| keeping_physicians_engaged | Keeping Physicians Engaged | WSMA_Reports | Shared_Content/News/Latest_News/2019/March/keeping_physicians_engaged | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/Reports-Mar-April-Website-645x425.jpg" class="pull-right" /></div>
<h5>March 12, 2019</h5>
<h2>Keeping Physicians Engaged</h2>
<p>
By Pat Curry
</p>
<p>
When a longtime patient of Bruce Nitsche, MD, made a donation to the Virginia Mason Foundation, the patient asked if Dr. Nitsche could be involved in how to use the funds. A study from the Mayo Clinic found that sharing a meal helped with physician engagement; the foundation used some of the donated funds to try it.
</p>
<p>
"I called up the head of nutrition services and said, 'Do you think you could get the chefs to cater a lunch in the doctor's dining room once a month?'" Dr. Nitsche said.
</p>
<p>
They started with Cinco de Mayo, complete with Mexican music, mocktails, and handmade tortillas; it was a tremendous success.
</p>
<p>
"It was just fun," Dr. Nitsche said. "I remember sitting at a table with a longtime urologist and one of the newer internal medicine doctors. They had shared a lot of the same patients, but they had never met, and they introduced themselves to each other."
</p>
<p>
The lunches are just one way Virginia Mason, MultiCare Health System, Allegro Pediatrics, and other systems are addressing issues presented in Stanford Medicine's 2018 Physician and Advanced Practitioner Wellness Survey, commissioned by WSMA and the Washington State Hospital Association. Notably, the survey found that 42 percent of the surveyed physicians were moderately or highly likely to leave their organization within two years.
</p>
<p>
"It costs $500,000 to $1 million to replace a doctor who leaves, quits, or cuts down on their practice," Dr. Nitsche said. "It's a huge financial burden on the organization."
</p>
<p>
And it's not going to go away, said Scott Hansen, MD, who heads up Virginia Mason's psychiatry consultation service and professional staff engagement.
</p>
<p>
"What younger physicians will accept as working conditions is different than what physicians would accept several decades ago," Dr. Hansen said. "They aren't willing to spend 120 hours a week in a hospital."
</p>
<p>
Dr. Hansen noted that research very clearly shows what physicians believe to be important in their practice experience. Physicians want an electronic health record system that supports both good care and reduces time spent on activity that doesn't feel meaningful. They seek a sense of community and want to understand that they have the support of their supervisors.
</p>
<p>
"Developing frontline leaders is critical; it has so much to do with the experience of physicians over time," Dr. Hansen said.
</p>
<h3>Giving physicians more flexibility</h3>
<p>
Physician-owned Allegro Pediatrics, which has about 100 physicians working in eight locations, began studying physician burnout about three years ago. A physician survey focused on scheduling, how long physicians had with their patients, what their day looked like, and what was getting in their way of doing their jobs.
</p>
<p>
"The providers were saying they needed more support," said Tiffany Spanier, MD, who works in Allegro's Bellevue location. "It was very clear this was something we needed to address."
</p>
<p>
The results led to discussions about choice, flexibility, and autonomy, Dr. Spanier said. Physicians can pursue a partner track, a locums position, or a time-limited contract. Senior physicians have the choice of decreasing their call nights and weekend shifts, which lets them feel less burdened.
</p>
<p>
New physicians receive an extensive orientation and a mentor, and all physicians know that if they need to be out of the office for a family emergency, "the coverage is there immediately," she said. "That support is a huge sense of relief."
</p>
<p>
The practice also offers three-month paid sabbaticals to let physicians recharge and refresh. "A lot of them use that time to do research; others travel," she said. "We have a lot of part-time providers working in endeavors outside our practice: travel medicine, research; I'm teaching mindfulness. We're finding ways to give them the opportunity to pursue their passions."
</p>
<p>
Allegro continues to survey its physicians and encourages them to talk to clinic leadership. Dr. Spanier said she's going into clinics and starting conversations with physicians to "give them the framework to speak up even more.
</p>
<p>
"A lot of times, providers think the responsibility for burnout is going to land on their shoulders, and we don't want that," she said. "We don't want this on their shoulders. We want to continue to address it systemwide; we want them to know they're not alone."
</p>
<h3>Finding better workflow</h3>
<p>
It's not uncommon to hear physicians say they're being offered personal solutions, such as resilience training, to tackle systemic problems. MultiCare Health System is addressing that point with its Provider Wellness Team. The two-pronged approach offers free, confidential counseling and practice optimization consulting to address the pain points in a physician's practice.
</p>
<p>
"Eighty percent of burnout is the result of the workplace environment," said MultiCare practice optimization consultant Ellie Rajcevich. "Being able to provide that support has been a cornerstone of our program."
</p>
<p>
Most often, physicians contact the team because they're frustrated with some aspect of how their practice is running. For example, an internal medicine physician called because she had reduced her FTE from full time to .8 "to keep her head above water," Rajcevich said. "Even then, she was using days off to work. If the problem is all this work, reducing the FTE doesn't address the root of the problem."
</p>
<p>
To find solutions, the team starts by shadowing the physician.
</p>
<p>
"We look at the processes and what that physician's time and the team's
time looks like," Rajcevich said. "The teams we work with don't have the chance to step away from all the things they have to do every day. Having someone come in and say, 'This is what your work could look like' is an interesting experience for them."
</p>
<p>
Sometimes, dictation software or a medical scribe proves helpful. Other times, the consulting team identifies a task that is unnecessary or could be completed by someone other than the physician, such as responding to MyChart patient messages.
</p>
<p>
Quite often, part of the solution involves dealing with the Epic electronic records software. That's such a big part of a physician's workload that the consulting team is adding dedicated Epic trainers "so they can access what they need accurately and quickly."
</p>
<h3>Small steps toward a solution</h3>
<p>
All these efforts help, but they just scratch the surface of addressing what makes so many physicians consider leaving their jobs, Dr. Nitsche said.
</p>
<p>
"What needs to be done is make the job require less resilience to survive it," he said. "The whole health care system is troubled. It's like living in a dysfunctional family; you need to fix that. But you can also make people feel better along the way."
</p>
<p>
<em>Pat Curry is WSMA Reports' senior editor.</em>
</p>
</div> | 3/12/2019 4:04:33 PM | 3/12/2019 3:59:58 PM | 3/12/2019 12:00:00 AM |
| at_higher_risk | At Higher Risk | WSMA_Reports | Shared_Content/News/Latest_News/2019/March/at_higher_risk | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/Reports-Mar-April-Website-645x425.jpg" class="pull-right" /></div>
<h5>March 8, 2019</h5>
<h2>At Higher Risk</h2>
<p>
By Marcia Frellick
</p>
<p><em>Members only, sign-in required</em></p>
<p>
Jessica Bloom, MD, a family physician in Bellingham, knows the dark corners of burnout and knows when she's getting near them. Sensing those danger zones is part of an ongoing self-care strategy forged during a five-year time period when the "good Midwestern girl who is always fine" actually wasn't.
</p>
<p>
Dr. Bloom, now 45, looks back at that time when, in addition to practicing medicine, she was the wife of a family physician, the mother of three children under the age of 10, and the sole caregiver for her aging father.
</p>
<p>
She describes feeling empty. She forgot to attend some of her kids' events. She got angry when someone at work told her she hadn't completed her charts. She asked her husband why he stayed with her when she wasn't so sure, in his shoes, if she could.
</p>
<p>
"I felt so tired," she said. "All I wanted for my birthday was to be alone."
</p>
<p>
Bloom said her patient care never wavered, though she admits she may have been less engaged with some. But she felt torn about whether she should spend more time at work, where she was handling things well, or more time with her family.
</p>
<p>
Safety nets are easier to build when certain numbers of physicians meet the definition of burnout, she said, but what the numbers don't reveal are that many physicians are "just a 'something' away from a crisis"—a patient's bad outcome, a fight with a spouse, a death in the family, or a personal illness.
</p>
<p>
Experiences like Dr. Bloom's spurred the WSMA and the Washington State Hospital Association to commission Stanford Medicine's WellMD Center to survey physicians and advanced practitioners about burnout and professional fulfillment. The report found that 43 percent of Washington's physicians and advanced practitioners are experiencing burnout, compared with the national benchmark of 36 percent. Additionally, 34 percent reported they are fulfilled professionally, lower than the national average of 41 percent.
</p>
<h3>No health care organization beat both benchmarks</h3>
<p>
Jennifer Hanscom, WSMA's chief executive officer, said that the most surprising result of the survey was that no large medical groups, hospitals, or health systems in Washington beat the national benchmarks for both burnout and professional fulfillment.
