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Meet Your Doctor
MAY 2018 • ISSUE 43
BABY BOOMERS
David M. Holmes, a family medicine physician with ECMC, discusses how faith can help in the healing process
Doctor Salaries
SPECIAL ISSUE
Report shows physicians have had modest rise in salaries. See how much they earn P. 19
• Eight health issues affecting boomers • Blood pressure: understanding the new guidelines • Checklist for your Social Security annual check-up • Lifespan in the U.S. decreases • Aerobic exercise: key for brain health n Starts on page 13
n Related: NY ranks nearly worst state for docs. Page 19
All That Overtime Could Be Killing You Study: Working more than 60 hours a week increases the risk of coronary heart disease, stroke
Occupational Hearing Loss Earlier this year, rock and blues musician Eric Clapton, 72, said that he was losing his hearing and was diagnosed with tinnitus — or ringing in the ears. We spoke with local experts about the problem and how to prevent it Page 17
Runners and walkers — get ready! May marks the start of the spring running season.
Slim Down with Shiitake Mushrooms
They contribute to weight management by providing enough protein and fiber to keep us feeling fuller longer.
BLOOD PRESSURE New guidelines mean more Americans have high blood pressure. Find out if you are one of them. Page 12
5,000 Years of Civilization Reborn
ALL-NEW PROGRAM WITH LIVE ORCHESTRA
This Epic Production immerses you in stories reaching back to the most distant past. You’ll explore realms even beyond our visible world. Featuring one of the world’s oldest art forms— classical Chinese dance—along with patented scenographical effects and all-original orchestral works, Shen Yun opens a portal to a glorious civilization of unrivaled beauty, artistry, and inspiration. Enter a world where philosophers and poets alike sought harmony with the Dao, or “Way,” of the universe. Where maidens danced with heavenly grace and generals fought with explosive athleticism. Where timeless tales of valor and virtue were born. Where heaven and earth intersected. And even magic was possible. Experience the superb artistic and spiritual heritage of the profound Chinese culture. Experience Shen Yun.
“These beautiful, gifted people are expressing
something that’s both pure and good.” —Philadelphia Weekly
Where Art Connects Heaven and Earth…
“Absolutely the greatest of the great! Really out of this world! There is no word to describe it... If I had to, the words might be 'divine,' 'reborn' and 'hope'...You have to see it to believe it.” —Christine Walevska, master cellist
Shen Yun’s unique artistic vision expands theatrical experience into a multi-dimensional, deeply moving journey through one of humanity’s greatest treasures— the five millennia of traditional Chinese culture. “There is a massive power in this that can embrace the world. It brings great hope… It is truly a touch of heaven.” —Daniel Herman, Minister of Culture of the Czech Republic
The Perfect Gift for Mom
“Absolutely THE NO. 1 SHOW in the world!” —Kenn Wells, legendary lead dancer of the English National Ballet
“Beautiful… A nimble
mastery of traditional talents.” —Chicago Tribune
“A visually dazzling tour of 5,000 years of Chinese history and culture.” —San Francisco Chronicle
Scan the QR code to visit the Shen Yun website. Watch trailers, or even buy tickets directly on your device.
Shea’s Buffalo Theatre | May 9–10 | 1-877-519-0905 | ShenYun.com/Buffalo Page 2
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • May 2018
EAT WELL Partner with Your Provider
Eat Right Pack more nutrition into your day with a colorful main dish. Try to eat a rainbow of fruits and vegetables with every meal – the brighter the better. Consider flavor, texture and color. •
Fruit
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Greens
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Sweet vegetables
For adults over 50, the benefits of healthy eating include increased mental acuteness, resistance to illness and disease, higher energy levels, faster recuperation times and better management of chronic health problems. Take action by consulting your doctor.
Feel Better When you choose a variety of colorful fruits and veggies, whole grains and lean proteins you’ll feel vibrant and healthy, inside and out. It’s all connected – when your body feels good you... •
Feel better
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Sharpen the mind
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Live longer and stronger
New to Medicare? Let WellCare help you live healthier. Jason Hollister, Sales Manager 1-716-846-7900 | www.WellCareNow.com
Always talk with your doctor(s) about the care that is right for you. This material does not replace your doctor’s advice. Sources: WedMed.com, fnic.nal.usda.gov, and helpguide.org.
Y0070_NA029063_WCM_ADF_ENG CMS Accepted 05242015
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WellCare (HMO) is a Medicare Advantage organization with a Medicare contract. Enrollment in WellCare (HMO) depends on contract renewal. A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings, call 1-877-699-3552 (TTY 711). There is no obligation to enroll. Please contact WellCare for details. WellCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-374-4056 (TTY: 711) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-374-4056 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務 。請致電 1-877-374-4056 (TTY: 711) 。
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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ECMCC: $3.2 Million Operating Surplus for 2017 Amount is the highest for the hospital since 2010
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rie County Medical Center Corporation (ECMCC) recently announced that it closed 2017 with a $3.2 million operating surplus on its total $647 million in operating revenues, reflecting the hospital’s overall strong performance in health care services for the year. The hospital — Western New York’s only level 1 adult trauma center — grew days cash on hand from 68 days in 2016 (with $110 million in cash) to 101.5 days in 2017 (with $171.2 million in cash) and grew revenues from $616.5 million in 2016 to $647.4 million in 2017. This surplus represents the highest amount for the hospital since 2010, and ECMC is one of the only public hospitals in New York state to show a positive operation margin in 2016 and 2017. ECMC was also able to recover much of its operational costs related to the cyberattack of April 2017 with $10 million of cyber insurance proceeds. “While we are proud of the ECMC family being good stewards of public assets, we are most proud of the improvements in our quality and patient experience scores,” said ECMCC President and CEO Thomas J. Quatroche Jr., Ph.D. “Over the years, the image of ECMC has changed significantly, which has resulted in more patients choosing ECMC than ever before. Our sound financial footing, along with our great outcomes and
quality scores, is not typical of many large public teaching hospitals in New York, or across the country for that matter.” For the first time, inpatient hospital visits exceeded 19,000. Inpatient surgeries were up 9.7 percent and total surgeries increased by 1.3 percent over 2016; additional growth occurred in: orthopedic surgeries (3 percent), kidney transplants (8 percent) and neurological surgeries (19.6 percent). Further growth occurred in the ECMC’s outpatient clinics, including primary care (2 percent), neurology (3.7 percent), urology (2.5 percent), cardiology (5.4 percent) and the Center for Occupational and Environmental Medicine (5.1 percent), and similar increases occurred in ECMC’s department of rehabilitation services, where inpatient admissions increased by 19.5 percent and outpatient services, which grew by 25.2 percent. ECMC also saw an increase in the acuity, or level of illness in patients, with an increase of 14,155 patients admitted through the emergency department and an acute case mix index of 1.85 (an indicator of a patient’s severity). In addition to this solid operations volume, ECMC’s Terrace View Long-Term Care Facility in May earned a four-star rating for overall quality from the federal Centers for Medicare and Medicaid Services (CMS).
WNY Orthopedic Surgeons Unify to Address Opioid Crisis They have come up with new guidelines to prescribe and dispose of unused narcotics
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n an effort to address the opioid crisis in Western New York, a group of 35 orthopedic surgeons from eight separate practices came together recently to collaboratively develop guidelines for prescribing narcotics after elective orthopedic procedures. Those guidelines have been distributed to all orthopedic surgeons in Western New York. Physicians from the following practices participated: UBMD Orthopaedics & Sports Medicine, Excelsior Orthopaedics, Northtowns Orthopedics, Pinnacle Orthopedics, Knee Center of WNY, Lakeshore Orthopedic Group, Buffalo Medical Group and WNY Knee & Orthopaedic Center. Orthopedic surgeons, by nature of their specialty, commonly prescribe narcotics to patients to help minimize pain after bone, joint and soft tissue procedures. Conservatively, tens of thousands of these pills go unused each year after elective orthopedic surgeries done in the Western New York region alone. Physician Leslie J. Bisson, MD, the June A. and Eugene R. Mindell professor and chairwoman of the department of orthopedics in the Jacobs Page 4
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School of Medicine and Biomedical Sciences at the University at Buffalo, and president of UBMD Orthopaedics & Sports Medicine, moderated the Western New York Orthopaedic Summit on Opioid Prescribing. “There is evidence that many patients don’t take as many narcotic pills as are prescribed, and some of these unused pills could be diverted to illicit use,” said Bisson. “Nationally, close to 100 people perish each day in opioid-related deaths. In Erie County alone, there is one death per day.” To develop the guidelines, surgeons reviewed the literature and met to discuss the most commonly performed surgeries and quantity of narcotics each provider typically prescribed. They also incorporated recent recommendations regarding opiate prescribing developed by the American Academy of Orthopedic Surgeons. “It was gratifying to see surgeons from so many different groups come together in pursuit of a common goal,” said Bisson. “The summit unified us in our intention to proactively combat the opioid issue here in Western New York.”
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • May 2018
CALENDAR of May 14
HEALTH EVENTS
Catholic Health holds event for health providers Western New York healthcare professionals are invited to attend an open house hosted by Catholic Health’s Living Independently For Elders (LIFE) program to learn about career opportunities in this unique healthcare setting. The Healthcare Professionals Open House will take place on from 3 to 6 p.m., Wednesday, May 16, at the Our Lady of Victory Senior Neighborhood in Lackawanna. LIFE is Catholic Health’s Program of All-Inclusive Care for the Elderly (PACE) program, a dynamic and innovative healthcare model that helps the elderly maintain their independence — living in their own homes, by offering a wide range of support services at a central location. Attendees will have an opportunity to learn more about the LIFE concept, speak with peers, and tour the LIFE program facilities. Demand for the program has grown significantly and Catholic Health recently announced plans to expand to a second LIFE program site in Cheektowaga. Healthcare Professionals Open House participants must register online to attend the event. Registration is open until 3 p.m. May 14 by calling 716-706-2115 or visiting CHSBuffalo. org/LIFECareers.
May 16
Support group to focus on osteoporosis To help area residents diagnosed with osteoporosis live their healthiest life, Catholic Health will hosts an osteoporosis support group from 10 to 11:30 a.m. the third Wednesday of every month at the Beechwood Residence Auditorium, 2235 Millersport Highway at North Forest Road, Getzville. This month’s meeting, being held on May 16. Meetings for the remainder of the year will be held June 20, July 18, Aug. 15, Sept. 19, Oct. 17, Nov. 21 and Dec. 19. The osteoporosis support group is free and open to all. The meetings feature guest speakers discussing various topics of interest to help people living with osteoporosis or at risk for developing the condition, live safely and comfortably. New members and walk-ins are welcome. For more information, call Catholic Health’s HealthConnection at 716447-6205.
May 19
Senior Health & Fitness Fair in Akron The Clarence and Akron-Newstead Senior Centers are hosting the Senior Health & Fitness Fair 2018 from 9 a.m. to non, Saturday, May 19, at 5691 Cummings Road, Akron. The completely free event offers lunch; health screenings by Catholic Health and others; exhibits on senior health, fitness, safety and government benefits; prizes; and seminars on nutrition, shingles vaccines and nursing home Medicaid planning. Linda Pellegrino of Senior Radio will be a special guest. Sponsors of the fair are BlueCross BlueShield of WNY, Independent Health, United Healthcare, UniveraHealthcare, Wegmans, Assemblyman Michael Norris and Friedman & Ranzenhofer, PC Attorneys . For further information, contact Debb Sabbatis at 716-542-6645.
May 2, 17, 19
Windsong Radiology to offer mobile mammography A recipient of funding from the NYS Department of Health and Health Research, Inc.’s (HRI) Mobile Mammography Van grant, Windsong Radiology Group is working collaboratively with churches, payors, community and healthcare partners to improve breast cancer screening rates in Western New York. Underserved and never before served women in all eight counties (Allegany, Erie, Cattaraugus, Chautauqua, Wyoming, Niagara, Orleans and Genesee) who had limited or no access to breast cancer screening, will now have access to the high quality services that Windsong provides. The mobile mammo coach will provide 3D mammography or digital breast tomosynthesis, a state of the art technology that has proven to detect smaller cancers earlier, when they are easier to treat. The service will be available Erie and Niagara counties in the following schedule: • 9 a.m. to 3 p.m., May 2 at Kmart, 1001 Hertel Ave Buffalo. • 3 to 7 p.m., May 17 at Niagara Falls MHA- Independent Health Foundation, 3001 9th St Niagara Falls. • 9 a.m. to noon, May 19 at Akron Senior Center, 5691 Cummings Rd, Akron. • 10 a.m. to 6 p.m., May 24 at Tops Super Store, 425 Niagara St Buffalo.
