TEXAS FAMILY PHYSICIAN VOL. 71 NO. 4 2020
TAFP 2.0 Introducing A New Member Engagement And Governance Structure
Find Where You Fit In
Austin, TX Permit No. 1450
PAID
Presorted Standard U.S. Postage
Now, more than ever… we need you. Healthcare has never seen greater challenges, but at Conviva, we firmly believe challenge equals opportunity. Conviva is a physician-led primary care group leading the way in delivering positive health outcomes for seniors through more than 90 locations in Florida and Texas. We focus on prevention and are supported by data that helps to inform best practices across our patient population.
WE ARE LOOKING FOR CLINICIANS TO BE PART OF THE CONVIVA TEAM. Conviva Physician Group offers: • Physician-led management and partnership status
• Flexible work schedules with paid vacations
• Highly competitive compensation with an industry leading benefits package
• No nights or weekends
If you’re looking to practice medicine on a team where you will have a voice and an opportunity to make a positive impact, visit us at ConvivaPhysicians.com or email Recruitment@ConvivaPhysicians.com. Follow us on LinkedIn @ConvivaPhysicianGroup
INSIDE
23
TEXAS FAMILY PHYSICIAN VOL. 71 NO. 4 2020
16
TAFP 2.0
The Academy introduces a new member engagement and governance structure to conduct business more efficiently and make better use of volunteer members’ time. See where you fit in. By Jonathan Nelson and Kathy McCarthy
23
Finding joy in stressful times
TAFP now offers members access to anonymous therapy sessions at a greatly reduced cost so you can unload some of your burden and be more present for your patients and family.
By Anticipate Joy
27
Research: Using partners’ emotions and perceptions to model men’s violence and alcohol use in violent relationships
By David Katerndahl, MD
6 FROM YOUR PRESIDENT Blessings, hopes, and new beginnings 8 AAFP NEWS 2021 coding changes 9 TFMPP REPORT Preceptorship program results from 2017 class 10 MEMBER NEWS Report from TAFP Annual Session and Primary Care Summit | Meet TAFP’s new officers 27 PATIENT CARE MS: A physician-turnedpatient’s perspective 30 PERSPECTIVE Change is on the horizon
e
edicin m y l i m a f ture of
e fu h t e p a h help s
By volunteering to precept a Texas medical student, you can open a door to a new world for the next generation of family doctors. QUESTIONS? Give us a call at (512) 329-8666 or send an email to Juleah Williams, jwilliams@tafp.org. This work was supported in whole or in part by a grant from the Texas Higher Education Coordinating Board (THECB). The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policy of the THECB.
! r o t p e c e r be a p
PRESIDENT’S COLUMN
TEXAS FAMILY PHYSICIAN VOL. 71 NO. 4 2020 The Texas Academy of Family Physicians is the premier membership organization dedicated to uniting the family doctors of Texas through advocacy, education, and member services, and empowering them to provide a medical home for patients of all ages. TEXAS FAMILY PHYSICIAN is published quarterly by TAFP at 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. Contact TFP at (512) 329-8666 or jnelson@tafp.org.
OFFICERS president
Amer Shakil, MD, MBA
president-elect treasurer
Mary Nguyen, MD
Emily Briggs, MD, MPH
parliamentarian immediate past president
Terrance Hines, MD
Javier D. “Jake” Margo, Jr., MD
EDITORIAL STAFF managing editor
Jonathan L. Nelson
associate editor
Jean Klewitz
chief executive officer and executive vice president
Tom Banning chief operating officer
Kathy McCarthy, CAE
advertising sales associate
Audra Conwell
CONTRIBUTING EDITORS Lisa Doggett, MD, MPH David Katerndahl, MD Kathy McCarthy Yetunde Sokunbi, MD
Articles published in TEXAS FAMILY PHYSICIAN represent the opinions of the authors and do not necessarily reflect the policy or views of the Texas Academy of Family Physicians. The editors reserve the right to review and to accept or reject commentary and advertising deemed inappropriate. Publication of an advertisement is not to be considered an endorsement by the Texas Academy of Family Physicians of the product or service involved. LEGISLATIVE ADVERTISING Articles in TEXAS FAMILY PHYSICIAN that mention TAFP’s position on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. The person who contracts with the printer to publish the legislative advertising is Tom Banning, CEO, TAFP, 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. © 2020 Texas Academy of Family Physicians POSTMASTER Send address changes to TEXAS FAMILY PHYSICIAN, 12012 Technology Blvd., Ste. 200, Austin, TX 78727. 6
TEXAS FAMILY PHYSICIAN [No. 4] 2020
Blessings, hopes, and new beginnings in difficult times Inaugural address of the newly installed TAFP President By Amer Shakil, MD TAFP President father, Mohammad Mansha Yad, was an i feel incredibly blessed and honored to engineer by profession, but his true passion be elected as president of Texas Academy was writing. He was a world-renowned of Family Physicians. I recall my first TAFP writer for our national language, Urdu. meeting in the winter of 1998 after I had He established a writer’s forum soon after moved to Dallas and joined the St. Paul the inception of the capital city of PakiResidency Faculty. The following year, I stan, Islamabad. He attended those weekly joined the Commission on Academic Affairs meetings from his mid-twenties until a and since then, I have hardly missed any day before he passed away at the age of 74. TAFP meetings. A year later I also joined My mother, Farhat the Dallas Chapter Nasim, the anchor of of TAFP, where I still our family, showed her serve on the board. As I have prepared for my unwavering support The reason I have year as TAFP President, for him throughout all been so regular in my I have considered many those years. She cooked attendance to these different goals and special meals for meetings is none other innumerable meetings than the welcomobjectives. However, after my father would host ing, supporting, and the COVID-19 pandemic at home for his writer nurturing environment hit, I learned about so friends and our very of TAFP, exemplified by many family physicians large family. its visionary leadership TAFP has had a and staff year after who are struggling or significant impact on year and meeting after have had to shut down my professional career meeting. I was lucky to their practices. I think development. Here at find great mentors like the most important work TAFP, I learned how to Linda Siy and Doug conduct business meetCurran, colleagues like of my presidency would ings, lead teams, and Jake Margo and Ashok be to provide support for work with professionKumar, and of course our members in these als. I learned how to all of our TAFP staff unprecedented times. write and keep meeting members. minutes. I participated In addition, both in leadership forums, St. Paul and UT learned how to engage in healthy debates, Southwestern residency programs also be tolerant of an opposite viewpoint, and to supported and encouraged such activities create and adopt to changes in our goverand participation. My biggest support for nance structure. all these times has been my lovely wife, Dr. As I have prepared for my year as TAFP Khalida Yasmin, who helped lift my spirits President, I have considered many differin times when I thought I would not be ent goals and objectives. However, after the able to continue to participate due to other COVID-19 pandemic hit, I learned about so responsibilities of family, my job, and commany family physicians who are struggling munity service. or have had to shut down their practices. I’m often asked by my friends how can I think the most important work of my I be so consistent in my commitments. presidency would be to provide support Definitely it’s a blessing from God and some for our members in these unprecedented good habits I learned from my parents. My
times. Be it supporting the Primary Care Marshall Plan, providing counseling services for members who are struggling or feeling burnout, or just being there to listen in this era of social distancing and fear of human touch, it seems to me we have plenty of work to do to support our members. This will be an important legislative year, the 87th Texas Legislature. What format they will use to conduct business we don’t know, but we know they will meet. I’ll be working closely with our TAFP team to provide any assistance they need from me. We will also be implementing our new governance structure. As TAFP President, I’m looking forward to engaging in this transition. My hope is that it will increase opportunities for more members to participate and continue our tradition of diversity and inclusion. With recent and ongoing events of police brutality against the Black community, I’m committed to providing open and safe spaces for these difficult discussions around anti-racism. Our Texas Academy has wonderful tradition of diversity. Now we have the chance to join with the community at large and work toward true equity and justice, and to work to end racism and senseless hate. I would to thank the TAFP Board of Directors, the Academy’s members and staff for entrusting this responsibility to me. TAFP has not experienced a time like this before where we could not to hold our meetings in person and must conduct our business virtually. Despite all these challenges, our TAFP staff as always has risen to the challenge and made it smooth and easy. I would like to offer special thanks to my mother for her prayers and well wishes, and to Yasmin for being the backbone and unwavering support. I praise God for blessing us with two wonderful sons, Salim and Imran Plumb, who are working on the front lines during this pandemic as a primary care physician and a police detective; and their spouses, Jill and Ashly Plumb respectively; and for the greatest joy of our lives, our grandchildren, Gabriel, Layla, Zain, Dean, Jasmin, Farah, and Violet; and most special of all, our granddaughter in heaven, Malin Rose Plumb.
