Pennsylvania Psychiatrist July 2018

PENNSYLVANIA

JULY 2018

P S YC H I AT R I S T NEWSLETTER OF THE PENNSYLVANIA PSYCHIATRIC SOCIETY

PRESIDENT’S MESSAGE

by Ahmad Hameed, MD, DFAPA PaPS President

I hope that you and your family had a wonderful July 4th. Summer has been a long time coming and I hope that we will not have an early winter.

Pennsylvania Psychiatric Society works diligently to advocate and advance issues near and dear to you. In this, my first message as the president of the Society, I want to assure you that we will continue to be the stewards of your trust in us. We will continue to provide our membership with the best value for being members of PaPS. We will continue to focus on maintaining and expanding our membership. We are blessed to have a very active government relations committee which is generally on top of any legislation which can affect us, as psychiatrists.

We continue to engage with our political and governmental leadership to clearly explain our positions and stands on numerous legislation. We will continue to have our patients’ best interest as the driving force for all our efforts.

We have been, and we will continue to be good stewards of our finances. We will continue to reevaluate our budget so that our membership continues to get the benefits promised to them. We will continue to provide educational opportunities to our membership so that they can continue to provide evidence-based care to their patients. We encourage all members to attend all meetings so that we can become more powerful voice for our patients and psychiatry in the Commonwealth of Pennsylvania.

Ahmad

Meet your 2018 Executive Committee

New officers of the Pennsylvania Psychiatric Society (PaPS) were formally installed at the Annual Business Meeting on June 2, 2018.

Ahmad Hameed, MD, DFAPA is your new president. Dr. Hameed is vice chair of education and residency program director in psychiatry at Penn State College of Medicine at Hershey. He serves as co-chair of the PaPS Government Relations Committee and is a member of the Education, Ethics and Membership committees.

Keith Stowell, MD, FAPA serves as president-elect. Dr. Stowell is assistant professor at the University of Pittsburgh School of Medicine, Department of Psychiatry. He is currently the associate chief of clinical services at Western Psychiatric Institute & Clinic, where he oversees psychiatric emergency services, crisis services and the network admissions office.

Dr. Stowell also serves as director of forensic psychiatry.

Richard R. Silbert, MD, DLFAPA is your vice president.

He is senior medical director at Community Care Behavioral Health Organization (CCBHO), Moosic and is an associate professor of psychiatry at The Commonwealth Medical College. Dr. Silbert serves as president of the Greater Northeast PA Chapter of the American Foundation for Suicide Prevention (AFSP) and co-chairs a treatment committee that is part of a stop heroin/opioid overdose coalition.

Dhanalakshmi Ramasamy, MD, FAPA serves as treasurer of PaPS. Dr. Ramasamy is a child and adolescent psychiatrist at the Lehigh Valley Health Network, Pennsylvania and a clinical professor of psychiatry at University of South Florida. Dr. Ramasamy is a past president of Lehigh Valley Psychiatric Society and serves on the PaPS Education Committee.

Hope S. Selarnick, MD, DFAPA serves as secretary. Dr. Selarnick is director of addiction services and medical director of the opioid treatment program at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia. She is a past president of the Philadelphia Psychiatric Society (PPS) where she is a member and former chair of the Women’s Committee.

Dr. Selarnick is also active on the PPS/ PaPS Education Committees.

TABLE OF CONTENTS 2 | It’s the Symptoms that Matter 3 | Activity Update 4 | Early Career Psychiatrist Update 5 | Chapter Highlights 6 | Telepsychiatry Update 8 | Welcome New Members 9 | Resident Representative Update 10 | Physicians Health Program 101 11 | Meet Your Staff

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EDITOR’S COLUMN It’s the Symptoms that Matter

by Edward C. Leonard, Jr., MD, DLFAPA The best place to feel the pain of the mentally ill and gain respect for their plight (and that of their families) may be a first-person account that offers close views of symptoms. The personal context provides non-statistical, non-replicable data yet allows seeing the problem as patients do and recognizing their efforts to avoid its consequences. Reports of even the best psychiatric research seldom reach through the protocol to engage with the human agonies of suffering and disability, although that effort may be needed to encourage successful treatment. To augment your empathy, I suggest you read a very recent book which not only details the symptomatic development of delirium from brain tumors but also discusses which parts of the brain may be responsible for them.

The Neuroscientist Who Lost Her Mind: My Tale of Madness and Recovery by Barbara K. Lipska with Elaine McArdle links her encephalopathic symptoms to similar symptoms from persons with major mental disorders. It is eerie that the author is in charge of a thousand brains donated to NIMH for research and has a major research model for schizophrenia named after her. It is utterly implausible that she lied (by omission) to stay qualified for a checkpoint inhibitor immunotherapy study that didn’t help her metastatic melanoma, caused horrible adverse effects, and may have delayed extremely helpful treatment with therapy targeting the BRAF protein.

