| letting-the-healer-heal | Letting the Healer Heal | Leadership | Shared_Content/News/Latest_News/2023/letting-the-healer-heal | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/november-december/cover-wsma-reports-novdec-2023-645x425px.jpg" class="pull-right" alt="cover of November/December 2023 issue of WSMA Reports" /></div>
<h5>November 6, 2023</h5>
<h2>Letting the Healer Heal </h2>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>
The emotional toll that comes with working in medicine has never been higher. The pandemic has strained the entire health care system to the breaking point and many physicians with it.
</p>
<p>
"Everyone is so overworked," says Judith Kimelman, MD, OB-GYN with Seattle Obstetrics &amp; Gynecology Group and chair of the north and western states region for the American College of Obstetricians and Gynecologists. "Burnout is just rampant among physicians, and it can lead to depression and suicides."
</p>
<p>
Indeed, according to the American Medical Association, recent studies place the national burnout rate for doctors in practice at more than 40%. An even more frightening statistic is the suicide rate for physicians, which is twice as high as it is for the general population.
</p>
<p>
Faced with patients experiencing such turmoil, physicians would readily recommend counseling. Indeed, wellness programs for physicians are not new and exist in a wide variety, from employee assistance programs to peer counseling sessions.
</p>
<p>
Yet many doctors are reluctant to seek the same help for themselves. A primary reason is the worry that talking to someone about their problems will end up being used against them. More than 40% of physicians do not seek help for burnout or depression for fear of disclosure to a state licensing board.
</p>
<p>
"There are too many reasons why physicians choose not to get the help they need," says Jesse Ehrenfeld, MD, president of the AMA. "Concerns around confidentiality are one of them. I work in a health system with a terrific employee assistance program, but too many of my colleagues are afraid to use it. Anything we can do to strengthen their trust and not impact licenses in a negative way is important."
</p>
<p>
Dr. Ehrenfeld knows firsthand how fear can cause a doctor to hesitate about getting much-needed help. "I had an experience of having a physician colleague walk into my office in crisis, having an acute psychotic episode at the hospital," he recalls. "I walked that physician to the employee assistance program, and the very first question they asked was, 'What does this mean to my license?' "
</p>
<p>
Sadly, says Dr. Ehrenfeld, that fear is widely shared. "That is not uncommon," he says. "That is the very first question that people ask."
</p>
<p>
Confidentiality concerns aren't the only barrier to physicians accessing wellness programs.
</p>
<p>
"One of the big issues is that we have a culture that you're tough, you don't let people know you have a weakness, you don't reach out to people, you don't show vulnerability," says Dr. Kimelman. "When you have that culture of not talking about it and denying your emotions, it's really bad for people."
</p>
<p>
While the culture of never showing weakness may be fading, confidentiality concerns remain strong. In a litigious environment, virtually everything becomes discoverable during in a lawsuit, making physicians rightfully cautious about sharing anything for fear of the impact their frank conversations may have.
</p>
<p>
"In obstetrics and gynecology, there's such a concern for potential litigation, that there's a fear of talking to anyone," says Dr. Kimelman. If a problem arises, "you're told right away, 'Don't talk to anyone,' " she notes.
</p>
<p>
Litigation isn't the only factor, Dr. Ehrenfeld points out. "There's concern about the impact on their career in medicine," he says. "Doctors may not seek help for suicidal thoughts because of fear of disclosure to the state medical board."
</p>
<p>
Yet physician wellness programs can be incredibly helpful. John Chuck, MD, chief wellness officer at California Northstate University, testifies to their value. "I'm of the strong opinion that the king of all health is mental health," he says. "It really determines how one thinks about one's self and one's place in the world."
</p>
<p>
In his previous position as the regional chair of the Physician Health and Wellness Leaders Group in The Permanente Medical Group, Dr. Chuck participated in a pilot program where he saw a therapist for six months. "I loved it so much that I continued to do it well after the pilot was over," he says. He is currently seeing a life coach through a program offered through his local medical society.
</p>
<p>
"I personally have benefited from counseling and coaching," says Dr. Chuck. "It keeps me right in the head."
</p>
<p>
So much so, that he has become an evangelist for physicians seeking help from mental health professionals. "I talk about it publicly," he says. "We need to emerge from the outdated belief that physicians don't need help to be emotionally well. We probably need such help more than anybody given the tremendous responsibilities and burdens we carry every day."
