Job Security Amidst Mental Health Distress: Physicians Deserve to Get Help Without Fear

By Russell Libby, MD

The COVID-19 pandemic has added a new dimension of stress for physicians. Most of us live with some degree of anxiety and occasional depression, and it might be argued that it reflects some of the traits that drive us to become physicians. Our altruism, intuitive and learned skills and work ethic create a high standard against which we measure our achievement and professional satisfaction. In the best of circumstances, we are challenged to find balance in our lives and are increasingly prone to burnout.

COVID-19 has impacted our personal safety and the potential for us to unknowingly infect others, especially those we live with and care most about. It has changed the way we practice, disrupting our routines and undermining our operational viability. It has imposed limitations on the care we provide and prevented us from doing all we can for our patients and their families or loved ones at a time they may need it most.

It is not in our nature to admit we cannot cope or adapt, but this added stress has pushed some of us beyond our limits. Even more difficult is recognizing when we are at risk of stress negatively impacting our physical and mental health and the quality of care we can provide. Why are we reluctant to seek help when we really need it most?

We cannot continue to ignore this problem…

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Act Immediately: Important News on the Provider Relief Fund

Due largely to AMA and specialty society advocacy, the Health Resources and Services Administration (HRSA) has decided to reopen the reporting time for recipients of Period 1 Provider Relief Funds. In our March 31, letter to HRSA, the AMA and 31 national medical specialty societies noted small and rural practices appeared to be particularly impacted by the potential recoupment, and that physician practices were unaware of the deadline.

Those physicians who received more than $10,000 in provider relief funds and failed to submit their period 1 report should act immediately. Between Monday, April 11 and Friday, April 22, 2022, at 11:59 pm ET, providers who have not submitted their Period 1 report may submit a late Reporting Period 1 report request. Physician practices should receive information about how to submit a request directly from HRSA via email.

If a provider did not submit a Period 1 report and does not hear from HRSA, the provider may initiate communication by calling (866) 569-3522. During this reopening period, a provider must choose an extenuating circumstance(s) that prevented compliance with the original reporting deadline. While attesting to an extenuating circumstance is required, no supporting document or proof is required. If HRSA approves the extenuated circumstances form, the provider will receive a notification to proceed with completing the Reporting Period 1 report shortly thereafter. Providers will have 10 days from the notification receipt date to submit the late Period 1 report in the PRF Reporting Portal. The AMA will continue to advocate for greater flexibility and more information to ensure physician practices have an adequate opportunity to come into compliance.

What is the MSVPAC? Why MSV’s Political Action Committee is so important

When you need to make an important decision but you’re not familiar with the subject area, what do you do? You consult an expert to get the details you need to help you make an informed decision.

The goal of MSV’s nonpartisan Political Action Committee (MSVPAC) is to do just that: provide legislative decision-makers with the information, data, and details they need to make informed decisions about healthcare-related issues and policies.

Despite the fact that healthcare issues are at the top of the agenda for our legislators here in Virginia, we only have one physician who is currently in the General Assembly. The MSVPAC represents the voice of Virginia’s physicians, PAs, and patients to legislators as they address healthcare issues, consider healthcare policy, and shape healthcare laws and regulations.

Not only do Virginia’s policymakers need to hear from physicians and PAs, they tell us they want to hear from us – so they can gain a clear understanding of the challenges and opportunities facing the medical profession.

Today the MSVPAC is the only PAC representing the unified voice of medicine in Virginia.

What is a PAC?

Just what is a PAC, or political action committee? The short story: Utilizing funds collected from individual contributions, a PAC seeks to influence and impact the political environment in a specific area.

The MSVPAC has a unique status as it is affiliated with the MSV but governed separately. A Board of Directors consisting of physicians, PAs, and practice managers oversees the finances and strategic vision. It is funded only from donations directly to the PAC, and only physicians and PAs, medical practices, and family members of physicians and PAs may donate to the MSVPAC.

Your MSVPAC works year-round to develop relationships with state and federal policymakers and their staff. Many PACs only delve out funds to favored legislators. However, our PAC contributes funds directly to legislators who support the policies developed by our members. We also host events throughout the year across Virginia to connect our member advocates to legislators. Continued and direct contact between our members and legislators is a crucial part of educating our elected officials on emerging issues related to the practice of medicine. If we can educate them early and often, we can help shape legislation and regulations coming down the road.