This book can be read as a treatise on denial, a powerful tool that many patients employ to avoid the painful realities of their disorders. The clearness with which she describes her flawed reasoning may help the reader recognize denial in other patients.

Lipska recaptures her self-talk while initially denying the likely metastatic origin of a sudden loss of part of her visual field.

Her wishful search for benign causes does end with medical confrontation and testing, but denial appears again in her decision not to report the new tumors found by her second-opinion evaluator of an MRI. After decades of success in her profession, it is to be expected that she has confidence in her judgement. Perhaps exaggerated by a damaged frontal lobe, her continued selfconfidence leads to foolhardiness and hubris. How this frustrates her family is also part of her symptomatic presentation.

Readers will end her book happy that a drug company gave her the apparently curative Dabrafenib (Tafinlar, Novartis) and Trametinib (Mekinist, Novartis) that her insurance company forbad.

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by Deborah Shoemaker, Executive Director and Lobbyist

ACTIVITY UPDATE

Finding the Silver Lining As I am writing this article, I am sitting at the shore with my kids. It cannot get any better than this for me. I can honestly say this is the first time in at least 20 years that I have gone on vacation in June because of legislative sessions. In that respect, I do feel guilty. But I am still watching the legislative calendar from afar, trusting that nothing major happens while I am asleep at the wheel. Our outside lobbyist has her finger on the pulse, of which I am truly grateful and puts me at ease.

The past few weeks alone have been traumatic to say the least – the completed suicides of fashion designer Kate Spade and chef/ food critic Anthony Bourdain, the national drama unfolding at the United States/Mexican border where our most vulnerable, youngest inhabitants are being separated from their parents, Governor Rendell’s announcement that he has Parkinson’s Disease, and that is just scratching the surface. These are only a few topics that have been weighing on my mind and in the deepest parts of my heart.

I have been on my own personal journey to understand why dreadful things happen to good people, or even how to maneuver the unexpected curveballs that life throws at you. In my time of reflection, I keep coming back to another saying told to me as a child, “find the silver lining.” Not easy to do when we are looking at the tragic loss of life, or when faced with well-intentioned legislation created in response to these tragedies. I would like to focus my comments on the issues at hand and how we can find the silver lining.

Issue at Hand: Increased Suicide Rates/Searching for Answers It comes as no surprise to many of you that there is an increase in completed suicides across the nation and here in the commonwealth.

Each death is tragic, placing families and loved ones in unfamiliar territory and unexplained grief. Families question what they did wrong, how they missed the warning signs, and what could have been done differently. Many questions remain unanswered and nothing they can do will bring their loved one back.

However, when a celebrity or someone who seemingly has everything – money, fame, family, just to name a few – tragically and suddenly ends their life, the world notices and questions why this would happen. What caused the death? Unfortunately, the media begins to dig deep into their mental health and substance use history, often forgetting to respect the privacy of the family. With the deaths of both Kate Spade and Anthony Bourdain, the families jumped ahead with personal statements to cut off any negative press. There was a request for privacy, but an acknowledgement of a personal mental health history and a supportive family left behind.

Silver Lining: Resources Available As luck would have it, the CDC recently released a suicide factsheet detailing the most recent statistics, highlighting risk factors and resources.

The APA’s communication office also reacted quickly after both tragedies and created a press release sent out to all media outlets.

Although additional funding is needed to support state and national suicide prevention efforts, this is a good first step.

Issue at Hand: Increase in School Shootings/Increased Gun Violence Unfortunately, school shootings and other mass casualties because of gun violence have become commonplace in our society. From Parkland, Florida to McKinney, Texas, there have been at least 46 incidents of gunfire on school grounds this year alone. Parents, teachers, family members, friends, and other loved ones are searching for answers as to what possessed these shooters to lose control. Of course, the media and well-intentioned policymakers look first at the mental health history of the individual who caused such unnecessary losses of life. They are unaware of the evidence-based research and statistics that reinforces that most individuals with mental health needs are the victims and not the perpetrators of violence. They are also unaware that psychiatrists cannot predict violent behavior or that involuntary commitment history does not make someone inherently violent or capable of acting out in such a tragic way.

Silver Lining: Grassroots Advocacy and Physician-led Leadership with Policymakers There is still hope amidst this trying time. Victims of violence are standing up for themselves and their friends by asking Congress and local state legislatures to act to end gun violence. The most prolific example of this new-found advocacy is the Kids March on Washington this past spring.

During the annual meeting in New York, the APA released a public opinion poll that solidified the national public outcry for Congress to act to end gun violence and to appropriate funding for the CDC to conduct additional research into this public health crisis.

Just last month, the AMA delegation voted to adopt several of nearly a dozen gun-related proposals presented by doctor groups that are part of the AMA’s membership. They agreed to: • Support any bans on the purchase or possession of guns and ammunition by people under 21.

• Back laws that would require licensing and safety courses for gun owners and registration of all firearms.

• Press for legislation that would allow relatives of suicidal people or those who have threatened imminent violence to seek courtordered removal of guns from the home.