Reach health consumers, providers. Advertise with In Good Health. One ad working all month. Call 716-332-0640
NEW 1-day workshop for women who live alone
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ewer U.S. kids are plagued by tooth cavities compared to just a few years ago, but income disparities persist, according to a new U.S. government study. Researchers found that in 20152016, about 43 percent of children aged 2 to 19 had cavities. That was down from 50 percent four years earlier. This is the good news. On the other hand, disparities were apparent: Hispanic kids had the highest prevalence of cavities, at 52 percent. And children from lowerincome families had a substantially higher rate of cavities than those from wealthier families. In addition, many kids — 13 percent — had cavities that had gone untreated, and black children were at greatest risk. “We’re making progress, but there’s still work to be done,” said lead researcher Eleanor Fleming, of the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics. Groups including the American Academy of Pediatrics and the American Dental Association suggest children start dental care when their baby teeth emerge, or by 12 months of age. The findings, released April 13 by the CDC, come from an ongoing study of Americans’ health and nutrition habits conducted through home interviews and physical exams at mobile health clinics. In the most recent study years — 2015-2016 — just over 43 percent of U.S. kids aged 2 and up had cavities. That included 13 percent with untreated cavities. By comparison, those figures were 50 percent and 16
percent, respectively, in 2011-2012. The picture looked worse as family income declined. Among families living below the federal poverty line, 52 percent of kids had cavities. That compared with 34 percent of kids from families with incomes greater than 300 percent of the poverty level. Similarly, almost 19 percent of kids from low-income families had untreated cavities, versus 7 percent of those from higher-income families. Racial disparities were evident, too: About 17 percent of black children had untreated cavities, compared with just under 12 percent of white kids and 10.5 percent of Asian kids. Why has the overall prevalence of cavities gone down? It’s not possible to tell from the study, Fleming said. The keys to cavity prevention, she noted, include a few basics: brushing with a fluoride toothpaste and flossing every day; limiting sugary drinks, and regular visits to the dentist. It’s not clear whether any changes in those habits, or access to dental care, might explain the recent decline in kids’ cavities, according to Fleming. “Cavities are the most common disease among children,” she said. “But not everyone gets them. They are not inevitable.” Taking your kids to the dentist twice a year will help, Roldan said. But, she added, “what happens in between is even more important.” Choose water instead of sugary drinks, she advised, and make sure your kids brush regularly, especially before bed.
Alone and Content: How to Survive & Thrive on Your Own Saturday, May 19 9:30 am - 4 pm (breakfast refreshments and lunch included) House Content B&B, Mendon, NY
In this workshop led by Gwenn Voelckers - a woman who's "been there" - you'll discover how to think differently about living alone, overcome loneliness,reconnect with your true self, and socialize in a couples' world. $165 fee covers engaging, interactive discussions, empowerment exercises, and trusted resources.
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Serving Western New York A monthly newspaper published by Local News, Inc. Distribution: 32,500 copies throughout more than 1,500 high traffic locations in the region In Good Health is published 12 times a year by Local News, Inc. © 2018 by Local News, Inc. All rights reserved. 3380 Sheridan Dr., # 251 • P.O. Box 550, Amherst NY 14226 Phone: 716-332-0640 • Fax: 716-332-0779 • Email: editor@bfohealth.com
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Cavity incidence among kids drops 50% in four years
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Fewer U.S. Kids Are Getting Cavities
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Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo • Writers: Deborah J. Sergeant, Jim Miller, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Julie Halm, Kyra Mancine, Ernst Lamothe Jr., Julie Halm Advertising: Anne Westcott, Amy Gagliano Layout & Design: Dylon Clew-Thomas • Office Assistant: Kimberley Tyler No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.
Buffalo & WNY Healthcare Newspaper May 2018 •
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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Meet
Your Doctor
By Chris Motola
Diabetes Now Affects 23 Million U.S. Adults
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he latest tally of Americans adults affected by diabetes finds more than 23 million struggle with the blood sugar disease. Of those, the vast majority — 21 million cases — are caused by Type 2 diabetes, which is often linked to overweight or obesity, according to the report from the U.S. Centers for Disease Control and Prevention. Another 1.3 million cases are attributed to Type 1 diabetes, an autoimmune disorder where the body fails to produce enough of the blood sugar hormone insulin. The number of diabetes patients is now “nearly 10 percent of the entire [adult] population,” noted physician Robert Courgi, a diabetes specialist at Northwell Health’s Southside Hospital in Bay Shore, Long Island. “As expected, the overwhelming majority is Type 2 diabetes — usually caused by obesity and treated with pills,” added Courgi, who was not involved with the new report. On the other hand, “Type 1 diabetes results in a destruction of the pancreas, is difficult to diagnose and must be treated with insulin,” Courgi said. “Type 1 must be recognized quickly and treated appropriately.” The new CDC numbers were based on 2016 data on more than 33,000 adults from the federal government’s National Interview Survey. The researchers noted that the 2016 survey was the first to add “supplemental questions to help distinguish diabetes [by] type.” According to the team, led by CDC investigator Kai McKeever Bullard, certain populations seem to be hit harder by either Type 1 or Type 2 diabetes. For example, the researchers said “white adults had a higher prevalence of diagnosed Type 1 diabetes than did Hispanic adults,” while “blacks had the highest prevalence of diagnosed Type 2 diabetes.” While Type 2 diabetes affected about 8 percent of white adults, that number rose to 9 percent of Hispanics and 11.5 percent of blacks, the report found. Overall, diabetes prevalence rose with advancing age but fell as levels of education and income improved. The findings were published March 30 in the CDC journal Morbidity and Mortality Weekly Report.
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David M. Holmes, M.D. Family medicine doctor at ECMC discusses how faith can help in the healing process Q: Your practice spans a lot of different areas, I understand. A: I’m a family physician at ECMC Family Health Center. We train residents and medical students. It’s a busy clinic. I also do some addiction medicine at a different site, mostly opioid addictions. So we use Suboxone to help with that. I have a program I developed where patients choose if they want to be in a secularor faith-based program; and in both programs do journal writing, read books, answer questions in a workbook. That’s in addition to their counseling programs and Suboxone treatments. I do some volunteer free clinic work in Buffalo and inpatient work at ECMC at the county hospital, and inpatient pediatrics at Oishei Children’s Hospital. And I also do obstetrics, so I deliver babies at the children’s hospital as well. Q: And your work on global health? A: I’m the director of the global health education program at the university. Our medical students went to four different countries recently doing medical relief work: Haiti, the Dominican Republic, Costa Rica and Panama. Those are the first-year students. For senior medical students, they can go almost anywhere in the world as an elective. It’s usually only one or two students at a time. Q: You mentioned your faith-based work briefly, and I understand it’s a big part of your work. What do you believe the role of faith is in health? A: The idea was around for a long time, but it was in the 90s that they started doing research into the area. A lot of studies found a positive correlation between faith and health. One study with over 20,000 patients in it looked at length of life and found that those who attended religious services more than once a week, on average, lived seven years longer than those who never
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • May 2018
attended services. The difference for the African American population was even higher, at 14 years. Some of that may be the social benefits. Q: Did they compare it to other social activities? A: There was another study that compared volunteers in secular organizations to religious service attendees and there was a difference in favor of religion. Those who did both lived even longer than those who just attended religious service. There’s not a big difference in terms of, say, cancer survival, but there’s a huge difference in terms of quality of life, incidences of depression and coping. There have also been some studies into chronic pain and faith showing faith does sometimes help with some of the chronic pain issues. Again, some of that is the social aspect, but faith itself did seem to help people cope with pain. At the addiction clinic, a lot of our patients got addicted trying to treat chronic pain, so we have some people there who have benefited. Q: How do you break the topic of faith with patients? A: Now, my job isn’t to push religion on people, it’s to help assist patients in improving their health and well-being. I can do that with a prescription, a procedure, with counseling. I consider faith as another tool. There may not be a need or it may not be appropriate with everybody. I basically just ask patients what’s important to them. If they say faith, I ask how so. If it’s not important, we go on to other topics. I’ve found that for people for whom it is important, they appreciate it. Q: Do you run into a variety of faiths? How do you deal with different ones? A: Where I am in Amherst, if
patients are religious, they’re usually Christian. There are others who called themselves spiritual but not religious that we see. Some people have an overwhelming sense of religious guilt, though, and in those cases faith can actually be hurtful. You can try to address that with people as well. Q: Where do you think the line is between faith as a supplement to medicine and faith-healing? A: I have a patient who told me he stopped taking his blood pressure medicine because people at church were praying for him. He’d been off the pills for about two weeks when I saw him. His blood pressure was OK, so I said, “Your blood pressure is OK now, but if your blood pressure starts going up again, I’m going to recommend you go back on the pills.” He was also a smoker, so I suggested his church pray for him to stop smoking to help his blood pressure, but he clearly wasn’t ready to stop smoking, so he didn’t like that idea. Another patient was diabetic and felt she was healed, so she stopped taking her insulin, had a reaction and got into a car accident. So they consulted me to help manage the diabetes. The challenge with a lot of these healing services is they tell you in order to be healed, you have to have faith and to show your faith you have to stop your medicine. So it’s kind of a Catch-22. What I told her was that God can heal, but in her situation she was not healed. She still had the diabetes. And my recommendation was that, until she was healed, to keep taking her insulin. In other words, take it until you’re healed, don’t stop it and hope you’re healed. She seemed to understand that. I will often ask patients if they want me to pray with them. Q: Is it hard to figure out where people’s boundaries are with something as personal as faith, or lack thereof? A: My guideline is that if I’m 95 percent sure someone would be OK with me asking, then I’ll ask them. I mean, we’re trained to ask all kinds of personal questions about a person’s sexual history, but for some reason when it’s comes to someone’s spiritual history, it’s kind of taboo. But now there’s some movement in medical schools to train physicians to take a student’s spiritual history. It’s just a few simple questions that can give you a quick idea of where the patient is at.
Lifelines David M. Holmes, M.D. Position: Clinical associate professor of family medicine and director of global health education at University of Buffalo Hometown: Stony Brook, NY Education: University of Vermont (medical degree); University of Buffalo (residency) Affiliations: Erie County Medical Center; Oishei Children’s Hospital Family: Married, four children, one grandchild Awards: Top Docs in WNY (2013); Alumni Achievement Award (2011); New York State Family Physician of the Year (2007); Recent Alumni of the Year Award (2007); Siegel Teaching Award (2004) and Humanism in Medicine (1999) Hobbies: Tennis, running, travel
All That Overtime Could Be Killing You Study: Working more than 60 hours a week increases the risk of coronary heart disease, stroke
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40-hour work week may sound like a vacation to those burning the midnight oil. But a study in the American Journal of Industrial Medicine shows that consistently surpassing this standard can be detrimental to your health. Researchers said they found that working 61 to 70 hours a week increased the risk of coronary heart disease by 42 percent, and working 71 to 80 hours increased it by 63 percent. Heart disease is the leading cause of death worldwide, with more than half a million deaths each year in the United States alone, according to the U.S. Centers for Disease Control and Prevention.
Another study, published in The Lancet, found that employees who work long hours have a higher risk of stroke than those working standard hours. Even more shocking is that putting in these extra hours may not even lead to increased productivity because long work spans can actually decrease your efficiency. Germany boasts the largest economy in Europe, yet the average worker there only spends 35.6 hours a week on the job. Working less may not seem like an option at first, but here’s how to make it a reality. First, get more sleep at night.
This will give you the energy to be more productive during the day and get out of the office sooner. Create an organized list of tasks each day. Check off each item when completed to give yourself the motivation to get through your day more efficiently.
Working fewer hours will give you more free time in the short term and could decrease your risk of heart disease to give you a higher quality of life in the long term, according to the researchers.