</p>
<p>
"At the very least, good counseling has two great effects," he adds. "You feel deeply heard and you begin to understand that you are not alone in your suffering."
</p>
<p>
Dr. Kimelman believes that peer- to-peer programs can be particularly helpful for physicians. These sessions are an opportunity for physicians to talk to someone who can provide context for the difficult patches that physicians sometimes experience.
</p>
<p>
Peer support programs rely on physicians from any type of practice who undergo training. They are not mental health counselors and the program is not meant to be long term. "It's just a chance for people to get that first touch that somebody cares," says Dr. Kimelman. If additional resources are necessary, the peer counselor would be able to provide them. The programs are available in multiple health care systems in Washington state.
</p>
<p>
"Let's train people in the field to have those open conversations with a peer, to help people reframe what they've been through," she says. "It's not so much the specifics, but how they perceive the problem. They can help physicians with coping mechanisms and normalize their feelings, letting them know they are not alone. It helps them get perspective."
</p>
<p>
In addition, physicians and physician assistants in Washington also have the Washington Physicians Health Program, which provides help for health professionals who may not be able to practice safely due to an impairing or potentially impairing health condition.
</p>
<p>
"Washington is very lucky to have the program," says Dr. Ehrenfeld. "I'm really pleased for my colleagues in Washington, but there's obviously an opportunity to strengthen what's happening through confidentiality protections."
</p>
<p>
The AMA has been spearheading policy changes to allow physicians to get much- needed care without unnecessary fear of career repercussions. The association has been promoting legislative and regulatory changes to create a "safe haven" through which physicians and other health care professionals can seek and obtain confidential care.
</p>
<p>
Several states have already passed legislation to offer such protections. Virginia was the first, passing a measure in 2020. Indiana, South Dakota, and Arizona have all followed suit. The laws further the goal of supporting physicians and health care professionals to seek professional support to address career fatigue, burnout, and behavioral health concerns with broad confidentiality and civil immunity protections, with a focus on "career fatigue and wellness" rather than "burnout." The AMA has proposed draft legislation and regulatory language in the hopes of promoting adoption in other states.
</p>
<p>
For peer-to-peer counseling, confidentiality protections may not be an absolute necessity. "Nobody is taking notes or listening as an expert," says Dr. Kimelman. "They're just dealing with the emotions from a harmful event and helping people cope." However, the protections would remove the barrier that prevents physicians from accessing the programs out of fear.
</p>
<p>
The WSMA and the Washington chapter of ACOG are working together to consider seeking confidentiality protections for physician wellness programs next year. "It's the perfect partnership to work on this together," says Dr. Kimelman.
</p>
<p>
In the meantime, she says, it's important for physicians to know that asking for help isn't a sign of weakness.
</p>
<p>
"We're all human," says Dr. Kimelman. "Things happens, and we're going to have emotions about them. It's important to work thought those emotions. We're caring physicians."
</p>
<p>
<em>John Gallagher is a freelancer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the November/December 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 11/6/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| passion-and-policymaking-at-2023-house-of-delegates | Passion and Policymaking at 2023 House of Delegates | Leadership | Shared_Content/News/Latest_News/2023/passion-and-policymaking-at-2023-house-of-delegates | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/september/2023-annual-meeting-main-graphic-v2-645x425px.png" class="pull-right" alt="2023 WSMA Annual Meeting House of Delegates logo"></div>
<h5>November 1, 2023</h5>
<h2>Passion and Policymaking at 2023 House of Delegates</h2>
<p>
Nearly 200 delegates representing numerous specialty and county medical
societies in Washington convened at The Westin Bellevue in late September for
the 134th Annual Meeting of the WSMA House of Delegates. Holding the
legislative power of the WSMA as defined in the association's bylaws, this
select group of physicians, residents, medical students, and physician
assistants were tasked with establishing policy and electing officers for the
association-while having a bit of collegial fun in the process.
