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Incentivizing Residencies
Florida leaders work on ways to increase residency slots, keep COM graduates in state By LyNNE JETER
Two years ago, 282 graduates of Florida medical schools left the state to pursue PGY-1 (first-year) residencies because of a shortage of in-state slots that continues to exacerbate the growing physician shortage in one of the nation’s fastest-growing and fastest-aging states. “Unfortunately, we lack sufficient residency slots for the number of medical students we graduate in the medical schools in the state,” said Tampa General CEO Jim Burkhart. “We have a great exodus every year of very talented
graduates of medical schools who can’t stay … because we don’t have enough slots.” For example, only 10 of 33 graduates of the University of Central Florida (UCF) College of Medicine’s (COM) charter class found in-state residency slots; only two will remain in Orlando. This fall, 100 students will enter the UCF COM; next fall will signal the first full class of the four-year-old (CONTINUED ON PAGE 4)
Physician Workforce Report
Big Problem for Tiny Patients
Inaugural Physician Workforce Assessment and Development Strategic Plan aims to strengthen capabilities, improve practice environment ... 7
Task force launches program to raise awareness about drugaddicted moms and newborns By JEFF WEBB
Alarmed by the soaring numbers of babies who are addicted to prescription drugs before drawing their first breath outside the womb, Florida’s Department of Children and Families (DCF) and the Attorney General have quickened the pace in their race to raise awareness about what
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they, as well as many caregivers, have deemed an epidemic. The Statewide Task Force on Prescription Drug Abuse & Newborns, created by the state Legislature in 2012 to study and make recommendations about the escalating problem of pregnant addicts and infants, released its final report in February, two full years before its mandated
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2015 deadline. The result is a 55-page document that details the prevalence of Neonatal Abstinence Syndrome (NAS) and what it is costing taxpayers and healthcare providers. More directly, the task force made recommendations about how to address the problem through education, documentation and rehabilitation of pregnant (CONTINUED ON PAGE 8)
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PhysicianSpotlight
Kyle Lee Garner, MD Gulf Coast Obstetrics and Gynecology of Sarasota By JEFF WEBB
SARASOTA - If his love of performing, cooking and using sharp knives had taken another turn, Kyle Lee Garner might have found a home as a chef on the Food Network. Instead, you’ll find him pursuing his first loves, medicine and surgery, at Gulf Coast Obstetrics and Gynecology of Sarasota. It’s a path Garner has been on his whole life. “Ever since I was about 4 or 5 I knew I wanted to be a physician. I give credit to Dr. Carrington, my pediatrician,” said Garner, who grew up an only child in Atlanta. “He was a stern, but gentle, man and when I went to his office, I was fascinated with the tools he had that allowed him to peer into my ears, listen to my heart and make me feel better,” Garner remembered. But it was a friend in 10th grade who helped him overcome shyness that might have hindered him from being the accomplished physician he is today. “I had a profound fear of public speaking. I was even afraid to ring my best friend’s doorbell next door because his parents might answer,” said Garner. “Finally, when I went to a new high school in 10th grade, one of my friends signed me up to join the choir without my knowledge. I was terrified. But, as time went on, I really grew to like the stage, and overcame that fear. It really helped me grow,” he said. Garner said he continued to be “big into music and theater” as he pursued his bachelor of science degree at Davidson College in North Carolina, where he played the lead in Joseph and the Amazing Technicolor Dreamcoat. “I think it was probably one of the most fun things I’d ever done,” he said. Because of his childhood experience with Dr. Carrington, Garner said he enrolled at Bowman Gray School of Medicine in Winston-Salem, N.C., planning to be a pediatrician. But he realized soon he “really liked all of kinds of medicine,” and after earning his MD in 1997, Garner said, he completed a family medicine internship and residency at the University of Tennessee in Memphis. “But I kept gravitating toward OB/GYN patients. I really loved caring for pregnant patients, and I was enthralled with surgery. I loved the immediate satisfaction that came from making someone better with surgery,” said Garner. So, he stayed on in Memphis to complete another internship and residency, this one in obstetrics and gynecology, and because he had met a young lady from Sarasota named Kristi, who was working on her masters degree in nutrition. With their first child only an infant, the Garners made the decision to make Sarasota their home, primarily because of the importance they placed on being near family. “My wife was born and raised here. All
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of her family is here: aunts, uncles, nieces and cousins,” said Garner. “That has been really great for (our daughters),” of whom there are now three, Lauren, Leah and Laine, he said, and all of whom are aspiring ballerinas. But balancing the demands of his professional and personal lives has been one of his greatest challenges, Garner said. “Trying to maintain a healthy marriage, raise three upstanding daughters, all while caring for patients and delivering babies at all hours of the day and night is extremely difficult,” he said. “The secret is having an unbelievably understanding and patient wife. And my girls are getting to the ages (9, 7 and 4) where they also understand why I have to leave the dinner table,” he said. Garner’s responsibilities increased significantly when he became chief of OB/ GYN at Sarasota Memorial Hospital late last year. In addition to the day-do-day leadership that position requires, the hospital is in the throes of a huge capital project that is spotlighting his specialty. This fall, SMH is set to open the Courtyard Tower, a $186-million, nine-story structure that will dedicate three floors to pregnant moms and their babies. It will include labor and delivery suites, mother/baby suites, the neonatal intensive care unit, three operating rooms, and comfortable amenities for expectant mothers who choose all-natural or low-in-