</p>
<p>
"With the investments that the WSMA and many medical systems and groups have put into leadership development, I thought that more groups, particularly those in a strong physician-led culture, would have had a higher professional fulfillment score," she said.
</p>
<p>
She said she was also deeply concerned, as the results support that growing numbers of physicians may be on a tragic path. Some studies have shown that about 400 physicians nationally die by suicide each year.
</p>
<p>
The WSMA has targeted burnout and lack of fulfillment since 2014 when it launched Healthy Doctors, Healthier Patients, which is aimed at drawing attention to how increasing administrative burdens affect physicians and threaten optimal patient care.
</p>
<p>
Before that, the attitude in medicine was that physicians needed more skills to increase resilience. In other words, Hanscom said, it was physicians' responsibility to take care of themselves. Thinking evolved away from individual responsibility into how to fix a broken system that is overwhelming physicians and employees.
</p>
<p>
In tackling the issue, the WSMA found a fitting partner in the Washington State Hospital Association, as the two groups regularly bring together medical officers to address issues related to quality and patient safety. "There was a recognition in our Medical Officers Collaborative that together, we could address the issue of burnout—this is our collective responsibility," Cassie Sauer, chief executive officer of WSHA said. "We decided to launch a statewide assessment of physicians and advanced practitioners to inform our work. It is so important for both the clinician and his or her patients that we create more support for wellness."
</p>
<h3>Four factors drive fulfillment and burnout</h3>
<p>
The survey results pointed out that four factors—gratitude, alignment between personal values and organizational values, control over schedule, and peer supportiveness—were independently linked with professional fulfillment and burnout.
</p>
<p>
Addressing those key areas may be the "secret sauce" in Washington, said Christopher Bundy, MD, MPH, executive medical director of the Washington Physicians Health Program.
</p>
<p>
He pointed out the scope of the survey was important: "The goal really shouldn't be just the reduction of burnout, but to really promote professional fulfillment, and this report provides some strong pointers to where we should look," he said.
</p>
<p>
A top area of concern, Dr. Bundy said, is organizational leadership, which had the most impact on burnout and professional fulfillment among the factors highlighted in the report.
</p>
<p>
"Physicians are often accidental leaders," Dr. Bundy explained. "They are good doctors who are respected by colleagues for their clinical acumen and their emotional intelligence who want to serve the profession and essentially volunteer to be in leadership roles, for which they have little training or experience."
</p>
<p>
Management is a science, he said, and physicians need leadership training and development, professional coaching, and leader certification programs. Complicating leadership is the rising turnover that occurs with mergers and acquisitions.
</p>
<p>
Increasing peer support will also be crucial in bolstering physician wellness, Dr. Bundy said. He pointed to the example set by Confluence Health in Wenatchee which, he said, was able to turn peer review into peer support.
</p>
<p>
"So often, peer review is thought to be a blame game," Dr. Bundy said. Peer review there focuses on discussion about how the organization can improve after a poor outcome, leading physicians to feel supported instead of interrogated.
</p>
<h3>Some strategies are inexpensive</h3>
<p>
Some of the problem areas identified have very inexpensive fixes. For example, a culture of gratitude is a strong driver of professional fulfillment, the survey noted.
</p>
<p>
This is simply the frequency with which physicians and advanced practitioners are thanked by leadership and how often health care providers are thanking the people they work with, said Mickey Trockel, MD, PhD, a clinical associate professor in psychiatry and behavioral sciences at Stanford and the primary developer of the survey measures.
</p>
<p>
Shifting culture can be a challenge, but the cost is low and if the thanks are sincere, it can be effective, he said. A culture shift also is needed to remove the stigma from seeking mental health treatment in medicine. Dr. Trockel pointed to higher anxiety levels in the survey for Washington physicians compared with the national benchmark and said reasons for that are worth exploring further.
</p>
<p>
Alignment between an organization's professed values and the way physicians see the organization's values is also important, he said. An example of misalignment might be an organization that says it values physician wellness but allows surgical residents to work more than 80 hours a week.
</p>
<p>
Hanscom said the WSMA will use the survey results to explore with national experts how to facilitate improvements at the practice level and through the association's advocacy agenda.
</p>
<p>
That support—and the ongoing focus on burnout from medical leadership across the state—is vital as physicians such as Dr. Bloom work to maintain a healthy balance between taking care of their patients and themselves.
</p>
<p>
If burnout is a 1-10 scale where "1 is Pollyanna" and 10 is the peak of despair, she said her worst days hit about a 7. With the help of a life coach and through her work as a leader of the Physicians' Wellness Alliance, she says she hovers around a 3. But she is well aware that the number can bounce and it's "a process and a practice to stay as whole as we can."
</p>
<p>
<em>Marcia Frellick is a freelance journalist who specializes in health care topics.</em>
</p>
</div> | 3/8/2019 3:02:28 PM | 3/8/2019 2:13:43 PM | 3/8/2019 12:00:00 AM |
| a_lonely_but_not_isolated_experience | A Lonely, but Not Isolated, Experience | WSMA_Reports | Shared_Content/News/Latest_News/2019/March/a_lonely_but_not_isolated_experience | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMAReports-Extras-Website-645x425.jpg" class="pull-right" /></div>
<h5>March 6, 2019</h5>
<h2>A Lonely, but Not Isolated, Experience</h2>
<p>
David Gavareski, MD
</p>
<p>
David Gavareski, MD, practiced family medicine for more than 30 years at Family Health Associates in Bellingham. Retired in 2018, Dr. Gavareski shared his experience with burnout with <em>WSMA Reports.</em> To read more about the work WSMA is doing to support physician wellness, visit the <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA_Reports_Archive/WSMA/News_Publications/Publications/WSMA_Reports_Archive/WSMA_Reports_Archive.aspx?hkey=d3cb4400-8f2b-4fd4-9e4f-f970296623b3">WSMA Reports archive</a> and look for the March/April 2019 edition.
</p>
<p>
<strong><em>WSMA Reports: What was your experience with burnout?</em></strong>
</p>
<p><strong>Dr. Gavareski</strong>: My personal experience has a significant component of addiction and chemical dependency. When I was a child, I had asthma, and there was little to treat it other than vaporizer and cough syrup. I always felt better, but thought it was the vaporizer. Later, when I took codeine cough syrup, I felt much better, more relaxed, and had more energy. I never dreamed that occasional use, either for a cough or to relax, would lead to addiction. And with a "candy store" full of samples readily available in the late ’70s and early ’80s, that process was helped along. As with most drugs of addiction, the initial good feelings were never replicated. Ultimately, that added to my stress, worries, and frustrations over not being able to control my use.
</p>
<p>
Following medical school, residency, and beginning practice, I experienced significant stress as I coped with the arrival of a daughter, an extremely busy practice and trying to live up to all of the expectations. I did not do a good job balancing time and priorities. It was difficult to deal with the pressure to succeed and to try to be the best.
</p>
<p>
The burnout I experienced in a highly demanding profession and family life, coupled with a disease that I was not able to control or cure on my own, became terribly oppressive. I clearly had a problem, but I was extremely fearful of the consequences of admitting it.
</p>
<p>
<strong><em>What was key to healing and what kept you in medicine?</em></strong>
</p>
<p><strong>Dr. Gavareski</strong>: Ultimately, through an intervention with my wife and a counselor, I went to treatment at a local recovery center, which was the best decision I had made in years. I was introduced to 12-step recovery (which I have actively participated in since) and referred to what would become the <a href="https://wphp.org/">Washington Physicians Health Program</a>. Learning that there was a positive way to deal with the addiction as well as learn to live a more balanced life, I began a journey which, though difficult, has provided me with tools, advice, and relationships that added to my personal, professional, and family life.
</p>
<p>
WPHP has been an amazing partner and mentor. The fears I had about having to be involved with a state-sponsored monitoring program were unfounded. While they are tasked with protecting the public, they are also extremely committed to helping physicians and other professionals regain useful and productive lives, both professionally and otherwise.
</p>
<p>
<strong><em>Your advice for physicians suffering from burnout?</em></strong>
</p>
<p><strong>Dr. Gavareski</strong>: There are many of us who have been through the same difficulties, have found answers and a much better way of life. WPHP is an incredible resource. <a href="https://www.kavumd.org/">KAVU</a> and the wellness programs that are being developed have a potential to be a significant help. You don't have to be afraid to say something and seek help.
