the Stethoscope the Stethoscope
September 2019 Issue
Quarterly Newsletter of the Erie County Medical Society
Quarterly Newsletter of the Erie County Medical Society • June 2021 Issue
A Message From Your President
Oh, morning, at the brown brink eastward, springs. by Jeffrey McGovern, MD, FCCP, FAASM, President, ECMS
Jeffrey McGovern, MD, FCCP, FAASM, President, ECMS Rebecca Doctrow Association Executive rdoctrow@pamedsoc.org Phone: 833-770-1542 1438 West 38th Street Erie, PA 16508 Administrative Office/ Mailing Address: 400 Winding Creek Blvd. Mechanicsburg, PA 17050 eriecountymedicalsociety.org
The opinions expressed in this publication are for general information only and are not intended to provide specific medical, legal or other advice for any individuals. The placement of editorial content, opinions, and paid advertising does not imply endorsement by the Erie County Medical Society.
Gerard Manley Hopkins (1844-1889) was a prolific English poet and Jesuit priest who wrote poetry in the Victorian era. The poem stanza quoted above addresses the indefatigability of nature despite the excesses of the Industrial Revolution. I could think of no better reference to capture the relief and excitement of physicians moving forward from the pandemic. We remain indefatigable, like Nature, despite the excesses and devastation of our modern-day scourge, COVID 19. We as one spring up as morning. —Gerard Manley Hopkins I reviewed with great interest the recent Medscape 2021 survey detailing health and economic issues affecting physicians. While not a robust scientific survey it does as in surveys past shed light on the status of our field. Some of the items deserve special mention. When asked about identifiable challenges to the practice of medicine, respondents noted rules and regulations (23%) and long hours (14%) while only 7% cited the burdens of COVID 19 management. A recent opinion piece in the Wall Street Journal written by a practicing cardiologist echoes the sentiments of the burden of rules and regulations (https://www.wsj.com/articles/the-crushing-burden-ofhealthcare-microregulation-11619622081?mod=hp_listc_pos4). When medical residents in the survey were asked about their future employment options an equal number replied that they would consider both practice ownership, or private practice, as well as employment from a hospital entity. Prognosticators have long predicted the demise of private practice, so it isn’t clear if this survey marks a change or a statistical blip. We are aware that medical school applications are increased (https://www.aamc.org/news-insights/applications-medicalschool-are-all-time-high-what-does-mean-applicants-and-schools), so it will take several years to determine the trajectory of these options. An encouraging answer is one provided to the question about choosing the medical profession all over again. In 2013 a slim majority of 51% reported positively to this question, while in 2021 77% responded that Continued on page 2
Oh, morning, at the brown brink eastward, springs. Continued from page 1
fit into your professional life? I would argue in all transparency that advocacy and education provided by your medical society always has a place whether you are employed or in private practice. If you have been away from the society, I ask you to take a second look. You are always welcomed back. The Erie County Medical Society has your interests in mind. Please be sure to read Dr. Pelkowski’s article in this Stethoscope which reviews a motion he will introduce at the upcoming Pennsylvania House of Delegates. Know too that with the support of the board we are planning to sell the society building to place us in a better fiscal position for the future. We will be sure to have a place for society meetings without the burden of building upkeep. You will be around in years to come, and we want the ECMS to be present for you then too. We also look forward to rescheduling the many activities which were on the docket when cousin Covid came to visit. Stay tuned and please read the communications as we kick this unwelcome guest to the curb.
they would choose the medical profession again if given the option. What accounts for the major change? Perhaps the answer to the next survey question provides a clue. Respondents were asked to answer why they work as a physician. The two major and equally weighted answers were “to make the world a better place” (26%) and “patient gratitude” (26%). Perhaps the silver lining of the pandemic did indeed bear out the mettle not only of the health care team, in general, but also the physician leading the health care team, in particular. The respondents’ ages were generally in those in active practice (35-64) and a majority were primary care physicians in the patient trenches. At best the response are encouraging and time will bear out if these are ongoing trends. On a final note, I want to extend my wishes to each of you for a serene summer. We are all acutely aware that our times off are bound ineluctably to trying to finish work before and after our vacations. We ask ourselves whether it is worth all of the hassle. Yes, it is if it brings us away if only for a bit of quiet and fellowship. Remember too that your medical societies both at the state and county level continue to work for you in all seasons. Where does the society
On behalf of my fellow board members I want to extend our appreciation for all that you do as physicians. Your time and energy in dedication to our patients is never in vain. It is an honor to serve along with you.