</p>
<p>
Before the House got down to its official business, delegates and other
interested WSMA members attending the meeting heard from outgoing WSMA
President Katina Rue, DO, who kicked off Saturday's opening session with
opening remarks and the presentation of the 2023 WSMA Apple Awards. Following
Dr. Rue, Secretary of Health Umair Shah, MD, provided an overview of changes
in Washington's public health infrastructure and outreach since he took
office, and encouraged greater collaboration with physicians in the field. The
House then paused for reference committee breakout meetings, where resolutions
were discussed and debated in small-group settings.
</p>
<p>
Up next: The WAMPAC Luncheon. A perennial favorite, this fundraising event for
WSMA's nonpartisan political action committee featured the majority and
minority leaders of the state House of Representatives, who talked policy and
politics before taking questions from WSMA members. Keeping things lively,
WSMA staff led a raffle for WAMPAC's Diamond Club contributors in attendance
along with a game of trivia to test the political acumen of attendees.
</p>
<p>
Saturday afternoon, as reference committee members got to work drafting their
reports (learn more about this process on the
<a href="[@]wsma/events/annual_meeting/annual_meeting.aspx#about">Annual Meeting webpage</a>), attendees reconvened for CME presentations covering critical topics in
medicine. Stephen Bezruchka, MD, led an impassioned discussion on how
physicians can tackle factors that have the greatest impact on population
health-and why physicians should act and not despair when facing these
daunting problems. Ed Walker, MD, senior physician advisor for the WSMA Center
for Leadership Development, followed with a perspective on the importance of
burnout recognition and treatment from a system-level view rather than a
self-care, wellness model. Then the American Medical Association's immediate
past chair of the board of trustees Sandra Adamson Fryhofer, MD, did a deep
dive on the AMA's Recovery Plan for America's Physicians.
</p>
<p>
Finally, attendees and staff gathered to inaugurate WSMA's 2023-2024
president, Mukilteo OB-GYN Nariman Heshmati, MD, celebrating the start of his
tenure at a reception in his honor-and unwinding after a long day of House
business.
</p>
<p>
Sunday dawned with delegations meeting at their respective caucus breakfasts
to review reference committee reports in anticipation of the morning's final
House session. After the House convened, but before they got down to business,
delegates heard a moving speech by WSMA's new president, Dr. Heshmati (read or
watch his speech at wsma.org).
</p>
<p>
Speakers Matthew Grierson, MD, and Ray Hsiao, MD, then deftly led delegates
through debate and action on the business before the House. Up for
consideration were nearly 40 resolutions, many of which tackled major topics
being grappled with nationwide, including the role of AI in medicine,
unionization, the opioid epidemic, and more. Ultimately, the policies adopted
by the House on Sunday shared a collective emphasis from the house of medicine
to keep medicine "physician driven and patient focused" in the face of major
societal disruptions.
</p>
<h3>Official Actions of the 2023 House of Delegates</h3>
<div class="row">
<div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/venticinque-230924-4025-large-for-web-round.png" class="pull-left" style="width: 125px;"></div>
<div class="col-md-10">
<p>
Policymaking is at the heart of the WSMA Annual Meeting, as the
approximately 175 WSMA members who make up the House of Delegates, the
WSMA's "physician legislature," gather to debate and determine policy for
your state medical association. The policies passed during this year's
House of Delegates reflect an urgency on behalf of Washington's physician
community to reclaim the primacy of the patient-physician relationship and
ensure physicians stay in the driver's seat of patient care. For a full
account of the actions of the House, download the
<a href="[@]wsma/about/who_we_are/house-of-delegates.aspx?hkey=c5e98d40-6e37-4bc0-9bda-a7aa66e67919&amp;WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927">Official Actions of the 2023 WSMA House of Delegates</a>.
</p>
</div>
</div>
<h3>Meet WSMA's new leadership</h3>
<div class="row">
<div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/heshmati-nari-2021-round-125x125px.png" class="pull-left"></div>
<div class="col-md-10">
<p>
In addition to determining policy for the WSMA, the 2023 House of
Delegates inaugurated a new president for the WSMA and elected new
officers and board members.
</p>
<p>
OB-GYN Nariman Heshmati, MD, FACOG, of Mukilteo was inaugurated as WSMA
president for 2023-2024. Dr. Heshmati is the executive medical director of
affordability, advocacy, and pharmacy for Optum Washington, which includes
The Everett Clinic, The Polyclinic, and the Optum Care Network Pacific
Northwest. Watch his inaugural address below.
