicians physicians with with MSMS a starting point to evaluate key areas that a starting point to evaluate key areas that should be addressed in contracts, employshould be addressed in contracts, employee documents, documents, and and compliance compliance plans: plans: ee Managed Care Contracting Managed Care Contracting Employed Physician Physician Contracting Contracting Employed Compliance Program Compliance Program Employee Manual Manual Employee HIT/EHR Vendor Contracting Contracting HIT/EHR Vendor

Special Legal Legal Services Services Special

MSMS members members in in need need of of aa thorough thorough leleMSMS gal review and consultation pertaining to gal review and consultation pertaining to overpayment audits, bylaws, and contracts overpayment audits, bylaws, and contracts are able able to to receive receive this this benefit benefit for for aa fixed fixed are fee for for the the following following services: services: fee Employment Contract Review Service Service Employment Contract Review Physician Audit Audit Consultation Consultation Service Service Physician Medical Staff Bylaws Review Service Medical Staff Bylaws Review Service HIT/EHR Vendor Vendor Contracting Contracting HIT/EHR Review Service Review Service

Health Law Law Library Library Health

The MSMS MSMS Health Health Law Law Library, Library, assemassemThe bled by our Legal Counsel, is available bled by our Legal Counsel, is available digitally so so members members can can access access itit 24/7.

24/7. digitally Information available through the Library Information available through the Library designed to to assist assist physicians physicians in in learning learning isis designed about and understanding the many Michabout and understanding the many Michigan statutes statutes and and regulations regulations which which affect affect igan the practice of medicine in our state and the practice of medicine in our state and includes a variety of topics from "AIDS/ includes a variety of topics from "AIDS/ HIV" to to "Scope "Scope of of Practice," Practice," as as well well as as ananHIV" titrust regulations, Michigan’s new physititrust regulations, Michigan’s new physician licensure licensure laws, laws, and and the the latest latest reporting reporting cian requirements. requirements.

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Legal Alerts Alerts and and Guides Guides Legal MSMS legal legal alerts alerts and and guides guides provide provide aa MSMS succinct legal analysis of both timely and succinct legal analysis of both timely and long-standing issues that impact the praclong-standing issues that impact the practice of of medicine. medicine. These These resources resources provide provide tice members with with an an informative, informative, on-demand on-demand members tool to answer questions regarding regulatool to answer questions regarding regulations, processes, etc. to ensure compliance. tions, processes, etc. to ensure compliance.

Many of of the the alerts alerts are are based based on on trending trending Many inquiries directly directly from from physicians physicians and and inquiries their staff.

Below are excerpts from our their staff. Below are excerpts from our most recent and popular documents. most recent and popular documents.

ASK OUR LAWYER

CONTRACT REVIEWS

MEDICAL RECORDS RECORDS GUIDE GUIDE MEDICAL “Neither the the HIPAA HIPAA Privacy Privacy Rule Rule nor nor the the “Neither MMRAA permits permits you you to to withhold withhold medical medical MMRAA records until a past due balance is paid. records until a past due balance is paid.

However, you may insist that the patient However, you may insist that the patient prepay the appropriate copying fee and the prepay the appropriate copying fee and the fee charged for preparation of a summary fee charged for preparation of a summary of the medical record (see CHAPTER 9).” of the medical record (see CHAPTER 9).”

“For Michigan health professional licens“For Michigan health professional licensing purposes, MCL §333.16213 requires ing purposes, MCL §333.16213 requires that you keep your medical records for a that you keep your medical records for a minimum of seven years from the date of minimum of seven years from the date of service to which the record pertains unless a service to which the record pertains unless a longer period of time is required by another longer period of time is required by another federal or Michigan law or regulation or federal or Michigan law or regulation or by generally accepted standards of medical by generally accepted standards of medical practice. MCL §333.16644, which applies practice. MCL §333.16644, which applies only to dental records and requires them to only to dental records and requires them to be maintained for ten years from the date be maintained for ten years from the date of service, is an example of a statute requirof service, is an example of a statute requiring a longer retention period.” ing a longer retention period.”

“The statute of limitations on potential “The statute of limitations on potential medical malpractice claims should be conmedical malpractice claims should be considered before destroying any medical residered before destroying record. You do not want to any be inmedical a position cord.

You do not want to be in a position of having to defend a medical malpractice of having to defend a medical malpractice claim without the medical records that are claim without the medical records that are the subject of the claim.” the subject of the claim.”

HEALTH LAW LIBRARY

ALERTS, GUIDES & CHECKLISTS

Toaccess accessany anyor orall allof of To these member resources, these member resources, visitmsms.org/Resources msms.org/Resources visit or contact theMSMS MSMSHealth Health or contact the CareDelivery DeliveryDepartment Departmentat at Care 517/336-5723 or via email at 517/336-5723 or via email at cwheeler@msms.org. cwheeler@msms.org.

(CONTINUED ON PAGE 14) (CONTINUED ON PAGE 14) JANUARY / FEBRUARY 2020 |

michigan MEDICINE® 13

MEDICAL RECORDS POLICY MODEL AND LICENSURE REQUIREMENT FOR MICHIGAN PHYSICIANS “The Michigan Public Health Code (the "Code"), at MCL § 333.16177(4), requires a physician or other applicant for an initial Michigan health professional license, or a licensee applying to renew a license, to provide the Michigan Department of Licensing and Regulatory Affairs (the "Department"), on the application or the license renewal form, with an affidavit stating that he or she has a written policy for protecting, maintaining, and providing access to his or her medical records in accordance with Section 16213 of the Code.”

