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1423 Randy LaneJefferson City, MO 65101(573) 634-3415

www.maops.org

D.O.

Non-ProfitU.S. Postage

PAIDJefferson City, MO

Permit No. 169

SEPTEMBER 2018

www.docme.org

October 19-21, 2018The Elms Hotel and SpaExcelsior Springs, MO

MAOPS is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. MAOPS designates this program for a maximum of 15 AOA Category 1-A CME credits and will report CME and specialty credits commensurate with the extent of the physician’s participation.

What is Physician Burnout? By David Tannehill, DO, FACP • 2018-2019 MAOPS President

We have a stressful job. Regardless of specialty or practice setting, all of us – while blessed with the skills, knowledge and gifts needed to take care of people – face stressors and frustrations that put us all at risk for physician burnout. If you finally get a day or a weekend off, but can’t face Monday, that’s a warning sign. If you go on a vacation and come back not feeling recharged, not feeling like you’re ready to tackle the day, that’s a warning sign. The stress and frustration inherent to being a physician in 2018 is simply part of the job. But you should be able to cope. You should be able to recover when the breaks come. If you find yourself not coping, not recovering well, dreading the workday, workweek or next patient encounter, maybe you have developed burnout. And if so, you need help.

Physician burnout has three classic descriptive symptoms:• Physical and emotional exhaustion. This isn’t just tired after a long day. This is feet-in-concrete, crushed-

heart and soul-desperately-wanting-to-quit type exhaustion. This is the most common symptom.• Depersonalization. Negativity. Cynicism. Failing to see your patients as human beings and just another task.

This symptom compounds your misery – and negatively affects many of those around you. Worst of all, it hurts your patients.

• Reduced sense of personal accomplishment. Constantly asking, “What’s the point? Why did I waste my talents on medicine? I am no good at this job.” This self-loathing is an easy trap for doctors to fall into because we are programmed to be high achievers, topple goals and perform highly all the time. As burnout develops, the sense of failure grows.

The Maslach Burnout Inventory is a commonly cited tool for burnout screening. It is a series of questions that evaluates the three do-mains outlined above. According to the National Academy of Medicine, physicians who score highly on this assessment are at greater risk for medical error, malpractice, suboptimal patient care practices and professionalism, physician turnover and early retirement, lower medical knowledge, suboptimal professionalism, substance abuse, accidents and suicide.

My experience on the Board of Healing Arts has made the impact of burnout incandescently clear. No physician – none – ends up in front of the Board, subject to license discipline, without having had the ravages of burnout sideswipe their career. For all of these physicians, burnout is at least a major contributor, if not the sole reason, for their personal and professional missteps.

There are ways to get help. There are options for addressing the stress and decreasing the frustration. MAOPS is working with healthcare stakeholders in Missouri to

diminish the public health threat that is physician burnout. This issue of the Prognosis is dedicated to helping members recognize the signs and symptoms of stress and

connecting them to resources that can address burnout. We are here to help.

I hope you plan to attend our first Physician Wellness Retreat in October in Excelsior Springs, Missouri. We have put together a great weekend of activities, discussion and education that I am certain will be successful in helping those in attendance battle burnout more effectively.

If we do not identify burnout in ourselves and our colleagues, we risk failing to address it. If we fail to address it, we fail our patients and, more importantly, our families and ourselves.

Want to learn more? Additional resources on physician wellness can be found at www.maops.org/WellnessResources

CME CENTER

@maops_president

FED UP?Join MAOPS for a weekend of relaxation,

education and most importantly, PROBLEM SOLVING!

We’ll dive deep into some of the most common issues plaguing today’s physicians, including contract negotiations, maintaining your physical and mental health, EHR, work-life balance, burnout, and more!

SPOUSES WELCOME! Research shows that health plans work best when family is involved. Spouse tickets include an invitation to ALL retreat events!

It’s time to put thePHYSICIAN FIRST!