tervention childbirth experiences. Garner’s role as OB/GYN chief “can be a thankless job sometimes,” he said, “but the hospital has leadership taking it in the right direction. We finally have a common vision balancing physician needs, nursing needs, patient needs and administrative needs (to) where we need to take the department.” The hospital “has made this role far easier,” said Garner. “I have great support, starting from the people at the top of the hospital all the way down. They have supported me in trying to bring in the TeamSTEPPS training concepts. That is really important and a fairly new concept in medicine,” said Garner, 42. “It helps institutions like ours adopt a culture of patient safety. By improving how physicians, nurses and ancillary staff work together, we can significantly improve efficiency as well as patient safety,” Garner said. “Twenty years ago, physicians were the arbiter of all medical decisions because of their unique set of skills or their experience. They would walk in and flash the orders and tell the nurses what to do,
and everyone would run and do it. The doctor would save the day. But, as we have looked at patient safety, you realize that having an entire team devoted (and communicating) is crucial,” Garner said. “It’s a multidisciplinary thing. You have an obstetrician, a nurse, an anesthesiologist, a pediatrician, or the NICU, or the janitors who are turning over treatment or operating rooms. The TeamSTEPPS model really looks at everybody ... We can’t take care of a patient in isolation,” he said. “You have to involve everyone in how to get the patient from the front door to the delivery room, or the operating room, to the recovery room and out the door again.” That approach to patient care and hospital protocol is connected to Garner’s youth, he said: “My mother and father gave me great advice, not by words, but rather by actions. They both had a lot of common sense and an excellent work ethic. They taught me the importance of hard work and integrity, which has served me well over the years.”
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Incentivizing Residencies, continued from page 1 school when 120 students are admitted. “The state and local community are especially hard hit because residency programs haven’t kept pace with population and medical school growth,” said Deborah German, MD, vice president for medical affairs and founding dean of the UCF COM, noting that Florida has fewer than 18 residents and fellows on duty per 100,000 population, ranking it 42 of 50 states nationally. Orlando produces 102 graduate medical education (GME) graduates annually from core nationally-accredited residency programs. By comparison, Tampa produces 145, and Gainesville, 148. Of Florida’s nine medical schools – two
private osteopathic schools, one private allopathic school, and six public allopathic schools – an informal statewide chart released in 2011 shows 510 graduates with a surplus of 260 Florida PGY-1 residency slots in 2000, compared to a projected number of 1,317 graduates with a shortage of 490 slots estimated for 2020.
Challenges and Solutions
Robust medical school growth has drawn attention to the minimal growth of residency programs to provide post-graduate training to Florida’s graduating medical students, while also attracting quality medical school graduates from around the country
to provide the foundation for Florida physician workforce of the future, and positioning Florida to best work to develop residency programs to provide such training. Florida State University welcomed its first crop of medical students in 2001, Lake Erie College of Osteopathic Medicine (LECOM) in 2008, UCF and Florida International University (FIU) in 2009, and Florida Atlantic University (FAU) in 2011. UCF and FIU represent the tail-end of graduating their first full classes, in 2017. “When graduates stay in the area to complete their medical training, there’s a very high probability they will remain after training, and set up practice or join an established practice. This is the best way to
FLORIDA RESIDENCY MATCH RECAP FOR 2013 According to the National Resident Matching Program for 2013, PGY-1 quotas and matches per major medical centers in Florida: Bayfront Medical Center in St. Petersburg: 12 of 12 matched. Cleveland Clinic in Weston: 18 of 20 matched. Florida Hospital-Orlando: 36 of 36 matched. Florida State University in Tallahassee: 22 of 23 matched. Halifax Medical Center in Daytona Beach: 10 of 10 matched. Jackson Memorial Hospital in Miami: 210 of 211 matched. Larkin Community Hospital in South Miami: 8 of 8 matched. Mayo School of Graduate Medical Education in Jacksonville: 35 of 39 matched. Miami Children’s Hospital in Miami: 24 of 24 matched. Mt. Sinai Medical Center in Miami: 29 of 30 matched. Orlando Health in Orlando: 62 of 66 matched. St. Vincent’s Medical Center in Jacksonville: 7 of 7 matched. Tallahassee Memorial Healthcare in Tallahassee: 11 of 11 matched. University of Florida in Jacksonville: 81 of 81 matched. University of Florida-Shands Hospital in Gainesville: 153 of 163 matched. University of Miami-Palm Beach in Atlantis: 30 of 30 matched. University of South Florida in Tampa: 128 of 128 matched. West Kendall Baptist Hospital in Miami: 4 of 4 matched.