The MSVPAC strengthens MSV’s advocacy by engaging in the political process throughout the Commonwealth, 24/7, 365. A strong PAC is critical to maintaining a legislative climate that is favorable to physicians, PAs, and most importantly, patients.

Why the MSVPAC is important for physicians, PAs, and Patients

Simply put, the MSVPAC makes your voice — the voice of Virginia physicians, PAs, and patients — heard.

The MSV formed the MSVPAC because we believe physicians and PAs must play an active role in the development of healthcare policy.

To make an impact on your behalf, the MSVPAC:

  1. Monitors hundreds of bills and amendments in the commonwealth and takes action during legislative sessions of the Virginia General Assembly, including outreach, meeting with legislators, and strategically providing opportunities for physicians and PAs to testify in committee.
  2. Supports political candidates who value the practice of medicine.
  3. Builds relationships with pro-physician candidates and legislators.
  4. Provides information, data, and details to support and advocate for policy decision-making aligned with the positions of Virginia’s physicians and PAs.

At MSV, we believe a strong PAC is critical to maintaining a legislative climate favorable to physicians, your teams, and, most importantly, your patients. With so many non-physicians trying to drive and make healthcare decisions, we must work together to protect the interests of our patients and the physician profession.

So why is the MSVPAC important for you? Because when physicians are involved, patients come first.

Co-authored by MSVPAC Board Members:

Trisha Anest, MD and Robert Glasgow, PA-C, MPAS, MPH

Submit your vaccine administration claims for reimbursement by the April 5, 2022, deadline

The COVID-19 Coverage Assistance Fund, which reimburses for the claims for testing, treatment, and vaccine administration, is running out and the deadline to submit for vaccine administration claims is quickly approaching. Claims will be accepted through April 5, 2022, at 11:59 pm via the COVID-19 CAF portal. Claims submitted to the portal after the April 5, 2022, deadline will not be adjudicated. The Health Resources and Services Administration (HRSA) notes that claims submitted by the deadline will be paid subject to their eligibility and the availability of funds. The AMA has urged Congress to appropriate more money to support the COVID-19 efforts.

The dedicated Coverage Assistance Fund customer support may be reached at 833-967-0770 (TTY number 888-970-2920) Monday through Friday from 8:00 am – 8:00 pm EST or at [email protected].

Important Information for Providers Serving Virginia Medicaid Patients

During the Public Health Emergency (PHE), the Commonwealth of Virginia has maintained coverage for the Medicaid patient population thanks to the flexibilities and waivers afforded by state emergency orders and federal legislation. When Virginia is no longer under the PHE, the Department of Medical Assistance Services will begin their normal monthly practice of renewing Medicaid recipients. This means some patients previously enrolled may no longer be eligible or ensured covered.

Although Medicaid recipients cannot renew their coverage yet, they can begin updating their address and contact information now to make the renewal process more efficient. When talking with your patients who have Medicaid, encourage them to make sure their contact information, especially their address, is current and correct with the Department of Medical Assistance Services.

DMAS is also asking all Medicaid providers to familiarize their staff with the items that will remain active under the federal public health emergency and which items have now expired at the state level.

More Information and DMAS Updates for Medicaid Providers

National Nutrition Month: Help Patients Make Healthy Eating a Priority — Even On the Go

“I want to eat healthy, but I just don’t have the time.”

Sound familiar?

For National Nutrition Month, it’s important to recognize that time is the one thing we never have enough of. Just like you, your patients have long to-do lists and busy schedules. Unfortunately, when time is short, healthy eating often goes out the window.

You know diets high in saturated fat, sodium, and sugar can lead to conditions like obesity, high blood pressure, high cholesterol, and heart disease. In fact, most of the sodium we consume comes from restaurant, processed, packaged, and store-bought food — the very things we reach for when we’re in a hurry.

It’s important to help patients make healthy eating a priority — even on the go. Beyond informing them about health risks and encouraging them to make better choices, this list offers specific tips you can share to help patients eat healthy, or at least healthier, when time is tight and they’re on the move.