“A person who fails to comply with Section 16213 is subject to an administrative fine of not more than $10,000.00 if the failure was the result of gross negligence or willful and wanton misconduct. MCL § 333.16213(5).”

“Sample Medical Records Retention Policy. Instructions: Physicians and their medical practices may use this model policy for

guidance when drafting a Medical Records Retention and Disposition Policy for Michigan health professional licensing compliance per the requirements of the Michigan Public Health Code § 333.16177 and § 333.16213. Physicians are responsible to modify this model policy to suit the particular needs of their medical practices…”

MANDATORY FLU SHOT FOR EMPLOYEES: POLICY IMPLEMENTATION AND BEST PRACTICES “As a condition of employment, an employer may require that all employees receive a flu shot. However, an employer’s compulsory flu shot policy must provide for exemptions in order to comply with various laws regulating the employer/ employee relationship.”

“It is advisable for an employer that wishes to require flu shots to adopt a written flu shot policy so that all employees have reasonable advance notice that receiving an annual influenza vaccination is a condition of employment.”

“Educating employees about the benefits and importance of the flu shot may help maximize employee participation. Just like frequent hand washing and wearing gloves, the flu shot is an important protective measure for employees and patients. The Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers get vaccinated annually against influenza1.”

LEGAL ISSUES FOR PHYSICIANS TREATING HEARING IMPAIRED OR LIMITED ENGLISH PROFICIENCY PATIENTS “Several methods are commonly used by physicians to ensure effective communication with hearing impaired patients…The method(s) physicians choose to adopt—or may be required by law to provide at the physician’s expense—will vary depending on the

MSMS FOUNDATION’S 9TH ANNUAL

THURSDAY, MAY 14 – FRIDAY, MAY 15, 2020 DOUBLETREE HILTON, DEARBORN

#SSM2020 14 michigan MEDICINE®

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relevant facts and circumstances. The avail-

SERVICE ANIMALS AT PHYSICIAN'S OFFICE

ability and cost of qualified commercial

“The Americans with Disabilities Act ("ADA") requires places of public accommodation, including physicians’ medical practice offices and health-care facilities (individually referred to in this Legal Alert as a “facility” and collectively as “facilities”), to allow service animals to assist persons with disabilities.”

interpreting services, the need for an impartial interpreter, the number of hearing impaired patients in the practice, the patient’s individual wishes, the government’s enforcement practices, and the complexity of the encounter are some of the factors that may influence this decision.”

“Discrimination in the delivery of physician services based on a patient’s disability has been prohibited by federal and Michigan law for quite some time. A hearing impairment is considered a disability.” “…a December 5, 2001 HHS policy guidance document (the “HHS Guidance Document”) applicable to all health care providers receiving federal financial assistance, including physicians, does require that language assistance services be provided to LEP Patients in certain circumstances.”

To access any or all of these member resources, visit msms.org/Resources or contact the MSMS Health Care Delivery Department at 517/336-5723 or via email at cwheeler@msms.org.

“Service animals may accompany a patient, employee, or a visitor of a facility. These service animals must be allowed to accompany persons with disabilities in all areas where the public is allowed.”

“Emotional support animals or comfort animals are often prescribed by a doctor as part of a therapy or treatment plan. This may cause some confusion when determining whether to admit the animal into place of public accommodation. However, service animals and emotional support animals are treated differently under the ADA and Michigan law.”

Driven by results.

As counsel to the MSMS community for over 70 years, we know how to help physicians.

DETROIT

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T R OY

kerr-russell.com

JANUARY / FEBRUARY 2020 |

michigan MEDICINE® 15

FEATURE

PHYSICIAN LEADERSHIP

What it looks like and why it matters.

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Leadership. It’s a word used so often, in so many run-of-the-mill ways, that we tend to minimize its significance. In 2019, there is hardly a single résumé or CV that fails to include multiple references to leadership, or a professional development opportunity that neglects to cite it as a learning outcome.

L

eadership is more than a throwaway word— it is a lofty ideal worth pursuing and practicing over the course of a lifetime.

Michigan is fortunate to boast many physician leaders; men and women who assume important statewide advocacy roles are able to advance policies that support quality patient care, while simultaneously nourishing their own professional growth as leaders, collaborators, and mentors.

But what does physician leadership look like in daily life, and why does it matter to physicians, their colleagues, and their patients?

Starting from Behind Surprisingly, research shows most physicians begin at a distinct disadvantage where even their basic management skills are concerned. A pair of articles in the Harvard Business Review recently lamented the lack of management training physicians typically receive, and cited important benefits that arise when such skills are effectively developed—higher quality care, improved clinical outcomes, greater patient satisfaction, and better financial results., “In medicine, we’re trained in patient care and all the many theoretical and technical aspects that accompany it,” says Roy Soto, MD, an anesthesiologist who serves as

president of the Michigan Society of Anesthesiologists’ board of directors. “It’s our primary job, so it makes sense it should be our central focus. But it’s tough to overstate the importance of educating ourselves on what we’ve not been taught, so we can handle in-depth financial, management and strategic issues, as well.”

Most practical experiences tend to bear this out. In a world where physicians are trying to figure out tough issues like prior authorization, surprise billing, and an unprecedented amount of paperwork, the need for strong management skills is rising in importance.

