Summer 2012 - Broward County Medical Association
Transcription
Summer 2012 - Broward County Medical Association
Record the BROWARD COUNTY MEDICAL ASSOCIATION | S ummer 2012 2012 Commitments for In the Mix of Changes, What Should Doctors Keep Their Eye On? CBP-2679-Healthcare-MM-HR.pdf 1 4/17/12 12:04 PM Do you have a healthy one-on-one relationship with your bank? SM Maybe it’s time to get a second opinion. You’ve worked hard to build your practice. But navigating through today’s uncertain times requires a bank that understands the business of healthcare. That’s Comerica Bank. With nearly 150 years of experience, we’re here to help take your practice to the next level. Our dedicated Healthcare bankers bring a comprehensive approach to your business and personal goals. Through our diagnostic process, we can help you minimize costs and maximize opportunities. To get a second opinion on growing your practice, make an appointment with a Comerica Healthcare banker today. to ® Healthcare Ft. Lauderdale: 954.468.0600 or 800.225.6077 comerica.com/healthcare MEMBER FDIC. EQUAL OPPORTUNITY LENDER. NATIONAL SBA PREFERRED LENDER. the record • spring 2012 1 Officers & Board Members Kutty Chandran, MD, President Dana Wallace, MD, President Elect Richard Steinman, MD, Vice President Sanford Silverman, MD, Secretary/Treasurer Tony Prieto, MD, Chair, Board of Trustees Aaron Elkin, MD, Immediate Past President Co-Presidents, BCMA Alliance Susan Flaten, RN, Kathy Molinet, ARNP Diana Moll, MD and Joni Routman, RN Daniella Botoman, MD Ely Brand, MD William Bruno, MD Greg Burns, PA-C Lawrence Burns, MD, Assoc.Editor, The Record Alberto Casaretto, MD Linda Cox, MD Nabil El Sanadi, MD Paul Flaten, MD Jason Goldman, MD Mark Grenitz, MD Edwin Hamilton, MD David Kenigsberg, MD Alice Lin, OMS, NSU Jon Nguyen, OMS,NSU Arthur Palamara, MD Payal Patel, OMS, NSU David Perloff, MD Ramsey Pevsner, DO Tim Roedder, OMS, NSU Alan Routman, MD Robin Schugar, PA-C Yvonne Sherrer, MD Caren Singer, MD Marc Swerdloff, MD Victor Toledano, MD Christopher Wang, OMS, NSU Alex Youngdahl, OMS, NSU Ralph Zagha, MD AMA DELEGATES Robert Cline, MD Arthur Palamara, MD AMA Alternate Delegate Ronald Giffler, MD The Record: SUMMER 2012 Issue Associate Editor’s Page, Lawrence Burns, M.D. President’s Message, Kutty Chandran, M.D. EVP’s Message, Cynthia Peterson The Power of Welcome Physician Assistants: Working Side by Side with Physicians Surviving Healthcare: Challenges of Physicians Medical Care Today Routine HIV Testing in Clinical Settings What’s New With the Florida Board of Medicine? Accessing the Florida PDMP BCMA Congratulations Vestigial Knots in the Human Design BCMA New Members In Memorium BCMA 2012 Inauguration Dinner The Record is the official publication of Advertisers the Broward County Medical Association. Comerica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC If you are interested in a subscription or OptaComp/Dana Gracey . . . . . . . . . . . . . . . . . . . . . 1 to advertise in the magazine please Health Care Solutions Alliance . . . . . . . . . . . . . . . . 7 contact Cynthia Peterson CareCloud . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 [email protected] • 954.714.9772 Gulf Atlantic Legal Defense Insurance Inc. . . . . . . 16 Vincent DeGennaro, MD, President Elect Florida Medical Association Cynthia S. Peterson Executive Vice President 2 BROWARD COUNTY MEDICAL ASSOCIATION 3 4 6 8 9 10 11 12 14 16 17 18 20 21 22-24 Broward Health . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 For membership information please Office Space Available . . . . . . . . . . . . . . . . . . . . . 21 contact Cynthia Peterson Broad & Cassel . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC [email protected] • 954.714.9772 Pro Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . BC An Editorial Howdee Lawrence Burns, M.D. Associate Editor F ollowers of The Record know the magazine has changed over the years. More changes are coming. We just don’t know yet what they’ll be. Years ago various members of the BCMA took turns piloting the quarterly editions of the magazine, while others contributed articles, usually focusing on one theme at a time. Then two years ago a regional publisher took over the reign, hoping to profit by selling ads within the journal. That ended this fall, and the task of putting further editions together has fallen back onto the laps of BCMA members. Or rather onto their word processors and digital cameras. Yep, we’re back in the saddle and aim to fill the pages with facts and fun—and cover your backs from all the government agencies, insurance groups, and hospital organizations that are out to get you. I was one of the load-sharers from years back, and was quite pleased when the BCMA board, through Cynthia Peterson, recently asked me to take the helm as Associate Editor in steering The Record back under the group’s control. Hopefully, attending these board meetings will keep me fresh on what’s