Reiner Consulting & Associates Practice ManageMent ServiceS
Is your practice managing you, or are you managing your practice? Payer audits are at an all-time high. Have us review and validate that your records are consistent with cMS and commercial coding requirements. Let us educate and protect you from potential refunds and overpayments. Specializing in: • Practice assessments • Billing and coding audits • Documentation reviews • Managed care contract negotiation • recruitment • interim Management • Personnel and Work Flow issues • new Practice Set-ups
Exclusi ve discoun t for TAF P membe rs!
Bradley reiner, Ba reiner consulting & associates 212 covered Wagon Way, Driftwood, texas 78619 p (512) 858-1570 | m (512) 413-5678 | f (512) 858-1580 fax
www.bkrconsulting.org www.tafp.org
7
AAFP NEWS
COMING SOON ON TAFP’S
CME SCHEDULE C. Frank Webber Lectureship & Interim Session April 16-17, 2021 Renaissance Austin Hotel Austin, Texas Texas Family Medicine Symposium June 4-6, 2021 La Cantera Hill Country Resort & Spa San Antonio, Texas Annual Session & Primary Care Summit Nov. 5-7, 2021 The Woodlands Waterway Marriott Hotel & Convention Center The Woodlands, Texas 8
TEXAS FAMILY PHYSICIAN [No. 4] 2020
New AAFP resources walk FPs through 2021 coding changes By AAFP News Staff among the many lessons 2020 has taught us, being ready for whatever the future may hold is arguably the most critical. With that in mind, the Academy continues to develop resources to help physicians prepare for revised office visit evaluation and management coding and documentation guidelines the AMA introduced in 2019 that will take effect January 1. The 2021 Office Visit E/M Vignettes Module is the most recent addition to the AAFP’s diverse collection of information, resources and tools on E/M coding. You can access the new module on AAFP’s E/M coding resources webpage by going to www.aafp.org/ family-physician/practice-and-career/gettingpaid/coding/evaluation-management.html. Available exclusively to AAFP members, the new vignettes module walks users through four patient scenarios that illustrate how to apply the new guidelines to select the appropriate level of office visit using medical decision-making, or MDM. The resource also offers a brief recap of the other option for determining the appropriate level of service: total time spent by the physician or other treating clinician on the date of service. Regarding MDM, the article notes that the decision-making process comprises three components: number and complexity of problems addressed, amount and/ or complexity of data to be reviewed and analyzed, and risk of complications and/ or morbidity or mortality associated with patient management. To qualify for a particular level of MDM, criteria for two of the three elements must be met or exceeded. To aid physicians in selecting the appropriate MDM level for reporting an office or outpatient E/M service code from the four possible options — straightforward, low, moderate, and high — the AMA has devised a table listing the various criteria to choose from organized by corresponding CPT codes. (www.ama-assn.org/system/ files/2019-06/cpt-revised-mdm-grid.pdf)
If, on the other hand, a given patient visit was time-consuming but did not involve significant MDM, the physician may want to code based on total time. In such instances, total time means all face-to-face and nonface-to-face time the physician personally spends on the visit on the date of service. This would include time spent reviewing lab or test results and other reports, obtaining or reviewing the patient’s history, ordering tests and prescribing medications, and documenting clinical information in the EHR. It should be noted that the new guidance is one piece of a larger set of payment policy and rate changes in the 2021 Medicare physician fee schedule. CMS contends that the changes in the final rule will enable physicians to spend less time documenting and more time caring for patients. In addition to the ability to choose the E/M visit level based on either MDM alone or total time, other coding changes you’ll likely see next year include: • five levels of office visit E/M services for established patients (CPT codes 9921199215); • four levels of office visit E/M services for new patients (CPT codes 99202-99205); • revised definitions of applicable time and medical decision-making methodology for office visit E/M codes (CPT codes 99202-99205 and 99211-99215), with performance of history and exam required only as medically appropriate; and • a new primary care add-on code. Don’t put off preparing yourself and your practice team for the coming coding and documentation changes. Check AAFP’s E/M Coding webpage often for updated tools and resources to help smooth the transition. Source: AAFP News, Dec. 2, 2020. ©2020 American Academy of Family Physicians.
AAFP’S E/M CODING RESOURCES www.aafp.org/family-physician/practice-and-career/ getting-paid/coding/evaluation-management.html
Texas Family Medicine Preceptorship Program Residency Match Results for 2017 Participants Texas reinstated funding for the TFMPP in 2015 so in 2017, the second cohort of participants completed preceptorships between their first and second years of medical school. Now they’ve graduated so we can see what types of residency programs they chose.
80
medical students completed preceptorships in TFMPP in 2017.
FAMILY MEDICINE
40
entered primary care residencies in 2020 and 16 of those chose family medicine.
WHAT THEY SAID
WHAT THEY DID 9 OTHER
42
31
UNDECIDED
SUBSPECIALTY
6 SUBSPECIALTY
40
32
PRIMARY CARE
PRIMARY CARE Preferred specialty before preceptorship
9 FAMILY MED
5 OTHER PRIMARY CARE
Residency match in 2020 6 OB-GYN 8 PEDIATRICS
16 FAMILY
18 UNDECIDED
PRIMARY CARE
NO DATA
SUBSPECIALTY
OTHER
With COVID-19 limiting student opportunities in clinics and hospitals, I am beyond grateful that Dr. Billings and his staff welcomed me into their clinics with open arms. I can say that I got to play a part in helping out during the pandemic while serving in Alpine, Marfa, and Presidio.”
WHERE THEY WENT
37
STAYED IN TEXAS FOR RESIDENCY
34 LEFT TEXAS
MEDICINE 10 INTERNAL MEDICINE
9 OTHER
TFMPP matches first- or second-year students enrolled in a Texas medical school with an experienced and skilled family physician for a two- to fourweek period to help them gain real-life experience in a community setting. By participating in our preceptorship program, students will have the unique opportunity to explore what it means to be a family physician. Other: Two left medical school, five will graduate in 2021, one will graduate in 2023, and no information was found for one. This work was supported in whole or in part by a grant from the Texas Higher Education Coordinating Board (THECB). The opinions and conclusions expressed in this document are those of the author(s) and do not necessarily represent the opinions or policy of the THECB. Copyright ©2020 Texas Academy of Family Physicians
MEMBER NEWS
TAFP Annual Session and Primary Care Summit goes virtual because … 2020 By Jonathan Nelson and Jean Klewitz
family physicians and other health professionals from around the state logged in and streamed TAFP’s Annual Session and Primary Care Summit on November 6 and 7. A total of 553 people registered for the event for the opportunity to earn up to 13.75 AMA PRA Category 1 Credits™. The event began with a keynote address by TAFP Past President Tricia Elliott, MD, entitled “Racism is a Health Crisis: Family Medicine’s Call to Action.” She is the Vice President of Academic Affairs and Chief Academic Officer at John Peter Smith Health Network in Fort Worth, and she 10
TEXAS FAMILY PHYSICIAN [No. 4] 2020
is the current president of the Society of Teachers of Family Medicine. Other highlights included learning the latest on COVID-19; intimate partner violence; pain management; an AAFP update from Shawn Martin, the organization’s new CEO and executive vice president; and many more. Since the Academy did not meet in person this year, many of the events usually occurring around the CME General Session took place in the previous weeks. Committee, commission, and section meetings happened over Zoom mostly during October.