Space is limited to the first 64 physicians!A minimum of 15 AOA Category

1-a CME available

For more information on course offerings, registration, amenities and more visit...

www.maops.org/WellnessRetreat

Card Number: ______-______-______-______ Exp: _____ /_____

3 Digit Security Code: _________ Name on Card: ___________________

Billing Address: ____________________________________________________

Check payable to The Wetzel Foundation VISA DISCOVERMASTERCARD

Physician Wellness Retreat RegistrationName: _________________________________________________AOA #: ________________________________________________Full Address: ____________________________________________Business Phone Number: ________________________________Business Email: __________________________________________

Ticket Options (Circle All That Apply)Physicians: Member Rate - $595 • Non-Member Rate - $695Spouses: Member Rate - $225 • Non-Member Rate - $275Wine Trolley: One Ticket - $100 • Two Tickets - $200 ORBeer Stroll: One Ticket - $25 • Two Tickets - $50Total: $ ______________

Payment Method

Please return this form via: Email: ChrisB@maops.org • Fax: 573.634.5635or Mail: Wetzel Foundation 1423 Randy Ln. • Jefferson City, MO 65101

This is the first ever interactive

physician wellness program created

FOR physicians, BY physicians!

Online CME Courses at Your Fingertips!

• Courses starting as low as $30 • Personalized CME recommendations • “My Dashboard” tracks learning over time

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│4│SAVE THE DATE • 09.13.18 - An Evening with the President: Southeast Regional Visit • 10.19.18 - Physician Wellness Retreat • 11.14.18 - Mineral Area District Meeting • 12.14.18 - SLAOPS Christmas Party • 04.24.19 - MOAC 2019

MORE INFORMATION ON ALL MAOPS EVENTS CAN BE FOUND AT WWW.MAOPS.ORG/EVENTS

OfficersPresident: David Tannehill, DO, FACP

President-Elect: Steven Brushwood, DO

1st Vice President: Michael Brown, DO

2nd Vice President: Chris Wolf, DO, FAAPMR

Immediate Past President: John Bailey, DO

TrusteesStephen Bazzano, DO

Jack Bragg, DO, FACOI

Victoria Damba, DO

Jeff Davis, DO

Timothy Jennings, DO

Kenneth Jones, DO, FAOCR

Steve Linsenbardt, DO

Elizabeth Lucore, DO

Mark Pelikan, DO

Elisa Vinyard, DO

Bruce Williams, DO, FACOFP

Wanda Wilson, DO

Jared Nichols, DO

S/D Bryan Roberts

S/D Mindy Ward

S/D Parker Adams

Central Office TeamExecutive Director: Brian Bowles BrianB@maops.org

Associate Executive Director: Chris BowlesChrisB@maops.org

Executive Assistant: Leigh HaslagLeighH@maops.org

Director of Education & Strategic Projects: Alicia McGirl AliciaM@maops.org

Communication Coordinator: Gabby KellerGabbyK@maops.org

Administrative Assistant: Jamie ParsonsJamieP@maops.org

Central Office Phone Number: 573.634.3415Central Office Fax Number: 573.634.5635

Physician Suicide: Breaking the Silence!By Jim Wieberg, M.Ed., LPC • Director of MAOPS Physician & Health Professional Wellness Program

I was just told another chilling story of a tragic physician suicide – a doctor who on the surface had it all – skills, practice opportunities, a wonderful family, a great reputation in the medical community and what appeared to be a solid marriage. He left a note behind that said, “I feel all alone!” Such unnecessary losses are heart-breaking, but hardly surprising. Physicians have a higher suicide rate than that of the general population. In fact, the rate for male physicians is 70 percent higher than that of males of other professions. For female physicians, the rate is fourfold. Suicide is the second-leading cause of death for physicians aged 24 to 35 years, just behind accidents. In fact, every year, the equivalent of two medical school classes dies by suicide (about 400 physicians per year).

But why? Why should those in the healing profession, usually with outstanding access to care, be at such heightened risk? There are some facts that might explain it, at least in part.