It’s also a world where real leadership is needed—leadership that advocates for the needs of patients, informs state and federal

“It is hard for one person to do everything.

Collaboration gives physician leaders an ability to keep learning and growing, to try doing things just a little bit better. Sharing that responsibility is so important.”

ANAND THAKUR, MD

policy, seeks the opportunity to grow and innovate, and supports the advancement of important research.

But in a profession where even basic management training is often lacking, finding talented leaders ready to engage and lead on this broader level can be a challenge.

What Physician Leadership Looks Like in 2020 The default setting for generations of would-be physician leaders has been based on the relatively dysfunctional model of giving orders and expecting them to be carried out. It’s natural and grounded in decades of training suggesting that, when an answer is necessary, it is the physician who must find (diagnose) it and then tell everyone on the team what to do, or how to treat it.

A growing body of research and practice suggests, however, that physician leadership is most effective when it is collaborative in nature. Anand Thakur, MD, an anesthesiologist and pain management specialist from southeast Michigan who chairs the board of the Michigan Society of Interventional Pain Physicians, suggests collaboration can be an asset.

“It is hard for one person to do everything,” Doctor Thakur says. “Collaboration gives physician leaders an ability to keep learning and growing, to try doing things just a little bit better. Sharing that responsibility is so important.”

Doctor Soto takes the concept a step further. “As a leader, you need to recognize the Peter Principle at work in yourself— the point at which you have risen to your level of incompetence,” he chuckles.

CONTINUED ON PAGE 18

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PHYSICIAN LEADERSHIP– CONT. FROM PAGE 17

“Effective leaders need to be highly self-aware, so they can stay effective while learning and growing and helping others reach their own potential.”

ROY SOTO, MD

“Effective leaders need to be highly selfaware, so they can stay effective while learning and growing and helping others reach their own potential.”

Inspiration. Collaboration. Innovation and strategy. Self-awareness and the ability to listen well. For Michigan’s physician leaders, these are recurring themes they use to define leadership in themselves and the colleagues they most admire.

They’re principles that raise the bar well above mere technical knowledge and management capacity, and demand much more of physicians who wish to lead.

While some leaders are born for the role,

Biggest Contributors to Burnout

others must learn the skills necessary to inspire others and generate extraordinary results. The good news? It can be done— and the pathways already exist.

their work, it’s essential that physicians are directly involved in healthcare leadership to navigate a better way forward for the profession and patients.

Here in Michigan, many physicians are honing robust leadership skills through a dynamic array of statewide medical societies—societies that are thirsty for knowledgeable, engaged members willing to share their expertise and grow as leaders.

The problem? Too few physicians have the bandwidth to add statewide society work to their to-do lists.

Engaging at a Statewide Level In Chicago at the 2017 annual meeting of the American Medical Association, delegates adopted a policy encouraging physicians to serve on the boards of healthcare organizations. In doing so, the association cited numerous studies showing “significant evidence that the participation of physicians in the governance of many health care organizations is associated with higher business performance, clinical quality and social outcomes.”

A blog post shared by Forbes and The Physicians Foundation shines additional light on the need for statewide physician leadership.

With today’s challenges in the house of medicine, the shifting landscape of healthcare and the unpredictable fate of [state and] federal legislation impacting

“I think one of our biggest challenges is maintaining an engaged and involved membership,” says Perry Pernicano, MD, FACR and president of the Michigan Radiological Society. “In our busy lives there are many other demands, commitments, and distractions.”

Doctor Thakur agrees.

“Engagement is one of our core goals right now,” he says. “We’re being very deliberate as we set strategies and look for ways to get more of our members involved and speaking out on behalf of their patients.”

Of course, it is impossible to discuss physician engagement in statewide leadership societies without examining trends related to physician burnout.

A 2019 Medscape report shows that 40 percent of male physicians and 50 percent of female physicians say they are experiencing symptoms of burnout. The biggest contributors to these phenomena are related to issues that have little to do with actual patient care, and are more closely related to external forces such as bureaucracy and paperwork.

Too many bureaucratic tasks Spending too many hours at work Increasing computerization of practice (EHRs) Lack of respect from administrators/employees, colleagues or staff Insufficient compensation/reimburement Lack of control/autonomy Government regulations Feeling like just a cog in a wheel Emphasis on profits over patients Lack of respect from patients 0

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| JANUARY / FEBRUARY 2020

10%

20%

30%

40%

50%

60%

This poses something of a chicken-andegg problem for Michigan physicians. If they could free themselves from this heavy paperwork burden, they would have more time available for participation in statewide societies—which could, in turn, advocate for policy changes that can help alleviate the need for such extensive bureaucracy and paperwork and address these critical burnout triggers.

bers to retain them and garner their participation in organized medicine,” he says.

New technologies and communications tools play an important part in meeting those needs.

Perhaps the deciding factor in favor of statewide engagement over paperwork is what Doctor Thakur calls “the big win” of his role in the Michigan Society of Interventional Pain Physicians.

“One of the greatest challenges facing leaders today is the need to deal with the rapidity of change and stay in touch daily,” says Warren Lanphear, MD, FACEP, who chairs the board of the Michigan College of Emergency Physicians. “This high-tech world demands familiarity with social and other media, and you cannot ignore the conversations.”