On October 24, the Academy held a combined Member Assembly and Annual Business and Award Meeting. Outgoing president Javier D. “Jake” Margo Jr., MD, presided over the event. Delegates from TAFP’s local chapters elected Lane Aiena, MD, to serve as new physician director, and Ike Okwuwa, MD, and Gerald Banks, MD, to serve as at-large directors on the board. Marian Allen, MD, was elected as the Special Constituency representative on the board, and Elena Zamora, MD, and Marc Ghosn were elected to the board to serve as the resident and student directors respectively.
TAFP’s 2020 award recipients Physician of the Year: Adrian Billings, MD, PhD Adrian Billings, MD, PhD, of Alpine, earned his medical degree and a PhD in experimental pathology at UTMB Galveston. After completing residency and obstetrics fellowship at JPS in Fort Worth, he moved to Alpine in Pecos County and began practice to fulfill his commitment to the National Health Service Corps. Since 2014, Billings has been the director of the Texas Family Medicine Preceptorship Program, helping TAFP administer the state-funded program to bring preclinical students to family medicine offices across the state. In his relatively short career, he’s had hundreds of medical students and residents rotate with him. He practices fullscope family medicine in an underserved community. He also serves outside the exam room and is committed to education. He pioneered a community-based medical Spanish rotation in Presidio and recently collaborated with Texas Tech in Odessa to bring a rural residency rotation to Alpine. Billings joined the stream late, accepting the award after performing an emergency Caesarian section. “Thank you for what you’re doing,” he said. “You are all heroes for the work that you’re doing. We have to be active; we have to be advocating for our patients.” Presidential Award of Merit: Linda Siy, MD Linda Siy, MD, of Fort Worth, has cared for patients as part of the JPS Health Network since 1995 at the JPS Northeast Tarrant Medical Home. She has been involved with TAFP for many years and in a variety of ways; as a past president, as a delegate to the AAFP Congress of Delegates, as chair of the TAFP Political Action Committee, and she currently serves as the TAFP Foundation President. “It is an honor to be recognized for doing something that I have loved to do all these years,” Siy said. “My involvement with the TAFP and the AAFP, as well as my local chapter here in Tarrant County, over the years has been quite rewarding, both personally and professionally.” Her commitment to TAFP extends beyond attending or chairing meetings. She also identifies and encourages young leaders. Siy takes time writing personal notes
Adrian Billings, MD, PhD, and Kristin Kinsley, a medical student at Texas Tech University Health Science Center, survey the landscape on a brief stop along the road from Alpine to Presidio.
“In his relatively short career, [Dr. Billings has] had hundreds of medical students and residents rotate with him, and we’ve heard from them about how transformative the experience was. He practices full-scope family medicine in an underserved community, but in spending time with him, students also see his service outside the exam room and his commitment to education.” — Javier “Jake” Margo Jr., MD
[cont. on 13]
www.tafp.org
11
NPI 2021 SCHEDULE MARCH 4 – 7, 2021 | AUSTIN
SEPTEMBER 9 – 12, 2021 | DALLAS
Omni Austin Hotel at Southpark 4140 Governor’s Row | Austin, Texas 78744 | (800) 843-6664 $149 per night
Marriott Dallas Las Colinas 223 West Las Colinas Blvd. | Irving, Texas 75039 | (800) 228-9290 $139 per night
Dermatologic Procedures
March 4-5
$1,495
Dermatologic Procedures
Sept. 9-10
$1,495
EKG Interpretation
March 4-5
$1,095
Exercise Stress Testing
Sept. 9-10
$1,095
Mastering Protocols for Optimization of HRT
March 4-5
$1,295
Mastering Protocols for Optimization of HRT
Sept. 9-10
$1,295
Point of Care Ultrasound (POCUS)
March 4-5
$1,495
Hospitalist Procedures
Sept. 9-10
$1,495
Aesthetic Procedures
March 6-7
$1,295
Suturing
Sept. 9-10
$1,495
Exercise Stress Testing
March 6-7
$1,095
Aesthetic Procedures
Sept. 11-12
$1,295
Joint Exam and Injections with Ultrasound Guidance March 6-7
$1,495
Suturing
$1,495
Contraceptive, Women’s Health and Vasectomy Procedures
Sept. 11-12
$1,495
Joint Exam and Injections with Ultrasound Guidance Sept. 11-12
$1,495
Wound Care Management and Advanced Suturing Sept. 11-12
$1,495
March 6-7
JULY 15 – 18, 2021 | HOUSTON
JW Marriott Houston by The Galleria 5150 Westheimer Rd. | Houston, Texas 77056 | (800) 228-9290 $135 per night
DECEMBER 9 – 12, 2021 | HOUSTON
Dermatologic Procedures
July 15-16
$1,495
Colonoscopy
July 15-16
$1,495
Joint Exam and Injections
July 15-16
$1,495
Mastering Protocols for Optimization of HRT
July 15-16
$1,295
Contraceptive, Women’s Health and Vasectomy Procedures
July 15-16
$1,495
SMART Workshop (Sideline Management Assessment Response Techniques)
July 16
EGD (Gastroscopy)
July 17-18
Hospitalist Procedures
JW Marriott Houston by The Galleria 5150 Westheimer Road | Houston, Texas 77056 | (800) 228-9290 $119 per night Dermatologic Procedures
Dec. 9-10
$1,495
Mastering Protocols for Optimization of HRT
Dec. 9-10
$1,295
Point of Care Ultrasound (POCUS)
Dec. 9-10
$1,495
X-Ray Interpretation
Dec. 9
$850
Allergy Testing and Immunotherapy for Primary Care Physicians
Dec. 10
$850
$1,495
Aesthetic Procedures
Dec. 11-12
$1,295
July 17-18
$1,495
Hospitalist Procedures
Dec. 11-12
$1,495
Joint Exam and Injections with Ultrasound Guidance July 17-18
$1,495
Joint Exam and Injections with Ultrasound Guidance Dec. 11-12
$1,495
Splinting and Casting
July 17-18
$1,495
Suturing
$1,495
Wound Care Management and Advanced Suturing July 17-18
$1,495
$395
For complete course information and to register, visit NPI online at www.NPInstitute.com or call (866) NPI-CME1 today.
FEBRUARY 17-20, 2022 | PHOENIX
Dec. 11-12
Hyatt Regency Phoenix 122 North Second St. | Phoenix, AZ 85004 | (877) 803-7534 $239 per night — More information coming soon!