Healthcare in a Minute By George W. Chapman
Physicians Rated: Patients Give Their Doctors 4 Out of 5 Stars
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he online ratings site “Healthgrades” and the Medical Group Management Association collaborated on a survey to determine what people think of their physician. Close to 7 million people went online to rate over 1 million physicians. The bottom line is that people don’t just want to see a physician, they want to be seen. People care about both the clinical and patient experiences as essential to a positive encounter with their provider. Fifty percent of people cited at least one of these factors as
Walmart Getting Into the Act Hopefully, the physician practices that belong to the Medical Group Management Association will take heed of the above survey results. Physician- and hospital-sponsored primary care practices are under assault. Large corporations see an opportunity and are keenly attuned to consumer trends and desires. Not to be outdone by the announced mergers of Cigna/Express Scripts and Aetna/CVS, Walmart announced a possible deal with insurer Humana. Walmart would pay Humana around $37 billion. All three merger partners have said the improvements in access to convenient community-based care far outweighs concerns about hurting competition. They claim they are responding to what consumers want, implying physician and hospital sponsored practices are failing to meet the grade. Just a few weeks ago Amazon, JP Morgan Chase and Berkshire Hathaway announced a potential joint healthcare venture.
important: compassion, comfort, patience, personality and bedside manner. Twenty-three percent cited at least one of these factors as important: knowledge, time, insurance, appointment scheduling and communication. There was little difference in physician ratings by gender. Overall, respondents were very happy with their physician giving an average rating of four out of five stars. In open comments, the interaction with staff was critical to a positive experience.
Fraud Down The DOJ and HHS recovered $2.6 billion in fraudulent claims last year. This is a decline of 21 percent from the previous year because stricter enforcement efforts are making it harder to get away with fraud. The joint anti-fraud effort has a recovery to expense ratio of 5 to 1. In other words, the government spends $1 to recover $5. Last year, the government (DOJ/DEA) created an opioid fraud unit. In just a couple of months, the DEA revoked the controlled substance license of 147 prescribers. The DEA is focusing on prescribers and pharmacies that dispense disproportionate amounts of controlled substances. The DOJ is seeking special permission from the courts to participate in settling lawsuits filed by states against opioid manufacturers and drug distributors. Superbugs Are Here Seemingly right out of some
dystopian science fiction novel, the Centers for Disease Control has discovered hundreds of antibiotic-resistant superbugs. The CDC’s Antibiotic Resistance Lab found 221 bacteria that could not be killed by any or most known agents. It costs us $2 billion per year to combat these superbugs which, if uncontained, are on track to kill more people than cancer by 2050. The CDC has issued containment strategies to healthcare facilities, emphasizing the need for quick identification of superbug cases including regular internal infection control assessments. People most at risk for spreading infections are people who have recently traveled or were treated elsewhere. Healthcare Cost Study Confusing There is no argument: US healthcare costs too much. A recent study published in JAMA, Journal of the American Medical Society hypothesized that our exceedingly high cost per capita of care ($10,000-plus) is not because of too many doctor visits, hospitalizations, procedures and tests. Researchers concluded it’s the cost of these services that create the overall high cost of care compared to virtually every other country. No kidding! Their reasoning is specious. Americans don’t see their doctor as much and have fewer procedures versus other countries because costs are prohibitive. Our notoriously high deductibles and copays serve as disincentives to seek care. So the volume of services we consume is artificially low due to high out-ofpocket responsibilities. Citizens of other developed countries don’t face our financial barriers and see their providers more often. The result is better outcomes. Healthcare Success Success in healthcare emanates from an active partnership between provider and patient. Neither partner
May 2018 •
can say they “owe it all” to the other. There are seven things patients can do to be a better partner in their care. Ask questions about tests, procedures, treatment plan, medications even the provider’s experience. Be clear on what the game plan is. Know what’s in your record. The information belongs to you. Most of us now have electronic records and most practices offer access through an online portal. Be prepared for your appointment. Do your homework. Know your family history and your medications. It doesn’t hurt to go online and research your symptoms or illness. Be open and honest. It doesn’t help to sugarcoat things like the medications, vices or bad habits. Be committed to the game plan. There can’t be success without your participation and buy in. Seek “well” care, not just “sick” care. When you’re in the exam room because your aren’t well, the provider’s focus will be on only that. There is little time to discuss or review your master plan. Keep your appointment. Life is full of surprises and unplanned events; so when one occurs please call the office and reschedule! The quickest way to fall from grace with any provider is to be a “no show”.
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George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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Benefits of Integrative Medicine Extend Beyond Wellness, Mayo Clinic Finds
May marks the start of the spring running season — and there are all types of races to choose from in the Buffalo area.
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ntegrative medicine has become an increasingly popular way to enhance treatment for health concerns. At Mayo Clinic, two forms of integrative medicine acupuncture and massage have already helped numerous patients. In a review of several case studies in Explore, Mayo Clinic researchers examined the potential role of integrative medicine as a therapeutic and diagnostic benefit when combined with a patient’s treatment plan. A massage therapist’s ability to have hands-on contact with a patient and potential for seeing patients for multiple sessions not only can relieve symptoms, but also aid diagnostic detection. Such was the case in a study where Mayo Clinic researchers observed a patient who underwent a partial small bowel resection and was being followed up with massage for persistent pain. The massage therapist detected tenderness upon palpating an area and alerted the patient’s care team. Subsequently, the team found an intestinal leak and infection in the abdominal cavity. “We have done over two dozen studies on massage and acupuncture showing the benefits that both treatments have on patients. Skilled practitioners of integrative medicine are able to be a member of the care team and contribute their expertise, while also delivering care directly to patients,” says physician Brent Bauer, director of research for Mayo Clinic’s integrative medicine program, who is the lead author. Acupuncture is another treatment that has been widely noted for its role in helping with chronic pain management. “Our experience with patients at Mayo Clinic confirms that we see a tremendous number of patients for which acupuncture is a central part in their pain management strategy,” says Bauer. Along with pain relief, acupuncture also can play an important role in assessing underlying health issues. Another case study focusing on acupuncture treatment at Mayo Clinic revealed that a mass was identified on a patient who initially was referred for acute upper-back pain. The acupuncturist noted a small mass in the muscle and brought it to the attention of the primary doctor. Subsequently, an ultrasound of the area was ordered, which showed that the mass was positive for sarcoma. As these case studies show, bringing acupuncture and massage into the clinical setting can have benefits that extend beyond therapeutic wellness. Acupuncturists and massage therapists can bring another level of healing and a second set of eyes to a patient’s overall treatment plan. As Bauer notes, “That is the definition of integrative medicine in a nutshell — combining the best of both worlds to optimize health and healing for our patients.”
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Sprint into Spring By Kyra Mancine
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unners and walkers — get ready! May marks the start of the spring running season. Temperatures are ideal to participate in a race. It’s not too hot, not too cold, and the humidity hasn’t kicked in yet. There are plenty of races out there — from small community races to larger events, beginner to advanced. Whether this is your first 5K or your 50th, lace up those shoes and get out there. Not a runner? You can always walk these events, or attend as a spectator to cheer your friends and family on. Friday, May 4
St Martha’s Parish Fiesta 5k Ole!
This inaugural race in Depew includes a chicken dinner, beer tent, live music, raffles and a shirt to the first 200 registered. There’s also a 1 mile fun walk. Race begins at 6 p.m., starting from the church. www.facebook.com/ events/146716999333882/
Catalyst Fitness Race for A Cause 5k
This evening race in West Seneca includes music, a photo booth, door prizes and raffles at the post-race party. Proceeds go to the American Cancer Society – Relay for Life. First 100 registered get a shirt. 6:30 p.m. start. https://catalystraceforacause1. racedirector.com/ Saturday, May 5
Grand Island Half Marathon & 10k
Sponsored by the Greater Buffalo Track Club, both races start at 9 a.m. from the main parking lot at Beaver Island State Park. Half marathoners receive a finisher’s medal. The 10k race is one loop, the half marathon is two loops around. Enjoy post-race food and beverages. Route is scenic and flat with water views. www.greaterbuffalotrackclub. com/gi-half-marathon-10k
DeSales Race for Fitness 5k, 1 mile walk/run, Kid’s Dash
This family-friendly event starts from DeSales Catholic School in Lockport. Participants receive a
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • May 2018
healthy food goodie bag, T-shirt, post-race refreshments and raffles. The 5k starts at 10 a.m., the untimed 1 mile race starts at 9:30 a.m. and the free Kid’s Dash starts at 9:30 a.m. https://runsignup.com/Race/ NY/Lockport/DeSalesRaceforFitness Sunday, May 6
Running Water 5k, 1 mile walk
Proceeds of this fundraising event go toward providing clean water to Sierra Leone, West Africa. Route is around Clarence Town Park in Clarence. Race starts at 1:30 p.m. Participants receive a drawstring cinch pack and post-race refreshments, as well as the opportunity to win awards for money raised. http://ltlol.com/events/running-water-5/ Friday, May 11
Buffalo Greek 5k
Up for some Greek food? Run this event and enjoy a Greek meal and beverage after. Race starts at 6:30 p.m. from the Annunciation Greek Orthodox Church in Buffalo. https://runsignup.com/Race/ NY/Buffalo/BuffaloGreek5k Sunday, May 13
Mother’s Day Breast Cancer Canal Walk & 5k Pink Dress Run
Get sponsored to run or walk in this traditional race that grows every year. The run starts at 9 a.m. and the walks (one or two mile) start at 10 a.m. from the Widewaters Marina on Market Street in Lockport. New this year is a cash raffle. www.breastcancercanalwalk. org/home-page.html Friday, May 18
Kelly Tough 12k Run & Walk
Held at the Buffalo Bills Field House (ADPRO Sports Training Center) in Orchard Park, this is a Hunter’s Hope awareness and fundraising event. Starting at 6:30 p.m., participants can enjoy family-friendly activities, food, entertainment and awards. Choose between an individual 12k, 4-person relay, 1.2k fun run/walk or you can even join in as a virtual runner to fundraise and earn
awards. https://huntershope.org/kelly-tough/
Tiger Trot 5k
This is the first race in a new South Buffalo Run series of races. Run along McKinley Parkway. The race begins at 6:30 p.m. Registration includes a t-shirt and post-race party. http://thetimon5k.itsyourrace. com/event.aspx?id=10350 Saturday, May 19
Charge of the Knights 5k
This evening race runs through the village of Williamsville. Run the 5k beginning at 6 p.m. or participate in a 1-mile fun run/walk at 5:30 p.m. This family-friendly includes a post-race party with food, live music, raffles and a beer tent. http://ssppschool.com/newsevents/charge-of-the-knights-5krace/ Saturday May 26 & Sunday May 27
Buffalo Marathon 5k and Buffalo (half and full) Marathon
Thousands run this race — especially because the flat, certified course is a Boston Marathon qualifier event. Saturday is the 5k starting at 8:30 a.m. Runners get a T-shirt, finisher’s medal and post-race party. Up for the Donnelly Challenge? Run the 5k and the marathon and you’ll get a special award. The half and full races start at 6:30 a.m. on Sunday. There is also a Stars & Stripes Relay (teams of four running with the flag), a kid’s mini marathon at 10:30 a.m. on Saturday and, new this year, a Stampede 1k event for dogs. www.buffalomarathon.com/ This is just a sampling of the many running events in and around Western New York. For more races, visit the following websites: • www.checkersac.org/Home. php • http://buffalorunners.com/ calendar_2018.htm • http://runningintheusa.com/ race/list/5k/buffalo-ny
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Things You Need to Know About Robotic Surgery
By Ernst Lamothe Jr.
A conversation about robotic surgery with physician Steven D. Schwaitzberg, chairman of the department of surgery at UB
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obotic surgery has been around for some time but still can remain a mystery to patients. They hear the term and think they know exactly what it means. Not only are many incorrect but they are unaware of the vast changes and number of procedures where the new technology has become commonplace. “The advent of robotic surgery has really changed the profession with some surgeries having tremendously better outcomes for the patients,” said physician Steven D. Schwaitzberg, chairman of the department of surgery at the University of Buffalo. “It is still something that you should discuss with your doctor first because not all surgeries need to be done robotically.” Schwaitzberg would like the public to understand more about the technology and had several thoughts and facts to share about robotic surgery.