“I get to talk with other physicians who are facing the same challenges I am, and we can work collaboratively together to find good solutions,” Doctor Thakur says. “Especially now, when our state and nation are facing this huge opioid epidemic, it’s important for us to come together around ideas that work.

Indeed, peer-to-peer social media tools are helping leverage physician learning and engagement. Sites like Doximity, SERMO and Daily Rounds offer connectivity to younger generations of physicians—but are they a substitute for local, personal engagement with colleagues?

“As colleagues working in the same field, we know our issues better than anyone and we’re able to speak the same language, support each other, and share effective strategies with policymakers and the public.”

It’s widely known that face-to-face, personal interactions are more satisfying and nourishing than those that occur online, so it similarly stands to reason that this type of engagement is going to more powerfully combat the symptoms of burnout and foster greater professional enrichment.

Darius Karimipour, MD, who chairs the Michigan Dermatological Society, says it’s particularly important to engage with younger physicians.

“Medical societies need to recognize the differing needs and desires of younger mem-

Preference for Listening over Talking Increases with Position in the Organization

From Membership to Leadership At the Michigan Dermatological Society, the most important decisions Doctor Karimipour makes involve leadership transitions.

“I think identifying the next generation of leaders is very important,” he says.

“Identifying people interested in society committee membership who are ‘doers’—that’s what strengthens committees and hence the society’s mission.”

It’s what Doctor Pernicano calls “getting the right people in the right places.”

CONTINUED ON PAGE 20

“An important characteristic for a leader is a willingness to serve. I view my position as one of service to the society and its membership—and to provide good service, one must be a good listener. ”

In other words, physicians win—both personally and professionally—when they begin engaging with statewide organizations in their areas of practice.

DARIUS KARIMIPOUR, MD

63%

Top Management

62%

Senior Leaders

57%

Middle Managers

56%

Supervisors

0

10%

20%

30%

40%

50%

60%

70%

Percent of People with a Preference for Listening

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PHYSICIAN LEADERSHIP– CONT. FROM PAGE 19

“Our mission, core values, and

“An important characteristic for a leader is a willingness to serve,” Doctor Pernicano says. “I view my position as one of service to the society and its membership—and to provide good service, one must be a good listener. We’re looking for people to be aware of and responsive to the needs and wants of our entire membership.”

In 2017, a study by Zenger and Folkman found that, indeed, listening is one of the most important characteristics of effective leadership. This research showed that “leaders with a preference for listening are rated as significantly more effective than those who spend the majority of their time holding forth.” In fact, this study found a direct correlation between a strong preference for listening and an individual’s position within an organization (see chart on page 19).

One area where leadership through listening can take hold quickly is the development of an effective mentoring relationship. Statewide organizations offer tremendous opportunities for connecting with experienced colleagues and peers who can offer leadership models and advice.

“It’s critical that we all find excellent mentors,” says Doctor Soto. “It’s not always easy to do, but being involved in a medical association or society makes it far less challenging. I was able to locate four or five people I could learn from, and they’ve made a tremendous difference in my own career and leadership growth.”

Research supports Doctor Soto’s enthusiasm for peer mentoring among physicians.

Having one or more mentors is shown to foster more satisfying and successful medical careers, and statewide societies offer a rich soil for fertile peer relationships.

Doctor Pernicano says, “Do not think you are alone or that you have to do everything yourself. Be willing to ask for help and advice.”

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vision—these are all vital and coexist together. Not to get too philosophical, but like the past, present and future, they all are part of the same continuum.

PERRY PERNICANO, MD, FACR

The Challenges of Leadership So, you’ve joined your statewide society and are starting to learn, grow, and develop in new ways. In fact, you’re now assuming a broader leadership role. What can you expect?

Today’s leaders say they work hard to keep their minds focused on the big picture.

“Our mission, core values, and vision— these are all vital and coexist together,” says Doctor Pernicano. “Not to get too philosophical, but like the past, present and future, they all are part of the same continuum. I work to organize and motivate others [around these items and our day to day activities, which lead us to them].”

While it’s important for a leader to keep an eye on the horizon, Doctor Soto says he also spends a lot of time digging for intelligence behind the scenes, so he can keep his members a step ahead of the curve.

“I’ve always got my nose to the ground,” says Doctor Soto. “I’m looking at what’s going on in Lansing, with the bigger picture, and trying to make sure we’re working together in ways that allow us to be nimble and responsive.”

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This agility is what helps keep today’s leaders on the leading edge of policy and practice. In fact, Doctor Karimipour says the need for constant adaptation and growth are essential drivers for his organization.

“What worked in the past may not work as well in the future due to changing needs and demographics, but education is the strength of our society. We are continually looking at ways of enhancing our educational experiences.”

Even as this important work is ongoing, an experienced leader also is working to understand the difference between catalysts that should serve as drivers of change and mere noise.

“The most important thing a good leader can do is listen to all sides of an issue before making a decision,” says Doctor Lanphear. “There are vocal, persuasive people out there that can lead you to forget there may be other viewpoints that have as much or more validity. It’s critical to hold off on making rash decisions.”

Doctor Thakur puts it very simply. “An organization can’t do 17 things at once,” he says. “Effective leaders have to identify one, maybe two goals, and dedicate themselves to moving the needles on them before going on to the next thing. It’s all about knowing where you can have an impact, and then going about the hard work of making it.”