</p>
<p>
<em>Dr. Gavareski is part of the Physicians Wellness Alliance, as are Drs. Laura Backer, Richard Krebs and Jessica Bloom. Read their stories in the <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA_Reports_Archive/WSMA/News_Publications/Publications/WSMA_Reports_Archive/WSMA_Reports_Archive.aspx?hkey=d3cb4400-8f2b-4fd4-9e4f-f970296623b3">WSMA Reports archive</a>, March/April 2019 edition. They are available for speaking engagements. Call 541.543.7283 or write <a href="mailto:info@physicianswellnesalliance.org">info@physicianswellnesalliance.org</a>.</em>
</p>
</div> | 3/7/2019 12:25:24 PM | 3/6/2019 11:29:14 AM | 3/6/2019 12:00:00 AM |
| physicians_are_not_alone_in_the_journey | Physicians Are Not Alone in the Journey | WSMA_Reports | Shared_Content/News/Latest_News/2019/March/physicians_are_not_alone_in_the_journey | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMAReports-Extras-Website-645x425.jpg" class="pull-right" /></div>
<h5>March 6, 2019</h5>
<h2>Physicians Are Not Alone in the Journey</h2>
<p>
Richard Krebs, MD
</p>
<p>
Excerpts from this commentary by Richard Krebs, MD, appeared in the March/April 2019 print edition of WSMA Reports. Dr. Krebs practiced family medicine for 20 years, served as a surgical assistant for 18 years, and retired in 2015. Here, he shares his journey through burnout in the hopes that doing so will help others.
</p>
<p>
My relationship with burnout has been a long journey, a road I've travelled many times. In the past, there weren't many travelers who were willing to share in the journey, and it was a lonely path. Now, nearly 25 years later, more colleagues are sharing their experiences, and I don't feel so alone, so ashamed.
</p>
<p>
My journey began in the late 1980s and early '90s, when I finally realized and acknowledged I had nothing left to replenish my emptied emotional and physical well.
</p>
<p>
I had a loving family, a wife and two children, and a successful family practice. My joy was spending whatever time was necessary to be with my patients, and to "hear" the issues they brought to me. I was a doctor, but more importantly, I was a healer. I brought my heart to my practice every day and to every patient.
</p>
<p>
But as the business side of practicing medicine changed, it became more difficult to spend the time I thought was necessary to be with my patients. I was becoming emotionally and physically depleted. I was also less emotionally available to my family. My turning point was when, after a particularly difficult day, I had a fleeting thought of suicide while driving. I thought, "I just want to stop feeling like this. If I drive my car into the base of this bridge, it will all be over."
</p>
<p>
I sought help through counseling, personal growth groups and exercise. I was prescribed antidepressants for depression and stimulants for ADD in order to stay on task and see the number of patients necessary to maintain a viable private practice. I was physically and emotionally exhausted.
</p>
<p>
My wife and I attended a workshop titled "Physician Heal Thyself" in San Diego in February 1993. At that workshop, I realized I wasn't alone in my struggles and was able give a name to what I was going through: physician burnout.
</p>
<p>
After that conference, I was energized to work on healing myself and to offer support to others going through similar struggles. My wife and I started a group in Bellingham that we called ADAPT (And Doctors Are People Too). Our group was open to physicians and their spouses. We met twice a month, shared our stories and offered each other support. I continued individual counseling and personal growth groups. I started giving talks about burnout to physician groups and healers in correctional medicine. For me, sharing was healing. I was a survivor.
</p>
<p>
After much thought and counseling, I made the decision to leave my private family practice after 20 years. My partners told me: "Rich, when you leave, the heart will leave our practice." But with the support of my family, friends and colleagues, I stopped practicing medicine in 1997 for six months, using that as a time to renew and reflect. I realized that the type of medicine and healing that nourished my soul was no longer viable in the current medical and reimbursement climate.
</p>
<p>
I needed to support my family and wanted to stay involved with medicine. So, I went to work in a university student health clinic and started assisting in surgery. The surgical assisting became a full-time practice. Although I no longer had a practice and patients of my own, I enjoyed the interaction and "healing" I was able to bring to the working relationships with the support staff in surgery. I created an emotional and time boundary in my new work that I was unable to sustain in my private practice. I continued to give talks on burnout and stayed involved with other physicians interested in talking about and supporting colleagues affected by burnout.
</p>
<p>
Several of us started <a href="https://www.physicianswellnessalliance.org/">Physician Wellness Alliance</a> to address issues of burnout. As a result of that, we do presentations, and implemented the <a href="https://www.kavumd.org/">KavuMD</a> concept and website where physicians can anonymously assess their personal risk of burnout as well as have access to teletherapy. Several of us are available to meet with any physician who might be struggling. We meet informally as individuals, listening with the heart of someone familiar with the journey of burnout, who cares and has survived.
</p>
<p>
Burnout affects each of us differently, it is so personal. It affects more than 50 percent of our medical community. There is no one solution that can be prescribed for all. I believe the best way to help other healers is to tell our story, to be vulnerable and available, to listen to their unique story. We should encourage our colleagues to get whatever support is necessary, either peer support or professional counseling to help them make whatever changes are necessary to make them whole.
</p>
<p>
I'm grateful to have passed through that dark time with my marriage, family and professional life intact. I feel I can give back by being there for other healers who might be struggling. So many people in the healing profession and other walks of life have lost their balance and forgotten why they chose to serve. Our hearts and ears must be ever vigilant to be a support, to listen and care. Physicians are not alone.
</p>
<p>
<em>Dr. Krebs is part of the <a href="https://www.physicianswellnessalliance.org/">Physicians Wellness Alliance</a> and is available for speaking engagements. Call 541.543.7283 or write <a href="mailto:info@physicianswellnesalliance.org">info@physicianswellnesalliance.org</a>.</em>
</p>
</div> | 3/7/2019 12:54:37 PM | 3/6/2019 10:59:30 AM | 3/6/2019 12:00:00 AM |
| sharing_struggles_yields_hope | Sharing Struggles Yields Hope | WSMA_Reports | Shared_Content/News/Latest_News/2019/March/sharing_struggles_yields_hope | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMAReports-Extras-Website-645x425.jpg" class="pull-right" /></div>
<h5>March 6, 2019</h5>
<h2>Sharing Struggles Yields Hope</h2>
<p>
Jessica Bloom, MD
</p>
<p>
WSMA Reports reported aspects of Dr. Jessica Bloom's story in the March/April 2019 cover story. In this online "extra," Dr. Bloom shares additional insights into her journey through burnout in the hopes that doing so will help others who share the same struggle.
</p>
<p>
I experienced "overwhelm" for decades as many of us in medicine do. There came a time when I felt like all of the important things in my life were like plates being spun on sticks: patient care, my kids, my marriage, my aging parent, and me too. I watched the plates wobble, but I couldn't figure out which to spin faster first. I knew something was going to drop.
</p>
<p>
When my father's wife died unexpectedly and I was suddenly his primary support again, I thought all the plates would fall. I cut back where I felt I could, but I couldn't make things better. I was depleted. I poured myself into my patients and my kids, but then I had nothing left for my physician spouse or for me.
</p>
<p>
I daydreamed about running away. But where to? What from? I wasn't sure. When I would share my fatigue, I was advised to go on a "retreat." When I shared my overwhelm from multiple call schedules, the advice was to cut back a part of my practice that I enjoyed.
</p>
<p>
What actually helped? When my dad got sick, I worked with a therapist. Then, I agreed to help an acquaintance who was training to be a life coach. I found that to be a way to externalize my thoughts and structure them for better perspective. In those appointments we discussed which plates I could put down and when. More importantly, we identified what I wanted to do that I couldn't because of the overwhelm.
</p>
<p>
I never wanted a solution that took me away from medicine. Some of the physician coaches out there have stopped practice, but I needed to find something that kept me whole to do the work I love.
</p>
<p>
Around this time, I was asked to spearhead a local physician wellness project. I needed to see if I could toss life lines to others. Incorporating compassion, connection, and creativity into the work became a gift that returned in kind.
</p>
<p>
Now I work on building a better safety net for physicians, such as <a href="https://www.kavumd.org/">KavuMD.org</a>, the <a href="https://www.physicianswellnessalliance.org/">Physicians' Wellness Alliance</a>, and the PeaceHealth Wellbeing Committee. Through all of that, we work on mindfulness opportunities for physicians, social gatherings to build community, working with our local hospital for improving spaces for physicians, trying to build a peer support system. All of this is extra work, but it is work that feeds me.
</p>
<p>
I like medicine so much more when I know my colleagues. I'm putting my heart into the work of wellness because I really love my docs. I get excited when I talk to others supporting physicians. In fact, each therapist I've interviewed to be a part of KavuMD has added to my thinking about how to support each other.