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Latest trends: As technology continues to move forward in health care, it has allowed robotic surgery to enter some previously uncharted territory. The latest trend is using robotics for outpatient hernia and gallbladder surgeries. Schwaitzberg said about 1 million people have their gallbladders removed per year and about 8 percent are using robotic surgery. “This is something we have definitely seen an increase in over the last few years,” he said. “There are instances where we truly see a difference in recovery time.” In addition, he has seen increases
in robotics for hysterectomies as well as hernias. Thanks to innovations in robotic technology, surgeons can perform hernia repair surgery through tiny incisions rather than the large incisions associated with traditional open surgery. The result is less damage to surrounding tissues, less pain for the patient and a much quicker recovery — often within days.
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You are still getting a real doctor: People hear robotics and their minds wander to maybe the unimaginable. While robotic technology has taken the health care industry to some of those unimaginable heights, there is not a robot that is doing the procedure. Robotic surgery is a set of instruments for doing laparoscopic surgery done through small incisions and a camera. “The single-most popular myth or stereotype is that people think the robot is going to do something on its own and that is not the case,” said Schwaitzberg, who is also the director of surgical planning for Great Lakes Health. “Each robotic procedure is performed by a surgeon sitting at a console directing the robotic arms for every movement.”
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There is training involved: A surgeon can’t simply perform robotic surgery just because he or she wants to. The first step in learning how to make the most out of what these tools have to offer is to start by watching robotic surgery. As part of robotic surgery training, doctors view live surgery being performed by other surgeons.
Often, this includes real-time instruction at the same time. Surgery observation can take place before or after teaching discussions. This gives surgeons a chance to ask any questions they have about the equipment. After observing several robotic surgeries, surgeons can try the tools out themselves with a surgeon already trained on the instrument. “We undergo training courses on how to use robotics and that includes the entire surgical team,” said Schwaitzberg. “We also perform in-service training on how to position the robot’s arms, how to bring it to the patient safely in the operating room and how to clean it.”
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Smaller incision and scarring: Even with successful surgeries, people sometimes complain about scarring. When it comes to procedures such as rectal and other cancers near the pelvis, previously it might require large incisions. But with robotics, the camera and instruments are introduced through ports that allow access to the inside of the patient. “Slowly, people are understanding the benefits of robotic surgery,” he said. “It really helps the surgeon focus on cases that depend on exact precision. Cancers that are in the lower pelvis region are perfect examples because the robotic arms allow for better movement in that location.”
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Better health: Doctors stress that good healthy habits can go a long way for not even needing surgery. But also, being in better health can help ensure you are eligible for surgeries and that
Physician Steven D. Schwaitzberg. starts with avoiding bad habits like smoking. By now, we all know the information about smoking being bad for individuals and the overall population. While statistics are encouraging with the number of young smokers dropping with each year, issues persist because other elements have filled in the void of tobacco. “A patient who is a good candidate for general surgery is a good candidate for robotic surgery,” said Schwaitzberg. “We tell our patients they should refrain from smoking.” In addition, exercising is key. Exercising at any age is essential to good health. It becomes even more paramount as you get older because you are fighting the uphill battle of aging. Physicians recommend regular exercise such as regular walks. Even 20 minutes of activity a day, three times per week, provides benefits. Thirty minutes every day is even better. “Ideally, a patient should be exercising regularly. Something as simple as walking can make a great difference,” he added.
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“Well written and very informative.” Mary Reich, Bowmansville “I love the front page and all the relevant articles Alex Jasinski, Buffalo “Informative and Interesting as I am sick a lot.” Pamela Taschetta, North Tonawanda “Interesting and informative articles. Health tips, recipes, health news.” Holly Weisenberger, Tonawanda “All articles are so informative.” Joyce Dean, Buffalo “Various health and medical conditions covered. Easy to read and understand.” Mary Morse, Buffalo
“Very good Information. I will distribute it at work.” John Hayne, Lancaster “Quite informative and in language I can understand.” Donna Dobucki, West Seneca “Very Informative.” Gary Wolf, North Tonawanda “I love the Savvy Senior column.” Cheryl Massett, West Seneca “The article on what to do if a loved one dies is wonderful and very important to me. The article on social security was very informative. I love the paper and will probably order it.” Louis Gagola, Cheektowaga May 2018 •
“I love your newspaper so much that I am doing things to make my life better to live better.” Anthony Bryant, Buffalo “Many up-to-date concerns & remedies along with stories.” Patty Fedile, Blasdell “Knowledgebale articles, easy to read. Great topics for life styles. Thank you!” Jennifer Allen, Buffalo “Current info on health issues and events in the area.” Maryann Gullo, Grand Island “Very good articles that feature local healthcare professionals Jillian Marks, Orchard Park “Variety of articles. Very good paper.” Tomas McNulty, Orchard Park
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Live Alone & Thrive
By Gwenn Voelckers
Practical tips, advice and hope for those who live alone
Embracing Faith: ‘You Are Never Alone’
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his year, Easter and Passover overlapped. While the two celebrations are very different, they share common themes: spring and hope. The coinciding of these two holidays reminded me of the healing power of faith and a conversation I had with Teresa Jackson, one of the most thoughtful and inspiring women I’ve met through my Live Alone and Thrive workshops. She is now happily remarried. Her faith lifted her up and carried her through the darkest times. Her journey may inspire yours. n Would you care to share a little bit about your faith? I’m a Christian. I’ve looked at other religions and have made a conscious decision to remain a Christian, even though I don’t understand it all. n What role did your personal faith play in your adjustment to living alone? My Christian beliefs hold to the tenet that I am never alone — that Christ is with me wherever I am. I’ve prayed a lot and have found indescribable peace in that praying. n What was the biggest challenge you faced living alone and how did your faith help you heal? Grieving the end of my marriage
caused me the most pain while alone. All the ‘what ifs and why mes’ really tore at my heart. “The Purpose Driven Life,” by Rick Warren, and other inspiring Christian books helped me get things into perspective. I also listened to Christian radio programs. Talking to girlfriends was also a huge part of my healing. n Is there a particular experience you had that captures the power of your faith? My son was 7. After dinner he brought me his homework book to sign, as this was his teacher’s daily requirement. He’d been at his dad’s house the previous three days and I saw his dad’s girlfriend’s signature on the parent line in the book. Something snapped — all the weeks my precious children were away from me ... all the awfulness ... all the hatred and injustice and fear. I sucked it up and forced my shaking hand to sign my name next to hers. I made my way outside, stumbling in the cold, and collapsed under my pear tree. I laid on my back clutching my chest, my heart. No tears. Just intense pain. I did not, could not, make a sound nor move, but after a while
Nursing: Is the BSN Worth It? By Deborah Jeanne Sergeant
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eginning in 2020, new registered nurses will be required to earn their bachelor’s in nursing (BSN) within 10 years of their initial licensure. Existing RNs will be grandfathered in. But is earning the BSN worth it? Yes, according to Cheryl Nosek, doctor of nursing science, professor and chairwoman of the nursing department at Daemen College in Amherst. More baccalaureate-trained nurses promotes better care, she said. Nosek cited a 2003 research by nurse Linda Aiken, PhD, at the University of Pennsylvania, which states that increasing the number of baccalaureate-trained nurses improves patient outcomes. “It’s definitely a step in the right direction for health care,” Nosek said. “The research shows that hospitals with 10 percent more of baccalaureate-trained nurses than associate-trained nurses have a 7 percent decrease of patient death. She’s done several studies herself and found similar results. We have pretty convincing evidence it makes a difference.” In addition to improved patient outcomes, Nosek also thinks it Page 10
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will help nurses. Many health care organizations want bachelor-trained nurses, especially for positions in management and leadership. “There are definitely more opportunities for baccalaureateprepared nurses,” Nosek said. “Hospitals are looking for bachelor’s prepared nurses. If you don’t get it, the positions are more like in skilled nursing facilities. If you really want to work in a hospital, to secure that position, the BSN will be a tremendous help.” She added that even lateral moves within a hospital, or re-hire by the same organization, often require a bachelor’s degree. Nearly all positions for nurses involving research, technology or education require the BSN. Without the additional education, these higher-paying positions are usually out of reach. Physician extenders — physician assistants and nurse practitioners — are in greater demand to help fill in the gaps because of the physician shortage. Baccalaureate-trained nurses can further help extend the care because of their additional training.
my mind prayed a lament, begging God for relief from this excruciating pain. In that instant, a ‘peace that passes all understanding’ moved over me and I felt my golden retriever, Kyla, appear and quietly curl up next to my body. n Did you ever lose faith or struggle to regain your faith? I did not lose my faith but, boy, did I ever have a few words with God! One morning during breakfast with my two young boys, I ran to the garage and grabbed my bike after just learning of another injustice the boys endured. I needed to get out of the house so the boys wouldn’t hear my rant at their father. I tore down the road, enraged and screaming at God, ‘How could you let this happen?!’ About a half mile from home, I saw a doe standing by an apple tree by the side of the road. I calmed down immediately and just sobbed. I turned the bike around just as the sun burst over the horizon, washing the sky, the quiet country road, and me in orange light. I was reminded again ‘You are never alone.’ n What advice would you give to those whose suffering has challenged their faith? Remember a time when you risked it, trusted God, and felt pretty good after you did. Remember that, ‘This, too, shall pass.’ Remember that there are things we can only learn when we are alone. That God has a bigger plan than our plan. n What do you find most rewarding about your faith? I feel like I have a purpose in life. My job is to be a servant to God. He’s the boss of me! The thing is, I need to figure out each day what he’d like
me to do with the time and resources he has put in my care. n What role does prayer play in your life? Prayer is the great wireless communication connection to God. God speaks to us in three ways, (1) through the Bible, (2) through people, which includes books people write and teachers like you, and (3) through prayer, which includes sending things in nature to us for comfort like sunrises, dogs, and deer. n How can those who live alone activate their faith more fully? It’s like exercise and eating right. You get out of it what you put into it. You prepare your body for the years ahead by keeping moving and putting good things into it. You prepare your mind for the times ahead by studying your faith, whichever faith you choose, and putting good things into your mind, like good music, good words, and good visuals. n Was there a favorite scripture passage that lifted you up during your challenging times that you’d like to share with my readers? ‘Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.’ Philippians 4:6-7
RNs often serve on multidisciplinary teams where many of the other members have received at least bachelor’s level training, such as occupational and physical therapists. “That doesn’t mean RNs are not good nurses,” Nosek said. “The BSN add something to the nurse’s critical thinking and clinical skills. It’s not that RNs don’t provide good care.” Most schools’ RN-to-BSN program takes one year full-time or two years part-time. Because many RNs are still working when they want to earn their BSN, many schools work with students to offer online classes that they can work on at any time. Many health care institutions work with RNs through tuition reimbursement programs because they want to employ more BSNs. Any hospital with “magnet status” actively seeks baccalaureatetrained nurses. The American Nurses Credentialing Center began its magnet recognition program in 1993. The hospitals with magnet status demonstrate more satisfaction among their RNs, low nurse turnover and improve patient outcomes. Nosek said that magnet status empowers nurses at the bedside and gives them more control over how they practice. By employing more baccalaureate-trained nurses, hospitals can better achieve their goals. The organizations are also required to hire more BSN employees, especially for nursing
leadership roles. Michele McKay, certified nurse educator and president of the Professional Nurses Association of Western New York, said that further training helps nurses keep pace with the dramatic changes in healthcare that has taken place in the past 20 years. She holds a master’s degree in nursing. “We’ve seen a lot of changes in technology and the systems that care for patients,” McKay said. “With all the changes, the complexity of health care has increased dramatically. There are much fewer in-patient beds than there were even 10 years ago. Today’s RN has to be able to make a lot of independent, critical decisions, sometimes in very independent settings.” Health care systems and insurance have also become much more complex. McKay said that baccalaureate training can help nurses better navigate these issues. “We by all means support all levels of RN, but our mission is to educate and promote professionalism in nursing for the benefit of our community,” McKay said. “It’s not like an associate’s degree nurse isn’t a skilled, educated practitioner who provides good care.” Whether a BSN or RN, nurses sit for the same board examinations. “The bachelor’s degree that promotes greater engagement in how to make effective change for our patients and communities,” McKay said.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • May 2018
Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive empowerment workshops for women held throughout the year in Mendon, N.Y. For information about her workshops, book, or to invite her to speak, call 585-624-7887, email gvoelckers@rochester.rr.com, or visit www.aloneandcontent.com.