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michigan MEDICINE® 21

Welcome New Members Allegan

Jackson

Lenawee

Claudia Jarrin Tejada, MD

Peter Scuccimarri, MD

Mohammad Asad, MD

Kenneth Lempert, MD

Stephanie Judd, MD

Andrew Kaiser, MD

Jon Maxwell, MD

Omar Khorfan, DO

Calhoun

Harold Kim, MD

Marie Burke, MD Trevor Smith, MD

Genesee

Kalamazoo Academy of Medicine

Macomb

Rebecca Klisz-Hulbert, MD

Fasahat Hamzavi, MD

Ada Kusnetz, MD

Joseph Doe, MD

Mary Kosir, MD

Leonard Lachover, MD

Sudad Louis, MD

Thomas Li, MD

Ariel Majjhoo, MD

Randy Lieberman, MD

Okezie Aguwa, MD

Kent

Susan Mosier-LaClair, MD

Katia Asali, DO

Vikram Rao, MD

Brendan Banyon, MD

Marquette/Alger County

Roozbeh Mansour, MD

Wilfredo Rivera, MD

Mandeep Bath, MD

Keith Connolly, MD

Rohit Marawar, MD

Paul Telehowski, MD

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Andrew Swentik, MD

Elizabeth May, MD

M Varkey Thomas, MD

Anna Chojnacki, MD

Vishwas Vaniawala, MD

Orrie Close, MD

Midland County

Stephen Migdal, MD

Joseph Varghese, MD, FCCP

Brandon Francis, MD

Guy Boike, MD

Mira Mitry, MD

Angela Gonda, MD

Chelsea Houthoofd, MD

Bashar Mohamad, MD

Kirthi Lilley, MD

Jefferey Michaelson, MD

Houghton/Baraga/Keweenaw

Michael Henderson, DO

Bonnie Hafeman, MD

Raheel John, DO

Monroe County

Syed Raza, MD

Jennifer Johnston, MD

Nicholas Schenk, MD

Faisal Ridha Al-timimi, MD

Kathleen Pilchowski, MD

Ingham

Kathleen Justice-Kirtek, MD

Ahmed Abubaker, MD

Brett Kucej, MD

Oakland County

Abdulghani Sankari, MD

Stacie Adams, MD

Donald LaBarge, MD

Aiden Abidov, MD

Dahlia Sano, MD

Archana Bhatt, MD

Esther Lehmann, MD

Samet Albayrak, MD

Housam Sarakbi, MD

Craig Cole, MD

David Lieuwen, MD

Alireza Amirsadri, MD

Nagaratna Sarvadevabatla, MD

Marie Cole, MD

Gary Mally, DO

Fadi Antaki, MD

Philip Schmitt, DO

Tracey Danloff, MD

Nanci Mercer, MD

Richard Balon, MD

Ashok Shah, MD

Theresann Huprikar, DO

Robert Morley, DO

Keiva Bland, MD

Julio Sosa, MD

Daniel Isaac, DO

Keith Morrow, DO

Nimrod Blank, MD

Carolyn Sprague, MD

J’Aimee Lippert, DO

Anand Rao, MD

Allison Brown, MD

Choichi Sugawa, MD

Leo Maher, MD, MHA, FAAN

Matthew Rose, MD

Susmita Chowdhuri, MD

Steven Tennenberg, MD

Kyle McDonald, DO

Dominic Scola, MD

Michelle Dawson, MD

Nitin Vaishampayan, MD

Todd Moyerbrailean, DO

Lucas Sheldon, MD

Gunter Deppe, MD

Jesse Veenstra, MD, PhD

Barbara Pickut, MD

Harkiran Singh, MD

Sorabh Dhar, MD

Jinping Xu, MD, MS

Colton Prudnick, DO

Joel Stracke, DO

Lawrence Flaherty, MD

Maria Yaldo, MD

Jill Sadoski, MD

Nicole Van Allen Horne, MD

Joseph Fontana, MD

Jay Yang, MD

Millicent Schratz, DO

Todd Vogel, MD

Gabriella Geiszt, MD

Deborah Wagenaar, DO

Michael Votruba, MD

Luay Haddad, MD

Ottawa County

William Zimmerman, DO

Amanda Williams, MD

Kimberly Hart, MD

Rick Baszler, DO

Sammy Yacob, MD

Michael Hill, MD

Jean Ross, MD

Jacob Rube, MD

Isablla/Clare

Deslyn Hobson, MD

Tamara Moutsatson, DO

Jeffrey Hotaling, MD

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|| JANUARY JANUARY // FEBRUARY FEBRUARY 2020 2020

