by Dominic Cirillo, MD, PhD, President, Resident Physician Section
It's an exciting time to be training in Preventive Medicine!
This morning I gave a talk at Patient Safety Rounds for our hospital's quality officers about a QI project regarding work distractions occurring from the somewhat ubiquitous personal electronic devices we have today. Perhaps ironically, I came back to the office to and caught up on my social media as I downed another coffee. I had time to peruse an update about the Ebola outbreak in Western Africa, which reminded me that I have an upcoming module to review Public Health Preparedness and the use of the Incident Command System in events similar to what they are facing. I had seen the process in motion during my last rotation at the county health department during the recent measles outbreak. I bookmarked some popular media articles on vaccine adherence, since that's certainly a popular and relevant topic. I then prepared myself for my new clinic, which is with a local smoking cessation expert and preventive cardiologist. Luckily, I was working with him last fall when the new lipid, hypertension, and obesity guidelines came out, but I decided I better refresh my memory (and my smartphone) so that I'll be prepared. As the evening wrapped up, I listened to a webinar about the ACGME guidelines and Next Accreditation System. This was a helpful presentation, since I want to understand the issues that our residency programs face. The IOM report on Graduate Medical Education was also just released, so I hope that we, as the community of preventive medicine residents, can advocate for training program support equitable to the perceived benefits and responsibilities for training our generation of public health physicians.
Despite the appearance of a long stream of consciousness, the cornucopia of experiences and opportunities that we have in preventive medicine is both exhilarating and daunting. We are training at a time of major changes in health care and in public health. Moreover, we are training at a time where leadership is needed. I have a number of colleagues, in both medicine and public health, who are finding exciting niches to work. But, I feel that we need to emphasize the benefits of dedicated training, standardized competencies, and cohesion among our professional community. These experiences and opportunities may not be comparable to our colleagues who may have pursued degrees in both fields sequentially. So, I would like to challenge us all to engage our colleagues who may be equally excited when they heard about the once in a lifetime opportunities that you get during your program. Lastly, please share your experiences with the Resident Physician Council and ACPM staff, and consider volunteering for some of the committee work that is available. Looking forward to seeing you at Atlanta!
Career Subtrack @ PM 2015
Exciting opportunities for preventive medicine residents at Preventive Medicine 2015 in Atlanta, through the Career Subtrack!
As in previous years, Preventive Medicine 2015 is the premier conference for preventive medicine specialists and specialists-to-be in the United States.
As in previous years, the Career Subtrack is offering exciting opportunities for you to network and find mentors in your training
and early career:
• Roundtable session - Mixing opportunities for 1:1 interaction and group learning, experts in various preventive medicine fields and areas will lead brief discussions around their work while providing career advice. Participants will have the opportunity to rotate among different categories of preventive medicine roles before a "meet the College leadership" reception;
• Interesting careers in preventive medicine - back again by popular demand, this session provides more detailed insight into the exciting nature of different preventive medicine roles and a panel discussion that can help residents reflect on potential future career prospects;
• The "Breakfast Club" mini-mentorship program - being run together with the Young Physician Section's overarching College mentorship program, this program will pair mentors and mentees up in small groups by interest. The goal is to encourage 1 on 1 interaction at informal times throughout the conference as the initial phases towards developing a professional connection. A great opportunity to link up with a mentor in your field of interest.
• Residency Fair: an opportunity to learn about leading Preventive Medicine residency programs; network with faculty, directors, potential collaborators, and employers!
While exciting to participate it, if you want to have a role in shaping these activities as a moderator or organizer, take this opportunity now (plus it earns you points towards College fellowship!) to e-mail: firstname.lastname@example.org today.
The IMD Exclusion Rule in the Age of the Affordable Care Act
| By Melanie Golembiewski, MD|
As part of Medicaid enactment within the Social Security Act of 1965, an exclusionary clause forbids Federal Medicaid matching funds to be provided to Institutions of Mental Disease (IMD). IMDs are defined as inpatient/residential facilities with more than 16 beds and greater than 50% of their patient census occupied by those with severe mental disease. At its conception, this rule sought to deinstitutionalize the care of the severely mentally ill and decrease patient warehousing through a financial disincentive for inpatient treatment. Today it stands as a barrier for those with mental health concerns, and this is seen clearly with the public health epidemic of substance abuse.
Substance abuse addiction affects all races, genders, ages and socioeconomic backgrounds. In 2012, an estimated 23.1 million Americans (8.9% of the population) qualified as needing substance abuse treatment based on self-reported use. That year only about 2.5 million (1%) individuals received treatment, with a major reason cited as lack of access and availability. By not allowing Federal Medicaid reimbursement, the burden of care of addiction has remained with the States and care therefore varies greatly. Treatment facilities that are not receiving adequate reimbursement for addiction treatment services choose to either not expand residential/inpatient services past 16 beds or decline patients with Medicaid.