• Encourage better training for physicians in how to recognize patients at risk for suicide.

• Push to eliminate loopholes in laws preventing the purchase or possession of guns by people found guilty of domestic violence, including expanding such measures to cover convicted stalkers.

At the state level, PaPS has been working with Representative Todd Stephens, the author of proposed legislation (House Bill 2227, Printer’s Number 3344) to create Extreme Risk Protection Orders (ERPOs) to provide clinical guidance to ensure that the rights of individuals with mental health needs are protected throughout the gun revocation/ P E N N S Y L V A N I A P S Y C H I A T R I S T | J U LY 2 0 1 8

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restorative process. Thanks to our clinical and government relations committee leadership for assisting in this critical issue.

We remain vigilant at the state Capitol and with the Wolf administration on scope of practice issues, proposed changes to the current Mental Health Procedures Act, Minor’s Consent Act, and other confidentiality-related statutes for individuals with substance use challenges. We also stand against proposed legislation related to outof-network billing, prior authorization, and unfair insurance practices that impede access to medication, treatments or services or would overcharge patients for services rendered within a treatment regimen, and the list grows daily. Although we have incurred a few expected losses prior to the legislative summer recess, our voice remains strong and sought out by key policymakers and crucial stakeholders across

the commonwealth and in national circles.

Our silver lining is that this is the second year of a two-year legislative session. This is an election year, so there is a threat of dangerous waters ahead. However, PaPS has strong leadership to move ahead as challenges face us. Our voice is being heard, solicited at the Capitol on legislative initiatives that affect all citizens of the commonwealth. We have friends within the Wolf administration that listen to us, placing our members and our staff on key advisory committees as appropriate.

This does not mean that we will win every battle before us. But we will face these challenges with dedication, hope for the greatest good, and armed with the clinical knowledge and expertise that guides the crucial work you perform daily.

EARLY CAREER PSYCHIATRIST UPDATE

by Hetty Eisenberg, MD, MPH I have been thinking a lot about our relationship with technology – professionally, personally, and socially.

As the Pennsylvania Psychiatric Society moves to embrace online forums for connecting and distributing information to its members, ECPs are in a unique position to offer leadership on this front.

The recent transition to an online-only newsletter, the establishment of PaPS Twitter accounts, and an effort to make meetings accessible via video streaming are a few examples of how an embrace of technology may help us, as an organization, to modernize how we connect with our members. Meanwhile, the use of technology in our professional lives is moving forward in ways that have great potential to lead to improved patient care – from telepsychiatry practices that reach underserved settings to data-mining in electronic health records to better identify the needs of our patients. As ECPs, we have familiarity and comfort with these tools and are positioned to offer this expertise to our colleagues.

ECPs are also in a unique position of having witnessed firsthand the drawbacks of technology. In light of the many recent concerns about online privacy, it is vital that we share these insights as well. Having

done all my training in the San Francisco Bay Area before moving back to the east coast, I sometimes feel the discrepancy between the high-tech culture I became accustomed to in San Francisco and the relative newness of it all here. Despite the conveniences of technology during my 13 years living in the Bay Area, however, the messages I received from my mentors in the psychiatry departments at UCSF and Stanford were far from positive. We had seminars advising us on how to minimize our online presences as we saw up close how internet privacy issues can negatively impact patient care and professional safety. Moreover, we experienced how social networks can be as alienating as they are connecting for our patients, and we witnessed the transformation of our city’s infrastructure and a housing crisis that spawned a public health emergency.

As we move forward to embrace technology organizationally and professionally in Pennsylvania, we have an opportunity to do so with intention. All of us have experiences – both positive and negative – with technology in our current practices. How can we use these to learn from and shape our choices as a professional organization? How can we use technology judiciously, so that we harness its potential rather than fall victim to its challenges? This is an exciting place to be, and a place where we, as ECPs, have great power to make ourselves heard. Do you have experiences with or strong opinions about technology that you’d like to share with us? Please be in touch!

Psychiatrist Named AMA President-Elect Psychiatrist and APA member, Dr. Patrice Harris was elected as the AMA President-Elect at the AMA Annual Meeting in Chicago on June 12, 2018. Thanks to everyone that supported her campaign with your members. Dr. Harris will be the first African-American woman President of the AMA. Our own Dr. Kenneth Certa served as her campaign manager. More information can be found here.

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CHAPTER HIGHLIGHTS

CENTRAL CHAPTER President Update

Kawish Garg, MD, FAPA On April 17th, we had our council meeting followed by CME event “Psychopharmacology – Risk Management and Legal Implications of Prescribing.” The PaPS orientation for new officers was held at PAMED headquarters on June 2nd in conjunction with the state council meeting.

We are looking forward to our upcoming residents’ night event on August 23rd at Colonial Golf and Tennis Club from 6 – 8 pm. For the first time, we are introducing poster presentations for the residents. For residents who are interested in presenting, please submit your name, hospital affiliation, title of your poster to Jordan Dale, CPPS Meeting Manager, via email to centralpapsych@papsych.org. Please register

by August 3, 2018. Cash prizes will be awarded to first, second, and third place posters.