TOTAL: 880 OF 903 MATCHED.
Breakdown of Florida PGY-1 match rates by the most popular specialties: Internal medicine: 233 Family Medicine: 79
Pediatrics: 112
General Surgery: 84
Emergency Medicine: 53
Obstetrics and Gynecology: 39
Psychiatry: 43
Anesthesiology: 32
Radiology: 12
Breakdown of 23 unfilled residency slots by specialty: Anesthesiology: 7
Family Medicine: 3
Medicine-Preliminary: 2
Neurology: 1
General Surgery: 3 Surgery-Preliminary: 7
SOURCE: Association of American Medical Colleges (AAMC)’s 2011 State Physician Workforce Data Book.
FLORIDA RESIDENTS & FELLOWS Of 3,512 total residents and fellows in Florida (1.4 per 100,000) on duty as of Dec. 31, 2010 in ACGMEaccredited programs, the breakdown is: 2,176 allopathic school graduates 266 osteopathic school graduates 1,064 international medical graduates (IMGs). 4
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Note: Florida has the third most IMGs, accounting for roughly one-third of all active physicians. SOURCE: Association of American Medical Colleges (AAMC)’s 2011 State Physician Workforce Data Book, National Resident Matching Program.
respond to the physician shortage in Florida,” said LECOM associate dean Robert George, DO, in Bradenton. Of 152 LECOM medical students who graduated on June 9, 36 percent (55) Dr. Robert George will remain in-state to complete residencies and internships. Statistics show that residents and fellows retained from Accreditation Council for Graduate Medical Education (ACGME) programs are highly likely – roughly twothirds, according to the Association of American Medical Colleges (AAMC) – to practice medicine in the area in which residencies and fellowships are completed. Various solutions have been put into place via innovative partnerships to address the residency shortage. For example, Tampa General Hospital, a teaching hospital for the University of South Florida (USF) Health Morsani COM, has 200 residency slots, yet hosts 310 residents. “That additional 110 slots, the hospital pays for out of pocket,” said Burkhart. “That’s $100,000 plus for every resident. We can’t afford to keep doing that, particularly when reimbursement from Medicare, Medicaid, commercial insurance and everything else continues to take a hit.”
PCP Focus
In keeping pace with primary care needs, 51 percent of 2013 PGY-1 slots in Florida fall under PCP status (internal medicine, pediatrics, family medicine and obstetrics and gynecology), according to the Patient Centered Medical Home model. AAMC’s 2011 State Physician Workforce Data Book lists Florida with 16,060 total active primary care physicians for a population of 18.7 million, resulting in a ratio of 9.2 per 100,000. “We’ll need more primary care doctors, but why would anyone want to go into primary care when they’re not paid as well, yet have the same level of student loan debt as other students? The real debt occurs when you’re going to medical school,” said Burkhart. “When you’re a resident, at least you’re making some money. Radiology, for example, pays significantly more than primary care (for the ROI). We have to do something to maybe help offset or cover or forgive debt for medical students going into primary care, and not just in rural areas. Not everybody lives in a rural area. A lot of people in urban areas need primary care doctors. It’s a universal problem.” Last month, UCF COM took a fresh step in training more PCPs when the ACGME approved its first university-sponsored residency program in partnership with the Orlando VA Medical Center and Osceola Regional Medical Center. The internal medicine residency will create 20 slots in 2014 and increase to a maximum of 60 MD graduates annually. “Residency programs are part of the promise that was made to this community and an important element in a medical school that will anchor a medical city,” said German. “If we have more residencies, we’ll have more trained doctors in our (CONTINUED ON PAGE 6)
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Incentivizing Residencies, continued from page 4 community because many doctors practice where they complete their residency programs.” Here’s how it works: Participating hospitals pay residents a stipend and cover the salaries of physician instructors; those costs may be reimbursed through federal Medicare and Medicaid funds. The COM will provide administrative support and oversight of the GME program from its existing state budget. UCF’s program will use an innovative scheduling of residents called the 4+1 rotation schedule, which alternates traditional 4-week hospital and specialty rotations with 1-week blocks of ambulatory or out-patient care. Residents support the 4+1 because it allows them to focus on specific clinical facilities and cuts down on time-consuming travel and logistical problems that occur when residents are dashing from facility to facility in the middle of a rotation. By the end of 2013, Osceola Regional, which is undergoing an expansion program, will have 317 beds. In addition to planning its Level II Trauma Center and meeting the needs of Osceola and Orange counties, Osceola Regional offers specialty programs, such as its Central Florida Cardiac and Vascular Institute and Orthopedic and Spine Center. “As a part of HCA West Florida, we view creating residency programs as an investment in the future of medical care for our community,” said Osceola Regional
CMO Aida Sanchez-Jimenez, MD, who will serve as GME site director. Florida Hospital is also strengthening Orlando’s PCP workforce with accreditation for a pediatric residency program. The first residents will begin training at the Florida Hospital for Children next July. “The hospital is educating the doctors of tomorrow while helping fill an area of medicine where we’re seeing a shortage of physicians,” said Stacy McConkey, MD, pediatric residency Dr. Stacy McConkey program director at Florida Hospital for Children. (Of 112 PGY-1 positions available this year, all were matched.) The 3-year pediatric residency program will have six residents per year, with a total of 18 residents when completely full. Residents will complete their inpatient rotations at Florida Hospital for Children, and have a variety of outpatient pediatric subspecialty rotations including dermatology, urology and neurology. The residents’ primary outpatient experience will be at the new Florida Hospital Center for Pediatric and Adolescent Medicine Clinic in Winter Garden.