[cont. from 11]
to encourage them to continue to show up and get involved. For the medical students attending her clerkship rotations, she goes out of her way to bring in practicing physicians — many of whom are TAFP and AAFP leaders — giving those future physicians a taste of what family medicine has to offer. Public Health Award: Tom Banning Tom Banning is TAFP’s CEO and executive vice president. He served as TAFP’s director of legislative and public affairs before taking over as CEO in 2007. Banning directs overall strategy including, advocacy, continuing medical education, and communications activities for the Academy, with more than 9,000 members. The public health award is given to physicians and non-physicians who have an extraordinary impact on public health. As the pandemic hit in Texas, Banning was quick to react. He understood the gravity of the situation and quickly saw that while attention was focused on hospitals, private practice physicians were being overlooked. He used his years of experience and relationships to gather physician stories and amplify them in the media. He made sure TAFP member’s struggle with obtaining PPE, financial concerns, and their critical role in keeping patients healthy and out of the hospital was added to the COVID-19 narrative being told. He also used a connection to get a supply of PPE and personally drove across the state to deliver masks and other life-saving equipment. “The real heroes and the people that really deserve this award are our members, who have kept their doors open during this pandemic continuing to screen potential COVID-19 patients, treat them, care for them, whether they were at home or in the office,” Banning said. “Not to mention, caring for your established patients that were still struggling with chronic illness or other acute problems. So I thank you. I can’t tell you what it means. I just wish we could have done more and I hope that we’ll be able to do a lot more in the future to make sure that you have the PPE and the protection that you need to continue doing your job. Thank you all for everything that you do.” Special Constituency Leadership Award: Terrance Hines, MD Terrance Hines, MD, is the executive director and chief medical officer at Uni
In lieu of the annual Past Presidents’ Breakfast and photograph, several esteemed past TAFP presidents donned the Hi-Roller hats they receive at the end of their presidency, logged in to Zoom, and attended the installation of officers.
“The real heroes and the people that really deserve this award are our members, who have kept their doors open during this pandemic, continuing to screen potential COVID-19 patients, treat them, care for them, whether they were at home or in the office.” — Tom Banning
versity Health Services at The University of Texas at Austin. He has served on multiple committees and commissions and was installed this fall as the TAFP Parliamentarian. He has served previously on the TAFP Board of Directors and he has represented Texas during AAFP’s National Conference of Constituency Leaders several times. The award honors an outstanding member who is a strong advocate for special constituencies.
Installation of officers Before the board of directors met on October 31, the Academy held a virtual officer installation. AAFP Board Chair Gary LeRoy, MD, joined the stream to swear in the new officers: President Amer Shakil, MD; President-elect Mary Nguyen, MD; Treasurer Emily Briggs, MD; and Parliamentarian Terrance Hines, MD. www.tafp.org
13
MEMBER NEWS
Amer Shakil, MD, MBA | President
Mary Nguyen, MD | President-elect
Dr. Shakil holds the Dr. Bill Ross Professorship in Family Practice at the UT Southwestern Department of Family and Community Medicine and he is the vice president of the Dallas chapter of TAFP. He also assists in the creation of faith-based free clinics. Shakil earned his Bachelor of Medicine and Bachelor of Surgery at Punjab University, his Medical Doctorate from the Education Commission on Foreign Medical Graduates in Philadelphia, and his Master of Business Administration in Healthcare Organization Leadership from the University of Texas.
Dr. Nguyen shares a family medicine practice with her husband in the rural town of Castroville and counts special needs advocacy as near and dear to her heart. She attended medical school at the University of Texas Health Science Center at Houston completed residency at Christus Santa Rosa in San Antonio. She served as a Member Constituency Delegate to the AAFP Congress of Delegates and she is the treasurer of the Alamo Chapter of TAFP. She’s an avid supporter of the arts and she enjoys attending the symphony and theater with her family.
MEET TAFP’S NEWLY INSTALLED OFFICERS Emily Briggs, MD, MPH | Treasurer Dr. Briggs is the founder of Briggs Family Medicine, where she practices full-spectrum family medicine and obstetrics, and she is the medical director for two New Braunfels school districts. She has served as the new physician board member for both TAFP and AAFP. She has served as president of her county medical society and the Alamo Chapter of TAFP. She received her Bachelor of Science from Texas A&M University, her master’s in public health from the University of Houston School of Public Health, and her medical degree from the University of Texas Health Science Center at Houston. She completed residency at Christus Santa Rosa in San Antonio.
14
TEXAS FAMILY PHYSICIAN [No. 4] 2020
Terrance Hines, MD Parliamentarian Dr. Hines completed undergraduate and medical school at Texas A&M University and residency at John Peter Smith Hospital in Fort Worth. He spent 10 years at Baylor Scott & White Health in Austin and became the Assistant Division Director for Primary Care. He is an adjunct assistant professor at Texas A&M College of Medicine and affiliate faculty at Dell Medical School at UT Austin. Since November 2019, he has served as the Executive Director and Chief Medical Officer at University Health Services at The University of Texas at Austin. He recently was recognized with the Austin Under 40 Award in Medicine and Health Care as well as the TAFP Special Constituency Leadership Award.
Javier D. “Jake” Margo Jr., MD Immediate Past President Dr. Margo practices family medicine in his hometown of Rio Grande City. He is president of both the TAFP Valley Chapter and the Hidalgo-Starr County Medical Society. He is director of obstetrics and emergency medical services for his local county hospital where he works in the emergency department. Margo received his medical degree from Texas A&M College of Medicine and completed a residency with the John Peter Smith Family Practice Residency Program in Fort Worth. He is also a member of the Texas Medical Association’s Border Health Caucus and Small District Caucus, and he is a member of the Wilderness Medicine Society.
Treated Fairly.
comprehensive solutions
coverage for healthcare risks of all types and sizes
superior claims counsel
ProAssurance has been monitoring risk and protecting healthcare industry professionals for more than 40 years.
financial strength
Work with a team that understands the importance of delivering reliable healthcare professional liability solutions.
reliable coverage
risk management and loss prevention support
expertise when you need it most When you are treated fairly you are confident in your coverage.
Healthcare Professional Liability Insurance
ProAssurance.com/Texas
TAFP Introducing a new organizational structure to enhance member engagement By Jonathan Nelson and Kathy McCarthy
for many years, a core group of dedicated family physicians have congregated twice each year at TAFP’s annual and interim meetings to sit on committees and conduct the business of the Academy. A frequent topic of discussion has always been how to attract more members to volunteer to serve in this capacity. As it turns out, there are a finite number of family doctors you can fit around a table in a hotel conference room for a three-hour committee meeting. And there are only so many physicians who can make a three-year commitment to break away from their practices for a few days two times a year to attend those meetings. A few years back, ideas began to percolate for new ways to engage members in the Academy’s work. In 2019 the board of directors appointed a task force to evaluate TAFP’s committee, commission, and section structure and make recommendations for change by November of 2020. Then came COVID-19. Suddenly we were all logging in to Zoom meetings, setting up our home studios, and canceling in-person events. At TAFP headquarters and for the members of the Task Force on Governance, the writing was on the wall. We needed to leverage communication technology to engage more members in multiple ways to access their talent and expertise while using their time efficiently and effectively.