For one, stigma is alive and well among physicians. Some of it was institutionalized by state departments of health with licensure ap-plications that asked physicians whether they had ever had a psychiatric condition – mind you, not whether they had one currently or whether it affected their current functioning – but ever! Fortunately, through advocacy and education, most of these types of questions have been eliminated. However, that is not the only cause of stigma. There is still much secrecy about mental health and concerns about its effect on career prospects. Note that this occurs in a very worrisome context: Physicians often do not have regular checkups, obviating opportunities for screening.

Yet, psychiatric conditions and suicidal ideation are far from rare in physicians. In a survey of students, house staff and faculty, 10 to 12 percent reported suicidal ideation, but only 25 percent of those endorsing current suicidal thoughts were taking antidepressant medica-tion, and only 16 percent were receiving psychotherapy. The treatment gap is staggering.

Depression and alcohol misuse increase the risk for acting on suicidal thoughts, and data suggest that physicians are just as likely as the general population to meet the criteria for depression. As well, alcohol misuse is a common response to unmanageable stress, and a survey showed that 20 percent of medical students, trainees and faculty reported “drinking too much,” which is associated with suicidal ideation, suicide attempts and severe depression.

A critical question is why no one detects the suffering of these physicians.

After all, they are surrounded by other health care professionals who should be able to see what is happening. However, most physicians have enormous personal strength, both emotional and intellectual “reserves.” Accordingly, they often are able to compensate for the presence of psychiatric symptoms, which makes it difficult to identify them so they can receive assistance, and that leads them to feel more isolated, since no one knows how they really feel.

The remedy then is self-identification. Many medical schools, including our osteopathic schools in Missouri, are now proactive in letting students know they have access to care and encouraging them to seek help if they are feeling overwhelmed or distressed. That should promote a lifelong attitude to self-care. But what about all of the physicians who are already out in the workforce? How can they be reached? An action plan is to partner with medical organizations and associations and use communication channels like the “Prognosis” to remind physicians about the signs and symptoms of depression or alcohol misuse and reinforce the notion that treatments can and do work.

I invite all physicians, especially those feeling alone, “stressed out,” or just needing collegiality in a safe environment, to join me and my colleagues at the Center for Mental Wellness of Capital Region Medical Center, Heather Johns, LCSW, and Russ Carpenter, DO, at MAOPS first Physician Wellness Retreat October 19-21 in Excelsior Springs. As well as presenting during several of the sessions at the event, we will be available the entire weekend to answer your personal and confidential questions regarding the issues you may face. I think this will be a great weekend for all and encourage you to attend. This will be an attendee-driven, flexible curriculum so we can address the things you want to address. Because they play an integral part in your health, spouses are welcome and encouraged to attend.

MAOPS Wins AOA S.T.A.R. Award...Again!For the second year in a row, and the fourth time in five years, MAOPS has won the AOA’s prestigious Strategic Team Award Recognition. The award recognizes the affiliate that has done the most in advancing the osteopathic cul-ture. MAOPS President David Tannehill, DO, FACP; Imme-diate Past President John Bailey, DO; and Central Office Team member Leigh Haslag accepted the award on MAOPS behalf at the AOA House of Delegates on July 21. MAOPS was chosen for its work in international medicine support-ing the mission of Logan Banks, DO, in Kibuye, Burundi; the

development of an app, CMEprn, which physicians use to find continuing medical education programs around the country; and the development of a 23-member coalition of states working together nationally on continuing medical education programs and promotion.

AOA Announces Decoupling of Membership and Board CertificationAOA President William Mayo, DO, announced that the AOA will no longer require membership in the organization for a physician to be AOA Board certified. The announcement came in conjunction with another regarding the settlement of a lawsuit in which the AOA was sued for the requirement. The AOA had determined to decouple membership and board certification in March of 2017, but had not announced an official date, even after repeated requests to do so from MAOPS. The decoupling will go in effect 30 days after the settlement is approved by the court. The earliest this could happen is December 2018. The AOA maintains that its business practices were sound but agreed to settle the lawsuit in order to focus resources on advancing their strategic plan.