State and National Movement
In Florida, the Governor’s Office attempted this year to increase funding for
residency programs, which might incentivize development of positions in the state. The increased funding was included in the Appropriations Act that state lawmakers passed several weeks ago; a “conforming bill” addressed funding for Medicaid-supported residencies. In Senate Bill 1520, which Gov. Rick Scott approved May 20, the Statewide Medicaid Residency Program expands primary care specialties beyond the PCMH scope to include preventive medicine, geriatric medicine, osteopathic general practice, and emergency medicine. Because of complicated formulas regarding changing reimbursement methodologies for hospitals, the money represented in the GME budget line item doesn’t represent all new money. For GME expenses from the general revenue fund, $33 million was the tally. Add to that $46.9 million from the Medical Care Trust Fund. SB 1520 calls for a complex allocation formula to particular medical schools or hospitals, up to $50,000 per FTE (full-time equivalent) resident. Nationally, to help fill the gap between first-year residents and residency slots, the American Medical Association (AMA) in mid-January announced a $10 million competitive grant initiative, “Accelerating Change in Medical Education,” to be distributed over the next five years to fund projects that support a significant redesign of undergraduate medical education. Eighty-two percent of the nation’s
141 accredited medical school submitted proposals by the Feb. 15 deadline, necessitating an additional vetting process. This month at its annual meeting, the AMA will determine the disbursement. “Florida schools will hopefully get some of the money, for which we’re grateful, but it’s not anywhere close to putting a dent in our needs,” said Burkhart. Additionally, to address the gap of medical school graduates who won’t match to a residency program, legislation was reintroduced in March in both houses of Congress to create new residency positions for Medicare-supported training slots via the Resident Physician Shortage Reduction Act of 2013. Senators Bill Nelson (D-Fla.), Chuck Schumer (D-NY) and Harry Reid (D-Nev.), and Representatives Aaron Schock (R-Ill.) and Allyson Schwartz (DPa.) led the reintroduction of the bills (S. 577, H.R. 1180) to create the additional GME positions, according to the AMA. (At press time, GovTrack estimated a 1 percent chance of S. 577 moving from the Senate Finance Committee, and a zero percent chance of H.R. 1180 moving from House committees.) Editor’s note: Next month, Florida Medical News will continue to focus on the needs for residency programs in the state.
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Physician Workforce Report
Inaugural Physician Workforce Assessment and Development Strategic Plan aims to strengthen capabilities, improve practice environment By LyNNE JETER
Only 14 percent of the state’s 44,804 licensed, practicing physicians are younger than age 40, according to the Florida Department of Health’s inaugural Physician Workforce Assessment and Development Strategic Plan. Released late last year, the plan is chock full of expected and surprising trends in a snapshot to strengthen the state’s physician workforce capabilities while also enhancing the practice environment. “The strategies proposed … lay the groundwork required in pursuit of that goal,” explained John H. Armstrong, MD, state surgeon general and council chairman, about physician attraction, retention and retraining. “Florida shapes a stronger physician workforce today by reviving existing incentive programs, targeting specific types of non-practicing physicians for incentives or retraining opportunities, and improving Florida’s practice climate to reduce physician departures.” Creating Graduate Medical Education (GME) opportunities to narrow the gap between medical school graduates and first-year residency slots is a top priority. “Preventing the annual export of qualified GME candidates to other states
is the crucial first step toward shaping the physician workforce of the future,” noted Armstrong. A demographic snapshot shows the average Florida physician is mid-career (59 percent between ages 40 and 60), male (75 percent), and white (63 percent). Every week, a majority spend 36 to 40 hours on patient care, seeing an average of 76 to 100 patients in a single specialty group practice. Two-thirds don’t provide on-call emergency room coverage because of hospital by-law exemption (20 percent), lifestyle considerations (16 percent) and undisclosed reasons (45 percent). Of active, licensed physicians reporting an impending move out of state (4 percent), one-fourth don’t yet have a planned destination. Others plan to relocate to Texas (153), California (120), South Carolina (85), Georgia (85), and New York (66), with the balance scattered around the country, mostly on the East Coast and in the South. Notable trends: • Twenty-four percent of OB-GYNs no longer deliver babies because of liability exposure, cost of professional insurance, medical malpractice liti-
PHYSICIAN WORKFORCE SPECIALTY COUNTS BY COUNTY: (Note: 157 unique specialties have been divided into 16 main specialty groups.)