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Member News New
Reinstated
Jayda Watkins, MD Peter Hopkins Laucks, DO Allison Leigh Smith Edwin Cacundangan Hojilla, MD David Ross Croasdale, MD Christopher Ryan Sherry Marques Neilson, DO Jeremy Shapiro, DO Danielle Rutherford, DO Anthony Thomas Battista Jr., DO Jeffrey Zoltan, MD Kevin Zachary Black, MD Casey Gernovich, DO Maria Eileen Yruma, MD
Paul W. Heberle, DO David Hunter Snow, DO Divya Koradia, MD Laura J. McIntosh, MD Bruce Armstrong Philip E. Gallagher, MD
The Quote
CORNER
“ As to diseases, make a habit of two things — to help, or at least, to do no harm.” ― Hippocrates
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Syringe Services Programs Timothy D. Pelkowski, MD, MS, FAAFP Every day, 10 Pennsylvanians are lost to substance use disorder. This disease can affect any individual and threatens entire communities within the Commonwealth. Pennsylvania has the 3rd highest rate of drug overdose deaths in the country and the 9th highest rate of new human immunodeficiency virus (HIV) infections. The Centers for Disease Control and Prevention (CDC) has noted that Pennsylvania is one of the states at risk for increases in HIV and hepatitis C virus (HCV) infections. When needles are in short supply, injection-drug users (IDUs) will share their needles. The sharing of syringes is fueling the spread of these diseases across the Commonwealth. Hospitalizations in the U.S. for substance-userelated infections costs over $700 million each year and Pennsylvania bears a significant portion of that cost. Few physicians have not seen the horrific impact that this disease can take on our patients and their families. Syringe services programs (SSPs) provide free sterile syringes and collect used syringes from IDUs to reduce the transmission of blood borne pathogens, including HIV, hepatitis B virus, and HCV as well as to prevent skin infections, abscesses, and endocarditis. Injection-drug use is responsible for a significant number of these infections in Pennsylvania. These programs have overwhelming medical evidence as to their success and have been shown to be cost-effective as well. SSPs have been associated with a 50% reduction in HIV and HCV incidence. Further, when this is combined with medication assisted treatment for opioid use disorder, HIV and HCV transmission has been reduced by over two-thirds. SSPs provide a bridge to comprehensive prevention services and referrals to IDUs that can help reduce the spread of these infections and can increase access to health care and substance abuse treatment for this population. These services include access to clean syringes and other medical supplies, disposal of syringes, referral to drug treatment and other social services, HIV and HCV testing, naloxone, and many other public health services. Taken together SSPs are a critical public health intervention for all of Pennsylvania’s communities that are struggling with this epidemic. There is over 30 years of robust research that exists around this public health endeavor. The American Medical Association, CDC, National Academy of Medicine, and the World Health Organization all support these programs. There are numerous Pennsylvania State organizations that explicitly support these public health services. This includes all of the Deans of Pennsylvania’s public health schools as well as the Pennsylvania Academy of Family Practice, Pennsylvania Association for Addiction Medicine, Pennsylvania Chapter of the American Academy of Pediatrics, Pennsylvania Psychiatric Society, Pennsylvania Public Health Association, Pennsylvania Society of Addiction Medicine, and the Pennsylvania State Nurses Association. The Federal Consolidated Appropriations Act of 2016 includes language that gives states and local communities the opportunity to use federal funds provided through the Department of Health and Human Services to support certain components of SSPs. The American Rescue Plan Act of 2021 is recent legislation that allocates $30 million for harm reduction services which includes SSPs. There are now more than 400 SSPs operating in almost 40 states. Pennsylvania needs to take advantage of these funds to combat this epidemic in our communities. Currently, Pennsylvania state law defines syringes as illegal drug paraphernalia. This legislative barrier prevents the widespread operation of syringe service programs throughout the Commonwealth. Currently, syringe services programs operate successfully in Philadelphia and Pittsburgh, where they were authorized under local public health authority for over the past 2 decades. But other areas of the state have not benefitted from these programs because of local concerns that they conflict with state law. It is essential that this barrier be removed to allow these effective public health services to be available to all those in need in Pennsylvania. Continued on page 5
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Syringe Services Programs Continued from page 4
SSPs are not an endorsement of drug abuse and function to actually increase public safety. There has been no increase in the crime rate in the communities that offer these services and SSPs have not been shown to increase the frequency of injection-drug use. Rather, these proven and costeffective services have been shown to reduce the rates of HIV and HCV transmission, and increase the chance of someone’s entering treatment to overcome substance use disorder. These programs also decrease syringe litter and needle stick exposures in the community. Bills to legalize these programs have been introduced several times in the Pennsylvania legislature, but none have ever passed. Stigma exists around these services despite the overwhelming evidence that they help protect our communities. The Erie County Medical Society needs to explicitly support the removal of all barriers to increasing the availability of SSPs in Erie County and should actively advocate for these proven services for our marginalized patients with substance use disorder. Timothy D. Pelkowski, MD, MS, FAAFP is the current District 8 Trustee to the Pennsylvania Medical Society Board of Directors and current Member At Large on the Erie County Medical Society Board of Directors. References: • Center for disease control and prevention (CDC). Syringe services programs (SSPs). www.cdc.gov/ssp. Last accessed May 3, 2021. • Rich JD, Adashi EY. Ideological Anachronism Involving Needle and Syringe Exchange Programs: Lessons from the Indiana HIV Outbreak. JAMA. 2015 Jul 7;314(1):23-4. PMID: 26000661. • Schwetz TA, Calder T, Rosenthal E, Kattakuzhy S, Fauci AS. Opioids and Infectious Diseases: A Converging Public Health Crisis. J Infect Dis. 2019 Jul 2;220(3):346-349. PMID: 30941402. • Weinmeyer R. Needle Exchange Programs’ Status in US Politics. AMA J Ethics. 2016 Mar 1;18(3):2527. PMID: 27002996.