16
TEXAS FAMILY PHYSICIAN [No. 4] 2020
www.tafp.org
17
T
he task force commenced its work just as the novel coronavirus began to consume our thoughts and change our lives. As they examined the existing governance structure, they noticed that many of our committees were based on our staff departments. An evolved structure would be based on the three pillars of the strategic plan the Academy adopted in 2018: the health of the physician and the practice, the health of the patient and the population, and the health of the specialty and the organization. They also considered the time commitment required of volunteers in the old structure. A survey of current and potential volunteers showed fewer than 30% were interested in multi-year, multi-meeting commitments, but more than 66% expressed interest in short-term opportunities. Almost 90% of current volunteers said they would be likely to engage in virtual meetings. The new structure would need to offer short-term opportunities to collaborate virtually on defined projects. The task force had two perfect models for such project-oriented collaborations. They had their own project, which was conducted entirely on GoTo Meeting, and they had the example of the TAFP Behavioral Health Task Force. As a result of our strategic plan objectives, the Academy pulled together a team of members with expertise in mental and behavioral health along with a few specialists from outside the Academy to identify ways to help primary care physicians integrate advanced behavioral health services into their practices. They were also tasked with building a toolkit of resources we could offer on the TAFP website. They began meeting in early 2019 via video conference and they used a secure cloud-based platform to contribute to the project. Within a matter of months, they had produced a valuable set of resources for members and nonmembers alike, and they had forged a collaborative network of colleagues who still ping one another with the occasional idea. Some of those members had not previously been that involved with the Academy’s committees and other groups, but now, they had made connections. Task forces and work groups provide a new set of opportunities for members to engage, and by expanding our modes of communication, we can erase the barrier of distance across this vast state. After several productive meetings and many draft proposals, the Task Force on Governance presented a new member engagement and governance plan to the board of directors in November, and the board voted to adopt it. We are implementing the plan now and you’ll soon begin receiving information on how you can get involved.
The future of TAFP governance and member engagement COUNCILS The main feature of the new organizational structure is the set of three councils that report directly to the board of directors: the Council on Health of the Public and Science, the Council on Medical Practice, and the Council on Workforce and Member Engagement. Each council will include 14 active members plus one member of the board of directors, a resident member, and a student member. Active members will serve a two-year term with the opportunity to be reappointed once. The councils will meet in person at the annual and interim meetings, and will meet virtually at least a few times during the year. 18
TEXAS FAMILY PHYSICIAN [No. 4] 2020
Each council will also host a live forum open to all members during the annual and interim sessions. These forums are akin to a town hall meeting, at which the councils will report on their projects, discuss hot topics, entertain questions and discussion from the audience, and perhaps invite presentations by guests to benefit the Academy. The Task Force on Governance envisioned a cycle that would provide ongoing dialog and feedback between the council and members attending the forums. Aided by that dialog, the councils will enlist participation in projects and initiatives that will be accomplished by task forces and work groups. Task forces will be formed to tackle specific projects, like planning a public health initiative or writing a resolution to the AAFP Congress of Delegates. Work groups will be assigned to carry out ongoing responsibilities, like CME planning and selecting award winners. The councils will oversee the work of these teams, request board approval for anything that requires it, and report on their progress at the next live forum. The councils will also establish goals and objectives in their area of focus, plan the agenda for the forums, and provide guidance to TAFP staff. Members will be able to volunteer for task forces and work groups at any time as those teams are created. You could sign up at a live forum, for example, or you might be recruited by a colleague or a council member. Also, the Academy has developed an enhanced member interest questionnaire called the TAFP Engagement Form, and an accompanying database, so when we need volunteers for a certain project, we will know whom to contact. (To complete the form, go to www.tafp.org/membership/get-involved.) Once this gets rolling, it could greatly expand the amount of work the Academy can accomplish and the number of members engaged in that work.
COUNCILS AND OBJECTIVES Council on Health of the Public and Science Objective: To improve the health of Texans and their communities. Council on Medical Practice Objective: To support the family physicians of Texas and their practices. Council on Workforce and Member Engagement Objective: To advance the specialty of family medicine and strengthen our organization.
NEW TAFP GOVERNANCE AND MEMBER ENGAGEMENT STRUCTURE TAFP Governing Bodies Board of Directors Councils Standing Committees Standing Committees
Councils 15 members
Personnel and duties as described in TAFP bylaws
Board of Directors
2-year terms Meet in person and virtually
3-year terms Meet virtually or in person as needed
Host open, in-person forums
Councils
Standing Committees
Council on Medical Practice
Bylaws Committee
Council on Health of the Public
Nominating Committee
Finance Committee
Council on Workforce and Member Engagement
Work Groups and Task Forces Councils appoint these committees to complete duties and projects as needed
Advisory Groups
Meet virtually as needed
Delegation Advisory Group
Short-term commitment Open to all members
Advisory Groups
Undergraduate Medical Education Advisory Group
Membership determined by position or office
Graduate Medical Education Advisory Group
Meet virtually or in person as needed
Member Communities Open to all members Meet mostly virtually, but can meet in person Can develop ideas and petition councils Member communities include: • Medical Student Member Community • Resident Member Community • Research Member Community • Maternity Care Member Community • Rural Practice Member Community • Community of Member Constituencies ... and more
www.tafp.org
19
STANDING COMMITTEES The existing standing committees of the Academy — the Finance Committee, the Nominating Committee, and the Bylaws Committee — will be retained and will continue to perform their business as usual. However, they will only schedule meetings as needed and will have the freedom to meet virtually.
At TAFP, our hope is that this evolution will allow you more opportunities and multiple access points to make the most of your membership, and that it will help us save you time and provide you more of what you need.
ADVISORY GROUPS The new plan introduces the concept of advisory groups, the membership of which would be determined by a physician’s position or office. These groups will advise the board and might assist the councils. For example, the existing Commission on Core Delegation will transition to the Delegation Advisory Group and will be comprised of the TAFP Board of Directors, members serving in elected and appointed positions with AAFP, TAFP’s representatives to the AAFP Congress of Delegates and the Texas Medical Association Interspecialty Society, and any members serving in the leadership of TMA. We will also have an Undergraduate Medical Education Advisory Group and a Graduate Medical Education Advisory Group, comprised of medical school faculty and residency and fellowship faculty. MEMBER COMMUNITIES “So what about our beloved sections?” you may be asking. Fear not! The plan calls for a new and elevated role for our old member community format, and our existing sections will transition to member communities to jumpstart what we believe will become a thriving network of dialog and activity. These groups will be free to meet virtually and at in-person meetings, if they choose, and they’ll be able to set their own agendas and be as active as they wish. The most important component for the member communities will be an online discussion forum we’re calling TAFP Exchange. As 2020 winds to a close, we are in the process of developing this platform, which will allow members to explore and join communities, engage in dialog, share documents and resources, and meet new friends with similar interests and concerns. Initial communities will include research, maternity care, rural physicians, solo and small group practice physicians, early career physicians, and what we’ve known as the special constituencies, although they’re currently exploring a name change. And as we go, there’s no doubt more member communities will form as you and your colleagues discover a need. The Task Force on Governance and the board hope these communities become the spawning grounds of great ideas as well as the Academy’s sensory organs where unexpected trouble is first detected. While the member communities like the advisory groups have no governance responsibility, members can petition the councils — and even the board of directors if the matter is urgent — with ideas and concerns. You can imagine those members then serving on task forces and work groups assigned to execute those ideas and address those concerns. We think exciting days are ahead for member communities, so watch for more information about TAFP Exchange and plan to join as many communities as you like.
“Sign me up! How can I get involved?” Each year, you will have an opportunity to apply to serve on councils and committees. A screening committee of board members will make recommendations to the board of directors. That process has [cont. on 22] 20
TEXAS FAMILY PHYSICIAN [No. 4] 2020
Financial Planning for TEXAS FAMILY PHYSICIANS
HOW IS YOUR
FINANCIAL WELLNESS?
Working With the TAFP for
OVER 25 YEARS
• Do you have enough money to retire? • Have you constructed a Social Security strategy?
www.BenoldFP.com info@benoldfp.com 817-235-6863
• Are your investments performing?