Catholic Health System Named Leader in Maternity Care Culture of nurturing, feeling of family part of success By Jana Eisenberg
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culture emphasizing family, nurturing and quality care is one of the things that makes the Catholic Health System and its labor, maternity and neonatal facilities top of mind for women and families selecting a place to give birth in Western New York. So says Anthony Pivarunas, chairman of obstetrics and gynecology at Catholic Health’s Sisters of Charity Hospital in Buffalo. Catholic Health’s other hospitals in Buffalo include Kenmore Mercy, Mercy and Mount St. Mary’s. It’s not just their focus on fulfilling their mission, or feedback from thousands of patients and their many “repeat” customers. Catholic Health’s attention to service and quality care was recently recognized as part of BlueCross BlueShield of Western New York’s Blue Distinction Specialty Care program. Both Sisters of Charity and Mercy hospitals were named “Blue Distinction Centers for Maternity Care.” Another important piece of evidence is that in 2017, more than 6,000 babies were delivered in all of Catholic Health’s facilities — and according to New York State Department of Health statistics, Sisters Hospital delivered more
babies than any other hospital west of Syracuse. A recent visit to Sisters found Pivarunas both describing and demonstrating how this culture fosters loyalty, love and success. “We — physicians, residents, nurses, midwives and all of our staff — try to create a culture of care, to go by ‘the golden rule’ — we treat each other the way we’d want to be treated,” said Pivarunas. “We try to provide our patients and families with the care and treatment that we’d want for our own family member.” A point of pride and proof is the staying power of many of Catholic Health’s maternity, labor and delivery, and neonatal nurses. During an impromptu tour, Pivarunas glowingly pointed at colleagues in nursing stations, asking them to state how many years — most in decades — that they had been there. Aimee Gomlak, Catholic Health’s vice president for women’s services, adds that other elements help the system’s care stand out. Joint training for doctors, nurses and midwives helps strengthen the services they can offer and builds a team culture. No ‘secret sauce’ “There’s no ‘secret sauce,’” said
Losing a Baby By Julie Halm
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Physician Anthony Pivarunas of Catholic Health’s Sisters of Charity Hospital in Buffalo. ““We try to provide our patients and families with the care and treatment that we’d want for our own family member,” he says. Cause unknown
Program at Catholic Health helps mothers and fathers who have lost a baby other’s Day is a joyful time for many families. But for mothers who have lost their children during pregnancy or shortly after birth, it can be an emotionally challenging day and grieving both openly and internally can be a difficult process. The Footprints on the Heart program provided by Catholic Health in Buffalo seeks to help mothers and fathers who have lost a baby as a result of miscarriage, ectopic pregnancy, stillbirth and newborn death. There are several terms that arise when discussing the loss of a baby during pregnancy or shortly after birth, and the particular terms are not often discussed or widely understood. According to the Centers for Disease Control, a miscarriage is typically defined as the loss of a baby prior to the 20th week of pregnancy, and at any point after that, it is considered a stillbirth. In the case of an ectopic pregnancy, the fetus develops outside the uterus, typically in a Fallopian tube, which does not allow for the proper development of the fetus.
Gomlak. “Our people work so well together partly because they train together. It shores up any individual weaknesses and capitalizes on everyone’s strengths. “They really see each other as a team. We also have incredible leadership and a supportive atmosphere for nurses.” Gomlak and Pivarunas say this all translates to quality patient care and results. “When women come here, they know they have options,” said Gomlak. “For example, if they don’t want to, they don’t have to be in a bed when they’re giving birth. They can labor in a tub, with a peanut ball, or in another position. They can breastfeed or not. If they’re giving birth by C-section, they may choose a clear surgical drape, which allows them to see and be more a part of the procedure.” At Sisters’ newly completed
A newborn or neonatal death is the passing of a baby within the first 28 days of life, and can be caused by birth defects, premature birth, low birth weight and several other factors. According to Amy Creamer, licensed mental health counselor who facilitates the group, mothers and fathers are welcome if they have lost an infant who doesn’t fall into the 28day parameter. For many, discussing these types of loss openly can be difficult, and all too often can be met with a less-than-positive reception. “We have an expectation that we will have to bury our parents, or even our siblings or spouses. But we don’t think about having to bury our children. It kind of goes against the natural order of things,” said Creamer. That discomfort can lead to people shying away from discussing the topic or openly offering support to grieving parents, said Creamer. This societal hush can also lead to a lack of understanding as to the prevalence of these types of loss.
According to the CDC, one in every 100 pregnancies that reach the 20-week mark will end in a stillbirth. While some risk factors have been identified, such as smoking or smoke exposure during pregnancy and preexisting medical conditions including high blood pressure and diabetes, the cause of many stillbirths is still unknown. “Stillbirth occurs in families of all races, ethnicities and income levels, and to women of all ages,” states the CDC’s website. The occurrence of miscarriages is even more common. According to the March of Dimes, of women who know they are pregnant, between 10 and 15 percent will experience a miscarriage. March of Dimes is a nonprofit organization that seeks to improve the health of expecting mothers and their infants, including aiming to prevent birth defects, premature birth and infant mortality. Additionally, roughly one out of every 100 women will experience two or more miscarriages in a row. According to the American Pregnancy Association, 1 out of 50 pregnancies are ectopic. An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. The difficult nature of these topics often results in their absence from public discourse, causing those who are dealing with such a loss to
May 2018 •
In 2017, more than 6,000 babies were delivered in all of Catholic Health’s facilities — more than any other hospital west of Syracuse. Level III neonatal intensive care unit for babies 23 weeks and older, the hospital provides a state-of-the-art space that can accommodate more of these youngest patients and where families can even stay while their infants are receiving treatment. In addition to labor and delivery services and perinatal testing, and Sisters Hospital’s NICU, Mercy Hospital has a Level II NICU (32 weeks and older), and Mount St. Mary’s has a Level I NICU that can accommodate babies at 37 weeks and older. “We’re over the national percentage of nurses who receive electronic fetal monitoring certification,” attested Gomlak. “One hundred percent of our nurses are EFM certified. That’s partly because of our focus and training. So, they all know how to understand the monitoring results the same as a physician or resident. We are also at 100 percent certification for everyone in the neonatal resuscitation program.” “In our work, we look at what the common safety issues are around labor and delivery,” Pivarunas said. “We look at our outcomes and how we can improve for the future. Cars are safer than they used to be, and so are hospitals in general. We’re all human and need to make things better.” feel isolated. Around Mother’s Day, those who have lost a pregnancy can often feel that their loss goes unacknowledged. “As a culture, we don’t really recognize those women as mothers, which can be really difficult, especially this time of year,” said Creamer. “A mom who doesn’t have any live children but has gone through a loss or multiple losses is very much a mother.” Creamer said what parents who have suffered these losses are grieving is different, but no less painful than other types of losses. “When you lose someone like your grandma, you’re grieving the memories,” she said. “What these parents grieve are the hopes and dreams that never became memories.” For those looking to comfort and support loved ones who have lost a baby during or shortly after pregnancy, Creamer suggests simple acknowledgments, such as a “Thinking of you” card or a phone call or message to check in, which could go a long way. The Footprints on the Heart support group meets at 6 p.m. on the first Tuesday of every month at the Piver Center Conference Room, 2121 Main St., Buffalo. The next meetings will be on May 1 and June 4. It is strongly recommended that those interested in attending RSVP to Creamer at 862-1678 in order to be aware of any potential scheduling changes.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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SmartBites
The skinny on healthy eating
crumbs and egg. Refrigerate mixture for 10 minutes. Divide mixture into 4 portions and shape into 1/2-inch thick patties. Place on a lightly oiled baking sheet. Bake at 425°F for 8 minutes, flip; then cook for 7-8 minutes more. Meanwhile, combine ingredients for spicy aioli in a small bowl and mix well. Top burgers with spicy aioli and garnish of choice.
Slim Down with Shiitake Mushrooms
W
ith swimsuit season right around the corner, many of us are looking to drop a few pounds. But how do we stick to our diets when some of the lower-calorie foods are so blah? Mushrooms, including shiitakes, may be the ticket, as they provide a big blast of deliciousness for very few calories. One cup of cooked shiitakes, for example, has only 80 calories and next to no fat. Make your next burger with half beef and half chopped shiitakes — and you’ll have a tasty patty with half the calories and fat. Low calories notwithstanding, shiitakes contribute to weight management by providing enough protein and fiber to keep us feeling fuller longer. According to a recent study on satiety published in the journal of “Appetite,” those who ate a mushroom-rich meal experienced less hunger, greater fullness, and decreased prospective consumption compared to those eating meat. More research — conducted at the University at Buffalo — indicated that mushrooms may help with weight loss by regulating blood sugar. The preliminary study examined how plant-based glucose can aid in normalizing blood sugar, which then supports the essential hormone balance needed to shed pounds.
Peter Horvath, associate professor in the department of exercise and nutrition science at UB, suggested that both a mushroom’s dense phytonutrients and antioxidants work together to nourish cells and level blood sugar. Beyond being a dream diet food, this rich-flavored mushroom contributes more nutrition than you might think. Shiitakes are a knockout source of copper, selenium and vitamin B5 (pantothenic acid), nutrients we need to keep our systems running smoothly. An essential trace mineral, copper joins with iron to form red blood cells and helps maintain healthy bones, blood vessels, and nerves. Selenium is a powerful antioxidant that fights oxidative stress and helps defend the body from chronic diseases, such as heart disease and cancer. And vitamin B5 plays a role in energy metabolism, red blood cell production, and nerve function. All three keep the immune system humming. Lastly, shiitakes contain unusually high amounts of two antioxidants — ergothioneine and gluthatione — that some scientists suggest could help fight aging and bolster health, according to a team of Penn State researchers. Few mushrooms boast such high levels.
Shiitake-Black Bean Burgers with Spicy Aioli Adapted from One Green Planet Serves 4
For the Burgers: 1 tablespoon olive oil 2 cups shiitake mushrooms, stems removed, finely diced 15-ounce can unsalted black beans, drained and rinsed 1/4 cup finely chopped red onion 3 garlic cloves, minced 2 teaspoons lower-sodium soy sauce 1/2 teaspoon salt 1/4 teaspoon coarse black pepper 1/4 cup breadcrumbs 1 beaten egg For the Spicy Aioli: 1/2 cup plain Greek yogurt 1 garlic clove, minced 2 teaspoons hot sauce (recommend: Sriracha) 2 teaspoons fresh lime juice
Preheat oven to 425°F. Heat olive oil in large skillet over medium heat. Add onions and garlic and sauté until lightly browned, about 4 minutes. Add mushrooms and cook 3 minutes more, just until mushrooms start to soften. Remove from heat. Place beans in large bowl and mash. Stir in sauté mixture along with soy sauce, salt, pepper, bread-
Helpful Tips
If available, buy loose over prepackaged shiitakes (so you can inspect quality) and store in a partially open zipperlock bag, which maximizes air circulation without drying out the mushrooms. Look for shiitakes with the thickest caps you can find and avoid those that appear wet, slimy or shriveled. Take a whiff: they should smell earthy not sour or fishy. Keep packaged shiitakes in their original containers and simply rewrap those not used in the box with plastic wrap. Quickly rinse shiitakes before cooking, or simply wipe the caps with a damp paper towel; remove tough shiitake stems with a sharp paring knife.
Anne Palumbo is a lifestyle colum-
nist, food guru, and seasoned cook, who has perfected the art of preparing nutritious, calorie-conscious dishes. She is hungry for your questions and comments about SmartBites, so be in touch with Anne at avpalumbo@aol.com.