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Legislative Update: Informed Consent, Physician Assistants, and More Please note: This article is current as of June 10, 2021. As legislation is often on the move, visit www.pamedsoc.org and check The Dose for the latest updates on this and other legislation. As summer approaches, legislative activity begins to narrowly focus on the passage of a state budget. With significant monies coming from the Federal government, the political struggle this budget cycle will be more about where the money goes as opposed to where its coming from. Though June is traditionally budget time in Harrisburg, there are a number of “bills in play” that the Pennsylvania Medical Society (PAMED) is actively engaged in and some behind the scenes activity of which you should be aware. Informed Consent Several years ago, the Pennsylvania State Supreme Court made a significant ruling on a case involving physician informed consent that sent the physician and hospital community into a tailspin. Under the ruling, physicians could no longer delegate the process of gaining informed consent to a physician assistant, nurse practitioner, or even a physician colleague. The court ruled that only the physician performing the test or procedure could provide informed consent to patients. Working jointly with the Hospital and Healthsystem Association of Pennsylvania, PAMED is on the verge of reversing the action taken by the Supreme Court through language found in Senate Bill 425. In essence, this legislation statutorily returns the process of informed consent back to the way it was done prior to the court ruling. The bill has been approved by the Senate and House Health Committees and now awaits final consideration by the full House. A vote is expected in June. Physician Assistants For the past two years, PAMED has been meeting with physician assistants (PAs) who are seeking to change some of the processes by which they are approved to practice along with alternatives to the current requirements for physician supervision. Legislation (Senate Bill 397/Senate Bill 398) has been introduced that would, among other things, no longer require the state medical and osteopathic boards to approve PA agreements. The bill also would allow supervising physicians to determine the frequency of which they are currently required to review and countersign patient charts where PAs were involved in providing care. PAMED has been working closely with a coalition of physician organizations representing family physicians, internists, pediatricians, and orthopedic surgeons. The Pennsylvania Osteopathic Medical Association (POMA) has also been intimately involved. The coalition has expressed concerns with the current versions of Senate Bills 397-398 and are still determining their overall positions. The Senate Consumer Protection and Professional Licensure Committee voted to approve both bills during their meeting on June 8. However, the sponsor of the bills, Sen. Joe Pittman (Indiana), commented during the meeting that PAMED and POMA have expressed concerns with the current language and that discussions would continue before a final vote in the Senate takes place. PAMED formally opposed the bills until critical elements can be appropriately addressed. Restrictive Covenants PAMED has also been engaged in helping to advance legislation to address the issue of restrictive covenants in physician employment contracts. House Bill 681, supported by PAMED, is awaiting a final vote in the House before it makes its way to the Senate for consideration. Though the legislation may need additional amendments to “fine tune” its effectiveness, PAMED is urging its passage in the House. As one would expect, hospitals and health systems across the state are opposed to the measure. PAMED continues to remind legislators that non-compete contracts routinely disrupt patient
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Legislative Update: Informed Consent, Physician Assistants, and More Continued from page 6
PAMED is urging its passage in the House. As one would expect, hospitals and health systems across the state are opposed to the measure. PAMED continues to remind legislators that noncompete contracts routinely disrupt patient care and long-term physician/patient relationships when circumstances require physicians to change employment. PAMED urges its members to engage in support of House Bill 681 by reaching out to their local state Representative and asking them to support patients by approving this proposal. Prior Authorization The tug of war between physicians and health insurers on reforming prior authorization continues. However, efforts by PAMED and patient advocacy organizations are beginning to move the needle on Senate Bill 225. A recent press event, featuring patients whose health was negatively impacted } by prior authorization delays, was picked up by several media outlets including the Philadelphia Inquirer. Our grassroots and coalition efforts will continue on both Senate Bill 225 and House Bill 225 throughout the summer with the hope of seeing movement of these proposals in the fall… if not sooner. Telemedicine The COVID-19 pandemic has changed our lives in many ways. One positive change has been the efficacy and benefits of telemedicine. Patients and physicians alike have personally experienced the benefits telemedicine can provide to the health care delivery system. Working with other stakeholders, PAMED is happy to see that telemedicine has again been placed on the legislative agenda with the introduction of Senate Bill 705. Though similar legislation has previously stalled in the House after having been approved by the Senate, PAMED will be working with other stakeholders to see this bill cross the finish line this legislative session. Physician Complaints Lastly, PAMED is awaiting the introduction of legislation that will absolve physicians of the requirement that they disclose frivolous patient complaints filed with the state medical and osteopathic boards. Health insurers and other entities often ask physicians if they have been the subject of medical or osteopathic board complaints filed by patients. Few of these complaints result in any formal action taken by the boards yet physicians are required to acknowledge them. Legislation that will soon be introduced by Rep. Curt Sonney (Erie) will allow physicians to forget about patient complaints that their professional oversight boards found to have no merit. Physician Advocacy Physicians are encouraged to reach out to their elected officials to discuss these and other issues that impact their ability to appropriately and effectively provide patient care. For guidance in getting to know your legislators or specifics on current legislative activity, please reach out to PAMED’s Government Affairs staff by emailing David Thompson, Senior Director, at dthompson@pamedsoc.org.