</p>
<p>
When our Physicians Wellness Committee presented a panel discussion on surviving physician burnout, it was one of our best attended county medical society meetings. I moderated the panel, but also shared my story because as the only physician mother on the panel, it rounded out the perspectives. Telling our stories is important in order to humanize the toll medicine can take.
</p>
<p>
Often with burnout we race to solutions: Get mindful! Cut back! Get a counselor! Get a scribe! Each of those may be very helpful, but if we don't start with connecting with the human story, the loneliness persists. And blame is heaped on the physician who just isn't getting it done.
</p>
<p>
In the time I've been working on physician wellness, my father has died, my kids are growing, life keeps marching forward. And I still dip into overwhelm. But mostly, I'm grateful, and I like my primary job as a physician.
</p>
<p>
On the day I wrote this article, I spent 40 percent of my clinic hours treating depression. That's the other thing about doing this work, it has given me tools to pass onto my patients. A physician who is supported into a healthier existence can have a huge ripple effect.
</p>
<p>
I'm working to be part of that ripple effect. I have been told by so many physicians in our community that the emails I send help them feel connected. Stories can do that. I'm sharing mine in hopes that it will be helpful.
</p>
<p>
<em>Dr. Bloom is part of the <a href="https://www.physicianswellnessalliance.org/">Physicians Wellness Alliance</a> and is available for speaking engagements. Call 541.543.7283 or write <a href="mailto:info@physicianswellnesalliance.org">info@physicianswellnesalliance.org</a>.</em>
</p>
</div> | 3/7/2019 12:54:38 PM | 3/6/2019 11:21:54 AM | 3/6/2019 12:00:00 AM |
| three_wellness_tips_for_residents | Three Wellness Tips for Residents | WSMA_Reports | Shared_Content/News/Latest_News/2019/March/three_wellness_tips_for_residents | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMAReports-Extras-Website-645x425.jpg" class="pull-right" /></div>
<h5>March 6, 2019</h5>
<h2>Three Wellness Tips for Residents</h2>
<p>
Elizabeth Parker, MD
</p>
<p>
Understanding and supporting physician wellness is a complex endeavor encompassing personal resilience, community, and system-level organization. From my own experience, and at the risk of sounding glib, it's not enough to have a yoga mat and expect to be well.
</p>
<p>
Instead, let's cultivate a wellness toolkit that supports optimal health within these major areas. Here's how it could play out for a trainee:
</p>
<p>
<strong>Personal resilience</strong>
We learn about Maslow's hierarchy of needs in medical school. But often, in training, our own base needs (sleep, water, food) may not be met. While resilience ideally goes beyond these basic needs, for many of us this would be a good first step. Recommendation: Sleep when you can, grab water for rounds, carry snacks in your pockets.
</p>
<p>
<strong>Community</strong><br />
Feeling connected and supported by your team, department, and mentors is key. Find your people. Recommendation: Check in with your peers, ask for help when you need it, and intentionally stay connected (see related article below).
</p>
<p>
<strong>System-level organization</strong><br />
There are aspects of modern health care that support physician wellness—thank you support staff! There are also aspects that drag us down, including EHR click fatigue, prior authorizations, lack of open hospital beds, etc. As trainees, while we may not have the power to change the organizational systems within which we work, we do have the opportunity to learn about organized medicine and the power of our collective voices. Recommendation: Join a departmental/institutional committee or a professional medical organization, such as the Washington State Medical Association. It's easy and free to join the WSMA!
</p>
<p>
<em>Elizabeth Parker, MD, is a pathology resident at the University of Washington Medical Center. </em>
</p>
</div> | 3/7/2019 3:40:02 PM | 3/5/2019 3:46:52 PM | 3/6/2019 12:00:00 AM |
| uw_residents_run_for_wellness | UW Residents Run for Wellness | WSMA_Reports | Shared_Content/News/Latest_News/2019/March/uw_residents_run_for_wellness | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMAReports-Extras-Website-645x425.jpg" class="pull-right" /></div>
<h5>March 6, 2019</h5>
<h2>UW Residents Run for Wellness</h2>
<p>
Elizabeth Parker, MD
</p>
<p>
As Saturdays dawn over Seattle, several University of Washington Medical Center pathology residents meet up to run for health, wellness, and support. The idea to organize group runs was born out of a desire to stay active, explore Seattle parks, and to connect with one another outside of work and away from the hierarchy of medicine.
</p>
<p>
The runs are open to all, and there are often residents from various levels of training running along with significant others, kids, and friends in tow. Occasionally attendings, trainees from other specialties, and physician assistants will join. The group sticks to Seattle-area parks and has even completed several races together.
</p>
<p>
While Saturday morning runs may not work for every physician group, the participants on these runs find wellness and leadership support. Here's what a few of them have to say about running together:
</p>
<ul>
<li><strong>Marie Perrone</strong>, PGY3 resident: "I never regret getting up on Saturday morning to go running with the resident running group: What could be better?" </li>
<li><strong>Alex Mays</strong>, PGY3 resident: "Running together is a great equalizer—it's a much more informal environment and we can connect about life outside the hospital." </li>
<li><strong>Chris Chandler</strong>, PGY2 resident: "The group has become a cornerstone of my weekends and I look forward to getting out and seeing the city." </li>
<li><strong>Angelica Lerma</strong>, PGY3 resident: "Making time to run has allowed me to get to know my fellow trainees and to become close friends."</li>
</ul>
<p>
Happy trails!
</p>
<p>
<em>Elizabeth Parker, MD, is a pathology resident at the University of Washington Medical Center. </em>
</p>
</div> | 3/7/2019 3:40:14 PM | 3/5/2019 3:56:07 PM | 3/6/2019 12:00:00 AM |
| in_appreciation_wsma_member_dr_richard_dick_whitten | In appreciation: WSMA member Dr. Richard Whitten | WSMA_Reports | Shared_Content/News/Latest_News/2019/January/in_appreciation_wsma_member_dr_richard_dick_whitten | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/AM_2017.10.062_Whitten_645x425.jpg" class="pull-right" /></div>
<h5>January 11, 2019</h5>
<h2>In appreciation: WSMA member Dr. Richard "Dick" Whitten</h2>
<p>By Graham Short</p>
<p><em>The following article was featured in the January/February 2019 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em></p>
<p>
It's the end of an era: WSMA member Richard "Dick" Whitten, MD, of Sammamish has stepped down from his role as speaker of the WSMA House of Delegates, a position he held with dignity and aplomb for five years, and symbolically drawing to a close a time of tremendous leadership and service—more than 30 years worth—at the WSMA.
</p>
<p>
Dr. Whitten presided over the House of Delegates, with his trusted gavel and dog-eared copy of parliamentary procedures, starting in 2013, replacing departing speaker and Tacoma family physician Richard Hawkins, MD. Assuming his place, starting with the 2019 WSMA House of Delegates, will be Spokane pediatrician Deborah Harper, MD, who has served as vice speaker since 2016, and who will be flanked by a new vice speaker, Matthew Grierson, MD, sports medicine physician from Seattle.
</p>
<p>
Dr. Whitten's service as House speaker was just the latest in a long line of leadership roles at the WSMA held by the indefatigable physician and longtime member. His service included six years as a delegate representing King County (2007-13), four years as chair of the WSMA bylaws committee, and 25 years as a member of the AMA delegation, representing the interests of Washington physicians and patients on the national level at the AMA House of Delegates. Dr. Whitten has been a dedicated member of the AMA for more than 37 years.
</p>
<p>
WSMA's current AMA delegation chair, Spokane anesthesiologist Rod Trytko, MD, believes Dr. Whitten has been a fierce physician champion. "We all have benefitted from his relentless efforts to make Washington a great place to practice medicine and receive care. He also has been one of my most trusted friends."
</p>
<p>
Another champion of physicians and patients, Seattle internist and Qualis Health CMO John Vassall, MD, agrees: "For those of us involved in the practice of medicine and in advocacy for our patients and our colleagues, we know that words matter and details matter. Dick took this very seriously and made sure we did not forget the important words and the important details."
</p>
<p>
Dr. Whitten currently serves as medical director and vice president of health policy at Noridian Healthcare Solutions.
