Will You Forgive Me for Saving You?

Perspective in July 5 NEJM by Torree McGowan, MD, St. Charles Medical Group

"I remember the day I first met you. It was a quiet Sunday, early in the morning. I heard a commotion out by the check-in desk, and your mom’s scream: “My baby’s not breathing!” The first time I saw you was in your mom’s arms. Heartbreakingly, you weren’t snuggled like a baby should be, or even limp. Your tiny body was twitching, seizing. The cold clinical term “decorticate posturing” that flashed in the physician part of my brain seemed too rigid to be applied to your chubby toddler arms. ... 

Click title or here to read rest of an ultimate dilemma


The Bulletin Guest Column: Birth control law working, but needs work

Out State Representative and COMS member, Knute Buehler, MD, updates progress in Oregon after his bill allowing pharmacists to dispense oral contraceptives passed in 2015.

Click title or here to read the editorial


Bend Bulletin Report on Healthcare Professional Burnout in Central Oregon and Elsewhere

Is your physician burned out? Stress of practice takes its toll on doctors and patients
by MARKIAN HAWRYLUK | markianhawryluk | The Bulletin  | February 23, 2018
Report includes interviews of Mike Henderson, Matt Eschelbach, Fran McCabe and other COMS members

Tough industry
It’s hard for many patients to understand why their physicians are so unhappy. Doctors make good salaries, drive fancy cars and live in big homes. It is one of the most respected professions in the U.S., and its members are honored by being called doctor wherever they go.
But medicine has steadily become a more difficult industry. Physicians are expected to be nearly all-knowing and infallible, even as the collective volume of medical sciences increases at a breakneck pace.
An ever more costly health care system is rapidly evolving, spawning new payment and care delivery models. Government and private payers are demanding more data, more proof that what doctors are doing actually improves health care.
Studies have linked burnout to work processes inefficiencies, excessive workloads, work-home conflicts, organizational climate, and loss of control or autonomy. While doctors talk about the practice of medicine as an art as much as a science, the system is quickly converting doctors, nurses and other providers into highly educated and highly paid factory workers.
Health care systems count the number of patients seen and the number of procedures completed, rather than the number of patients whose health has improved. Doctors are expected to see more patients, providing better care at a lower cost, so they work longer hours. An AMA survey found that about 25% of doctors now have workweeks of more than 60 hours, compared to 11% in other professions. And according to researchers from the Mayo Clinic, every additional hour per week worked increases the risk of burnout by 3%. Each night and weekend on call increases the risk by 3%-9%. And every hour spent at home on work-related tasks ... increases the risk by 2%. And doctors on the front lines in primary care, internal medicine or the emergency room have four times the burnout rate of other doctors.
Part of the problem is the way doctors are paid for treating patients. The reimbursement system is still mainly fee-for-service, where doctors get paid based on the number of procedures they complete. That prompts doctors graduating with an average of $225,000 in medical school debt and years behind other professions in buying a house or saving for retirement to pursue specialties that do more procedures. Primary care doctors, on the other hand, get paid less for evaluating and managing patients, and must overbook their daily schedule to maintain their salaries. The average salary is now $200,000 for primary care physicians and $300,000 for specialists.
Yet a recent survey found that only 25% of doctors were willing to take a salary cut to reduce the administrative burdens they say add to their stress. At the Pease Symposium on burnout in November in Bend, a physician wellness coach suggested doctors schedule patient-free days before and after vacations to ease the stress of taking time off. One doctor attending countered that they don’t make any money on days they don’t see patients.

To read the entire report, click title or here.


Pease|Pariser Symposium: November 2-3, 2017

Anxiety, Exasperation, Exhaustion, Depression, Burnout, and Suicide in Healthcare Professionals

The program is now set for St. Charles - Bend Center for Health & Learning, after Epic was convinced to allow use of the Center during the month that had the entire facility reserved.  We will now start at 5p on Thursday, November 2 with:
   !   Small-group sessions with experts from Rayleigh-Durham, Indiana University, Eugene and OHSU,  followed by
  !!   Dinner and our keynote speaker Dike Drummond from Seattle and continue the next morning with
 !!!   Grand Rounds at 7p with experts from Eugene and Epic, and conclude immediately after with
!!!!   Small-group sessions with experts from Eureka, University of Washington and Central Oregon between 8 and 9a.


Webinar on New Medicare Card: February 21st 3-4 pm EST

The AMA has arranged for a CMS briefing on the new Medicare card on February 21st from 3-4 pm EST. 
Click title to register.

The new Medicare card is a result of MACRA’s requirement that CMS issue Medicare cards that do not display Social Security Numbers to address the risk of beneficiary identity theft. New Medicare cards will be issued beginning in April 2018 and physician offices must be prepared to accept the new Medicare identification number at that time.

As the new Medicare cards will significantly impact physician practices’ workflows, we strongly encourage state and specialty society staff, as well as physicians and their office staff, to attend this webinar.  It will include time for Q & A and will be recorded for those who are unable to attend.


Woody Peoples Back Home: The Bulletin Front Page Report

Woody is back home from Mosul, Iraq, after two months of volunteering on the front lines to take care of families injured by the Syrian war. "Home" is all relative. Read the report to realize the difference.

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2nd 2017 Meeting: How to Continue to Avoid Opioid Epidemic Here in Central Oregon

April 10, 2017    Opioid Overdose Epidemic: What is a Clinician To Do?

Not only is the State of Oregon the only state to have had a reduction in the opioid overdose mortality rate, the rate in Central Oregon is lower than the rest of the state and has shown, as of 2015, no evidence for an increase that has affected the rest of the West and the rest of the United States. Rates of opioid overdose deaths, hospitalizations and opiate prescription overall and of <120 morphine equivalent doses in Deschutes County have all declined by 7% to 47% during recent years.
Jessica LeBlanc, MD (pictured), Kim Swanson, PhD, and Kym Garrett, LAc reviewed methods medical professionals can utilize to prevent the national opioid epidemic from affecting our community.

Click title for Central Oregon data and presentation materials
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1st 2017 COMS Meeting: Plans for Medical Professional Wellness Program

February 6, 2017
Donald Girard, MD (pictured), Emeritus Professor and  Past Associate Dean of Graduate Medical Education, OHSU, as well as past Chair of Oregon Medical Board, and Amanda Borgess, Executive Director. Greater Metropolitan Portland Medical Society, described the success of their Medical Professional Wellness Program, following the accomplishment of a similar program in the Lane County Medical Society.  COMS and the St. Charles Healthcare System have decided to embark mutually on a similar program in Central Oregon. The planned program will be readily accessible at the convenience of the provider, confidential, free to the provider, private and minimally constrained by record keeping.

Click title for information re: Oregon Coalition for Medical Professional  Wellness