Jordan Benold, MBA, CFP®
Dr. Stephen Benold, CFP®
Experienced & Confidential L E G A L R E P R E S E N TAT I O N F O R T E X A S P H YS I C I A N S Statewide representation with more than 2000 cases and over 110 years collective experience.
Tony Cobos*
Michael Sharp*
Courtney Newton
Chris Sharp
Medical and Physician Assistant Board Actions Probation Modification/Termination Peer Review • Licensure • Reinstatement Medicare-Medicaid Appeals/TMF DEA/DPS Registration/Investigation Actions Medico-legal issues • Managed Care Exclusions Personal Counsel in Medical Liability Cases
4705 Spicewood Springs Rd, Suite 100 | Austin, Tx 78759
p 512 473 2265 f 512 473 8525
www.sharpcobos.com
*Board certified in Administrative Law by the Texas Board of Legal Specialization.
12-SC-0101-1.indd 1
5/10/12 10:40 AM
“WHERE DO I FIT IN THIS NEW STRUCTURE?” Member A You have served on commissions and attended many meetings over the years. You haven’t served on the board of directors but would like to in the future. You have the flexibility to attend live meetings and you can engage between meetings. You should apply for a council position. If you are not appointed, you should still attend Interim and Annual Session to participate in the live forums and volunteer for task forces and work groups.
Member B You are just starting your career in a rural area. You participated in TAFP meetings as a resident, but with loans to repay and a young family, you can’t commit to attending two live meetings a year. You want to be involved and could find some time to participate from home. You should fill out the TAFP engagement form and share your interests. You will get requests to participate in work groups, task forces, and member communities. If you attend a live meeting, you should participate in the live forums.
Member C You have attended committee meetings for many years, and you enjoy the camaraderie of seeing colleagues twice a year. You’re a dedicated TAFP member — perhaps a past leader — and you want to stay involved, but you’re ready for the next generation to take the lead. You should participate in live forums at Interim Session and Annual Session to lend your experience to the discussion. You can also volunteer for work groups and task forces and participate in member communities, maybe serving as facilitator.
Member D You just moved to Texas and you want to get started with TAFP. You aren’t sure you want to commit to attending multiple meetings a year, but you want to be more than a “checkbook” member. You should fill out the TAFP engagement form to share your interests and attend the next live meeting to participate in live forums to get a sense of the Academy. Volunteer for work groups and task forces, attend virtual or live member community meetings, and consider applying for a council in the future.
Members of the Task Force on Governance Adrian Billings, MD, PhD, chair; Lane J. Aiena, MD; Eric Alford, MD; Lindsay K. Botsford, MD, MBA; Emily D. Briggs, MD, MPH; C. Mark Chassay, MD, MBA, MEd; Tricia C. Elliott, MD; Brian D. Jones, MD, CPE; Jennifer Liedtke, MD; Li-Yu Huang Mitchell, MD; and Jennifer Molokwu, MD, MPH
[cont. from 20]
begun for the first appointments, and in the future, expect to receive notification in late summer that the application process has opened. As mentioned before, TAFP has developed an in-depth member interest form so we can learn more about you. We will use that information to invite you to join various member communities and to serve on task forces and work groups as needs arise. Once TAFP Exchange is up and running, explore your opportunities and join in on the discussions. When the day comes on which we can gather again in person, be sure to attend the live forums where you can contribute to the conversations, volunteer for task forces and work groups, and meet 22
TEXAS FAMILY PHYSICIAN [No. 4] 2020
new friends. And as always, give us a call or send us an email at TAFP headquarters — (512) 329-8666 or tafp@tafp.org — and we’ll point you in the right direction. At TAFP, our hope is that this evolution will allow you more opportunities and multiple access points to make the most of your membership, and that it will help us save you time and provide you more of what you need. As an association, our greatest resource is you, the members. With your talents, expertise, drive, and desire, we can do amazing things to help you provide the best care possible for your patients and your communities. And we’ll have fun doing it!
Finding joy in stressful times AN EXCITING NEW PARTNERSHIP FOR YOUR MENTAL WELLNESS By Anticipate Joy
2
020 began with such hope. Many entered the year with an expectation for new vision and focus. We never could have predicted that this year would be marked by a health crisis that would tax our medical personnel and resources to unfathomable proportions. We are not fully aware of the effects of this pandemic on the wellbeing of the physicians and other medical providers who have sacrificed their own health for that of others. In times such as these, fatigue, depression, stress, and burnout are words commonly used to describe the experiences of our medical heroes. Nevertheless, some doctors manage to find joy and hope in their daily experiences. Why is this important? Research tells us that people with high levels of hope and optimism are at a lower risk for coronary heart disease, they sleep better, have stronger immune systems, and live longer. It would seem that
optimistic people have found a fountain of youth, leaving their unhappy counterparts to wonder if there is any hope for them. Gone are the days that we view joy as a character trait that you either have or you don’t. Positive psychology can actually put your ability to experience joy squarely in your own hands. Joy is simply a choice. Each day you wake up with the power to choose joy by shifting your mind to aspects of your day that are enjoyable, satisfying, or fulfilling. Joy is not reserved for days when things align perfectly; when the kids don’t argue and your patient is compliant with your treatment regimen. Joy is possible even on days when you wake up late, your patient’s illness takes a turn for the worse, and you drop the ball on a major project at work. Remember, joy is simply a choice. How do we choose joy? It’s all in what you attend to. If your mind gravitates toward the negative aspects of your day, and you choose to replay every negative word that was said, every wrong choice, every www.tafp.org
23
5 EASY STEPS TO GET STARTED
1. 2. 3. 4. 5.
Get access. Use the customized scan code or bit.ly/35OQGqD to access your organization’s mental health benefits. Complete a brief intake. Answer a few questions about yourself. Purchase session(s). Take advantage of the low TAFP member rate. Purchase up to four sessions. Select a therapist. Review available therapists using filters and request a therapist that best fits your needs. Pick a time. After the therapist approves your request, select an appointment time that works for you and your therapist.
Common issues Anticipate Joy can address • • • • • • • • • • • • •
24
Pain Grief Guilt Feeling of being overwhelmed Burnout Anxiety Addictions Sleep disturbance Low motivation Isolation Lack of interest in activities Marital strain Irritability
TEXAS FAMILY PHYSICIAN [No. 4] 2020
missed opportunity, every fearful experience, then you have chosen depression, anxiety, and anger. But if you can stop those negative thoughts in their tracks, and instead, choose to notice what is enjoyable, satisfying, or fulfilling, THIS is how you chose joy! Despite your present stressors, you have the power to choose your focus and ultimately decide to experience joy or sadness. This means that with a little bit of effort on your part, you can maintain a positive perspective, if you choose to see the positive in spite of the negative, and to look for moments that are enjoyable, satisfying, or fulfilling. If physicians can’t find a path to enjoyable, satisfying, or fulfilling activities (and many may not, given your unique occupational stresses and exhaustion) or these feel daunting, they should seek out a professional therapist. Anticipate Joy is a convenient online counseling platform with licensed mental health therapists that offers services as a benefit to TAFP active members and resident members. Make a commitment to find greater satisfaction and meaning in your professional lives by accessing this TAFP benefit today.
WHAT IS ANTICIPATE JOY? Anticipate Joy is an innovative mental health treatment and wellness company that supports healing and personal growth through a HIPAA-compliant online professional counseling platform. Anticipate Joy creates an introduction between the client and the therapist, along with the technology that enables the client to have therapy sessions with a licensed mental health provider within the convenience of your own home.