PITTSBURGH CHAPTER

Pittsburgh News & Notes Greetings to the Members of Pittsburgh Psychiatric Society!

Amit Chopra, MD, FAPA President, Pittsburgh Psychiatric Society I feel honored to take over as the president of Pittsburgh chapter and look forward to a year full of educational activities for our members. We strive to strengthen the diversity of our society this year and hope to see increasing numbers of medical students, residents, fellows, early career, and private-sector psychiatrists attend our educational events.

We aim to prioritize the professional development and wellness of our members this year and cordially invite the members to our next educational session on Maintenance of Certification for Psychiatrists on August 6, 2018 at the Cambria Hotel. Following this event, we are looking forward to our Residents’ Research and Awards Night in September. This is a perfect opportunity for us to recognize the research work led by our resident members and to felicitate our outstanding members for lifetime achievement awards in academic, clinical, and public-sector psychiatry. For the first time, we are inviting medical students to present research work at the September event and hope to see generous participation from them.

We plan to increase our outreach to the all existing and prospective members in the Pittsburgh chapter to help grow our Society and add value to our Society membership. This year, we will be focusing on web-based interaction strategies to reach out to members and plan a membership drive to have more prospective members join us this year.

Finally, PPS stands to serve for the important mission of patient advocacy and we plan to organize a public awareness event for our patients and their families in conjunction with local and state patient advocacy

NORTHEASTERN CHAPTER

Pennsylvania Top Physicians Under 40 Congratulations to NPPS member, Angelica Kloos, DO, for being named one of Pennsylvania’s Top Physicians Under 40 by the Pennsylvania Medical Society. Dr. Kloos is a child and adolescent psychiatrist with UPMC Susquehanna who has provided patient care to children in the Williamsport area for more than five years. She has been instrumental in developing innovative models of care to manage the needs of the rural community she serves. She is a member of the Lycoming County Medical Society Board.

Upcoming Meeting NPPS will be hosting a CME event on Wednesday, October 10th, titled “Psychopharmacology – Risk Management and Legal Implications of Prescribing” presented by PRMS. The website will be updated as details are made available.

organizations. We welcome your valuable ideas, suggestions and feedback for us to be able to better serve your professional needs and look forward to a very interactive and productive year ahead.

Surviving Maintenance of Certification Program – August 6, 2018 Our next education program titled “Surviving Maintenance of Certification (MOC)” will be held Monday, August 6th, at the Cambria Hotel. Ann Thomas from the American Psychiatric Association will be the speaker. Click here to register.

Residents’ Research and Awards Night – September 24, 2018 The annual Residents’ Research and Awards Night has been scheduled for Monday, September 24th at The DoubleTree by Hilton Downtown Pittsburgh. Residents, medical students, and psychiatric nurse practitioner students are encouraged to present their research posters. To register to present a poster click here. Registration for all attendees will be available soon.

Dr. Chopra Becomes Pittsburgh Psychiatric Society President Marc E. Garfinkel, MD presents Amit Chopra, MD, the presidential gavel during the June 18, 2018, Annual Business Meeting.

Chapter announces loss of member: Neil A. Capretto, MD The Pittsburgh Psychiatric Society was saddened to learn of the passing a member, Neil A. Capretto, MD, on June 9, 2018. Dr. Capretto was the medical director of Gateway Rehabilitation Center and will be missed by all. His obituary is here.

CME: The Opioid Epidemic – What Psychiatrists Need to Know On June 18, Pittsburgh Chapter members attended a CME event titled “The Opioid Epidemic – What Psychiatrists Need to Know,” that was presented by Donna Vanderpool, MBA, JD, Vice President of Risk Management, Professional Risk Management Services.

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TELEPSYCHIATRY UPDATE The need for mental health treatment in this country (and in Pennsylvania) is largely unmet both due to an undersupply of psychiatrists as well as a maldistribution of where they are located. The Henry J. Kaiser Foundation estimates that only 47% of the national demand for mental health is provided.

Data from The American Academy of Child and Adolescent Psychiatry indicates the shortage of child and adolescent psychiatrists is even worse, with about half of the counties in Pennsylvania having none. The situation is expected to continue to worsen as over half of U.S. psychiatrists are aged 55 or older.

Telepsychiatry is positioned as one means to start to address these issues. In addition to helping to meet these needs, it has provided a way to add diversity to our practices by expanding the locations and types of services provided. Some typical service locations are outpatient clinics, partial hospital programs, residential treatment programs, hospital emergency rooms, and primary care or integrated care clinics. One can work from their office or from a home office (providing it is secure). Services can be provided at times convenient to the provider or used to moonlight after hours by taking advantage of time-zone differences between where one is located and the practice location. Telepsychiatry is well-positioned to provide mental health services in prisons and jails in a safe and secure manner.