</p>
</div>
</div>
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</div>
<script src="https://player.vimeo.com/api/player.js"></script>
<br>
<p>
Newly elected as officers at the meeting: John Bramhall, MD, PhD, Seattle
anesthesiologist, president-elect; Bridget Bush, MD, FASA, Anacortes
anesthesiologist, vice president; and Matt Hollon, MD, MPH, FACP, Spokane
internist, secretary-treasurer. The fifth officer of WSMA's executive
committee is Past President Katina Rue, DO, FAAFP, FACOFP, Yakima family
physician, who will serve as committee chair.
</p>
<p>
Newly elected to the association's board of trustees: Rajneet Lamba, MD,
Kirkland internist; Amy Ellingson, MD, Brewster family physician; Lisa
Ivanjack, MD, Bothell internist; John Scott, MD, Seattle gastroenterologist;
Peter Barkett, MD, Silverdale internist; and Andy Shang, medical student,
Pacific Northwest University of Health Sciences.
</p>
<p>
Visit the for a full roster of WSMA board of trustees members and to learn
more about the governing bodies of your state medical association.
</p>
<h3>2023 Apple Award winners</h3>
<div class="row">
<div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/apple-awards-2021-round.png" class="pull-left" style="width: 125px;"></div>
<div class="col-md-10">
<p>
This year marked the fifth annual WSMA Apple Awards, so named for the
common and locally appropriate symbol of good health. Winners of the 2023
awards:
</p>
<p>
Seattle ophthalmologist Aaron Weingeist, MD, retired Olympia OB-GYN Annie
Iriye, MD, and Redmond internist Teresa Girolami, MD, were each presented
a Grassroots Advocate Award, recognizing advocacy efforts and activities
that support WSMA legislative priorities.
</p>
</div>
</div>
<p>
Optum Washington received the 2023 Wellness Award, recognizing an organization
that has worked to put the joy back in medicine for Washington physicians,
either by supporting a culture of wellness, efficiency of practice, or
personal resilience.
</p>
<p>
Wenatchee family physician Mabel Bodell, MD, received the 2023 William O.
Robertson, MD, Patient Safety Award, named after WSMA past-president and
patient-safety champion William O. Robertson, MD, recognizing innovative
patient safety initiatives in the ambulatory care setting.
</p>
<p>
Seattle medical leadership educator Ed Walker, MD, received the President's
Unsung Hero Award, recognizing his extraordinary contributions and service to
the profession and our community.
</p>
<p>Congratulations to our award winners!</p>
<h3>Honoring our newest 50-Year Club members</h3>
<div class="row">
<div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/50-year-club-graphic-round.png" class="pull-left" style="width: 125px;"></div>
<div class="col-md-10">
<p>
This year, 15 WSMA members were inducted into the WSMA 50-Year Club, which
celebrates and honors members who have been practicing medicine for 50
years. They are: John Adkison, MD, of Yakima; William Butler, MD, of
Seattle; Gerald Duris, MD, of Puyallup; Thomas Gillette, MD, of Seattle;
William Hutton, MD, of Aberdeen; James Komorous, MD, of Clarkston; Gene
Liaw, MD, of Bellevue; John Luber, MD, of Tacoma; Michael Luce, MD, of
Dayton; Ronald Maier, MD, of Seattle; Kenneth Mayeda, MD, of Seattle;
Leroy Nill, MD, of Edmonds; Benjamin Podemski, MD, of Seattle; Christopher
Varley, MD, of Seattle; and Richard Veith, MD, of Seattle.
</p>
</div>
</div>
<h3>2024 Annual Meeting: Save the date!</h3>
<div class="row">
<div class="col-md-2"><img alt="" src="/images/Newsletters/latest-news/2023/oct/davenport-exterior-round.png" class="pull-left" style="width: 125px;"></div>
<div class="col-md-10">
<p>
Mark your calendars now for next year's meeting, Sept. 28-29 at the
Historic Davenport in Spokane.