</p>
<p>
From all of WSMA, a hearty "thank you" to Dr. Whitten for his leadership, service, and continued membership (38 years and counting). We are proud to have you as a member!</p>
<p><em>Graham Short is WSMA’s associate director of communications.</em></p>
</div> | 2/25/2019 11:46:35 AM | 1/11/2019 3:15:00 PM | 1/11/2019 12:00:00 AM |
| wsma_reports_physician_advocates_are_vital_to_wsmas_legislative_success | WSMA Reports: Physician advocates are vital to WSMA's legislative success | WSMA_Reports | Shared_Content/News/Latest_News/2019/January/wsma_reports_physician_advocates_are_vital_to_wsmas_legislative_success | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMA-Reports%20article%20graphic2018-Jan-Feb.jpg" class="pull-right" /></div>
<h5>January 8, 2019</h5>
<h2>Physician advocates are vital to WSMA's legislative success</h2>
<p>
By Marcia Frellick
</p>
<p>
<em>The following article was our featured cover story in the January/February 2019 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em>
</p>
<p>
With the 2019 state legislative session looming, thoughts of advocacy are fresh and physicians are among leaders looking for ways to change policies or to protect hard-won gains.
</p>
<p>
Washington physicians who embrace advocacy told WSMA Reports how they got started and why advocacy is important.
</p>
<h3>
Kim Schrier, MD, newly elected to Congress from Washington's 8th District</h3>
<p>
Dr. Schrier, a community pediatrician in Issaquah, said she never had thoughts of running for office until the 2016 election.
</p>
<p>
"When my member of Congress sided with party over the people in our district by voting to repeal the Affordable Care Act, hurting thousands in our district, I stepped up to run against him," she said.
</p>
<p>
Dr. Schrier, who has spoken at both the WSMA Legislative Summit and WSMA Annual Meeting, says it's critical that physicians step up and share expert perspectives on health care policy.
</p>
<p>
"Otherwise, we end up working in a system designed by non-physicians that may not work well for patients or doctors," she said.
</p>
<p>
Key health care-related issues facing the state and country need physicians' insight, she said, among them how to cover our uninsured or underinsured, how to address the opioid crisis, and how to expand access to health care in rural communities.
</p>
<p>
She advises physicians to "jump in and encourage your colleagues to join you. Physicians are natural advocates. We go to bat for our patients every day. We are inclined to study the issues and be thoughtful about solutions, to listen respectfully, and to speak up on behalf of our patients."
</p>
<h3>
Nariman Heshmati, MD, outgoing chair, Washington Medical Political Action Committee (WAMPAC)</h3>
<p>
In addition to his role with WAMPAC, WSMA's nonpartisan campaign arm, Dr. Heshmati is chair of the surgery section and a member of the clinical leadership board at The Everett Clinic and chief of women's and children's services at Providence Regional Medical Center in Everett.
</p>
<p>
Dr. Heshmati first got involved in advocacy nearly 20 years ago when he joined a political action committee as a medical student and started going to lobbying days. He saw the need to go beyond just what the patient needs at the moment and look ahead to making the system better for that patient and all others later on.
</p>
<p>
Physicians are uniquely qualified to speak on patient care, he said.
</p>
<p>
"We're not speaking on behalf of insurance companies," he emphasized. "We sometimes don't realize how much our opinions, voiced in unison, matter. It's a trusted opinion and we have to utilize that to make positive changes."
</p>
<p>
Time is always going to be a struggle for physicians, he acknowledged, but advocacy can also save time by changing the cause of inefficiencies, such as problems with electronic medical records, extensive regulations, and prior authorizations.
</p>
<p>
"You can make that system better and more efficient and then you'll have more time," Dr. Heshmati said.
</p>
<h3>
Avanti Bergquist, MD, child psychiatrist</h3>
<p>
Dr. Bergquist of Renton, a psychiatrist with Eating Recovery Center and Seattle Children's Hospital, got interested in advocacy when she saw the impact her husband, a public school teacher, could have when he was elected representative in Washington's 11th Legislative District in 2012. That was also the year she finished her child psychiatry fellowship.
</p>
<p>
Through the training they got in running a campaign (the Bergquists attended the American Medical Association's AMPAC Candidate Workshop, which teaches doctors how to run a political campaign) and her husband's election, she saw how one constituent and one legislator being interested in something important can make a huge difference.
</p>
<p>
Legislators need to hear from the experts to make informed decisions, she said. In her case, she worked on a state committee that advocated expanding the scope of a phone line offered by the University of Washington and Seattle Children's Hospital. The service helps physicians treating children with mental health issues since there is a severe shortage of child psychiatrists in the state.
</p>
<p>
Her advocacy work led her to run for election to her local school board, where she is now serving in her second year.
</p>
<p>
Advocacy has had a personal benefit as well. "This has really resolved my burnout," she said. "I'm helping patients and families in my direct clinical work but I was also able to make a positive impact on a much bigger scale. In clinical work, we get frustrated by red tape, but once I understood the policies and how to make a change, it's really helped me."
</p>
<h3>
Judy Kimelman, MD, an OB-GYN in private practice</h3>
<p>
Dr. Kimelman, an obstetrician-gynecologist in Seattle, works with the American College of Obstetricians and Gynecologists on the state and national level.
</p>
<p>
At the state level, she has helped organize the state chapter's lobbying day in Olympia, which helps mobilize advocacy for legislation that supports women's reproductive health issues. She teaches physicians the right and wrong way to lobby and how to navigate the legislative process. She even created a video, "Lobbying: the Good, the Bad, and the Ugly," on the process (available on YouTube).
</p>
<p>
On the national level, she meets with members of Congress on specific issues and has joined national lobbying efforts.
</p>
<p>
Her advocacy work started with efforts to try to stop nuclear proliferation when she was an undergraduate at Berkeley. Then at Stanford Medical School, she helped organize students across the country to advocate for change.
</p>
<p>
Later in practice, she saw colleagues struggling in the medical malpractice crisis.
</p>
<p>
"People were practicing so much defensive medicine, it didn't feel like good medicine," she said.
</p>
<p>
She contacted the WSMA to see what could be done with tort reform.
</p>
<p>
"That reinvigorated my desire to be involved in advocacy," she said. "We know the medicine and we know the science and it's important to use the authority that the MD or DO behind our name gives us to tell legislators why a bill is important or why it's important that it not pass."
</p>
<h3>
MOC law is evidence advocacy works</h3>
<p>
Kathryn Kolan, JD, director of legislative and regulatory affairs for the WSMA, said physicians need to be ahead of legislators in formulating policy or they will be governed by rules set by those with no experience in health care.
</p>
<p>
She added that she has seen physician input repeatedly result in policy change. One of the most recent examples was the law passed in the last state legislative session on maintenance of certification.
</p>
<p>
Physicians in the WSMA House of Delegates fought against MOC being a condition of licensure. The policy was adopted by WSMA in October 2017 and in January 2018, the state legislature passed the bill.
</p>
<p>
"Translating the patient and physician experience to policymaking is vital," she said.
</p>
<p>
<em>Marcia Frellick is a freelance journalist who specializes in health care topics.<br />
</em>
</p>
<div class="AsiInformation">
<h3><strong>What you can do</strong></h3>
<p>
Physician advocates offer these tips for taking action on advocacy.
</p>
<ul>
<li>Attend the annual WSMA Legislative Summit. The next one is Feb. 7 in Olympia. <a href="[@]WSMA/Events/Legislative_Summit/Legislative_Summit.aspx">Register online today</a>.</li>
<li>Enroll in the American Medical Association's <a href="http://www.ampaconline.org/political-education/ampac-candidate-workshop/">AMPAC Candidate Workshop</a>, which teaches doctors how to run a political campaign.</li>
<li>Connect with one legislator or policymaker who shares your interest on a particular topic.</li>
<li>Be patient, as change is often slow. Developing relationships is a good first step.</li>
<li>Write letters to the editor of your newspaper.</li>
<li>Post opinions on social media.</li>
<li>Call or email legislators.</li>
<li>Write a check to political action committees doing the work you support.</li>
</ul>
</div>
</div> | 2/25/2019 11:22:36 AM | 1/8/2019 3:40:49 PM | 1/8/2019 12:00:00 AM |
| wsma_reports_the_regulatory_process | WSMA Reports: The Regulatory Process | WSMA_Reports | Shared_Content/News/Latest_News/2019/January/wsma_reports_the_regulatory_process | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMA-Reports%20article%20graphic2018-Jan-Feb.jpg" class="pull-right" /></div>
<h5>January 8, 2019</h5>
<h2>The Regulatory Process</h2>
<p>
By Jeb Shepard
</p>
<p>
<em>The following article was featured in the January/February 2019 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em>
</p>
<p>
While the legislative branch's political intrigue and drama are at the center of our media circus, the fanfare fades once an executive signs a bill into law—and dwindles to a hum by the time regulatory departments and agencies initiate rulemaking. In fact, rulemaking is a process that barely registers on most people's radars.