The AOA has released answers to the most frequently asked questions surrounding the suit. A copy of that release can be found at...www.MAOPS.org/AOAFAQ

MO HealthNet Suspends Opioid Prescribing Initiative MO HealthNet has announced a six-month suspension of its Opioid Prescribing Initia-tive (OPI). The OPI was initiated in March 2018 with thousands of physicians receiving threatening letters regarding their prescrib-ing habits. MO HealthNet has taken heed of concerns by MAOPS that the OPI would not only make it difficult for patients in pain to receive the care they needed, but threat-ened to reduce access to care as physicians, tired of burdensome requirements and scru-tiny, left the Medicaid program. MO Health-Net acknowledges the goals and methods of the program could have been communicated to physicians in a more productive way and has stated they are committed to improving the process to meet the goal of the program: improving patient care and ensuring patients have access to care they need, even opioids. MAOPS will continue to participate in discus-sions with MO HealthNet.

CMS Director Notifies Physicians of Reduction in Burdens…and PayIn a letter to physicians, CMS Director Seema Verma, M.D. acknowledged the ad-ministrative burdens put on physicians by CMS and vowed to “turn the tide,” reduc-ing those burdens immediately. However, with those burdens come pay cuts. Dr. Verma stated that “we believe that any small negative payment adjustments would be outweighed by the significant reduction in documentation burden.” An analysis of the CME proposed rules provided by the AOA Department of Government Affairs illustrates what CMS has in mind, as well as the “small negative pay cuts.”

MAOPS needs your input. Are the paperwork burdens reduced enough? Is reim-bursement adequate? What is CMS getting right? What are they missing? Chime in by contacting MAOPS Executive Director Brian Bowles. Your comments will be used to formulate a response to the proposed rules. Take advantage of your opportuni-ty to have a voice!

To view the full letter to physicians and the AOA Department of Government Affairs analysis visit...www.MAOPS.org/CMS

Yasso Elected to AOA Board of Trustees; Kwon

Ends Her Term

MAOPS Past President Joe Yasso, DO, FACOFP of Lee’s Summit was elected to another three-year term as a member of the AOA Board of Trustees.

New MAOPS member Jennie Kwon, DO, MSCI of St. Louis, ended her term on the AOA Board of Trustees where she served as the New Phy-sician Trustee. Dr. Kwon also chaired the AOA Bu-reau of Emerging Leaders.

MAOPS 2019 Membership Campaign to Kick Off in October

Osteopathic physicians should be looking for their MAOPS membership information in the mail in early October. Now that you have more choice in the organizations you join, we hope you will choose MAOPS as one of the organizations you support. Since 1897, MAOPS has been the voice of the profession in the state. New members can join at a special introductory rate.

“Unaddressed mental health conditions are, in the long run, more likely to negatively impact one’s professional reputation and practice than reaching out for help early.” - American Foundation for Suicide Prevention

“Suicide is the second-leading cause of death for physicians aged 24 to 35

years...”

TEN

6.2X1 in 4

Minutes of moderate activity can improve your

mental Health

Residents with depression make 13%20%

The lifelong prevalence of Depression among physicians is...

more medication errors than their peers

Just

DID YOU KNOW?

in Women in Men - Current Psychology

- Loop UK - Mental Health America

- The Huffington Post - Current Psychology

-Expert Editor

Reading can help reduce

stress by about 68%

Music’s effect on anxiety levels is similar to the

effects of getting a massage

People are 12 times more likely to feel

happy on days that they spend

6-7 hours with loved ones

Meditation can reduce the

density of brain tissue associated with anxiety and

worrying

people globally will experience a

mental health issue in their life

- The National Center for Biotechnology

- The National Center for Biotechnology

Health professionals, like anyone else, are susceptible to substance, psychiatric and medical illnesses. If left untreated, these illnesses can put

even the finest clinicians and their patients at risk.

The MAOPS Physician Health Program can help!Contact Director Jim Wieberg at jwieberg@crmc.org

or (573) 632-5562

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