Telepsychiatry typically involves use of a secure audio and video link between the psychiatrist and patient or clinic. Simple telephone conversations are not typically considered a part of telepsychiatry. It is important that the technology used is secure and HIPAA compliant.

Common social platforms such as Skype or Facetime are not considered adequate. However, there are several platforms that do meet the necessary requirements that are reasonably priced. Security and confidentiality must be considered always. In addition to using secure software for the video link, it is important to also have a secure means of communication with staff at the destination facility which

by Robert E. Wilson, MD, FAPA

can include use of encrypted email. Most providers of telepsychiatry services choose to provide their service to an established clinic, rather than directly to a patient at home. This way, they can be certain as to who is present and that there are no unknown people off camera or other potential security breaches.

Currently, it is necessary to be licensed in the state where your patient is located. A separate DEA registration for that state is also required to prescribe controlled substances. The Interstate Medical Licensure Compact (IMLC) may eventually make this process more convenient, but it is not yet available in Pennsylvania. Pennsylvania passed legislation in 2016 to join the IMLC but has not yet implemented it.

Once it is in place, Pennsylvania would be the state of principal license for Pennsylvania psychiatrists. Then expedited applications to other Compact states can be made. The psychiatrist must be familiar with and follow the laws and regulations of the state where the patient is located. Similarly, CME requirements must be met for each state where licensed. Most malpractice insurers cover telepsychiatry, but it is important to verify that your policy will cover you in all locations where you practice remotely.

Another consideration in providing such services is maintaining an accurate medical record. When providing services for an agency, you would be expected to utilize their medical record. Use of an electronic medical record is important and it needs to be able to provide you with all necessary information, including labs results, vital signs, rating scales, and any other relevant clinical information. Your connection to it must also be secure and HIPAA compliant. Having staff local to the patient is also very helpful as they can help facilitate the interaction, provide the patient with written information as they leave, and access local emergency services should the need arise.

The American Psychiatric Association has put together a Telepsychiatry Toolkit that provides more detailed information on setting up and providing Telepsychiatry services. The American Academy of Child & Adolescent Psychiatry also has resources available on their web site.

Another resource is the Mid-Atlantic Telehealth Resource Center.

2018 – 2019 New Officer Orientation

Pictured are (left to right): Back Row: M. Aly Rifai, MD; Richard Silbert, MD; Keith Stowell, MD; Amit Chopra, MD Front Row: Hope Selarnick, MD; Ailyn Diaz, MD; Gail Edelsohn, MD, Elizabeth Ramsey, DO; Mandar Jadhav, MD; Hetty Eisenberg, MD

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On Saturday, June 2, the new officers of the Pennsylvania Psychiatric Society and chapters met in Harrisburg for an officer orientation. The new officers were introduced to one another, and policies and procedures to assist them during their terms were reviewed.

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2018 PaPS Presidential Award Kenneth J. Weiss, MD, DLFAPA, was presented the 2018 PaPS Presidential Award by PaPS Immediate Past President Gail A. Edelsohn, MD, MSPH, DLFAPA at the PaPS Council and Annual Business Meetings on June 2, 2018. Dr. Weiss, a Philadelphia psychiatrist, was selected by the PaPS Awards Committee for his outstanding service to the profession of psychiatry. Dr. Weiss is currently the associate training director, forensic psychiatry fellowship at the University of Pennsylvania, and in 2017, he was appointed the Inaugural Robert L. Sadoff Clinical Professor in Forensic Psychiatry at Penn.

Dr. Weiss received his medical degree from Hahnemann Medical College, completed an internship at the University of Pennsylvania at the Philadelphia General Hospital, and a psychiatric residency at Massachusetts Mental Health Center. He also completed a clinical fellowship in psychiatry at the Harvard Medical School in Boston, MA. He is a published author of over 40 scientific articles in addition to the emergency psychiatry book Handbook of Psychiatric Emergencies published in 1991, co-authored with Dr. William Dubin. His second book, Psychiatric Expert Testimony: Emerging Applications with co-editor Dr. Clarence Watson, was published in 2015.

Dr. Weiss continues to be very active in Philadelphia Psychiatric Society where he is a past president and currently serves as membership chair.

Welcome New Members We welcome the following new PaPS members and congratulate those Members-In-Training who have recently achieved General Member status (effective March 27, 2018 – July 5, 2018) CENTRAL General Member Wanda J. Gobin, DO PHILADELPHIA General Members Jenys Allende, MD Lynne D. Boone, DO

Members in Training Kalvin Foo, MD Sapneesh K. Jatana, MD Michael Nagayoshi, DO Uchechukwu Ogbuawa, DO Michael W. Pelekanos, MD Adam J. Sagot, DO Jasmine Sawhne, MD

PITTSBURGH General Members Feras Alawad, MD Henry M. Fourcade, MD Bryan W. Lockmer, DO Justin M. Shuster, MD

Gift Presentation to Outgoing President Dr. Hameed presents gifts to outgoing president, Gail A. Edelsohn, MD, MSPH, DLFAPA during the Annual Business meeting held on Saturday, June 2, 2018.