</p>
<p>
Conducted in meeting rooms around the state (with a concentration in Tumwater), the process unfolds far from the illustrious marble of the Capitol dome. There are rarely television cameras. But for all the attention given to the legislative process, rules quietly written by bureaucrats carry the same force of law as those written by elected officials.
</p>
<p>
In Washington state, language from bills that pass the Legislature and are signed into law by the governor is added to the Revised Code of Washington (RCW), the compendium of all state laws in force. Legislative language will contain specific concepts and goals, while often directing regulatory agencies and departments to fill in the details through rulemaking.
</p>
<p>
Lawmakers do this for several reasons, including a hesitancy to place complicated policy (think about the ever-evolving practice of medicine) in the RCW because it is so difficult to update; you have to pass another law. Deferring to regulatory bodies provides flexibility.
</p>
<p>
It also offers a more deliberate and comprehensive policymaking arena that facilitates expert input through a process not subject to the pressures and time constraints of the legislative session. Plus, regulatory bodies have the authority to conduct emergency rulemaking any time of year (not just when the Legislature is in session) to address issues that arise or when required to advance the agency's objectives.
</p>
<p>
The Administrative Procedures Act (APA) outlines how the rulemaking process must be conducted in our state. In short, an agency or department must release a "preproposal statement of inquiry," officially referred to as a CR-101, which is a "heads up" to the public that they intend to write a rule. The second step, the CR-102, includes draft language and an opportunity to comment. The CR-103 is the final, adopted rule. Once finalized, rules are added to the Washington Administrative Code (similar to the RCW, the WAC catalogues all state regulations).
</p>
<p>
In a typical year, the WSMA tracks a dozen or more rules and submits comments on a wide array of issues impacting medicine to various regulatory bodies, including the Washington Medical Commission, the Department of Health, the Health Care Authority, the Office of the Insurance Commissioner, Labor &amp; Industries, and the Department of Licensing. While our Olympia team has an intimate understanding of how the process works and a strong grasp on how a proposal will impact your practice, we are not clinicians; your feedback is critical to help guide our approach.
</p>
<p>
For example, in 2017, the legislature passed House Bill 1427, which directs relevant boards and commissions to write opioid rules for the professions they regulate. We worked on the bill while it was under consideration by the Legislature and participated in every stage of the rulemaking.
</p>
<p>
We were successful in many of our goals, but only because we solicited feedback from WSMA members and urged you to submit your thoughts to the state or endorse our comprehensive comment letter. Hearing directly from physicians and physician assistants had an impact on the rulemaking, as the APA requires that each comment be considered during the rulemaking process.
</p>
<p>
We thank you for your participation in prior efforts and hope you will get involved with us in the future.
</p>
<p>
The regulatory process, in all its mundanity, is a serious state policy tool that carries significant weight and will impact your patients and your practice.
</p>
<p>
<em>Jeb Shepard is WSMA's associate director of policy and regulatory affairs. </em>
</p>
</div> | 4/24/2019 3:42:19 PM | 4/24/2019 3:38:06 PM | 1/8/2019 12:00:00 AM |
| wsma_reports_know_what_youre_signing | WSMA Reports: Know what you're signing | WSMA_Reports | Shared_Content/News/Reports/2018/wsma_reports_know_what_youre_signing | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMA-Reports%20article%20graphic-2018-NovDec.jpg" class="pull-right" /></div>
<h5>November 21, 2018</h5>
<h2>Know what you're signing</h2>
<p>
By Tierney Edwards, JD
</p>
<p>
<em>The following Legal Matters column was featured in the November/December 2018 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em>
</p>
<p>
If you're starting your career or considering a big employment change, your new employer may offer you a recruitment agreement to sweeten the deal. But do you know what to watch out for before you sign one?
</p>
<p>
Recruitment agreements are contracts (separate from your employment agreement) physicians sign with hospitals, medical practices, or other employers to incentivize the physician to work where the employer is located—usually in a rural area where there is a physician shortage. To induce the physician into staying in a specified geographic area and joining the employer's medical staff, recruitment agreements often offer large signing bonuses, payments to cover relocation expenses, and guarantees to provide a minimum monthly salary.
</p>
<p>
While these financial incentives sound appealing, recruitment agreements often carry consequences you should consider before signing. Additionally, an advisory opinion from the Centers for Medicare &amp; Medicaid Services has stated that any subsequent changes to the terms of the recruitment agreement would likely violate the Stark Law exceptions that would normally allow employers to offer recruitment agreements. Consequently, a physician should review a recruitment agreement carefully with an experienced health care attorney to fully understand the benefits and obligations of the agreement.
</p>
<h3>Payments as a loan</h3>
<p>
On the surface, recruitment agreements appear to offer payments to augment a new physician's income, guaranteeing a certain minimum salary each month, regardless of how much the physician brings in for the employer. But these payments are actually structured as a loan or line of credit. Generally, the physician can avoid repayment by staying in the area and working for the same employer for a predetermined amount of time during which the loan is forgiven on a pro rata basis.
</p>
<p>
Every recruitment agreement contains a section frequently called the "Guarantee of Income." To illustrate how this works, let's say the recruitment agreement promises a physician a minimum salary of $20,000 per month. This means that when the physician collects less than $20,000 in a month, the other party to the agreement will make up the difference by drawing on the line of credit.
</p>
<p>
If the physician collects only $10,000, then the line of credit will provide the physician with an additional $10,000 to make sure the physician receives a total income of $20,000 for the month. This arrangement generally continues for 12 months, but some recruitment agreements contain Guarantee of Income terms that last for up to 36 months.
</p>
<p>
But these payments are essentially loans that are forgiven at a steady rate so long as the physician continues to practice in the area. One way or another, the physician will have to repay this debt, either directly or by pro rata loan forgiveness.
</p>
<p>
Recruitment agreements are written so that they comply with federal law, and as such, a physician enjoying perks such as loan forgiveness will still be required to pay applicable taxes as portions of the loan are forgiven. Such taxes will be in addition to taxes on other salary or income. This is an important consideration, and prudent physicians will consult with an attorney familiar with health law and related tax laws to fully understand how loan forgiveness might affect the taxes they're required to pay.
</p>
<h3>Consequences for early termination</h3>
<p>
Because recruitment agreements require a physician to stay in an area for a specified period, it is important for all parties to know when the agreement may be terminated, by whom, and for what reasons. The physician may be expected to immediately repay any outstanding balance on the loaned funds if he or she resigns before the loan has been completely forgiven.
</p>
<p>
The same can be true if the hospital terminates the agreement for cause, should the employed physician violate one of many stringently enforced terms of the agreement. The result may mean that a physician who desires to move away from the area must repay tens, if not hundreds, of thousands of dollars, often immediately, to cover the accrued amount of monthly salary payments.
</p>
<p>
Some recruitment agreements also penalize employed physicians for early termination of employment by requiring immediate repayment of relocation stipends and signing bonus amounts. Consider having a payment plan in place in case something unexpected forces you to move or change your practice.
</p>
<p>
Recruitment agreements are common and potentially advantageous for both rural employers and physicians thinking of jump-starting their careers in a new direction. However, these agreements can have significant financial consequences, even when fully vetted and complied with. If you are considering signing a recruitment agreement, do so only after ample consideration and careful review with an experienced health care attorney. .
</p>
<p>
<em>Tierney Edwards, JD, is WSMA's associate director of legal and federal affairs.</em>
</p>
</div> | 2/25/2019 11:45:40 AM | 11/12/2018 11:25:36 AM | 11/21/2018 12:00:00 AM |
| wsma_reports_reducing_unnecessary_testing | WSMA Reports: Reducing unnecessary testing | WSMA_Reports | Shared_Content/News/Reports/2018/wsma_reports_reducing_unnecessary_testing | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMA-Reports%20article%20graphic-2018-NovDec.jpg" class="pull-right" /></div>
<h5>November 19, 2018</h5>
<h2>Reducing unnecessary testing</h2>
<p>
By Jessica Martinson
</p>
<p>
<em>The following article was featured in the November/December 2018 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em>
</p>
<p>
John H. Vassall, MD, recently spoke with "a very thoughtful and efficient family physician" about a patient who was preparing for a total knee replacement.
</p>
<p>
The patient had come to her office with a request from the orthopedic surgeon for a preoperative evaluation and testing, including a CBC, EKG, and a nasal swab for MRSA. Dr. Vassall asked if she thought the CBC and EKG were indicated.