YOUR BENEFITS TAFP has purchased a bulk of sessions making online therapy available to you at a significantly reduced rate of $35 per session when you use the TAFP access. These sessions are available for active and resident members.
THE REALITY OF PHYSICIAN BURNOUT Not all heroes wear capes, especially during a pandemic. Medical providers all over the state of Texas have stepped into the role of unsung hero as they have worked in the trenches. There is no doubt that you have worked long hours and have taken the brunt of the mental and physical burn-out associated with COVID 19. Anticipate Joy is so excited to partner with TAFP to assist you in overcoming some of the emotional and psychological stress that you have had to endure.
SCAN HERE TO BEGIN
Insurance is Like PPE for Your Finances
In times like these, it’s best to take precautions and control what you can. You wear PPE because it will help limit your exposure to the novel coronavirus and help reduce the risk to your loved ones and society. Insurance is like that. It’s like PPE for your personal and professional finances. If something happens to you, insurance provides financial protection for you, your family and your practice. Are you sure your finances are well protected? For a no cost, no obligation review, contact a TMA Insurance Trust advisor today. If your finances are well protected, we will tell you so. If more insurance protection is warranted, we will tell you that as well. Call us toll-free at 1-800-880-8181 for a consultation or visit us online at tmait.org. It will be our privilege to serve you.
LIFE
HEALTH
INCOME
BUSINESS OVERHEAD
www.tafp.org
25
“It’s a wonderful thing to practice family medicine in the state of Texas, to have the opportunity y to get to know our patients and their families and to take care of them. As members of the Texas Academy of Family Physicians, we don’t just care for our patients in the exam room. We take care of them at the State Capitol, too. “I’m a monthly donor for the TAFP Political Action Committee because if we want policies that are good for our patients and our practices, we have to elect politicians who understand our issues. Support TAFPPAC and make your voice heard.” Justin Bartos, MD 2016 TAFPPAC Award recipient
www.TAFPPAC.org
26
TEXAS FAMILY PHYSICIAN [No. 4] 2020
PATIENT CARE
Multiple sclerosis and the National MS Society A PHYSICIAN-TURNED-PATIENT’S PERSPECTIVE. By Lisa Doggett, MD, MPH
I
woke up dizzy on a Monday morning in November, 11 years ago. I didn’t think much of it, and I went to work, as usual, at my small community clinic in Central Austin. But as the week wore on and my symptoms persisted, without any explanation, I began to worry. When I started to have mild diplopia and taste changes, I needed to seek care. A neurologist examined me and told me I was probably okay, but my dizziness continued. A few days later, after noting subtle nystagmus during my otherwise normal exam, a savvy ENT doctor ordered the MRI, revealing my diagnosis: multiple sclerosis. I was lucky. Most people with MS wait months or even years before they are properly diagnosed. My diagnosis took eight days because, as a physician, I understood something was wrong, I knew the ENT doctor who fit me into his busy schedule, and I had the
support and resources to get help fast. I worry when I think of others who can’t access the care they need. But as family physicians, we can help. Multiple sclerosis is a chronic, autoimmune condition that damages myelin, the protective coating around neurons, and disrupts communication between the central nervous system and the rest of the body. The cause is unknown. Common symptoms include visual changes, fatigue, numbness, weakness, cognitive changes, bladder dysfunction, depression, and impaired mobility and coordination. While it can occur at any age, most people with MS are diagnosed between ages 20 and 50. More women are affected, with a femaleto-male ratio of about 3 to 1. The presentation and symptoms, as well as the natural course of the disease, can differ considerably from person to person. www.tafp.org
27
As primary care physicians, we should keep MS in mind as a possible cause when we see someone with unusual neurologic symptoms, and we should ask about past episodes that may indicate a suspicious pattern.
28
TEXAS FAMILY PHYSICIAN [No. 4] 2020
I’m embarrassed to admit, as a family doctor, MS never occurred to me as a diagnostic possibility in my own case. My husband, an internist/pediatrician didn’t suspect it either. Neither of us had seen more than a handful of MS patients in our years of practice, and we had never diagnosed anyone with MS. Yet nearly a million people are living with multiple sclerosis in the United States. MS should have been on our radar. Because its presentation is so variable, and because most people with MS have the relapsing, remitting type and will get better between exacerbations, the diagnosis can be tricky. As primary care physicians, we should keep MS in mind as a possible cause when we see someone with unusual neurologic symptoms, and we should ask about past episodes that may indicate a suspicious pattern. Three decades ago, MS was often a devastating diagnosis, leading to long-term disability with no good treatment options. Now, nearly two dozen disease modifying medications are FDA-approved to reduce the progression of MS and limit disability. Diagnosing MS and starting treatment early can significantly improve a patient’s prognosis and quality of life. The National MS Society has been a critical driver behind MS research, advocating for support at the national and state levels and directly funding research studies. It also is an important resource for patients, their caregivers, and their physicians. In addition to providing solid, evidence-based educational information on their website, the NMSS can connect patients with MS specialists around the country. The MS Navigator Program (www.nationalmssociety.org/ Resources-Support/Find-Support/Ask-an-MS-Navigator) provides direct one-on-one support for people affected by MS including: • • • •
Information and education; Emotional support; Connecting with others with MS; Navigating the complexities of the health care system: finding a neurologist, accessing benefits and medications, etc.; • Resources to address financial issues and plan for the future; • Wellness strategies; and • Assessment for case management. There is no charge to participate, and the discussions and information shared are confidential. Another helpful resource for physicians is Project ECHO (www. nationalmssociety.org/For-Professionals/Clinical-Care/ProfessionalEducation/ECHO-MS), a guided practice model that increases workforce capacity of neurologists and other clinicians to provide best-practice specialty care for MS patients and reduce health disparities. Participants join an interactive video conference facilitated by one of three hub sites. For me, in addition to reliable information, the NMSS has offered a community of fellow “MS Warriors” and supporters. It has empowered me to share my story, lobby at the State Capitol on behalf of the MS community, and join nearly 10,000 fellow cyclists to ride the MS 150, a 150-plus mile bike ride from Houston to Austin, twice! Despite three relapses, I remain almost symptom-free with no discernible disability today, thanks to good medical care and effective treatment options. I work full time, exercise every day, and remain active in my community and with my family. I encourage all my fellow family physicians to become familiar with the resources offered by the NMSS and to seek to improve identification and treatment of all people living with MS.
RESEARCH
Support for this project included a grant from the Texas Academy of Family Physicians Foundation.
Support for TAFP Foundation Research is made possible by the Family Medicine Research Champions.
Using partners’ emotions and perceptions to model men’s violence and alcohol use in violent relationships David Katerndahl, MD
Introduction GOLD LEVEL Richard Garrison, MD David A. Katerndahl, MD Jim and Karen White SILVER LEVEL Carol and Dale Moquist, MD TAFP Red River Chapter BRONZE LEVEL Joane Baumer, MD Gary Mennie, MD Linda Siy, MD Lloyd Van Winkle, MD George Zenner, MD
Thank you to all who have donated to an endowment.
For information on donating or creating a new endowment or applying for research grants, contact Kathy McCarthy at kmccarthy@tafp.org.
Although much is known about the prevalence, risk factors, and consequences of intimate partner violence and its longer-term impact, gaps in our knowledge remain. Using data from prior studies of daily triggers of violent events, we created three Agent-Based Models (ABMs) of violence. While these three ABMs have successfully modeled violence and women’s decision-making, they all relied upon her daily reports of violence and household environment; the basis for these models did not include descriptions of his emotions and perceptions. The purpose of this study is to improve our understanding of the triggers of violent events within violent relationships through agent-based modeling by including his perceptions and emotions.