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Members in Training Nina Beizer, MD Gary M. Ciuffetelli, MD Amanda E. Downey, MD Kristen L. Eckstrand, MD Liu Yi Lin Yi, MD Laima Spokas, MD

PRMS Resident Poster Contest PRMS is hosting our first ever virtual poster contest for residents. Please click here to find a flyer that you are welcome to share with your residents who might be interested in this contest.

RESIDENT REPRESENTATIVE UPDATE

by Mandar Jadhav, MD Welcome to another year of psychiatry residency or fellowship training in the Keystone state. I will be your representative to the Pennsylvania Psychiatric Society’s Council for the upcoming year. I expect it will be a challenging and rewarding year ahead filling the rather large shoes of our previous representative, Dr. Singh, but with your input and support it should go well. We had our annual council meeting at the beginning of June. Let me recap some highlights from that meeting for you: • The outgoing president, Dr. Edelsohn, along with the rest of the council warmly welcomed incoming president, Dr. Ahmad Hameed.

• The Presidential Award was presented to Dr. Kenneth Weiss, associate program director for the forensic psychiatry fellowship at the University of Pennsylvania, for his lifelong contributions to improving psychiatric practice and education in our state.

• Chapter officers presented updates, of which these seemed most notable: • Central: Dr. Diaz identified increasing local physicians’ involvement in chapter activities and increasing recruitment of new members as their goals for the year.

• Philadelphia: One of their goals is to increase the role of women trainees and attendings in their chapter. They are also supporting a local effort to enable involuntary outpatient treatment to decrease the need for hospital readmission.

• Pittsburgh: Increasing diversity in their membership will be this year’s mission, along with recognizing and rewarding trainee research.

• Western: Dr. Ramsey highlighted an issue that led to impassioned discussion at the meeting: promoting physician wellness, considering recent news about inadequate support for physicians’ mental and physical wellbeing. This led to a new initiative, the Physician Wellness Taskforce. This is a brand-new workgroup with Drs. Albaugh, Altaker, Kaur, Eisenberg, Ramsey, and Selarnick, who will be working on identifying concrete steps that the Society can take to promote our health and wellbeing.

• Another topic that dominated the meeting was, expectedly, the budget. As more psychiatrists choose to be employed rather than independent practitioners, the Society faces challenges on how to keep us interested in being active members of the Society, as in the past, the Society’s greatest success stories have often involved protecting the ability for psychiatrist to practice independently. For several years, we have avoided raising dues, not even increasing them in line with the inflation rate, lest it lead to a decrease in membership revenue. However, with the cost of advocating for psychiatrists’ priorities steadily going up, the council agreed that an increase in dues has been long overdue. The good news for trainees is that our dues will not be increased.

• An issue that interested the ECP members of council and I was increasing our reach to our members with regards to sharing relevant news and updates. A social media committee was put together with Dr. Diaz, Dr. Colon-Rivera, and I, leading the effort in collaboration with Society staff.

• Finally, there was intense discussion about the “legislative watchlist,” which is a set of bills in the state legislature that the Society identifies as being pertinent to psychiatric practice in the state. This is an extensive, ever-evolving list. Fortunately, we have experts in the Society who keep track of this challenging domain, such as Dr. Certa and Executive Director Deborah Shoemaker, who inform the council and the Society at large about specific issues when appropriate.

On that note, let me welcome you once again to an exciting year for psychiatry in Pennsylvania.

Do not hesitate to send me an email with any questions or concerns.

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Physicians Health Program 101: Advocacy for Pennsylvania’s Physicians

by Elizabeth Ramsey, DO President, Western Pennsylvania Psychiatric Society According to the American Foundation for Suicide Prevention, physicians have greater rates of depressive symptoms and suicide risk than the general population. In the United States, approximately 300 to 400 physicians die by suicide every year. While there are multiple factors that contribute to suicide, undertreated or untreated mental health issues including depression are the most common factor. As a psychiatrist, I am constantly immersed in the mental health treatment system and its resources. However, other physicians may not be privy to those resources. Where do physicians seek mental health treatment? For physicians in Pennsylvania, the Physicians Health Program (PHP) provides a means to access mental health treatment and substance abuse treatment. I spoke with Kendra Parry, director of the PHP, to glean an understanding of the PHP’s services specifically related to mental health. The PHP, which has been active for over 30 years, is an advocacy program with existing resources for physicians in need of treatment. The program’s goal is to ensure physicians can continue to practice. Because of the program’s efforts, and the efforts of PHPs across the United States, approximately 96 percent of physicians who have participated in monitoring with a PHP are practicing in their chosen profession. In Pennsylvania, the process is straightforward. Allow me to explain how our PHP functions.

When a physician calls the PHP, a brief screening is completed.