</p>
<p>
"She was initially puzzled by my question, but after some reflection, admitted that neither was likely to add value to this patient's care," said Dr. Vassall, who is physician executive for quality and safety at Qualis Health, a board member of the WSMA Foundation for Health Improvement, and a member of the Washington State Choosing Wisely Task Force.
</p>
<p>
So why would she order the tests?
</p>
<p>
"My colleague sees between 20 and 30 patients a day," Dr. Vassall said. "She must make about 10 decisions per patient, which means 200 to 300 decisions per day. Sending the patient for the requested tests requires only one decision; evaluating the need for each of the three tests increases her mental workload to four decisions, and involves an additional discussion with the patient, adding more time and effort. Her professional survival involves simplifying her workload and reducing the number of decisions. Add to that the prospect of explaining to her colleague why she did not follow his instruction and you can see that this becomes onerous.
</p>
<p>
"Of necessity, we must do many things by standardized routine," Dr. Vassall noted. "However, it's time for us to reevaluate some of the testing we order prior to low-risk, elective procedures on healthy patients."
</p>
<p>
That is the message of "<a href="[@]Shared_Content/News/Membership_Memo/20180926/drop_the_pre_op.aspx">Drop the Pre-Op</a>," an initiative of the Washington State Choosing Wisely Task Force, which is co-sponsored by the WSMA, the Washington Health Alliance, and the Washington State Hospital Association. The initiative is a result from this year's report from the Washington Health Alliance, "First, Do No Harm: Calculating Health Care Waste in Washington State." The report found that at least 100,000 patients received unnecessary pre-op testing during a one-year period, at a statewide estimated cost of more than $92 million.
</p>
<p>
Naturally, physicians are well-intentioned in ordering the tests. They want to be thorough and they don't want a patient to be turned away on the day of surgery. Drop the Pre-Op points out that physicians agree that all patients need preoperative evaluation, but a low-risk patient having a low-risk procedure does not need pre-op testing.
</p>
<p>
The task force is spreading the word to the state's health care community about Drop the Pre-Op through a variety of channels, including an information sheet, PowerPoint decks to use at a staff meeting or during
grand rounds, and more, all available on our <a href="https://wsma.org/WSMA/Resources/Clinical_Quality/Choosing_Wisely/WSMA/Resources/Clinical_Quality/Choosing_Wisely/Choosing_Wisely.aspx?hkey=c623a808-1091-4ae4-98b7-fe7df46d01e7#physicians">Choosing Wisely Physician Tool Kit</a>.
</p>
<p>
If you need additional information or resources on Drop the Pre-Op, contact me at <a href="mailto:jessica@wmsa.org">jessica@wmsa.org</a>.
</p>
<p>
<em>Jessica Martinson is WSMA's director of clinical education and professional development.</em>
</p>
</div> | 2/25/2019 11:45:28 AM | 11/12/2018 11:32:45 AM | 11/19/2018 12:00:00 AM |
| wsma_reports_are_we_running_out_of_specialists | WSMA Reports: Are we running out of specialists? | WSMA_Reports | Shared_Content/News/Reports/2018/wsma_reports_are_we_running_out_of_specialists | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/WSMA-Reports%20article%20graphic-2018-NovDec.jpg" class="pull-right" /></div>
<h5>November 12, 2018</h5>
<h2>Are we running out of specialists?</h2>
<p>
By Marcia Frellick
</p>
<p>
<em>The following article is our featured cover story in the November/December 2018 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="[@]WSMA/News_Publications/Publications/Publications.aspx">purchase a subscription</a>.</em>
</p>
<p>
Patients in parts of Washington seeking care from specialists can face months-long waits for appointments and long drives. The latest estimates show dire shortages in many specialties and some are on track to get much worse in the coming decades.
</p>
<p>
Reports are lacking on the precise deficits, partly because the definition of "specialty" is different among government entities, because people are seeking the care across county and state lines, and because no one entity in the state tracks shortages in all specialties, said Renee Fullerton, workforce programs manager with Washington state's Department of Health.
</p>
<p>
Anecdotally, experts say the biggest shortage is in psychiatry and behavioral health. A physician workforce report in 2016 by the University of Washington Center for Health Workforce Studies showed only 727 psychiatrists delivering direct patient care in the state (10.1 per 100,000 population) and more than half of the state's psychiatrists were 55 or older. And that number dwarfs the number of behavioral/mental health/addiction specialists in Washington. That specialty has only 0.3 per 100,000 population in the state.
</p>
<p>
Ray Hsiao, MD, a child and adolescent psychiatrist practicing in Seattle, said about one-fourth of the counties in Washington don't have a single psychiatrist.
</p>
<p>
Driving the shortage, he said, are two main factors: too few training slots and insurance networks that have narrowed so much that patients can't find a psychiatrist who is taking new patients.
</p>
<p>
"If reimbursement were better, more would be able to take on new patients," he said.
</p>
<p>
Therefore, the most promising solutions currently lie in extending the reach of those already practicing, he said.
</p>
<p>
Dr. Hsiao pointed to the "collaborative care" approach developed by the UW as well as the university's AIMS (Advancing Integrative Mental Health Solutions) Center, which is the role model nationally, he said. The idea is that a mental health team of specialists in a central location helps primary care physicians and providers serve patients with mental health issues in their communities.
</p>
<p>
Traditional telemedicine would open up access, he said, but it needs to work in tandem with people located near the patient to help follow through on care.
</p>
<p>
"With telepsychiatry, you don't really know who you're seeing and you're working with them remotely," Dr. Hsiao pointed out.
</p>
<h3>Shortages of rheumatologists climbing</h3>
<p>
Some of the other areas of highest need include rheumatology, neurology, and some surgical subspecialties. Nationally, a 2015 American College of Rheumatology workforce study shows the demand for rheumatologists exceeded supply by 700 full-time physicians in 2015. The shortage is expected to soar to 4,133 by 2030 with increased demand, retirements, and more physicians working part-time.
</p>
<p>
Jeff Peterson, MD, president of the Washington Rheumatology Alliance, said Washington has only about 75 full-time rheumatologists and many regions in the state don't have any. A few big reasons behind the shortage, he said, are the relatively lower pay for rheumatologists because they perform fewer procedures, a lack of training spots for rheumatologists, early retirements, and the pressure to work in hospital systems that are buying up independent practices.
</p>
<p>
"You spend two more years in training and you're going to earn about the same as an internist," he said.
</p>
<p>
But perhaps more important than the pay gap is the pressure to join hospital systems, he said.
</p>
<p>
"We're the cowboys; we think out of the box," Dr. Peterson said. "We're the last stop for most people when they try to figure out the disease process. That spirit needs to be fostered and I think it's being squelched by people who say, 'You need to do it this way.'"
</p>
<p>
Dr. Peterson said the alliance is reaching out to fellows to let them know they have choices. If they do want to practice independently, the alliance can offer support on how to set up smaller businesses. The hope is that will help keep up rheumatologists' satisfaction rates and keep them in the state, he said.
</p>
<p>
Lack of rheumatologists in surrounding states mean patients are turning to Washington for help, contributing to wait times that range from three to six months, he said.
</p>
<p>
It's even worse for pediatric patients, Dr. Peterson said, because those specialists are all at one hospital, Seattle Children's.
</p>
<p>
Geographic disparities nationally are stark as well and numbers show rheumatologists are often centered in urban or suburban areas. The 2015 ACR study showed that 21 percent of adult rheumatologists are in the Northeast and 3.9 percent are in the Southwest.
</p>
<p>
Another area of significant need in Washington is neurology. According to the American Academy of Neurology, Washington had 351.9 neurologists in 2012, 51.3 short of the number needed to meet current demand. By 2025, the shortage is expected to almost double, with a workforce of 411 and a need for 508, leaving a shortage of 97 neurologists.
</p>
<h3>Looking for answers</h3>
<p>
Across the state, many are looking to telehealth as a solution. John D. Scott, MD, medical director for University of Washington Telehealth, said telehealth is advancing on three fronts. One is the Project ECHO (Extension for Community Healthcare Outcomes) program, under which primary care physicians all over the Northwest and in rural areas link with a group of specialists at a weekly teleconference and present cases so they can help deliver the care in primary care settings.
</p>
<p>
Another is the electronic consult system for primary care providers who have a question about a patient or are on the fence about whether the patient needs a specialist. The physician can send a message through the electronic health record to a pool of specialists and the appropriate specialist answers on how to proceed.
</p>
<p>
"The beauty of using the EHR is a lot of the relevant data is already in the EHR," Dr. Scott said. "We're now doing that for 14 different specialties and have had more than 4,000 patients who have benefited from this," he said. "A good example is in dermatology; we do about 150 consults a month."