Blood Pressure: Understanding the New Guidelines New parameters mean more Americans have high blood pressure By Jim Miller
I
f you’re unsure what your blood pressure levels should be, you’re not alone. Recent changes in the hypertension guidelines made by the American Heart Association and the American College Cardiology mean that roughly 30 million more Americans than previously thought are now considered to have high blood pressure (hypertension). According to the new guidelines, anyone with a blood pressure reading above 130/80 is considered to have high blood pressure. Previously, those with a blood pressure reading between 120/80 and 139/89 would have been put in the prehypertension category and wouldn’t have been considered hypertensive until they got to 140/90. But the new guidelines eliminate the prehypertension category, putting everyone with systolic pressure readings (top number) between 120 and 129 and a diastolic reading (bottom number) below 80 in a new “elevated” category. And those with a reading of 130/80 or higher fall in some stage of hypertension. Here’s Page 12
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a complete rundown of the new five category blood pressure ranges: • Normal: A top number less than 120 and a bottom number less than 80. • Elevated: A top number between 120 and 129, and a bottom number less than 80. • Stage 1: A top number between 130 and 139, or a bottom number between 80 and 89. • Stage 2: A top number of 140 or higher, or a bottom number of 90 or higher. • Hypertensive crisis: A top number over 180 or a bottom number over 120. Millions of Americans with high blood pressure don’t know they have it because it usually has no outward signs or symptoms. But high blood pressure, over time, can damage your arteries and increase your risk for heart disease, stroke, kidney damage and even dementia. To guard against this, everyone over the age of 40, as well as those younger with risk factors for hypertension should get
their blood pressure checked at least once a year. If you find that your blood pressure numbers fall in the “elevated” category, you should take steps now to get it under control. Lifestyle changes like eating a healthy diet, losing weight, exercising, watching your salt intake, quitting smoking and cutting back on alcohol is often all you need to get it back to normal. Even if your blood pressure numbers are in the “stage 1” category, lifestyle changes are recommended first, unless you’ve had a heart attack or stroke, or you’re at high risk for cardiovascular problems because you smoke, have high cholesterol or Type 2 diabetes. Then medications may be prescribed. But if your blood pressure falls in the “stage 2” or higher category, the new guidelines suggest medication, regardless of age, plus lifestyle
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • May 2018
changes. There are several different kinds of drugs used to lower blood pressure. It usually makes sense to start with the oldest, safest, and least expensive drug: diuretics or water pills, such as chlorthalidone or hydrochlorothiazide. But these meds can drive up blood sugar levels, so if you have Type 2 diabetes or are at risk of it, your doctor may prescribe another drug, such as an ACE inhibitor, ARB or calcium channel blocker. You should also be aware that blood pressure drugs could cause side effects including dizziness, gastrointestinal problems, fatigue and headaches. They can also cause a decline in kidney function so make sure your doctor periodically monitors your potassium levels. For more information, see the American Heart Association comprehensive web page on high blood pressure at Heart.org/HBP.
Golden Years “We understand now how nutrients and hormones in the body contributes to aging,” Kaplan said. “We know how to monitor those and this will continue to form the antiaging medicine boom. Replacing hormones can improve quality of life. Anti-aging is the hottest thing on the menu.”
4.
Smoking “Smoking is one of the top three health habits that cause half of morbidity and mortality,” said Robert Stall, MD and CEO of Stall Senior Medical, LLC in Amherst.
8 Health Issues Affecting Baby Boomers
5.
By Deborah Jeanne Sergeant
M 1.
any issues affect the health of older adults. Area experts weighed in on eight of them.
Alzheimer’s disease The number of people in New York with Alzheimer’s disease is expected to increase by 15 percent in the next seven years. “As we look at risk reduction and prevention, one of the things we’re looking at is how can we detect this disease at its earliest form,” said Cathy James, cochairwoman of the New York State Alzheimer’s Association Coalition. “We’re working on early detection at this point because we don’t have biomarkers. Clinical trials are going on to determine what those biomarkers are. Perhaps then, some of the medication that hasn’t shown efficacy at a certain stage would have more effect with individuals who are pre-clinical symptoms.” Age and genetics represent leading risk factors for Alzheimer’s disease. At present, nothing cures Alzheimer’s disease, but taking a few preventive steps may help delay onset for some of those who will develop the disease: exercise, maintaining physical health, proper diet, keeping the brain active and social interaction.
“Restorative sleep is also a factor that may recharge our brains,” James said.
2.
Physical decline “Fitness and exercise is huge,” said Leonard Kaplan, physical medicine and rehabilitation doctor at Osteopathic Wellness Medicine of Western New York Buffalo. “Maintenance of muscle strength and flexibility is a top anti-aging strategy. You can keep better balance and prevent falls, since that’s a huge problem, contributing to broken hips.” “Falls are not a natural part of aging,” James said. “Older adults do have control and can reduce that risk.” She said that maintaining well-lit environments without hazards such as throw rugs, clutter and extension cords helps prevent falls. People concerned about falling should consider taking fall prevention classes, as well as engaging in exercise that increases strength and balance.
3.
Hormone imbalance As human age, hormone production ratchets down and can become out of balance.
Nutrition “Poor nutrition contributes to so many diseases,” Stall said. “Nutrition is another of the top three health habits.” Dietitian Erin Burch, owner of Erin Burch Nutrition, PLLC in Orchard Park, advises older adults to cut back on high-sodium, high-sugar and nutrient-void foods by “making half of your plate vegetables,” she said. Many older adults fill up on simple carbohydrates, especially between meals, so eating right can help. “Be sure to include protein with every meal,” Burch said. That promotes satiety. Beverages can contain many empty calories. Burch advises clients to use water, not sweetened beverages or juice, for hydration. “Key nutrients to focus on include omega-3, vitamin D, vitamin B12, iron, and calcium,” she added.
6.
Preventive Medicine “The last of the three health habits is seeking the vaccinations and screenings you need from your doctor,” Stall said. Many health issues can be prevented, cured or mitigated if caught early.
7.
Polypharmacy While it can be dangerous — even lifethreatening to abruptly stop taking
medication — polypharmacy refers to taking many unnecessary medications or medication that should not be taken together. “With senior patients, medicine misuse and overuse is a gigantic problem,” Stall said. “People think the pharmacy catches all these problems in the computer for interaction. But the problem isn’t drug interaction but drug side effects that impact quality of life and could be predisposing to illness and death. That is still a major issue.” Stall uses an app to compare symptoms to medications patients take to reduce unwanted side effects and contraindication.
8.
Social isolation Seniors who spend too much time alone are at higher risk for depression. Isolation has also been associated with higher risk for dementia. “Our society is not set up like those in the past where multiple generations live in the same household and towns were smaller and more intimate,” Stall said. “People would see seniors every day. Many feel ignored and a burden.” He added that about 150,000 people over age 65 live in the communities of the eight counties comprising Western New York. “Many of those have trouble with transportation, even to go out to see their friends, let alone get to their doctor,” Stall said. “My priorities at this point in my career is to address social isolation.” The problem is pretty widespread, according to Laurie Laugeman, board certified holistic nurse and chapter leader of the American Holistic Nursing Association Western New York Chapter. “I wish more people would visit with them,” she said. She visits an elderly aunt weekly to learn sewing and crafts. Laugeman believes the visits “give her a strong purpose,” she said. “She has a lot of pain and mobility issues. I think the visits give her something to look forward to and to focus on the projects we’re working on. It’s a win-win.”
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Golden Years
US Lifespan Decreasing By Deborah Jeanne Sergeant
M
uch of the emphasis in modern medicine has focused on longevity. We want to live longer, healthier lives. But according to a December 2017 report from the Centers for Disease Control and Prevention, the expected lifespan of Americans has gone down. This breaks the trend of increasing lifespan. Men’s lifespan went shrank to 76.1 years, a drop of two-tenths of a year since the last report released in 2015. Women’s lifespan stayed at 81.1. Experts offered a few ideas as to why lifespan isn’t increasing — and it’s not only older people dying earlier, though individuals with health issues contribute toward the figures. “This generation, the 80-yearolds and seniors, have a stronger constitution and are healthier than in previous generations — They’ll live longer,” said Laurie Laugeman, board-certified holistic nurse who serves as the chapter leader of
the American Holistic Nursing Association Western New York Chapter. But that doesn’t mean that the current generation of middle-aged people are always making the right health choices. “As with anything, you get some people who know how to make changes and are motivated, but other chronic diseases are silent, like high blood pressure,” Laugeman said. “You won’t see the end result of not managing diabetes right away. But people get damage to their organs for not taking care of themselves. It’s really hard to change our lifestyles.” Instead of encouraging patients to enact many drastic changes, she encourages them to take small “baby steps” toward better health. Physician Robert Stall, CEO of Stall Senior Medical, LLC in Amherst, said fewer people are smoking than ever. Since many of the tobacco-related health issues take years to develop, it will take more time to demonstrate that antismoking campaigns are extending
lifespan. “The percentage of people who have heavy smoking habits has gone down,” Stall said. “When they get older, they’re not dying from smoking-related problems like they used to.” Overall, he believes that more older people are aging better and not dying sooner than seniors used to. Once a person survives to his 80s, Stall said most have a good chance of living into the 90s. Stall thinks that the longevity statistics have more to do with younger people dying prematurely from risky behaviors. In 2016, accidental drug overdoses killed more than 63,600 Americans, a jump of 21 percent in the previous year, and most of those were for people under age 55. “I think it’s most likely that younger people are dying at a higher rate because of the opioid epidemic,” Stall said. In 2007, the suicide rate per every 100,000 people was 11.27, according to the CDC. By 2016, it had steadily
increased to 13.42. While a relatively small factor, the increase contributes to the shortened lifespan statistics and represents the 10th leading cause of death.
“Stay active and multitask physically, like ballroom dancing or Zumba,” Durwall said. If the exercise involves learning and retaining skills, such as taking a martial arts class, that may offer more benefits, as would exercise that’s social in nature, such as participating on a sports team. Involving music could also promote more brain activity while in motion, such as a dance class. Older adults can still benefit from exercise, including improving overall health, possibly reducing the need for certain kinds of medication (with doctor approval), and supporting brain health. Though exercise offers numerous benefits to body and mind, it can’t guarantee lifelong cognitive health. Genetics, nutrition, social engagement and advanced age all represent other risk factors for cognitive decline. Physician Robert Stall, CEO of Stall Senior Medical, LLC in Amherst, said that the small size of the
Swiss study cannot establish a causal relationship between exercise and protecting cognitive ability; however, lifelong fitness brings so many other benefits, it’s worth pursuing. He said that fitness helps prevent falls, maintain healthy weight, lower blood pressure and cholesterol and keep muscles strong. “We don’t know enough about what causes demenStall tia to know what about exercise could prevent it,” Stall said. “It’s exciting if there is something that exercise can change the physiology to prevent dementia.” Before undertaking any change in nutrition or exercise, consult with a health care provider. A personal trainer may offer helpful advice for exercising safely and effectively.
What Kills Americans Based on 2015 data, the CDC listed the leading causes of death in order from most to least common as: • Heart disease: 633,842 • Cancer: 595,930 • Chronic lower respiratory diseases: 155,041 • Accidents (unintentional injuries): 146,571 • Stroke (cerebrovascular diseases): 140,323 • Alzheimer’s disease: 110,561 • Diabetes: 79,535 • Influenza and pneumonia: 57,062 • Nephritis, nephrotic syndrome, and nephrosis: 49,959 • Intentional self-harm (suicide): 44,193
Aerobic Exercise Key for Brain Health Practice helps prevent cognitive decline, say experts By Deborah Jeanne Sergeant
A
erobic exercise may offer protection from cognitive decline, according to two recent studies. • Researchers at the University of Southern California in Los Angeles in 2017 published a report showing that about one-third of Alzheimer’s disease cases could be prevented through changes in habits — including exercise. • A small study by the Center for Aging and Health at the University of Gothenburg in Sweden showed up to a 90 percent reduction in dementia associated with fitness regimens begun by women in their 50s who were followed for the next 44 years. Very few of the fittest women experienced dementia. The benefit lessened for women who were active, but not as fit, according to the study. Although any activity is better than no activity, an occasional stroll to the mailbox or quietly puttering in the garden won’t do it. To achieve this positive effect, the World Health Organization recommends that people 65 and older participate in at least 150 minutes of moderate to 75 minutes of intense activity every week. You may not dream of achieving a buff beach body, but staying fit may benefit the brain. Other studies indicate that Page 14
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starting younger in life offers the most benefit, but “it’s never too late to start,” said Cathy James, co-chairwoman of the New York State Alzheimer’s Association Coalition. “Sometimes we think of high impact, but even moderate exercise may help us lower our risk for things like Alzheimer’s disease and it can contribute to brain health.” Richard Durwall, 83, is known as “Mr. Fitness” at senior centers throughout the Buffalo area where he leads fitness classes. A lifelong athlete, Durwall personally vouches for the benefits of fitness. “Yes, there’s a connection there between fitness and reducing risk of Alzheimer’s,” he said. Several years ago, he said he met a well-known expert in Alzheimer’s disease. Durwall said that he was told the cutting edge research is pointing to exercise as the best way to reduce risk of this type of dementia. “Your mind is a reflection of your physical being to a great extent,” Durwall said. He encourages people to find activities that involve the mind and the body at the same time or that can be varied to engage the mind, such as taking a different route walking or biking.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • May 2018
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By Jim Miller
What to Know About the New Medicare Cards 5945 Vinecroft Drive Clarence Center, NY 14032 (716) 741-7741
Dear Savvy Senior, What can you tell me about the new Medicare cards? I’ve heard there are a lot of scams associated with these new cards and I want to make sure I protect myself.