Then the PHP determines a location where the physician may go for evaluation and/or treatment. An independent evaluation is completed by a provider who determines if there is a diagnosis. If a diagnosis exists, the provider develops a treatment plan with monitoring if needed. There are several types of providers: mental health, substance abuse, co-occurring, or behavioral. The providers may be based in outpatient, inpatient, or residential settings, and must have their own malpractice insurance. There are only a handful of psychiatrists who provide strictly mental health evaluations, a number which seems astonishingly low considering there are approximately 1,800 psychiatrists in Pennsylvania. Ms. Parry imparted that finding psychiatrists to complete evaluations in Pennsylvania is not always easy. Given our numbers, I think that is a significant issue. Several barriers to finding psychiatrists include the extensive nature of the evaluation, lack of time to gather clinical information, and many have difficulty dealing with the population. An evaluation may indicate the presence or absence of a diagnosis; but if continued treatment is recommended, the PHP attempts to find providers close to the physician’s home, ideally within an hour’s drive. If monitoring is recommended, then the physician must travel to Harrisburg to sign a monitoring agreement. Monitoring agreements may be for psychiatric specific issues including medication management and psychotherapy.

Monitoring is in place to hold physicians accountable for self-care

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behaviors that allow for personal stability and continued employment.

Physicians may call the PHP anonymously and ask for information.

What would keep a physician from contacting the PHP to initiate treatment? Unfortunately, physicians are wary of the stigma of mental health and substance use and the potential licensure issues surrounding treatment. Since many employers’ screen physicians for these conditions, it may be harder to gain employment and/or complete credentialing. Some physicians may not contact the PHP because they are not able to ask for help. Overall, untreated mental health issues may cause greater issues for a physician opposed to those seeking treatment. The PHP is well aware that treatment is effective. The PHP will advocate to an employer on a physician’s behalf.

According to Ms. Parry, the American Medical Association (AMA) is also advocating on behalf of physicians to ensure treatment does not impede the ability to practice.

The Voluntary Recovery Program (VRP), a program offered by the Professional Health Monitoring Program (PHMP), Bureau of Professional and Occupational Affairs, is a system which protects the confidentiality of physicians seeking treatment since it does not result in action against a physician’s license. Those involved in the VRP may remain anonymous. How may this affect a physician when applying for licensure in Pennsylvania? If a physician applying for licensure indicates a history of a mental health treatment or substance abuse, that information is passed along to the PHMP. At that time, a referral is made to the PHP for an evaluation. In 2017, approximately 35 percent of physicians voluntarily sought out the PHP. If a physician has a drug violation or refuses to participate in the VRP, they could be referred to the state’s legal division which may result in disciplinary action against their license. The PHP is a confidential program and does not fall under the Medical Practice Act. The PHP authors letters on behalf of physicians including recommendations and quarterly reports to the state. A physician may only be denied licensure if said physician refuses to follow the recommendations made by the evaluator, provider, and the PHP. If you are applying for licensure in a particular state, the best step would be to call that state’s PHP for information specific to that state’s licensure requirements.

A representative from the PHP usually attends the Philadelphia Psychiatric Society’s annual Addictions Symposium. The PHP is actively working to expand their provider network. If you are interested in becoming a provider or have a qualified recommendation, please contact Ms. Parry as soon as possible. The PHP may be reached at 717558-7819 or php-foundation@pamedsoc.org.

References: Healthcare Professional Burnout, Depression and Suicide Prevention, American Foundation for Suicide Prevention, 2018.

Meet Your Staff PaPS contracts staffing services with the Specialty Society Management Services (SSMS) Division of the Pennsylvania Medical Society. Staff, working from their Harrisburg-based office, are available to answer members’ questions about membership benefits, meeting updates, and assist with our members’ needs. In this issue, we introduce our executive and administrative staff members. In the October issue we will introduce you to our meeting planners.

Deborah Shoemaker is your executive director and works directly with the PaPS executive committee. Deb has been with the Society since September 2006. As a registered lobbyist, she works extensively with key members and staffers within the Wolf administration, in the areas of healthcare. Deb has a BS in political science from Messiah College. In her spare time, she enjoys attending her son Seth’s lacrosse activities, coaching Paige’s Girls on the Run team and attending her basketball games, going on vacation at the beach and other sunny venues, watching her Philadelphia Eagles and 76ers and staying active with her two dogs.

Contact Information: Email: dshoemaker@pamedsoc.org | Direct Dial: 717-909-2689 Serving as your associate executive director is Jennifer Redmond. Jenn works as the executive director of the Central, Lehigh Valley, Northeastern, Philadelphia, Pittsburgh, and Western chapters. She has been with PaPS since January 2017. She holds a BA in speech communications with a focus in public relations from Edinboro University. Jenn has three very active children who participate in multiple sports. In her limited spare time, she enjoys her yearly vacation to Hilton Head, SC, watching/judging gymnastics, and spending time with her friends.