</p>
</div>
</div>
</div> | 11/1/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |
| ya-es-tiempo-its-time | Ya Es Tiempo (It's Time) | Leadership | Shared_Content/News/Latest_News/2023/ya-es-tiempo-its-time | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/september-october/heartbeat-meljen-website-image-645x425px.png" class="pull-right" alt="Heartbeat: Vivienne Melvin MD logo" /></div>
<h5>Sept. 15, 2023</h5>
<h2>Ya Es Tiempo (It's Time)</h2>
<p>By Vivienne Meljen, MD</p>
<p>
Most of my patients have a look of surprise on their face when they first see me stepping into the exam or hospital room clad in casual scrubs, sneakers, a mask, and with my short wavy hair. Yet, so often I watch this common reaction melt away as it sets in that I'm speaking Spanish with them and I am their doctor. Just as my entrance often elicits surprise, my exit will end with some variation of them saying "Gracias, que Dios te bendiga doctora" (Thank you, God bless you, doctor). At the end of my day, these are the patients who fill my soul. Yet my heart hurts for them when I see how their struggles with the health care system affect their lives.
</p>
<p>
When I first started my OB-GYN practice, I felt patient questions about my age, life, and background were distractions from the care I was giving. I would try to address their questions honestly but briefly to maximize my time with them. That was, until I later recognized that for most of my patients, I am the first Latina physician and surgeon they are meeting. When I reflect on this, I realize that even at the diverse academic institutions where I trained, I hadn't met someone who was "like me" until I was a resident.
</p>
<p>
Patients are genuinely curious about how a young Latina, not unlike them, came to be in a position to care for them. They are hungry for culturally competent health care. They want someone to understand. I've never been more certain that maternal care in this country is not in a good place right now, and this is especially true for the ethnic minorities who make up much of Washington's medically underserved.
</p>
<p>
We know that diversity in the health care workforce improves the provision of care and patient experience. We also know that the few patients who can access health care in a culturally competent way are more likely to do so and thus have better outcomes. In this context, the closing of hospital maternity units across Washington and gaps in clinics accepting pregnant patients with Medicaid are creating wounds to our most sensitive communities that can only be fixed by taking the exact opposite actions and increasing access and care.
</p>
<p>
When compared to other gender-matched specialties, obstetric and gynecologic care is beyond disproportionally reimbursed. Health systems will say higher reimbursements are "not sustainable," but neither is providing high-risk services to the medically underserved on shoestring budgets and burning out the clinicians who are choosing to serve them.
</p>
<p>
I recognize each day that as the daughter of Cuban immigrants, my path could have been very different. As a teenager I interpreted for my Abuela (grandmother), who died unnecessarily from a preventable cervical cancer. I received Pell grants and went to medical school with not only student loans, but also medical debt. I've been a Medicaid patient. When patients tell me their struggles, I am looking at my own reflection. It's why I sought to work for an organization where I could have the greatest impact on the Latino community.
</p>
<p>
It will take deliberate work, but if we are going to support every woman in Washington there are no other options in my mind:
</p>
<ul>
<li>We need to bolster community-building around health care centers, so patients feel welcome and comfortable seeking care and the physicians and practitioners who are looking to serve these communities can be validated.</li>
<li>We need to support the education and pipeline programs of our youth in a meaningful way, much like the efforts of WSU's homegrown physician mission. I am an National Health Service Corps and Truman scholar-it is possible. These initiatives work.</li>
<li>We need to improve reimbursement for obstetric and gynecologic care so our clinicians and organizations can sustain care models that allow for the actual time it takes to counsel patients in their native tongue or with interpreters in a meaningful way. Not be rushed to meet the system's bottom line.</li>
<li>We need to maintain the caring clinicians we have and listen to the frontline voices.</li>
<li>We need to support women and diverse candidates to fill true leadership positions across all facets of this industry so they can be change agents.</li>
</ul>
<p>
Policy makers, insurers, leaders, and health care conglomerates may say they are "caring for mothers and infants," but their actions speak louder than words. Maternal services in Washington will continue to be plagued by staffing shortages and physician, midwife, and nurse burnout if we don't see radical change. Ya es tiempo. (It's time)
</p>
<p>
<em>Vivienne Meljen, MD, is an OB-GYN at SeaMar Vancouver Women's Health Center and an assistant professor at Elson S. Floyd College of Medicine, Washington State University.</em>
</p>
<p>
<em>This article was featured in the September/October 2023 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 9/15/2023 12:00:00 AM | 1/1/0001 12:00:00 AM |