</p>
<p>
The third route is traditional telemedicine with video and high-tech imaging. UW physicians can consult remotely and determine what medications are needed and whether the patient needs to be transported for further care.
</p>
<p>
However, traditional telemedicine has been stuck because of payment barriers that often make performing the service cost-prohibitive for physicians, Dr. Scott said.
</p>
<p>
"The idea is we try not to move people, but to move the knowledge," Dr. Scott said. "We're trying to make the primary care physicians work at the maximum of their training and trying to keep more patients in their communities."
</p>
<p>
A smaller program to add specialists, managed by Fullerton at the DOH, is the J-1 physician visa waiver program. Washington state employers can sponsor international physicians who have done their residencies and fellowships to work in an underserved area of Washington for three years.
</p>
<p>
However, only about 15 specialists are part of the program each year and the program must be a last resort. Employers have to show that have tried and failed to find an American candidate. Typically, the spots have been vacant for quite a long time, Fullerton said.
</p>
<p>
"It's not a first-line option, but it's a way to get access to care," she said.
</p>
<h3>Legislative wins for specialists</h3>
<p>
Katie Kolan, JD, director of legislative and regulatory affairs for the WSMA, said the association has successfully fought for changes in the legislature that have provided support for the state's specialists.
</p>
<p>
The WSMA was also able to help fend off the state's attempts to prohibit balance billing—the practice of charging patients for the difference between the dollar amount a provider bills for a service and the amount an insurer is willing to pay.
</p>
<p>
"Balance billing is a big [issue] for anesthesiology, emergency departments, radiology, and pathology," she said.
</p>
<p>
Even more significant was the passage of the Interstate Medical Licensure Compact, signed into law in 2017, which will make it easier for physicians to practice in any state that is a partner to the compact rather than having to go through each state's licensing demands.
</p>
<p>
"It's really important for specialists to be able to practice across multiple states," she said, "especially in the age of telemedicine."
</p>
<p>
<em>Marcia Frellick is a freelance journalist who specializes in health care topics.</em>
</p>
</div> | 2/25/2019 11:45:50 AM | 11/12/2018 9:46:15 AM | 11/12/2018 12:00:00 AM |
| wsma_reports_yakima_pediatrician_wants_to_make_her_city_the_healthiest_in_the_nation | WSMA Reports: Yakima pediatrician wants to make her city the healthiest in the nation | WSMA_Reports | Shared_Content/News/Reports/2018/wsma_reports_yakima_pediatrician_wants_to_make_her_city_the_healthiest_in_the_nation | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Logos/WSMA-Reports-Website-Graphic_645px.jpg" class="pull-right" /></div>
<h5>September 24, 2018</h5>
<h2>Yakima pediatrician wants to make her city the healthiest in the nation
</h2>
<p>
By Katie Howard
</p>
<p>
<em>The following Doctors Making a Difference column was featured in the September/October issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em>
</p>
<p>
Yakima County is the jewel in Washington state's agricultural crown, as the leader in production of apples, cherries and pears, and as the country's top producer of hops. Pediatrician Yami Cazorla-Lancaster, DO, aims to make it No. 1 in something else: wellness.
</p>
<p>
Yakima County often falls toward the bottom of the list of statistics on overall health of its population, with high rates of obesity, diabetes and mental health challenges, but Dr. Cazorla-Lancaster has a vision for the region's potential. Through her pediatrics practice, Nourish Health; interactive online courses via her Veggie Fit Kids program; and efforts to bring the Blue Zones Project to Yakima County, she is working to improve the health of children and adults across the region.
</p>
<p>
The Blue Zones Project refers to "zones" of the world, such as Okinawa, Japan, and Sardinia, Italy, whose residents have been found to live the longest. The project partners with communities around the country to improve health by making changes to local policies and infrastructure that encourage healthier eating, higher rates of exercise and greater community involvement. If the county proceeds with implementation, it would be Washington's first designated Blue Zone.
</p>
<p>
Dr. Cazorla-Lancaster talked to WSMA Reports about her approach to wellness and how the Blue Zones Project could jumpstart the region's transformation.
</p>
<p>
<strong>In your pediatrics practice, you focus on overall wellness. What do you view as the components of that and how do you implement them in your approach to caring for kids?</strong>
</p>
<p>
I believe that all children deserve the opportunity to live their very best lives and to live long, healthy and joyful lives. I know that the only way to achieve this is to focus on wellness, not sickness. First and foremost is the importance of nutrition, specifically eating more fruits, vegetables, whole grains, beans, and nuts and seeds.
</p>
<p>
Although I am a primary care pediatrician and routinely encounter the typical childhood infections and medical problems, I am deliberate about discussing nutrition, sleep, joyful movement, and stress as often as possible. I live and breathe lifestyle medicine. I spend the most time discussing these topics during routine checkups, but sneak it in at any opportunity.
</p>
<p>
I also take my passion online by creating content for Veggie Fit Kids via Facebook, YouTube and Instagram and am always quick to accept opportunities to talk to media or speak publicly about the principles of health. I want my families to feel that it is realistic and achievable for them to practice healthy lifestyle habits in our modern culture. By showing them what is possible, I can empower and inspire parents to adopt healthy habits for themselves and their families.
</p>
<p>
<strong>Do you see an opportunity for your approach to be implemented on a larger scale in Washington? </strong>
</p>
<p>
Yes, anybody can practice this way. They just have to find the routine and method that works for them. You develop your practice style like any other habit. You have to become deliberate about discussing these foundational principles that will help keep children healthy and happy for decades and could potentially help reverse chronic disease in adults.
</p>
<p>
<strong>Tell us about the Blue Zones Project and why you think Yakima is a good candidate for it.</strong>
</p>
<p>
I see Yakima as a hidden gem in the Pacific Northwest. Like a diamond in the rough, we have all the raw materials needed to become a thriving locus of health and well-being: plenty of sunshine, a plethora of produce, access to outdoor activities, and a growing desire for change.
</p>
<p>
What we lack is the belief that we can become an epicenter of health and wellness and the organizational structure to get us there. The Blue Zones Project is described as "a community well-being improvement initiative designed to make healthy choices easier through permanent changes to environment, policy, and social networks, which ultimately promotes change in daily healthy habits so that everyone can live longer, feel better and be happier." It is currently active in 10 states and 43 communities and the outcomes have been outstanding.
</p>
<p>
<strong>What kinds of programs or resources would Blue Zones bring to Yakima? </strong>
</p>
<p>
The Blue Zones Project is specifically tailored to the needs and desires of each community, but the overall goal is to make the healthy choice the "easy" choice by changing the environment around community members. We know that people spend most of their time within a five- to 10-mile radius, which they call the "life radius."
</p>
<p>
Although we spend a lot of time at home, we spend most our time at work, school, and other places around the community. Increasing the opportunity for healthy choices outside of the home nudges people into wellness.
</p>
<p>
It would include things like optimizing city streets to improve walkability, working with grocery stores and restaurants to increase healthy offerings, working with schools, and engaging individuals with purpose workshops and connecting them with volunteer opportunities.
</p>
<p>
They also help communities affect public policies. The great news is that the Blue Zones Project has seen great success so far. In the beach cities, the incidence of childhood obesity is now down 78 percent since the start of the project. This is incredibly powerful.
</p>
<p>
<strong>What outcomes would you hope to see at the completion of the project? What would make it a success in your perspective?</strong>
</p>
<p>
I like to dream big because why not? I would love for Yakima to become the healthiest city in the United States! I would love to see the prevalence of obesity and diabetes drop significantly, see an increase number of our community members walking and biking, eating more fruits and vegetables and our overall well-being index increase. I know it is possible and I know that we can do it. But I think the greatest success would be for Yakima to blossom into her true potential.
</p>
<p>
<strong>What can physicians in other communities do to promote healthier lifestyles? </strong>
</p>
<p>
Lead by example first and foremost. When you take care of yourself by nourishing your body with vibrant and health-promoting foods, make it a point to move joyfully, get plenty of sleep and decrease your stress, your own light shines brighter. You then begin to inspire and empower others.
</p>
<p>
Learn how to bring more joy and wellness into your own life and you will see how those around you will believe that it is possible for them, too. The amount of influence you have as a health professional is more powerful than you realize, and you can affect your patients' lives just by being healthy and joyful yourself.
</p>
<p>
<em>Katie Howard is WSMA's social media and content specialist.</em>
</p>
</div> | 2/25/2019 11:45:14 AM | 9/24/2018 12:25:30 PM | 9/24/2018 12:00:00 AM |