SARASOTA COUNTY: 904 Surgical specialist: 155 Medical specialist: 149 Internal medicine: 130 Family medicine: 121 Anesthesiology: 55 Radiology: 44 OB-GYN: 40 Dermatology: 38 Emergency medicine: 36 Pediatrics: 35 Psychiatry: 34 General surgery: 19 Neurology: 19 Pathology: 15 Other: 14 Pediatric subspecialist: 0
MANATEE COUNTY: 487 Family medicine: 91 Medical specialist: 85 Surgical specialist: 66 Internal medicine: 44 Pediatrics: 32 Anesthesiology: 28 OB-GYN: 28 Emergency medicine: 26 Psychiatry: 19 Radiology: 16 Dermatology: 13 Pathology: 11 General surgery: 10 Neurology: 9 Other: 6 Pediatric subspecialist: 3
CHARLOTTE COUNTY: 300 Family medicine: 47 Medical specialist: 46 Surgical specialist: 45 Internal medicine: 44 Emergency medicine: 18 Psychiatry: 17 Radiology: 15 Pediatrics: 14 Anesthesiology: 12 Neurology: 10 OB-GYN: 9 General surgery: 7 Dermatology: 6 Pathology: 5 Other: 4 Pediatric subspecialist: 1
(CONTINUED ON PAGE 8)
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Big Problem for Tiny Patients, continued from page 1 mothers and their babies. The 16-member task force, chaired by Attorney General Pam Bondi, unveiled its first initiative, the Born Drug-Free Florida website, recently at St. Joseph’s Hospital in Tampa. The $300,000 in seed money to fund this first step in a statewide public awareness campaign, which also includes dozens of billboards and public service radio and print media announcements, was provided by DCF. The state’s responsibility to address the NAS epidemic goes beyond the public health aspect; it also includes a financial obligation to taxpayers. In fiscal year 20112012, according to the task force’s findings, it cost Florida’s Medicaid program $32 million to care for babies going through withdrawal. However, the Legislature did not provide funding for the task force’s recommendation in the budget it submitted to the governor in May. In 2011, of 207,710 births there were 1,563 newborns diagnosed as exposed to drugs. That is three times the number in 2007. In Sarasota County, there were only 9 NAS cases reported in 2007, but that number rose to 93 in 2011. In Manatee County, that increase went from 6 in 2007 to 51 in 2011. Comparing the same time period in Charlotte County, the increase was 2 to 23. But the task force concluded that even those dramatic increases are low because NAS is substantially underreported, “Determining the full extent of NAS was an arduous task ... because Florida hospital discharge data is received as aggregated data from the Agency for Health Care Administration,” the report stated. “There is no statewide standardization for the diagnosis and reporting of substance-exposed newborns; policies and procedures for diagnosis and reporting therefore vary by hospital,” the task force agreed, adding that the best NAS data is provided directly from Florida hospitals. Area physicians who provide care for babies diagnosed with withdrawal and suffering labored breathing, seizures, tremors, and other discomfort that causes almost non-stop crying, agree about the condition being underreported. Patricia Blanco, MD, is a solopractice pediatrician in University Park who has been a caregiver and advocate for NAS babies even before the federal government declared prescription medicine abuse as the fastest-growing drug problem in 2010. She is medical director of the regional Children’s Medical Services, which helps special-needs children in Sarasota, Manatee, Charlotte and and DeSoto counties. Blanco also is medical director of the Medical Foster Care Program, which provides familybased care for infants Dr. Patricia whose mothers cannot Blanco 8
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care for them. In addition, she has served for several years on the Substance-Exposed Newborn Protection Committee, a multi-agency effort that includes representatives from Healthy Start, First Step, DCF, Sarasota Memorial and private sector social workers, all of whom have a desire to stem the tide of opiate-based substance abuse in pregnant women. Those combined responsibilities make Blanco a respected fixture on this subject at Sarasota Memorial Hospital, which houses the only neonatal intensive care unit in Sarasota County. “The task force’s findings are a good effort. It’s important that we have recognition all the way to the state and federal levels,” Blanco said. “But part of the (underreporting) problem is that we need to have our colleagues in obstetrics doing universal drug testing on all (pregnant women), including (standard blood-testing) panels. We would have a better understanding of exactly where we’re at,” she said. As it is, physicians are reporting “only those mothers who admit a drug history, or are in a drug treatment program, or who have been screened by the public health department. The private-pay moms are not screened universally and that is a problem,” said Blanco. “We need both verbal and urine screening” protocols. Anthony Napolitano, MD, is a neonatologist and medical director of the NICU at Sarasota Memorial and on staff at All Children’s Hospital in St. Petersburg. He echoed Blanco’s call for more standardized and widespread screening of pregnant women. “It’s way underreported,” he said. Caregivers “have to ask the question ‘Are you using substances?” prescription or illegal, he said. “The state needs to find a universal screening tool,” perhaps a questionnaire, Napolitano said, but he stopped short of endorsing mandatory drug testing, citing legal concerns. Napolitano said Sarasota County “is one of the most progressive counties in Florida because (stakeholders) actually recognized the problem before others started seeing it. They recognized it was a problem very early that you can’t just solve in the hospital. You have to reach