“Fun and Friendship Begin Here”
Leery Senior Dear Leery, The government will soon be sending out brand new Medicare cards to 59 million Medicare beneficiaries. Here’s what you should know about your new card along with some tips to help you guard against potential scams. New Medicare Cards Starting in April 2018, Medicare will be removing Social Security numbers from their new Medicare cards, and begin mailing them out to everyone who gets Medicare benefits. The reason for this change is to help protect your identity and reduce medical and financial fraud. The new cards will have a randomly generated 11-character Medicare number. This will happen automatically. You don’t need to do anything or pay anyone to get your new card. Medicare will mail your card, at no cost, to the address you have on file with the Social Security Administration. If you need to update your official mailing address, visit your online Social Security account at SSA.gov/myaccount or call 800-772-1213. When you get your new card, your Medicare coverage and benefits will stay the same. If you have a relative or friend who lives in another state and gets their card before you, don’t fret. The cards will be mailed in waves, to various parts of the country over a 12-month period starting in April, and ending April 2019. Medicare beneficiaries in Alaska, California, Delaware, the District of Columbia, Hawaii, Oregon, Pennsylvania, Virginia and West Virginia will be the first to receive the mailings, between April and June. The last wave of states will be Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio and Tennessee, along with Puerto Rico
and the Virgin Islands. When you get your new Medicare card, don’t throw your old one in the trash. Instead, put it through a shredder or cut it up with a pair of scissors and make sure the part showing your Social Security number is destroyed. If you have a separate Medicare Advantage card, keep it because you’ll still need it for treatment.
Independent Living For Seniors Over the age of 62 Springtime Soiree April 18th at Noon A special kid friendly luncheon for seniors and their families
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Watch Out For Scams As the new Medicare cards start being mailed, be on the lookout for Medicare scams. Here are some tips: n Don’t pay for your new card. It’s yours for free. If anyone calls and says you need to pay for it, that’s a scam. n Don’t give personal information to get your card. If someone calls claiming to be from Medicare, asking for your Social Security number or bank information, that’s a scam. Hang up. Medicare will never ask you to give personal information to get your new number and card. n Guard your card. When you get your new card, safeguard it like you would any other health insurance or credit card. While removing the Social Security number cuts down on many types of identity theft, you’ll still want to protect your new card because identity thieves could use it to get medical services. For more information about changes to your Medicare card go to Go.medicare.gov/newcard. And if you suspect fraud, report it to the FTC (FTCcomplaintassistant.gov), AARP’s fraud help line, 877-9083360, or your local Senior Medicare Patrol program. Go to SMPresource. org for contact information. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.
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ay “annual checkup” and most people imagine waiting at the doctor’s office. But there’s another type of checkup that can give you a sense of wellness without even leaving home. Visit www.socialsecurity.gov and follow these five steps to conduct your own Social Security annual checkup. Your Social Security statement is available online anytime to everyone who has a my Social Security account at www.socialsecurity.gov/myaccount. Creating your account gives you 24/7 access to your personal information and makes it impossible for someone else to set up an account in your name. We still send paper statements to those who are 60 and older who don’t have an account and aren’t receiving Social Security benefits. Your statement provides information about work credits (you need 40 credits to be entitled to a Social Security retirement benefit), estimates for retirement, disability, and survivors benefits, plus a history of your earnings. • Work Credits Count — If you have earned 40 work credits, your statement will show estimates for retirement, disability and survivors benefits. If you don’t have 40 work credits, the statement shows how many you have and how many you still need to qualify for benefits. • Review Earnings Record — Review your history of earnings year by year to make sure each year is correct. This is important because Social Security benefits are based on your lifetime earnings. If any years are incorrect or missing, you may not receive all the benefits you are entitled to in the future. If you need to correct your earnings, contact Social Security at 1-800-772-1213 between 7 a.m.
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • May 2018
and 7 p.m. Monday through Friday. Please have your W-2 or paystubs when you call. • Study Benefit Estimates — Review the section titled “Your Estimated Benefits.” Be sure to review not only your retirement estimate, but your disability and survivors estimates. No one likes to think about disability, but a 20-year-old worker has a one in four chance of becoming disabled before reaching retirement age, underscoring the importance of disability benefits. Since the value of the survivors insurance you have under Social Security may be more than your individual life insurance, be sure to check your survivors estimates also. • Calculate Additional Estimates — You can use our Retirement Estimator to compute future Social Security benefits by changing variables such as retirement dates and future earnings. If you want to project what future earnings could add to your benefit, visit www.socialsecurity. gov/estimator. • Schedule Your Annual CheckUp — Each year, make a date with yourself to review the most recently posted year of earnings on your Statement. By checking your record every year, you can be certain when you retire that Social Security will have a correct record of earnings to use when computing benefits for you or your family members. Social Security helps you secure your today and tomorrow by providing information to make your financial planning easier. Social Security is more than retirement; it is a family protection plan. For more information about benefits, visit us at www. socialsecurity.gov.
Eric Clapton announced earlier this year he was losing his hearing and was diagnosed with tinnitus — or ringing in the ears.
Occupational Hearing Loss is Preventable Expert: ‘Noise-induced hearing loss is permanent. It typically occurs gradually over months and years’ By Deborah Jeanne Sergeant
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arlier this year, rock and blues musician Eric Clapton, 72, said that he was losing his hearing and was diagnosed with tinnitus — or ringing in the ears. Noise exposure commonly causes tinnitus. While one-third of those between 65 and 74 have hearing loss, according to the National Institute on Deafness and Other Communication Disorders in Bethesda, Md., occupational exposure such as Clapton’s can cause hearing damage at younger ages. Occupational Safety and Health Act (OSHA) states that employers must monitor noise exposure at 85 decibels (db) that occurs for eight hours’ continuous exposure; however, sole proprietors, independent contractors and entrepreneurs often don’t concern themselves with sound safety while working. Certain occupations require
ability to hear well while working, which can make wearing hearing protection less desirable. Christine Graf, audiologist with Amherst Audiological Services in Amherst, said that noise exposure at small, family businesses and sole proprietorships “is an issue often overlooked.” Graf said that use of hearing protection across the industries in the past several years has increased; however, the rise in freelancers who typically aren’t as concerned about OSHA safety standards may be increasing the number of people who will suffer hearing loss. In a Forbes article published Jan. 10, contributor David Pridham stated that “freelancers already comprise 35 percent of the U.S. workforce — or 55 million workers in the U.S.— and they are expected to reach 43 percent of the workforce by 2020.” He also quoted a study by
Lawrence Katz of Harvard and Alan Krueger at Princeton which found that “’94 percent of net job growth in the past decade was in the alternative work category. And over 60 percent was due to the [the rise] of independent contractors, freelancers and contract company workers.’ In other words, nearly all of the 10 million jobs created between 2005 and 2015 were freelance.” While some people envision acute, loud sounds as damaging to hearing, Graf said that long-term exposure to even moderate to loud sounds affects hearing. “Noise-induced hearing loss is permanent,” Graf said. “It typically occurs gradually over months and years. Individuals often don’t realize how much they’re losing.” Eventually, the individual notices difficulty in hearing in the higher frequency range in certain situations, like listening to a granddaughter
speak in a crowded restaurant, but not in all situations. Or, a person may perceive that more people mumble or that they need to turn up the television louder to hear it well. At this point, the person may not see the need for a hearing examination. Although people should protect their hearing during leisure time as well as while working the duration of exposure at work can hasten hearing damage. “Typically, any type of noise where you would leave that environment and have ringing in the ears, that could indicate there’s the beginning stage of damage,” Graf said. Phone apps that act as a sound meter can indicate if the noise level could cause hearing damage, based on the sound intensity and duration. Personal protective equipment (PPE) can help mitigate the effects of occupational noise. Graf said that even small, foam ear plugs can help; however, the larger, over-the-ear muffs offer better protection. Plus, users can easily don them or remove them as they need to. For musicians, Graf recommends ear plugs that allow a full range of sound, but at a lower level. They cost around $120 to $150. Other specialty plugs work better for communication. How close the person is to the noise source and any pre-existing hearing loss also make a difference. “Even shorter loud sounds should be measured,” said Ron D’Angelo, audiologist with Clear Choice Hearing and Balance in Greece and Brighton. “Let’s say it’s not continuous but impulse noises of a short duration. They won’t know unless they have it checked out by a calibrated sound meter over a period of time.” Michelle Gross, member of the Hearing Loss Association of America Rochester Chapter board of directors, is also certified as an occupational hearing conservationist. “You can call a sound engineer, but some of it is common sense,” Gross said. “If you run a landscaping business where you’re on a lawn mower and use a weed whacker eight hours a day, that may be 85 db. That’s already the threshold set by OSHA for eight hours.” Phone apps may also give an idea of sound exposure over the duration of the workday. While OSHA’s regulation is a general rule, Gross said that some people with more sensitive hearing may be affected by lesser sound. PPE can reduce the decibels by the number that they’re rated. For example, a 75 db rating would reduce a 100 db sound to the effect of only 25 db. “If I were in business where there’s loud equipment, I would use my common sense and wear hearing protection,” Gross said.
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H ealth News Bariatric surgery group welcomes new doctor Trinity Bariatric Surgery is pleased to welcome physician Bala Thatigotla to its practice. An accomplished surgeon with more than 10 years of experience, Thatigotla performs a wide range of bariatric and complex abdominal surgeries at Sisters Hospital in Buffalo and its St. Joseph Campus in Cheektowaga. Board certified in general surgery and metabolic Thatigotla and bariatric surgery, Thatigotla completed a surgical residency at the Albert Einstein School of Medicine/Bronx Lebanon Hospital Medical Center in the Bronx and a fellowship in advanced laparoscopic/bariatric robotic surgery at Vanderbilt University Medical Center in Nashville, Tenn. He earned his medical degree at Sri Venkateswara Medical College in Tirupati, India, and completed post-graduate training in general surgery at The Royal College of Surgeons of Edinburg, United Kingdom. Thatigotla will see patients at Trinity Bariatric Surgery offices in Cheektowaga.
Brooks-TLC Hospital has new VP of operations Brooks-TLC Hospital System in Dunkirk has announced the appointment of Kenneth R. Morris as its vice president of operations, effective April 23. Morris brings 17 years of health care leadership experience, most recently as director of North Texas Morris Division of Neuroscience and Baylor University Medical Center, part of Baylor Scott & White Healthcare System , Dallas. In his role as member of the senior leadership team, Morris will lead day-to-day operations at Brooks Memorial Hospital and TLC Health Network. He will be responsible for development and oversight of division strategic and operational plans, growth and business development initiatives, operational quality initiatives, and the creation of high performing work teams in the areas of primary care clinics/ physician practices, pharmacy, imaging, laboratory, plant operations and safety, environmental services, nutritional services, bio-medical services, and fundraising. “Ken brings to us the leadership, Page 18
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experience and breadth of knowledge to oversee our hospitals and support us in taking our health system to the next level of service and excellence,” said Mary LaRowe, president and CEO of Brooks-TLC Hospital System, Inc. “Ken will be an integral member of our team as we move toward formal affiliation with Kaleida Health,” LaRowe said. “In addition to his extensive skills, Ken’s experience in hospital construction and redevelopment will be invaluable as we build the new Brooks Memorial Hospital and engage the future development of the TLC campus as a center of excellence for ambulatory services. He brings a successful track record of physician recruitment, environmental safety and emergency management and expansion of outpatient service lines,” LaRowe said. Morris holds an MBA from the University of Texas at Arlington and a BS in Health Administrative Services from Weber State University, Ogden, Utah.