With the passage of the Affordable Care Act (ACA) came the acceptance of substance abuse treatment as an Essential Health Benefit, the promise of access greatly expanded. The ACA also extends parity for behavioral health services to the level of broader medical services through extending the Mental Health Parity and Addiction Equity Act (MHPAEA) to those newly enrolled in individual and small group plans. It is estimated these laws will expand behavioral health coverage for 62.5 million people by 2020. However, insurance card in hand will not guarantee access in the current state of our mental health system. To achieve the underlying goal of improved patient care and population health, several areas of the current landscape will need to be addressed. These include allowing true expansion of services by eliminating the IMD exclusion, increasing workforce capacity to provide screening, brief interventions,and referrals to treatment once more readily available, adjusting to the new payer background associated with the ACA, and creating innovate strategies to re-integrate substance abuse and mental health into the broader health system.
To learn more about this policy issue, look into your stat's proposed Essential Health Benefits Benchmark Plan and check out:
Additional Information on Proposed State Essential Health Benefits Benchmark Plans
The Medicaid IMD Exclusion: An Overview and Opportunities for Reform
Medicaid Emergency Psychiatric Demonstration
Happenings Around the World
Below is a quick summary of recent happenings around the world.
• Forgotten vials of smallpox virus were found in a storage room in the FDA laboratory early in July.
• There are differences in prescribing rates of opioid painkillers amongst states in the US according to a recent CDC's MMWR. This is enlightening with the recent publication of the CDC's vital signs with 46 deaths a day attributed to opioid overdose.
• Vaccination coverage for adolescents aged 13-15 in the US is on its way to meet the Healthy People 2020 goals for greater than 80% for the Tdap (goal > 80%, currently ~88%) and the meningococcal conjugate vaccine (goal > 80%, currently ~78% from 2012-2013) according to July's CDC's MMWR. However, the rates for HPV vaccination with at least three doses lag behind at about 33% with the goal of greater than 80%.
• There is an Ebola outbreak in Sierra Leone that according to the WHO has claimed over 200 lives. It is in several other African countries as well. Health officials are responding to this situation.
• Locally, there was a record turnout for an ACPM sponsored webinar in conjunction with American College of Lifestyle Medicine webinar. This webinar is part of a larger lifestyle medicine curriculum project. To view this webinar and to sign up for future webinars, visit here.
| Crisis and Emergency Risk Communication|
| For preventive medicine residents, risk communication is a crucial and necessary tool in our arsenal. The ability to communicate well in times of crises will serve you well in the future. The CDC provides a great online training module. It also provides tip sheets and a full 400 page manual that you can peruse at your convenience. |
The module can be found at the following link:
Five tips for successful communication:
1. Be the first source for information
2. Express empathy early
3. Show competence and expertise
4. Remain honest and open
5. Commit and remain dedicated
Five communication failures
1. Mixed messages from multiple experts
2. Information released late
3. Paternalistic attitudes
4. Not countering rumors and myths in real time
5. Public power struggles and confusion
*Source: CERC Online Training, CDC
Monthly Management Tip (MMT)
- from Dr Syed and the management team at the WHO.
Topic: Simple Techniques to Manage Time
Concept in a nutshell:
There never seems to be enough time, especially at WHO. There are, however, simple techniques that can be applied to your everyday work that can potentially improve our effectiveness. Consider five practical points below for application in your work (taken from a list of 15 that you can access through the link in the further resources).
Five Action Points:
1. Practice asking yourself this question throughout the day: "Is this what I want or need to be doing right now?" If yes, then keep doing it.
2. Find some way to realistically and practically analyze your time. Logging your time for a week in 15-minute intervals is not that hard and does not take up that much time. Do it for a week and review your results.
3. Do a "to do" list for your day. Do it at the end of the previous day. Mark items as "A" and "B" in priority. Set aside two hours right away each day to do the important "A" items and then do the "B" items in the afternoon. Let your answering machine take your calls during your "A" time.
4. Read your e-mail at the same time each day. That way, you'll likely get to your mail on a regular basis and won't become distracted into any certain piece of mail that ends up taking too much of your time.
5. Best suggestion for saving time - schedule 10 minutes to do nothing. That time can be used to just sit and clear your mind. You'll end up thinking more clearly, resulting in more time in your day. The best outcome of this practice is that it reminds you that you're not a slave to a clock - and that if you take 10 minutes out of your day, you and your organizationwon't fall apart.