Methods The basis for the ABM was a longitudinal study of violent heterosexual couples in San Antonio, Texas; the methods used have been previously reported.1 A total of 105 prior-day → same-day relationships among 23 variables met this standard for inclusion in the basic model. To explore factors that may alter the solution, the strength and direction of some relationships must be allowed to vary from one solution to another (continuous variable parameters). After we identified the unique patterns, we sought to assess the potential impact that random stress as well as his and her feelings and behaviors could have on his and her violence, his stalking, and his and her substance use.
an intervention at work. In general, stress, his sense of insult as well as both his and her alcohol use were important factors, often impact each other’s alcohol or drug use. When HerConcern → HerConcern was maximal, his violence, stalking, and alcohol use were also maximal; her drug use depended upon his sense of insult while her violence depended upon her alcohol intake or lack of anger. However, when HerConcern → HerConcern was set to 0.75, the relationships among interventions became critical to outcomes. While his and her drug use as well as refraining from arguments had little impact, his and her alcohol use, his sense of insult, and her violence all had significant effects. In fact, her alcohol use also interacted with other interventions and was a source of atypical patterns.
Implications
Results
The ABM demonstrated that incorporating his feelings and perceptions into such modeling was critical to its results. In addition, her level of concern about the effects of violence on the children and how that concern varies from day to day. Modeling found that daily alcohol use did lead to his verbal abuse while heavy alcohol use led to physical violence, but drug use did not. Some interventions (stress, lack of her upset) were associated with reducing levels of his violence in some circumstances, but interventions often interacted with each other, sometimes resulting in unexpected outcomes. Her alcohol use was a particularly potent intervention and frequently interacted (often atypically) with other factors.
The baseline condition (without extremes in continuous variable parameters or interventions) yields no violence. HerConcern → HerConcern is particularly important in this ABM. When that relationship is left unspecified or is set to “0” or its minimum, no violence or alcohol or drug use is observed without
1. Burge, S.K., Katerndahl, D.A., Becho, J., Wood, R.C., Rodriguez, J., & Ferrer, R.L. (2019). Dynamics of Partner Violence and Alcohol Use in Couples: Research Methods. Violence & Victims, 34, 136-156. www.tafp.org
29
PERSPECTIVE
Change is on the horizon By Yetunde Sokunbi, MD
“Not everything that is faced can be changed, but nothing can be changed until it is faced.” — James Baldwin we can all agree that 2020 has been a roller coaster of a year. One for the history books. Who could have predicted COVID-19 — an illness that has completely changed how we live and interact with one another? As physicians we have pivoted to telemedicine visits in order to still care for our patients. But not only are we dealing with living through a historic global pandemic, we are also witnessing political and civil unrest right before our eyes. With the advent of the internet and 24/7 news cycle, we are all connected in a matter of milliseconds. The murder of George Floyd was horrific. Plain and simple. Watching the incident on the news, seeing the replay, is nothing short of traumatic. I think it was especially traumatic because of the deaths of Ahmaud Arbery and Breonna Taylor just weeks prior. And people were witnessing this in real time. Glued to their screens in disbelief that these events are happening day after day in the U.S. No longer could some say “we’re in a post-racial society” because video doesn’t lie. Systemic racism is now on the forefront of everyone’s minds. I work in Pearland, Texas, just minutes from where George Floyd was laid to rest. Seeing his funeral services on national TV and on the front page of newspapers all over the globe was surreal. Black people are dying simply because of the color of their skin. Unable to go for a run outside or enjoy a sunny day in the park without fearing for their safety. Not only are people of color concerned for their safety in the outside world, they are also very cautious when having to seek medical care. People of color are disproportionately affected — higher rates of hypertension, diabetes, and cardiovascular disease. Maternal mortality rates and adverse surgical outcomes are higher in the Black community. I’m a Black female physician. The daughter of two Nigerian immigrant physicians. I learned from a young age the value of hard work and giving back to the community. I learned that education is the key to success. I also learned that I would have to work twice as hard to receive half the credit because of my race. It’s a talk that all Black parents have with their children at some point. Growing up, how one dresses, talks, or styles their hair is important because we must always consider how others may perceive us. People of color deal with racism on a daily basis. From being followed in a store to being profiled when applying for a loan to being rejected for an interview based on their first name. 30
TEXAS FAMILY PHYSICIAN [No. 3] 2020
Microaggressions and overt aggressions are commonplace. Touching a Black woman’s hair or saying things like “you don’t sound Black” is offensive. There have been times in my professional career when I have walked into a patient’s room with my white coat, badge, and stethoscope, and would get asked “when’s the doctor coming?” “I’m here,” I reply and kindly introduce myself. Confused looks, furrowed brows. Then the questions come, regarding my schooling and birthplace. There aren’t many that look like me. About 2% of all U.S. physicians are Black females. Sometimes I’ve been mistaken for an MA or a nurse. Sometimes I’ve been asked “what are you exactly?” because people are curious about my race and I have an interesting sounding last name. I’ve been complimented on my English. English is my first and only language. I grew up in Texas. Black physicians are used to questions from curious patients. Used to being one of a handful (or the only one) at some professional meetings. Used to having to figure things out on our own, as finding a mentor after residency can be difficult. Used to interacting with staff that may not see you as an authority figure. But the world keeps turning. As the world turns, we as a society continue to evolve. We continue to learn better ways to interact with one another. Accept each other. Care for each other. Look after each other. As physicians, we are called to a higher standard. We are called to treat everyone who walks into our office with kindness and compassion. Heal and care for the sick. Get people well and keep them healthy and happy so they can live beautiful lives. In order to care for all patients, of every race, religion, creed, sexual orientation, and varying abilities, we must first look within. We must first uncover and identify any bias we may have. We must continue to be curious about the world around us. Learn about other cultures and religions. Reading is a great place to start. Since we can’t travel to other countries right now, reading books from authors of varying backgrounds allows us to see the world from a different perspective. A new light. Systemic racism is now a public health crisis. AAFP recently issued a statement acknowledging this as well as acknowledging racism within health care. Books such as “So You Want to Talk about Race” by Ijeoma Oluo and “How to be an AntiRacist” by Ibram X. Kendi are topping the best sellers lists now. Companies are actively adding people of color to their boards and adding Chief Diversity Officer positions because this work is important. This is a great start, but the work continues. We as physicians must be sensitive to what is going on in the world around us. Our patients depend on it.
FAMILY MEDICINE CLINICAL FACULTY OPPORTUNITIES
Baylor College of Medicine has opportunities for clinical faculty who are board certified/eligible in Family Medicine and/or interested
Houston, Texas
in providing non-operative obstetrics. In addition to joining an outstanding group of faculty dedicated to the care of a diverse patient population, our faculty have the opportunity to participate in academic activities including medical student and resident education.
APPLY ONLINE: jobs.bcm.edu
This position includes a faculty
FOR FURTHER INFORMATION CONTACT
appointment at a competitive salary with excellent benefits and the opportunity to join a distinguished institution.
ROGER J. ZOOROB, MD, MPH, FAAFP Richard M. Kleberg Sr. Professor and Chair DEPARTMENT OF FAMILY & COMMUNITY MEDICINE 3701 Kirby Drive, Suite 600 • Houston, TX 77098 Roger.Zoorob@bcm.edu • 713.798.2555 bcm.edu/departments/family-and-community-medicine
Interested candidates should apply at
jobs.bcm.edu
Baylor College of Medicine is an Equal Opportunity/ Affirmative Action/Equal Access Employer