BCBS: $1M grant to ECMC’s trauma center
Erie County Medical Center (ECMC) Corporation announced a $1 million grant for the hospital’s future trauma center / emergency department from the region’s leading health plan, BlueCross Blue Shield of Western New York. “This contribution is made on behalf of our members and is specifically focused on the need to expand behavioral health and detoxification care pathways in a more holistic way, starting at the point of admission, which is most often via ECMC’s emergency department,” said David W. Anderson, president and CEO, BlueCross BlueShield of Western New York. “We were particularly impressed with ECMC’s commitment to expand and enhance care pathways as part of their planned trauma Ccenter/ emergency department expansion.” ECMC Corporation President and CEO Thomas J. Quatroche Jr., PhD, said,”ECMC is deeply appreciative and thankful to BlueCross Blue Shield of Western New York for their commitment to ECMC’s critically important behavioral health and detoxification services, which often are connected directly to the hospital’s planned expansion of our trauma center/ emergencydepartment. The design of the new ED will create dedicated space for these patients, separate and apart from the medical treatment area.” In addition to being one of the largest chemical-dependency treatment centers in Western New York, ECMC is the only Buffalo-area hospital that offers a psychiatrist in the emergency room and chemicaldependency evaluations, both 24 hours a day, seven days a week.
Eastern Niagara, Kaleida Health one step closer
The New York State Department of Health Public Health and Health Planning Council recently voted to approve Kaleida Health’s active parent model with Eastern Niagara Hospital. “More progress, which is great news,” said Jody Lomeo, the president and CEO of Kaleida Health. “We thank the Department of Health for their belief in our organization and the opportunity to improve health care in Niagara County. It’s a win for the patients we serve.” A handful of state and federal regulatory agencies must still sign off on the affiliation. Those should occur in the near future. Under terms of the proposal, Kaleida Health will become the active parent of Eastern Niagara Hospital. Eastern Niagara Hospital Lockport & Newfane sites, ENH Ambulatory Care Center/Lockport Imaging Center and the Western New York Occupational Health Center will all become part of the Kaleida Health family. Officials say it is not a merger. ENH will remain a separate legal entity with a separate board of directors (advisory) that will develop recommendations to Kaleida Health’s board, which will have ultimate responsibility for Eastern Niagara Hospital. Eastern Niagara’s plan to build a new emergency department continue to move forward and will be done with the support of Kaleida Health. The plan is to build a new 21,000 square foot facility near the East Avenue entrance of the 134-bed hospital. The $8.2 million project calls for 16 private treatment rooms.
HealthNow‘s CEO Tom Schenk joins NYeC The New York eHealth Collaborative (NYeC) announced the recent appointment of HealthNow New York Inc. Chief Medical Officer Thomas Schenk to its board of directors. Three other professionals have also been appointed to the board. They are Jordanna Davis, president of healthcare consulting firm Rockingstone Schenk Group, Rochester Regional Health Chief Information Officer John Glynn and Onondaga County Commissioner of Health Indu Gupta. “We’re thrilled with the addition of these esteemed individuals to our board,” said David Klein, chairman, NYeC board of directors. “Their experience and background will bring new areas of expertise and complement the strengths of our existing board members.”
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In a press release, NYeC noted that Schenk is a well-regarded community pediatrician. “He joined HealthNow New York Inc., the parent company of BlueCross BlueShield of Western New York and BlueShield of Northeastern New York, in 2014 as senior vice president and chief medical officer. He’s served as managing partner of Delaware Pediatric Associates and was a founding member of the Optimum Physician Alliance, a mirror independent physician association in Western New York” NYeC also notes that Schenk serves on the board of HEALTHeLINK, the Buffalo Pediatric Society, the Population Health Collaborative, the March of Dimes WNY chapter and the West Buffalo Charter School. “I’m excited about the opportunity to connect our region’s focus on clinical information sharing with the successes of other areas represented by my fellow board members,” said Schenk. “As both a pediatrician and health plan executive, I view the work being done through SHIN-NY as essential to elevating the quality, integration, and sustainability of healthcare in New York state.”
Children’s Hospital Foundation has new VP
Andrew Bennett has been named vice president, of the Children’s Hospital Foundation. He joined Kaleida Health in 2017 and has been working as the director of business development at Oishei Children’s Hospital. “We are thrilled to have someone like Andrew leading our fundraising efforts for Children’s Hospital,” said Jody Lomeo, president and CEO of Kaleida Health. “In his short time in the organization, he has made an immediate and tangible impact. He brings a level of energy and passion that further positions us for success moving forward. We couldn’t be more excited.” Allegra Jaros, president of Oishei Children’s Hospital, said, “Andrew is passionate about our community, the health and well-being of our moms and kids. He is creative and collaborative. As the new leader of the Foundation, I am excited to work with him on behalf of the moms, babies, children and families that we serve.” Bennett has significant fundraising and nonprofit experience. Prior to joining Kaleida Health, he served as the executive director for The First Tee, a youth education program. He previously held roles as account executive for the United Way of Niagara and the United Way of Buffalo and Erie County. Bennett is a Western New York native who received his bachelor’s degree in political science from the University of North Carolina, Chapel Hill. He will be completing his master’s degree in communication and leadership from Canisius College in 2018.
Doctor Salaries Show Modest Rise, Report Says Survey shows salaries of male doctors remain much higher than their female counterparts
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rimary care and specialty doctors in the United States have seen a modest increase in earnings this year over last year, according to the Medscape Physician Compensation Report 2018. The increases reflect a continued rise in doctors’ income over the past seven years. While there are many reasons involved, the main one comes down to the basic rules of economics. “The fact remains that the physician workforce is relatively stagnant in terms of growth and that demand for physician services keeps rising. The result, inevitably, is more spending and higher incomes for physicians,” said Tommy Bohannon, vice president of Merritt Hawkins, a doctor recruiting firm. The overall average doctor salary — including primary care and specialties — sits at $299,000. The average salary for primary care doctors is $223,000, compared with $217,000 in 2017. For specialists, it’s $329,000 this year, compared with $316,000
last year. Top-earning specialties with the highest average salary include: • Plastic surgeons: $501,000 • Orthopedists: $497,000 • Cardiologists: $423,000 • Gastroenterologists: $408,000 • Radiologists: $401,000 The lowest-earning specialties, on average, are: • Internal medicine: $230,000 • Family medicine: $219,000 • Diabetes and endocrinology: $212,000 • Pediatrics: $212,000 • Public health and preventive medicine: $199,000 As in prior years, male doctors earn more than female doctors. Male primary care doctors earn $239,000, almost 18 percent more than women, who earn $203,000. Male specialists earn $358,000, about 36 percent more
than female specialists, who earn $263,000. Also as in previous years, white doctors earned more than those of other races. Here’s how they ranked: • White: $308,000 • Asian: $293,000 • Hispanic/Latino: $278,000 • African-American: $258,000
New York Ranks Nearly Worst State for Docs
To make it worse, physicians have experienced cuts of about 10 percent almost every year for the past decade, according to Kaplan. Meanwhile, costs increase. “That creates a horrible working environment and mental stress and forces the physician to see more patients,” Kaplan said. “You have to squeeze more people in the hour.” The time required to take electronic medical records during visits — or transcribe them later — have further squeezed cash-strapped practices. The records require more questions per visit. If a doctor doesn’t check off every box and include the required wording in each area of the chart, he doesn’t receive reimbursement for the visit. Instead of focusing on patients, doctors’ noses are buried in laptops as they fire off questions and tap in patients’ responses, he said. Kaplan said when he began practicing, nurse practitioners and physician assistants worked at a ratio of one per physician. Now physicians hire three to four of these “extenders” to see more patients. While extenders are well-trained, their education is not as extensive as a physician’s. Kaplan said that doctors function more like managers rather than spending time caring for patients. “Physicians are retiring earlier than they would because they’re tired of the system,” Kaplan said.
High premiums for medical malpractice insurance one of the reasons By Deborah Jeanne Sergeant
T
he personal finance website WalletHub recently released its report on 2018’s Best & Worst States for Doctors. New York came in third from last, meaning only Rhode Island and New Jersey are worse states in which to practice. South Dakota, Nebraska, Idaho, Iowa and Minnesota ranked as the top five best states. The report included 16 key metrics, which includes average annual physician wages to the quality of the public hospital system. For doctors practicing in New York, the outlook is grim. In the following categories, the Empire State rated: • 49th — Average annual wage of physicians (adjusted for cost of living) • 42nd — Average monthly starting salary of physicians (adjusted for cost of living) • 51st — Hospitals per capita • 16th — Insured population rate • 28th — Projected percent of population aged 65 & older by 2030
• 46th — Projected physicians per capita by 2024 • 49th — Malpractice award payout amount per capita • 50th — Annual malpractice liability insurance rate Leonard Kaplan, doctor of osteopathic medicine, is board-certified in pain medicine and in physical medicine and rehabilitation. He said insurance hassles were a main reason he founded Osteopathic Wellness Medicine of Western New York Buffalo. He also practices at the Dent Neurological Institute. “New York has more oversight than federal regulations on physicians,” Kaplan said. He believes that the state’s insurance model and reimbursement is very restricting on how physicians practice medicine. “You felt like you’re working for the insurance company and I think New York is probably one of the worst,” Kaplan said. “Buffalo, specifically, has one of the lowest reimbursements in the country.”
Who’s Up, Who’s Down? Is It Fair? Psychiatrists are seeing the big-
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gest gains in compensation this year (+16 percent). “We have never seen demand for psychiatrists this high in our 30-year history,” said Bohannon. “Demand for mental health services has exploded, while the number of psychiatrists has not kept pace. The short version is that aging produces many mental health challenges, including dementia and its associated pathologies, and that societal ills, such as the opioid crisis, are driving the need for more mental health professionals.” Other specialists who’ve gotten notable boosts in pay are plastic surgeons (+14 percent), physical medicine and rehabilitation specialists (+13 percent), oncologists (+10 percent), and rheumatologists and critical care specialists (+9 percent). Specialties earning less include general surgery (-9 percent), urology (-7 percent), otolaryngology,diabetes and endocrinology (-4 percent), and pathology and neurology (-2 percent). Overall, 55 percent of doctors feel that they’re fairly compensated. And for the third year in a row, doctors cited “gratitude/relationship with patients” as the most rewarding part of their job (27 percent), followed by “being very good at what I do/finding answers, diagnoses” (24 percent) and “knowing that I’m making the world a better place.”
“It’s an apprenticeship model. You can’t learn medicine from books. When you lose the older, experienced physician, you lose the opportunity for learning for the next generation.” Barbara Greenwald, executive director of the New York State Osteopathic Medical Society, said that the high rate of medical malpractice suits in New York has complicated the delivery of medical care. As a result, doctors must pay high premiums for medical malpractice insurance to protect themselves. She said that her organization and the Medical Society of the State of New York have been lobbying for a cap on emotional damage claims. “We don’t get very far,” she said. “Lawyers are more apt to go into politics than doctors.” She said that doctors in Downstate New York struggle to make enough money to afford the high cost of living in the city, since insurance reimbursements are so low. Here in Upstate, health organizations struggle to attract enough care providers to meet the needs. “To draw docs to sparsely populated areas, you need to enhance the infrastructure,” Greenwald said. “It’s a more complex problem. To attract physicians, they’ll want amenities and a hospital nearby. Some doctors are going back to making house calls. It should be ‘prescriber prevails’ instead of the insurance company deciding on cost.” To read the entire WalletHub report, visit https://wallethub.com/ edu/best-and-worst-states-for-doctors/11376.
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By acting today, we can heal tomorrow’s traumas.
Nicholas Ball, Trauma Patient
Karen Beckman-Pilcher, RN, Clinical Nurse Specialist of Emergency Services
Amy Terpening, Traumatic Brain Injury Survivor
Michael Manka Jr., MD, Chief of Emergency Medicine
Donna Oddo, Nursing Care Coordinator Emergency Department
As Western New York’s only Level 1 Adult Trauma Center, the future of healthcare at ECMC is clear. With a steady rise in patient volume, we know that more of our neighbors will depend on our lifesaving trauma and emergency care more than ever before. And with your support, they’ll receive it in a new facility with state-of-the-art technology, more space and privacy, and designed for better experiences and outcomes for patients and their families.
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