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ECMS President-Elect Kelli DeSanctis, DO was awarded with the
PAMED Everyday Hero Award. Congratulations, Dr. DeSanctis! Kelli K. DeSanctis, DO, who practices as a family medicine physician at Millcreek Family Practice & Internal Medicine in Erie, has been recognized by the Pennsylvania Medical Society (PAMED) as an Everyday Hero. PAMED’s Everyday Hero Award is designed to showcase talented physicians who probably don’t view themselves as heroes, but to patients and colleagues they are. Her colleague and nominator, Timothy Pelkowski, MD, calls her an “energetic” family physician in their community who “serves patients every day with skill, dedication, and compassion.” “In addition to providing stellar patient care, she has developed a passion for organized medicine in our community,” he said. She is currently serving as the president-elect of the Erie County Medical Society and will become its president in 2022. “She has particularly been focusing on young physician needs in our community through the Erie County Medical Society, Dr. Pelkowski said. “This work in the Erie County Medical Society has positioned her as a physician leader in our community.” Dr. DeSanctis provides well-baby, child, and adolescent care, as well as care for women, in Erie. Her clinical interests include geriatrics, LGBT+ health care, and medically supervised weight loss. “One of the things I love about being a family physician is that you can treat the whole family— from the children, all the way up to grandma and grandpa,” Dr. DeSanctis said. I love building that relationship. That’s why I love what I do.” One of the things that really makes Dr. DeSanctis an exemplary physician is the importance she places on carefully listening to her patients each day. “The best piece of advice I’ve ever gotten was from one of my teachers when I was in training, and he told me that if you listen carefully, your patients will tell you what their ultimate diagnosis is,” she said. “People know their bodies best. My job is to sit back, listen, use my brain, and help the patient and work with them to figure out what’s going on with their health.” When asked why she went into medicine, she said she could never picture herself doing anything else. “It’s the only thing I ever wanted to do,” she said. She received a medical degree from Lake Erie College of Osteopathic Medicine and completed her residency and fellowship at AHN Saint Vincent Hospital in Erie, Pennsylvania. When asked why she chose to practice in snowy Erie, she said, “I’m an Erie-an by choice. Even with our horrible winters, I’ve chosen to stay here. I grew up on the other side of the state and came to Erie to go to medical school, and I really fell in love with the area.” Patients and medical colleagues can nominate PAMED member physicians for this award at www.pamedsoc.org/EverydayHero.
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Sponsor registration is now open for the 11th Annual Health Expo! More information is available on the Health Expo registration portal.
More Information & Registration
Advertise With Us Erie County Medical Society has a variety of sponsorship opportunities available throughout the year. To learn more about these opportunities, visit the “Advertise With Us” page of our website. http://www.eriecountymedicalsociety.org/advertise
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2020–2021 ECMS Board of Directors Jeffrey P. McGovern, MD, FCCP, FAASM President
Thomas Falasca, DO, FACA, FACPM At Large Member
Narendra Bhagwandien, MD Immediate Past President
Timothy D. Pelkowski, MD At Large Member
Kelli DeSanctis, DO President Elect
Paul Malaspina, MD At Large Member
Terence O. Lillis, MD Secretary/Treasurer
Kirk Steehler, DO At Large Member
Peter S. Lund, MD, FACS AMA Representative
Amanda Marie Wincik, DO At Large Member
Kathleen Anne Costanzo, DO At Large Member
Michael Furey Student Representative