Contact Information: Email: jredmond@pamedsoc.org | Direct Dial: 717-909-2681 Dawn Losiewicz is our assistant executive director and has been with PaPS for the last 20 years. Dawn focuses on communications and marketing for PaPS, including social media, website development, and the newsletter. In her spare-time she enjoys reading, spending time with Jack, her Cocker Spaniel, and her four nephews.

Contact Information: Email: dlosiewicz@pamedsoc.org | Direct Dial: 717-909-2687

Jill Bennish is a member service specialist. Jill joined the PaPS team in August 2017 and previously worked for the County Commissioners Association of Pennsylvania for 15 years.

Jill’s primary focus is as state membership secretary. She also provides administrative support to the Central, Lehigh, Northeastern, Pittsburgh and Western chapters.

Contact Information: Email: jbennish@pamedsoc.org | Direct Dial: 717-909-2679

Rounding out the PaPS team is member service specialist, Andrea McCormick. Andrea joined our team in June 2018. Prior to joining PaPS, Andrea worked for the Commonwealth of Pennsylvania Department of Health and 10,000 Friends of Pennsylvania. Andrea provides administrative support to the state committees as well as the Philadelphia chapter.

Contact Information: Email: amccormick@pamedsoc.org | Direct Dial: 717-909-2686

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Classified Ads

Human Services Center, one of the largest Community Mental Health Centers in western Pennsylvania, located approximately 50 miles north of Pittsburgh, in scenic, rural, western Pennsylvania, is seeking a licensed psychiatrist for our Adult Services. Physician will provide medical diagnosis and treatment of patients including psychiatric evaluation, medication management and medication groups. Must be PA licensed and certified in Medicare and Medicaid. Salary, hours and benefits will be negotiated with successful candidate.

For consideration, send your CV to: John Baird, HR Manager, Email: jbaird@humanservicescenter.net, Phone: 724-510-3268

The Penn State Health Milton S. Hershey Medical Center Department of Psychiatry is currently recruiting board eligible/ certified psychiatrists for inpatient and outpatient positions in both adult and child psychiatry.

We are a growing, vibrant department in a strong academic medical center. We host specialty clinical and research programs, including research that crosses the translational spectrum. Our educational programs include adult psychiatry residency, child fellowship, psychology internship, externship and post-doctoral fellows. We have a strong collaboration with basic and clinical science in other neuroscience disciplines across several Penn State campuses.

With our clinical partner, the Pennsylvania Psychiatric Institute, the Department staffs several outpatient and partial hospital programs for children and adults, 89 inpatient beds, ECT and other neuromodulation services, specialty sleep and eating-disorders programs, and expanding psychiatric consultation and integrated care programs for Hershey Medical Center.

Successful candidates should have strong teaching as well as clinical skills and, optimally, potential for scientific and scholarly achievement.

We offer an attractive compensation package commensurate with qualifications. Tenure-track positions are possible. May be eligible for J-1 Waiver.

For consideration, send your CV to: Jenna Spangler, Physician Recruiter Phone: 717-531-4271 Email: jspangler2@pennstatehealth.psu.edu The Penn State Health Milton S. Hershey Medical Center is committed to affirmative action, equal opportunity and the diversity of its workforce.

Equal Opportunity Employer – M/W/V/D

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Lancaster Behavioral Health Hospital (LBHH) is a brand new freestanding 126-bed psychiatric hospital that promotes wellness by providing strength-based, trauma informed care. We believe recovery is possible for every person with a psychiatric diagnosis.

The collaborative, creative, therapeutic culture of LBHH will allow you to teach medical students, residents, fellows, and Nurse Practitioner students in a unique academic to be the future leaders in behavioral healthcare.

Lancaster Behavioral Health Hospital will focus on the care of those seeking general psychiatric acute care in addition to a number of specialty inpatient services.

Older Adult/Psych Med, Inpatient Dual Diagnosis, Adolescent and Women’s Trauma To learn how you can make a difference and for more information, please contact: Frank Zura, M Ed Physician Recruiter at 609.833.0858 or by email.

LICENSED PSYCHIATRIST PrimeCare Medical Inc. provides comprehensive healthcare services to county jails, prisons, and juvenile detention centers throughout the Northeastern United States. We are currently seeking a Licensed Psychiatrist to work full time in the medical department at the Dauphin County Prison located in Harrisburg, PA. The Psychiatrist will provide service to the inmate/patient population utilizing current standards of psychiatric practice and will assume responsibility for clinical management of the mental health program in accordance with NCCHC/ ACA Standards and PCM policies and procedures. PrimeCare Medical provides competitive salaries, paid time off, 401k with match, medical, dental, and vision coverage. Qualified applicants will be licensed to practice psychiatry in Pennsylvania, will be board certified or eligible, and maintain a current DEA number.

To apply you can email your resume / CV, fax the resume / CV to (717)651-1865, or call into PrimeCare Medical’s corporate office at 1-800-2457277 and ask to speak to a recruiter.