into the community.” Napolitano is active in the group Florida Perinatal Quality Collaborative where, “for the last two years, we have addressed issues that are really impacting mothers and newborns in the state. One of the issues we have looked at, of course, is prescription drug abuse and the impact of withdrawal on babies. So, not only is there an effort by state agencies now, there is an effort in place with the physicians who are trying to improve outcome. Napolitano praised how community partners, with Sarasota Memorial leading the way, have “worked together to solve this problem. ... The community rose to the occasion. They realized you have to address it from multiple sides,” Napolitano said. “Sarasota is actually a model county. It has taken a while for the state to see what we were seeing locally,” he said, adding that the task force’s initial efforts are encouraging. Blanco said she supports the Born Drug-Free program. But the problem of NAS is complex and will require multilevel education efforts that reach both mothers, their families and healthcare professionals, she said. “Teaching med school students about it is absolutely necessary,” she said. “It should be in the curriculum because it’s something they are going to have to deal with.” The state task force’s recommendations concurred with that observation, recommending the implementation of “educational curricula for healthcare professional schools for treatment of drug and alcohol addiction, as well as ongoing professional education.” But even though the educational component of solving the puzzle is very important, Blanco said, “there are some mandated pieces that should go with it.” The healthcare system and lawmakers still “have a lot of work to do with pain management clinics and the pill mills in our state,” she said. That includes pharmaceutical companies because “the number of pills (oxycontin, for instance) far outweighs the need of those who have chronic pain or cancer. We need some way to (better) control the release of those medications only to patients who truly re-
quire it,” she said. The NAS problem is “layers of issues, and we are creating some issues ourselves,” said Blanco, referring to physicians who too readily write such prescriptions. “Educating physician providers and putting in more enforcement of the availability of these pills, (along with) universal mandatory screening of pregnant mothers” should be priorities, she said. “You can’t tell by looking at a person if she is using prescription opiates. It crosses all socioeconomic and ethnic lines,” she said. But the ongoing community collaborations are a recipe for success, said Blanco. “We’ve been doing some really good work to address the problem. ... I am hopeful.”
Physician Workforce Report, continued from page 7 gation, declining government reimbursement rates, and other reasons. • With most of the state’s 1,797 radiologists working in a hospital setting, their practice characteristics reflect reading diagnostic mammograms and sonograms (79 percent), reading screening mammograms (77 percent), performing ultrasound and stereotactic-guided core biopsies (55 percent), reading breast MRIs (48 percent), and reading MRI-guided core biopsies (33 percent). The Physician Workforce Advisory Council is a 19-member group established by state lawmakers in 2010 to address physician workforce needs in Florida. “These strategies, objectives, and progress measures make up the Department (of Health’s) inaugural strategic plan, with an objective of strengthening the state’s physician workforce assessment and development capabilities,” Armstrong emphasized. medicalnews
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The Strong Patient Voice in the POLST Paradigm By RAFAEL J. SCIULLO
As a hospice care provider for more than 30 years, I know the bitterness that erupts when family members find themselves opposing one another because no one, including their physician, knows the treatment wishes of a patient who is no longer able to communicate. That’s one reason why I support Physician Orders for Life Sustaining Treatment (POLST), a model under consideration in Florida and already adopted in many other states. Research and technology have led to countless advances in medical care no one could have dreamed of even a decade ago. But even ground-breaking new treatments, the advent of widespread electronic medical recordkeeping and so forth have not changed the basic need patients have to believe that their physicians see them as individuals. You might say they want their interactions with their physicians to be off the charts. Patients want to be more than the COPD case or new chemotherapy referral. Most prefer their physicians to know who they are – to advocate for them. The POLST model goes a long way toward doing just that. You may be familiar with POLST. If so, you know the POLST paradigm spells out the expressed wishes of patients, and at the same time, ensures that physicians and other healthcare providers will be able honor such choices. In Florida, with our large population of elderly citizens and rapidly aging baby boomer generation accustomed to doing things its way, POLST is an ideal tool for doctors and other healthcare providers. The POLST model calls for thoughtful dialogue between physicians (or other healthcare providers) and patients regarding end-of-life treatment preferences. Coming to terms with such decisions can be challenging but many patients also find comfort in knowing that difficult decisions about their care won’t be left unmade, perhaps dividing their families or leaving choices up to strangers. Such discussions may culminate with completion of a POLST form, which carries the designation of a medical order. POLST directives are intended to supplement, not replace traditional advance directives for patients approaching the end of life. Because it is a medical order, POLST has greater impact in ensuring that a patient’s wishes will be carried out. It is recognized in all healthcare settings – hospital, long-term care and homecare or during transport. POLST orders can ultimately spare