www.msms.org/Membership

Saginaw County

Jennifer McDonald, MD

Michael, DOminello, DO

Milagros Reyes, MD

Gregory Bohn, MD, FACS

Guillermina Nava, MD

Renee Dwaihy, MD

David Rosenberg, MD

James Jesko, DO

Iris Noh, MD

John Ebright, MD

Arlene Rozzelle, MD

Zaira Khalid, MD

Jeffrey Orringer, MD

Mohammed Elbashir, MD

Melissa Runge-Morris, MD

Kathryn Mansuri, MD

Amy Orsini, MD

Zahia Esber, MD

Sana Salih, MD

Chetley Morrison, MD

Rajiv Patel, MD

Jonathan Faro, MD

Mack Savage, MD

Cristina Nituica, MD, FACS

Timothy Peterson, MD

Abubaker Hassan, MD

Charles Schiffer, MD

Jeffrey Osborne, MD

Maria Qunitanilla-Dieck, MD

Elisabeth Heath, MD, FACP

Jonathan Schwartz, MD

Nikita Roy, MD

Sruthi Renati, MD

Shira Heisler, MD

Erlene Seymour, MD

Linda Saab, MD

Chaur-Dong Hsu, MD

Tehmina Shakir, MD

Sanilac County

Jennifer Schwartz, MD

Mohammad Ibrahim, MD

Anthony Shields, MD, PhD

Phillipa Zylanoff, MD

Noah Smith, MD

Walid Ibrahim, MD

Michael Simon, MD, MPH

Trilokraj Tejasvi, MD

Rebecca Jameson, MD

Tirtza Spiegel Strauss, MD

Washtenaw County

John Wallbillich, MD

Areeba Jawed, MD

Michael Stellini, MD, MS

Aleodor Andea, MD

Frank Wang, MD

Lauren Keshishian, MD

Larry Stephenson, MD

Manal Assi, MD

Allecia Wilson, MD

Steve Kim, MD, FACS

Shelly Stettner, DO

Andrew Kin, MD

Paul Swerdlow, MD

John Ayanian, MD Lois Ayash, MD

Wayne

Christopher Kliethermes, MD

Manuel Tancer, MD

Allison Billi, MD

Heather Abraham, MD

Basheer Kummangal, MD

Lashawn Therrell, MD

Scott Bresler, MD, PhD

Christopher Adam, MD

Todd Lavery, MD

Alexandros Tselis, MD

Mari Paz Castanedo Tardan, MD

Zahra Ahmad, MD

Anna Ledgerwood, MD

Joseph Uberti, MD, PhD

Kelly Cha, MD, PhD

Victor Ajluni, MD

Stephen Lerner, MD

Aris Urbanes, MD

May Chan, MD

Asif Alavi, MD

Donald Levine, MD

Ulka Vaishampayan, MD

Andrzej Dlugosz, MD

Faisal Almufarrej, MD

Ho-Sheng Lin, MD

Gregory Washington, MD

Alison Durham, MD

Khaled Alshabani, MD

Charles Lucas, MD

Amy Weise, DO

James Elder, MD

Hassan Amirikia, MD

Maysaa Merhi Basha, MD

Ira Winer, MD, PhD

Charles Ellis, MD

Daniel Angell, DO

Steven Miller, MD

Lami Yeo, MD

Douglas Fullen, MD

Hadeel Assad, MD

Nicholas Mischel, MD

George Yoo, MD

Bardia Gholami, MD

Carter Bishop, MD

Lawrence Morawa, MD

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James Blessman, MD

Mary Morreale, MD

Jeffrey Zonder, MD

Leela Hamp, MD

Barbara Bosch, MD

Zaher Msallaty, MD

Kelly Harms, MD, PhD

Patricia Brown, MD, FACP

Zubin Mukadam, MD

Paul Harms, MD, PhD

Michael Bush-Arnold, MD

Regina Nagy, MD

Micheleen Hashikawa, MD

Michael Carron, MD

Tammon Nash, MD

Alexandra Hristov, MD

Tinnakorn Chaiworapongsa, MD

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Lydia Choi-Kim, MD

Leo Parsons OD

Timothy Johnson, MD

Jeremy Ciullo, MD

Philip Philip, MD, PhD, FRCP

Edward Jouney, DO

Graciela Conley, MD

Shishir Rao, MD

Angela Kuznia, MD, MPH

John Cramer, MD

Mihaela Elena Rapolti, MD

Lori Lowe, MD

Abhinav Deol, MD

Voravit Ratanatharathorn, MD, FACP

Jennifer Mancuso, MD

Anna Dewan, MD

Abdul Rauf, MD

Kelly McClean, MD

Lawrence Diebel, MD

Maurice-Andre Recanati, MD

JANUARY / FEBRUARY 2020 |

michigan MEDICINE® 23

Tackling Physician Burnout Requires Unprecedented Leadership

By Robert D. Morton, CPHRM, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company

T

he term “burnout” has been questioned as a labeling error—and rightfully so. Burnout implies victim shaming. What many healthcare professionals on the frontlines are experiencing is a normal response (symptoms) to an abnormal situation (cause), like sick fish in a tank of toxic water. A diagnosis of burnout suggests that the solution is to medicate the fish. A more holistic view is to say, “There’s really nothing wrong with you; let’s clean the tank.”

24 michigan MEDICINE®

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Contributed by The Doctors Company

thedoctors.com

and training due to labor law abuses, sleep/ food/water deprivation, discrimination, violence, understaffing, and more—driving up depression and suicide rates. Because of the profound impact on individuals, there is broad consensus about the immediate need to expand access to confidential, nonpunitive mental healthcare for doctors and nurses.

The World Health Organization (WHO) announced plans to include what it labels “burn-out” as an occupational phenomenon in the International Classification of Diseases (ICD-11). The syndrome, which results from chronic workplace stress, is characterized by feelings of exhaustion, increased mental distancing from one’s work or cynicism about work, and reduced professional efficacy.

The WHO’s actions seem to further legitimize what many are experiencing: an ever more exhausting, distancing, and chronically stressful healthcare system that makes connecting with patients and providing quality care more challenging and contributes to burnout, healthcare professional distress, or to what some have even labeled moral injury or human rights violations.