Healthy Eating Tips on the Go for National Nutrition Month

Make sure being busy isn’t an excuse for your patients to ignore their healthy eating goals, from what they choose to eat and even how they prepare it. Share these healthy eating tips to give them actionable ways to make better choices, even on the go:

Work, Activities, and More

  1. Keep fresh fruit handy as a snack. Oranges, bananas, and apples don’t need constant refrigeration.
  2. Pack lunch, dinner, and/or snacks to stay in control of options.
  3. Avoid or limit sugar-loaded fancy coffee drinks.
  4. Stay hydrated — thirst often disguises itself as hunger.
  5. Pack last night’s healthy dinner leftovers for lunch.
  6. Beware of mindless munching.
  7. Travel with smart nonperishable options for snacks or even lunch in a pinch. Try low-sugar, high protein energy bars or single-serve whole grain cereal packs.
  8. Choose foods high in protein and fiber to stay fuller longer.
  9. Don’t skip meals.
  10. Sip water.
  11. Avoid the sugar load of office cake or pastries, which can decrease your energy. Take one bite, say, “No thank you,” or leave it on the table.

Home

  1. Drink water with every meal.
  2. Canned and frozen veggies are speedy sides and can be more nutritious than fresh.
  3. Don’t skip breakfast! Grab-and-go choices include low-fat cheese sticks, fresh fruit, and low-fat yogurt tubes or smoothies.
  4. Do meal prep like chopping in advance so meals come together faster.
  5. Use prewashed, precut veggies to save time.
  6. Purchase low fat and low sugar frozen desserts.
  7. Freeze leftovers from healthy meals, they’re perfect for heating up in a pinch.
  8. Use leftover, prepped, or precut veggies to make a quick at-home salad bar.
  9. Weekends are a good time to batch cook for the week or stock the freezer.
  10. Bake potatoes ahead of time so they’re ready to heat and serve.

Fast Food

  1. Go for grilled menu choices.
  2. Only eat a few fries or skip them all together.
  3. Adults can order a kid-sized meal.
  4. Drink water or unsweet tea instead of sweet tea or soda.
  5. Skip the cheese and bacon on a burger.
  6. Choose wheat over white.
  7. Load up the veggies on sandwiches and burgers.
  8. Don’t double patties or super-size anything.
  9. Order thin crust instead of thick and skip pizza toppings like pepperoni.
  10. Choose low-fat salad dressing like vinaigrettes instead of creamy options.

Restaurants & Takeout

  1. Choose a veggie-heavy entrée.
  2. Avoid creamy or cheesy sauces.
  3. Opt for broiled, grilled, or baked instead of fried.
  4. Start with a salad to fill up more before the main course.
  5. Control portions — take extra food to go or split a meal with someone.
  6. Order chicken or fish instead of beef.
  7. Select smart sides, like a salad instead of mac and cheese.
  8. Ask for sauces and dressings on the side and control the amount.
  9. Put down the salt — restaurant food is usually already high in sodium.
  10. Skip the freebies like chips or bread.

We hope this list of specific tips helps you help patients make healthy eating a priority — even on the go. Bonus: We encourage you to use National Nutrition Month as an opportunity to apply these healthy eating tips to your own busy lifestyle!

Written By:
Mary Schmidt, MD, FIDSA, MPH

The information contained in this article is for educational purposes only and does not constitute health care advice.

Telephone Communication for Healthcare Providers: Safety Strategies

Nicole Franklin, MS, CPHRM, Patient Safety Risk Manager II, The Doctors Company

When casually or carelessly conducted, telephone communications can lead to diagnostic errors and misunderstandings that may culminate in professional malpractice claims.

Mitigate Malpractice Risk: Telephone Communication with Patients

Creating comprehensive, clear guidelines for telephone encounters with patients is critical in mitigating risk. Establish practice guidelines and ensure that all office and clinical staff are trained on their roles in communicating with patients by telephone. Protect yourself from potential liability by following these general practices:

  • Smile when greeting patients. Research has shown that people are able to tell if you are smiling by the tone of your voice.
  • Triage and refer all critical calls to emergency services. For more information on this topic, read the article Telephone Triage and Medical Advice Protocols.
  • Obtain as much information as possible about the patient’s presenting complaint. Listen carefully and allow the caller both the time and opportunity to ask questions.
  • Use easy-to-understand language that avoids medical terminology.
  • Obtain the services of an interpreter if you encounter a language difficulty. For more information, see ADA Requirements: Effective Communication.
  • Avoid distractions, such as checking email or attending to other duties, when speaking with patients.
  • Adhere to HIPAA rules and regulations to maintain patient privacy when communicating over the telephone, both inside and outside the office.
  • Develop written protocols for front office/unlicensed personnel to help them respond to patient questions and concerns.
  • Prescribe or advise by telephone only when you have reviewed the patient’s allergies, medications, and medical and surgical history. For more information on this topic, read our article Rx for Patient Safety: Use Ask Me 3 to Improve Patient Engagement and Communication.
  • Accept a third party’s description of a medical or dental condition only when you have confidence in that person’s competence to describe what he or she sees.
  • Make prompt referrals if the patient’s call concerns a medical or dental problem that is outside your expertise.
  • Confirm that pharmacists understand all dosages and instructions for drug prescriptions given by telephone.
  • Verify and document the patient’s adherence with telephone advice through a follow-up contact to ensure continuity of care.