patients’ families from choices they often feel ill-equipped to make. The order does away with the guess work and angst families often encounter when a relative is seriously ill, instead honoring a patient’s known treatment preferences. And physicians may rest-assured that they are providing exactly the kinds of treatment and care their patients have chosen themselves. Considered best practice by many healthcare providers, the POLST model offers these advantages: • It is a medical order signed by a physician. • It is a one-page, easy-to-follow standardized form. • Unlike DNR orders, POLST goes beyond resuscitation to cover an entire range of life-sustaining interventions, such as intravenous fluids, antibiotics, a feeding tube and artificial breathing. • The brightly colored POLST form is easily identified. As part of a patient’s chart, it travels with the patient from hospital, to nursing home, to ambulance, to the patient’s home and is recognized across all such treatment settings. As president and CEO of one of our nation’s leading hospices, I believe wholeheartedly in the value of patient choice. Studies have shown that most hospice patients choose at least one life-sustaining treatment, and with POLST, they also have the option of declining aggressive end-of life treatment. The POLST paradigm represents a significant step toward helping physicians carry out their patients’ end-of-life treatment and care preferences. That is why I’m pleased that our community hospice, Suncoast Hospice, is the first organization of its kind to pilot POLST in Florida. We look forward to helping seriously ill patients and their families achieve the peace of mind that comes from knowing their decisions about end-of-life care will be handled according to their own wishes and firmly supported by a signed medical order. Rafael J. Sciullo, MA, LCSW, MS, is president and CEO of Suncoast Hospice of Clearwater, Florida, a premier hospice provider recognized for its innovation, expertise and compassion in palliative and end-of-life care. A seasoned healthcare leader, Sciullo took over the top position at Suncoast Hospice in February of this year. He has been an administrator of other hospices and hospitals during his more than 30-year healthcare career. He is a nationally known advocate for endof-life care and has held leadership posts with the National Hospice and Palliative Care Organization (NHPCO). Sciullo may be reached at rafaelsciullo@thehospice. org or via the Suncoast Hospice website – suncoasthospice.org.
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GrandRounds Weiss Pediatric Care Unveils New Approach to Pediatric Medicine
PUBLISHED BY: SouthComm, Inc.
After working independently with children and families for more than three decades, longtime Sarasota pediatrician Robert Weiss, M.D., and wife Diane Weiss, M.S. Child Development and Parenting Specialist, are melding their 60 years combined experience to pioneer a new approach to pediatric care in Sarasota. In June, the couple opened Weiss Pediatric Care, on track to be Sarasota’s first certified Pediatric Medical Home. Structured to meet the latest standards from the American Academy of Pediatrics (AAP), the medical home is not a building, house, hospital or home care service, but rather a new, more comprehensive approach to primary care. The patient-centered medical home incorporates critical components of Bright Futures, the AAP’s national health promotion and disease prevention initiative, as well as, Healthy Steps, a national evidence-based initiative to foster healthy growth and development. Some of the services that will distinguish Weiss Pediatric Care as a Pediatric Medical Home include: physician home visits for newborns; child development specialist available at every visit; physician-guided health care education for parents, children and teens. The practice also will offer a dedicated parenting and child development information telephone line and certified breastfeeding counselor on staff.
PUBLISHER Jackson Vahaly jvahaly@southcomm.com FLORIDA MARKET PUBLISHER John Kelly johnkelly@orlandomedicalnews.com
SMH Names Nurses, Patient Care Techs of Excellence During Nurses’ Week, Sarasota Memorial paid tribute to the expertise and achievements of the health system’s more than 1,200 Magnet nurses. One of the highlights of the weeklong celebration was the naming of the 2013 Nurses and Patient Care/Multi-Skilled Techs of Excellence.
Nominated and selected by their peers, these exceptional caregivers set a high standard for top-quality, compassionate care. University of South Florida nursing students also named Melissa Kelley, RN, Cardiac Progressive 3, as Sarasota Memorial’s Preceptor of the Year.
SMH Wins Blue Distinction for Spine Surgery & Total Knee/ Hip Joint Replacement
Specialty Care® program is a national designation awarded by Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality specialty care – and has recently been expanded to include more robust quality measures focused on improved patient health and safety as well as new cost-efficiency measures. Since 2006, consumers, medical providers and employers have relied on the Blue Distinction program to identify hos-
Sarasota Memorial Health Care System received the highest level of distinction by Florida Blue, Florida’s Blue Cross and Blue Shield company, as a high performing hospital for quality and efficiency in spine surgery and total hip/knee joint replacements. The Blue Distinction Centers for
PHYSICIANS BUSINESS CONFERENCE Tools for Success
SAVE THE DATES October 26 and 27, 2013 Location: Sheraton Westport Lakeside Chalet Sponsored by St. Louis Medical News, this unique educational conference will include more than 25 hours of individual seminars focused on multiple business topics needed today by health care physicians and health care business managers. Health care business seminars are sold on an individual basis, giving attendees the ability to create their own educational experience. Come learn from business pros. Early seminar registration is encouraged since seating is limited for each seminar.