Physician Burnout Thought Leaders Weigh In Drs. Simon Talbot and Wendy Dean, who co-founded the nonprofit organization MoralInjury.healthcare, borrowed the expression “moral injury” from Jonathan Shay, MD, PhD, a clinical psychiatrist who coined the phrase. Briefly, it is: (1) a betrayal of what’s right, (2) by someone who holds authority, (3) in a high-stakes situation.

Discussions of moral injury include the view that repeated daily betrayals by authorities within the system are manifest in healthcare every day in the form of mandates from leaders to see more patients with less time to care for them, forced use of dysfunctional electronic health record (EHR) systems, overburdens by payers,

competing financial considerations, fear of litigation, and more. These types of betrayals run counter to patients’ best interests— which pains doctors, whose unifying creed is that patients come first.

While other physician thought leaders like Dr. Dike Drummond (thehappymd.com), Dr. Paul DeChant (author, Preventing Physician Burnout), Dr. Zubin Damania (aka ZDoggMD), and Dr. Pamela Wible (idealmedicalcare.org) may differ on the terminology, each makes a similar call for leadership and action equal to the severity and scope of the dilemma. They all call for partnering with enlightened leaders to change the systemic and institutional patterns that inflict betrayals on the practice of good medicine.

In response to systemic conditions, some doctors are quitting because having less time with patients has driven morale to rock bottom, and those who remain are warning of a mass exodus if things don’t improve. According to Paul DeChant, MD, MBA, a failure to step up and meet this challenge is a failure of leadership and constitutes management malpractice, with some administrators asserting that they are suffering from management burnout.

CONTINUED ON PAGE 26

Most of us do not see our administrators as oppressors but, rather, as stuck along with the rest of us in a system that has piled on time-consuming burdens—which saps us of the time and energy required to do the best we can for our patients in the time available.

Dr. Wible calls these issues human rights violations that begin in medical education

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TDC – CONTINUED FROM PAGE 25

Dr. Howard Marcus, an internist in Austin, Texas, responded, “Most of us do not see our administrators as oppressors but, rather, as stuck along with the rest of us in a system that has piled on time-consuming burdens—which saps us of the time and energy required to do the best we can for our patients in the time available.”

An Annals of Internal Medicine cost-consequence analysis reported that physician burnout is costing $4.6 billion per year related to physician turnover and reduced clinical hours. The authors offer a prescription that burnout “can effectively be reduced with moderate levels of investment,” suggesting there is “substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.”

The National Academy of Medicine issued a report that offers a bold vision for systemic change—because “the system,” the amorphous healthcare-industrial complex, is designed, unwittingly or not, to produce the results it is producing. When you take what is at its core

The scope and breadth of the problem requires unprecedented leadership, shared “collective and coordinated action across all levels of the health care system—front line care delivery, the health care organization, and the external environment.

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a moral and scientific enterprise, that is the practice of medicine, and relentlessly mess with it in an unscientific manner driven by economics and regulation, physician burnout is the expected outcome.

The scope and breadth of the problem requires unprecedented leadership, shared “collective and coordinated action across all levels of the health care system—front line care delivery, the health care organization, and the external environment.”

Leadership Matters The Mayo Clinic reported that a onepoint increase in the leadership score of a physician’s immediate supervisor was associated with a 3.3 percent decrease in the likelihood of burnout. This and other reports support the often-quoted conclusion that your supervisor is more important to your health than your primary care doctor. If leadership will not make this issue a priority, lead as though no help is coming.

Contributed by The Doctors Company

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Executive leaders in some healthcare systems are beginning to require all executive staff to frequently round with or shadow physicians and to ask questions like “What isn’t working?” To be of value, executive leaders must be armed with the courage to lead and an organizational commitment to change. Some systems have appointed chief wellness officers and formed clinician wellness teams, giving them authority to create opportunities to support well-being and resiliency.

Steven Beeson, MD, founder of the Clinician Experience Project, urges “to advance care for patients and take on the healthcare imperatives in front of us, we have to care for those caring for others first. To care for the care team we must listen to clinicians, respond to the things they need, invest in burden reduction, support and develop them to be their best, empower them to lead the way, allow them to be the clinician they envisioned, and appreciate the impact they make when we do these things.” (Stephen Beeson, MD, email communication, July 17, 2019.)

Efforts to Improve EHR Usability EHR rescue and optimization work is becoming more common to regain lost relationships with patients. Executive leaders who are desperate for help often contact firms like Medical Advantage Group (MAG), a subsidiary of The Doctors Company. MAG conducts system database audits, followed by workflow analysis, previsit planning, and redesign of work

screens to make the EHR function better as a convenient, accessible clinical source of truth. Ironically, this improvement in EHR accessibility and usability makes the EHR function more like old paper charts when everything was at hand. Other benefits of this work include increases in quality-based payments, improved EHR user efficiency and experience, reduced time spent searching, and reduced or eliminated “pajama time” (charting at home).

On a smaller scale, Dr. Gabe Charbonneau (fightburnout.org), a family physician and EHR problem-solver who is on a mission to disrupt burnout, finds his greatest fulfillment in helping doctors one-on-one.

Another example related to EHR usability is at Atrius Health, where a collaboration with its IT department reduced inefficiencies by cutting 1,500 clicks per day per physician. This sustained, resourced commitment to improvements resulted in less time spent in the EHR and improved professional satisfaction.

Additional Resource American Hospital Association (AHA)and AHA Physician Alliance. Well-being playbook: a guide for hospital and health system leaders; https://www.aha.org/system/ files/media/file/2019/05/plf-well-beingplaybook.pdf. Published May 2019.