Document All Telephone Communication to Mitigate Malpractice Risk

Disagreements about what was said during telephone conversations can be a major problem in professional malpractice cases. Follow these documentation processes to mitigate potential miscommunication and risk:

  • Document all patient telephone conversations in the medical or dental record—including those received and returned after hours. Include the date and time of each contact and when follow-up is completed.
  • Record all details immediately about the information you received, what you advised, and the orders you gave.
  • Implement an office process for calls received during office hours. Office staff should tell the caller when the provider is most likely to return the call. Include tracking and follow-up to ensure that the caller’s questions and problems are resolved and documented.
  • Document a patient’s hospital medical record with telephone conversations about the hospitalized patient—including any conversations with nurses or other providers.

Health Care Expenditures Attributable to Primary Care Physician Overall and Burnout-Related Turnover: A Cross-sectional Analysis

Abstract

Objective

To estimate the excess health care expenditures due to US primary care physician (PCP) turnover, both overall and specific to burnout.

Methods

We estimated the excess health care expenditures attributable to PCP turnover using published data for Medicare patients, calculated estimates for non-Medicare patients, and the American Medical Association Masterfile. We used published data from a cross-sectional survey of US physicians conducted between October 12, 2017, and March 15, 2018, of burnout and intention to leave one’s current practice within 2 years by primary care specialty to estimate excess expenditures attributable to PCP turnover due to burnout. A conservative estimate from the literature was used for actual turnover based on intention to leave. Additional publicly available data were used to estimate the average PCP panel size and the composition of Medicare and non-Medicare patients within a PCP’s panel.

Results

Turnover of PCPs results in approximately $979 million in excess health care expenditures for public and private payers annually, with $260 million attributable to PCP burnout-related turnover.

Conclusion

Turnover of PCPs, including that due to burnout, is costly to public and private payers. Efforts to reduce physician burnout may be considered as one approach to decrease US health care expenditures.

One of the more pervasive and prevent-able sources of disruptions to patient care is the occupational syndrome of burnout. The consequences of physician burnout are wide-ranging and include…

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Why America Has So Few Doctors

As a matter of basic economics, fewer doctors means less care and more expensive services. | By Derek Thompson via The Atlantic

The U.S. is one of the only developed countries to force aspiring doctors to earn a four-year bachelor’s degree and then go to medical school for another four years. (Most European countries have one continuous six-year program.) Then come the years of residency training. Many graduates have $200,000 to $400,000 in outstanding student loans when they enter the workforce. Medical education is a necessary good; nobody wants charlatans in the OR and snake-oil salesmen prescribing arthritis medication. What I’m asking is: What advantage do these additional years and loans get us?

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Dr. Lorna Breen Heroes’ Foundation Hails Senate Passage of Legislation Protecting Healthcare Workers’ Mental Health

The Dr. Lorna Breen Heroes’ Foundation today praised the U.S. Senate for passing the Dr. Lorna Breen Health Care Provider Protection Act. The legislation is named after Dr. Lorna Breen, a New York City emergency room physician who tragically died by suicide in Spring 2020 after treating confirmed COVID-19 patients, aims to reduce the stigma of seeking mental health assistance among health care professionals.

Jennifer Breen Feist and Corey Feist, co-founders of the Dr. Lorna Breen Heroes’ Foundation released a video praising the bill’s passage.

“We want to take a moment with you to pause and let all those health care professionals know that we heard you and we have been working diligently to support you,” said Jennifer Breen Feist, co-founder of the Dr. Lorna Breen Heroes’ Foundation. “We owe each of you our deepest gratitude for all you’ve done for us and for this country.”

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Looking for confidential support in Virginia? SafeHaven™ was founded in 2020 after recognizing a greater need to provide physicians and PAs the support they need to stay well and prevent burnout. Learn more here.