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More Information – Contact Larry Henry, St. Louis Medical News Phone: 314-917-6107 Email: lhenry@medicalnewsinc.com Seminar Registration – Seminar registration begins July 26. You can register on-line at www.stlouismedicalnews.com where you can also view detailed information about each seminar. Directions – Physicians Business Conference will be held at the Sheraton Westport Lakeside Chalet at 191 Westport Plaza, St. Louis, MO 63146. We suggest those flying to St. Louis Mapquest directions from Lambert International airport to the Conference site. Hotel Accommodations – Rooms can be booked at the conference site for $99 per night when you register for seminars at www.stlouismedicalnews.com.
ADVERTISING John Kelly 407.701.7424 Jkelly@tampabaymedicalnews.com Lyn Cassan 941.893.8868 Lcassan@medicalnewsinc.com Brenda Loyal 813-323-1037 BLoyal@tampabaymedicalnews.com Nicholas Mazeika 727-254-8165 Nmazieka@tampabaymedicalnews.com NATIONAL EDITOR Pepper Jeter editor@medicalnewsinc.com LOCAL EDITOR Lynne Jeter lynne@medicalnewsinc.com CREATIVE DIRECTOR Susan Graham susan@medicalnewsinc.com 931.438.8771 GRAPHIC DESIGNERS Katy Barrett-Alley, Amy Gomoljak Christie Passarello ACCOUNTANTS Kim Stangenberg kstangenberg@southcomm.com CIRCULATION subscriptions@southcomm.com CONTRIBUTING WRITERS Lynne Jeter Cindy Sanders, Jeff Webb —— All editorial submissions and press releases should be emailed to: editor@medicalnewsinc.com —— Subscription requests or address changes should be mailed to: Medical News, Inc. 210 12th Ave S. • Suite 100 Nashville, TN 37203 615.244.7989 • (FAX) 615.244.8578 or e-mailed to: subscriptions@southcomm.com Subscriptions: One year $48 • Two years $78
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Chief Executive Officer Chris Ferrell Chief Financial Officer Patrick Min Chief Marketing Officer Susan Torregrossa Chief Technology Officer Matt Locke Business Manager Eric Norwood Director of Digital Sales & Marketing David Walker Controller Todd Patton Creative Director Heather Pierce Director of Content/Online Development Patrick Rains Manatee-Sarasota-Charlotte Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2012 Medical News Communications. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.
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GrandRounds
Stelios Rekkas, MD
General, Bariatric and Robotic Surgery
Surgical Weight Loss pitals delivering quality care in bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacements, spine surgery and transplants. The selection criteria used to evaluate facilities were developed with input from the medical community and include general quality and safety metrics as well as program specific metrics. Blue Distinction Centers have met rigorous program standards and demonstrated better quality and improved outcomes for patients, with low rates of complications and readmissions. The program provides consumers with tools to make better informed healthcare decisions, and these results will enable employers, working with Florida Blue, to tailor benefits to meet their individual quality and cost objectives.
Medical Journalist and TV News Anchor Heidi Godman is Back On The Air After a 3-year hiatus, popular TV news anchor and medical journalist Heidi Godman is back on the air—this time, she’s taking on talk radio. Godman hosts the new show Heidi Godman “HEALTH IQ with Heidi Godman,” which airs Monday through Friday from 3pm to 4pm on WSRQ 106.9 FM and 1220 AM. WSRQ’s signal reaches listeners from Tampa south to Cape Coral, FL. The show will focus on all aspects of health and wellness. She talks daily to doctors and health experts on the Suncoast and across the country. The show is the brainchild of Jim Abrams, the national franchise guru whose latest venture is Fyzical. He’s producing the medically focused talk radio show to provide a vital community service. Godman spent 22 years at WWSB-TV in Sarasota, where she was the main anchor and medical editor. She left in 2010, and is now the executive editor of the Harvard Health Letter, a monthly medical periodical from Harvard Medical School. Medical News is pleased to provide space for press releases by providers in our Grand Rounds section. Content and accuracy of the releases is the sole responsibility of the issuer.
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Stelios Rekkas, MD, offers free monthly seminars that include information about Laparoscopic Sleeve Gastrectomy, a weight-loss surgery that removes approximately two-thirds of the stomach and can help to reduce diabetes, high blood pressure and other obesity-related conditions. Visit www.ManateeSurgicalAlliance.com to see a schedule of seminars. For an appointment, please call 941.254.4957. Most insurances accepted.
Originally from Manatee County, Dr. Stelios Rekkas obtained his medical degree from the University of Florida in Gainesville and completed his residency in general surgery at Mt. Sinai Medical Center in Miami Beach. He completed a minimally invasive/bariatric fellowship at Jackson South Community Hospital/Baptist Hospital in Miami.
ManateeSurgicalAlliance.com 5317 4th Avenue Circle East Bradenton, FL 34208
JUNE 2013
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