All 15 points (and further details) can be found here http://managementhelp.org/personalproductivity/time-stress-management.htm
|World Health Assembly on The Every Newborn Action Plan|
By Margarete Ezinwa MD, MPH, WHO Intern
Notes from the Technical briefing
There was a strong focus on women's health and violence prevention at the recent World Health Assembly, including a technical briefing on the Every Newborn Action Plan; chaired by the Director general of the WHO:Dr Margarete Chan, with Melinda Gates as the main speaker.
Dr Margarete Chan opened with the facts that neonatal deaths account for 44% of all child mortality and we have now an unprecedented opportunity; the plan is detail oriented practical and down to earth.
Mrs Melinda Gates in contrast focused on the individual stories of newborns she has seen die preventable death. They leave behind grieving mothers, fathers, siblings and communities. We must never forget the people for whom this plan targets.
Richard Horton from the Lancet put it in numerical context that 15,000 babies every day die within their first 24hr, or are stillborn, and less than 30% of these deaths or births are ever recorded. 290 000 mums die in childbirth, and with the proposed plans by 2025 3million lives per year can be saved. All three speakers emphasized that Accountability needs good data. Need to address data gap.
8 country Ministers of Health shared their own national stories, and the hope in the future ahead, as well as the need for commitment and communication, from countries, communities, funders and individuals. It
starts with us.
More can be found at WHO:
Every Newborn: an action plan to end preventable deaths
|Chit Chat with Jay Parkinson, MD, MPH|
Interview conducted by Shelly Choo, MD, MPH
Jay Parkinson is the CEO of Sherpaa, an online healthcare consultancy that aims to save employees healthcare money. He and his company have been featured on the New York Times and CNBC. He has been deemed as "Doctor of the Future" by several individuals.
How did you become interested in preventive medicine?
When I was in medical school, I really was at a lost in what type of doctor I wanted to be. A friend of mine introduced me to Jason Spangler, who was the chief resident of the Hopkins Preventive Medicine Residency at that time. Jason suggested that I should do a rotation at Hopkins. I followed his advice, and I just fell in love with the field. I, then, decided to enter a pediatrics residency first to get that clinical experience and then a preventive medicine residency afterwards since I just love the back end of healthcare.
Why does the back end of healthcare interest you so much?
It involves systems thinking. To me, I really like thinking big, and Preventive Medicine allows us to do that on the population level. The field also allows us to have the clinical experience but also to think larger than just the confines of what is within the exam room.
What were some important skills gained from your Preventive Medicine Training?
One of my favorite rotations was with Peter Pronovost at the Armstrong Institute for Patient Safety and Quality where I learned about systems care and design process. I learned about Toyota's Lean Program and how to bring that into medicine. I started to look at the world as a process and write that process down. This was extremely helpful in everything not only professionally but personally.
I also think the ability to write is extremely important. I worked with Sid Wolf at Public Citizen and we worked together to write three petitions to the FDA for black box warning or to ban medications. One of the petitions was published in the New York Times. At my next rotation with the Maryland State Department of health, one of the physicians sitting near by me was oblivious that I had written it and started commenting on the article. I thought it was funny that I had written the petition, that it was in the New York Times, and influencing individuals and medicine in a roundabout way. There is a power in communications.
How did Sherpaa start?
Most of my friends were artists and photographers. I was their introduction to medicine. Whenever there was something going on, they would send me photographs of their rash, and I would help them. I thought that using the web and texting could be a real practice as this is how we are communicating now a days.
What does Sherpaa actually do?
Healthcare can be simplified to two components: delivery and payment. Here at Sherpaa, we help with both sides. We help employees receive care with full time doctors working on our web app. We also have many people confused with the bills that they receive. We hire insurance experts to walk people through their bill. We want to make healthcare accessible, transparent, and really simple.
Where do you see Sherpaa going?
Sherpaa should be this edgy innovator that influences the whole healthcare system. You don't want to be the Walmart of healthcare but rather the Apple Genius Bar that is trying to innovate and do a better job. You also want to remain cool. You don't want to remain this stodgy, old corporate health company that is really boring. I always envision Sherpaa as innovative and edgy that also delivers an amazing service.
You are also this amazing portrait photographer. Does photography relate to medicine at all?
You have to have really good people skills as a photographer and as a clinician. Whenever you take a portrait of someone, it is the equivalent of meeting a patient at the office and to try to get him/her to open up about his/her health. To me, when I take a portrait of someone, it is about trying to get their guard down and capture the real person. Although the portrait is through the lens of the camera, it is through the interpretation of the photographer.
Do you have any advice for current residents?
Think outside the box. If you have a great idea, you do not have to go through the route that every other preventive medicine went. There is another Preventive Medicine Physician, Michael Parkinson who created the nation's first consumer driven health plan. He was a huge inspiration for me as he built an amazing company.
How do I get involved?
RPS is open to all resident members of ACPM. If you are interested in participating in any of our initiatives, contact one of the officers through www.acpm.org.