Reprinted with permission. ©2019 The Doctors Company (www.thedoctors.com).

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

Like any meaningful change, improvements require leadership with a growth mindset that demonstrates a deep respect for people and for the nature of their work.

This means exhibiting leadership behaviors such as deference to expertise and sensitivity to clinical operations—two characteristics of the continuous improvement mindset on the journey toward high reliability.

Effective leaders meet physicians where they live—on the frontlines of care—and seek to understand what is getting in the way of connecting with patients and providing quality care. The best leaders then work tirelessly to remove the barriers.

JANUARY / FEBRUARY 2020 |

michigan MEDICINE® 27

Educational Offerings MSMS On-Demand Webinars Webinars that meet Board of Medicine Requirements:

Webinars at No Cost to Members: Billing 101

Human Trafficking

Balancing Pain Treatment and Legal Responsibilities

Medical Ethics – Conscientious Objection among Physicians

Claim Appeals

Medical Ethics – Decision Making Capability Medical Ethics – Just Caring: Physicians and Non-Adherent Patients

Credentialing

Pain and Symptom Management Series

Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities

Balancing Pain Treatment and Legal Responsibilities

HEDIS Best Practices

MAPS Update and Opportunities

In Search of Joy in Practice: Innovations in Patient Centered Care

Michigan Automated Prescription System Update

Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage

Opioid Town Hall Pain and Opioid Management Prescribing Legislation

Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media

Tapering Off Opioids

MAPS Update and Opportunities

The CDC Guidelines

Medical Necessity Tips on Documentation to Prove it

The Current Epidemic and Standards of Care

Michigan Automated Prescription System Update

The Role of the Laboratory in Toxicology and Drug Testing

Opioid Town Hall

Treatment of Opioid Dependence

Prescribing Legislation

Update on the Opioid Crisis 2019 (Fulfills the 1-time training on opioids and other controlled substances awareness)

Reading Remittance Advice

Coding and Billing Webinars: Access to Medicare Changes to E&M Codes for 2019 and other Coding Updates Billing 101

Section 1557: Anti-Discrimination Obligations Sexual Misconduct – Prevention and Reporting Tips and Tricks on Working Rejections Update on Chronic Fatigue Syndrome Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS Update on Chronic Fatigue Syndrome Part 2: Uniting Compassion, Attention and Innovation to treat ME/CFS

Claim Appeals Credentialing Medical Necessity Tips on Documentation to Prove it Reading Remittance Advice Tips and Tricks on Working Rejections

Other Webinars: NEW – Michigan Medical Marihuana Law

Visit https://connect.msms.org/Education-Events/On-Demand-Webinars for complete listing of On-Demand Webinars.

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| NOVEMBER / DECEMBER 2020

Visit msms.org/OnDemand for complete listing of On-Demand Webinars.

Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.

SAVE THE DATE for 2020!

Spring Scientific Meeting

Annual Scientific Meeting

Date: Thursday, May 14 and Friday, May 15

Date: Wednesday - Saturday, October 21 - 24

Location: DoubleTree Hilton, Dearborn

Location: The Westin, Southfiled

Intended for: Physicians and all other health care professionals.

Intended for: Physicians and all other health care professionals.

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Contact: Beth Elliott at 517/336-5789 or belliott@msms.org

Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581.

JANUARY / FEBRUARY 2020 |

michigan MEDICINEÂŽ 29

ADVOCACY

Five Reasons to

BACK the PAC The Michigan Doctors’ Political Action Committee (MDPAC) builds and maintains strong relationships with lawmakers, as well as candidates running for political office.

As the face of physicians, MDPAC bring medical knowledge into

Activate your political voice!

The Michigan Doctors’ Political Action Committee (MDPAC) is the political arm of the Michigan State Medical Society.

It is a bipartisan political action committee made up of physicians, their families, residents, medical students and others interested in making a positive contribution to the medical profession through the political process. MDPAC supports pro-medicine candidates running for political office in Michigan.

Physician engagement is essential to the success of a pro-medicine legislature. Current and potential lawmakers want and need to hear from professionals in the field of medicine. Through MDPAC, you will activate your voice on the things most important to Michigan physicians.

discussions with political decision makers.

For more than three decades, MDPAC has mounted successful lobbying efforts on behalf of physicians.

For example... MDPAC protects and strengthens tort reform, stopped the physician’s tax, and has

helped to stop the expansion of a non-physician’s scope of practice.

MDPAC has power, prestige and respect! If you wake your sleeping giant, MDPAC could make rapid, positive change for physicians and patients. It could ease administrative pressures with the current prior authorization process, save you money

and time on your Maintenance of Certification, and advance public health issues.

Trial lawyers, insurance companies, and other political opponents raise massive sums of money.

Medicine’s friends, through MDPAC, must dig deeper to raise equivalent or greater amounts of funds to advance Michigan

physician’s agenda.

Get started today at MDPAC.org

The current political landscape is uncertain.

Only through a well-funded, unified voice will physicians and their patients’ interests be heard.

MDPAC is that voice.

Get your voice heard by contributing today at MDPAC.org

16 michigan MEDICINE

30 michigan MEDICINE®

| JULY / AUGUST 2017

| JANUARY / FEBRUARY 2020

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JANUARY / FEBRUARY 2020 |

michigan MEDICINE® 31

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