important and current to local docs, after several years of my own retirement. When I stopped working I had already been impressed—or depressed—with the geometric growth of committees and rules and obligation we all faced, but when I reviewed the last half dozen issues of the journal I was numb struck by the even grander scale of local, state, federal and corporate control. It made me wonder: does anybody enjoy being a physician anymore? Well, there’s no couch for rehab at The Record. But getting involved with it may put a little more fun, or at least self-reassurance, into your career. Readers will catch the journal evolving over the next few editions as we figure out what works and what doesn’t, but there are several features we’ll run with from the start. And whether the journal will stay on hard print or go fully electronic is on the board’s table for further discussion. Your thoughts will be important in making that decision. CONTRIBUTIONS. These will include written pieces by our docs or auxiliary members, including medical students. Articles may be about any important and timely medical issue doctors have to deal with. Case studies will also be welcome, hopefully aimed at more than a small part of a single specialty. And everyone is welcome to take a shot at writing some-thing warm, witty or just great-to-read. Not every written contribution needs editing, but some may require pencilediting, tightening or other changes to make the piece read better. Significant changes will go back to the author for an okay before publishing. This will be helped greatly by using the following process: write your contribution and save it as a document on your computer, then email it as an attachment to a letter to the BCMA. Doing it this way allows for editing directly online and will save a lot of time and work for the staff. Scanning the document eliminates this possibility, as does faxing pieces to the office. If this presents a problem for a contribution, get in touch with us and we’ll come up with another plan. THE MEDICAL STUDENT/RESIDENT. We share more and more of our time on the hospital campuses with medical students and residents. And they have a lot to say about it, so let’s hear them. We want to dedicate one page per issue for student/resident-written observations or thoughts, serious or funny, but crafted to sharing something worthwhile from the perspective of someone still on the academic ladder. The offer is open to any student or resident from a Florida institution. PHOTOS. We live in one of the world’s most beautiful areas. Let’s show it off. We would like to use photos taken by docs or associates or students of local cool things about South Florida, especially in Broward County. We want to make the covers of The Record dazzle with stuff of local pride, and keep that as an ongoing theme. Contributors will be given credit for bragging rights, but no payment will be available. And everyone loves those snapshots of doctors at parties or golf courses or sipping tea at the Great Wall. Whether the photos should be sent electronically or as hard copy has not yet been decided. Help us figure that out! I’M NOT the only doc in the BCMA or the county who’s interested in helping with The Record. Anyone else who wants to help either with editing, photo processing, or writing in various ways, please contact Cynthia, and we’ll plug you in. Now, back to the future! the record • spring 2012 3 Commitments for 2012 Kutty Chandran, M.D. President D uring my tenure as your new President, and beyond, it is my intention to honor the mission and the purpose of this organization as we work together to strengthen the sense of community throughout Broward County and its medical programs. I want to take this opportunity to thank the Board of Trustees, Board of Directors, and the members of the Broward County Medical Association for electing me as your 85th President of the BCMA. It is an honor and privilege to serve you. Thank you. As we all know, the world has gotten faster and more complicated, and as a result, each one of us faces new challenges on a daily basis. Processes and demands that were once a natural part of every day life seem to have become more and more daunting. Now, more than ever, we all need a “go to place,” one that serves as a context and a nexus for all phases of the medical community, to share situations, solutions and other forms of information that will ultimately support all of us in being more effective medical professionals. A year ago, while I was away for a weekend, a patient of mine for 20 years was hospitalized, and was assigned to a hospitalist. The following Monday, when I visited her, I got the following message: “Doctor, after all these years as your patient, when I really needed you, you were not here.” This, my friends, is the way the system has evolved. But is it what our patients really want? It’s tough to create change if we’re forced to do it alone. As members of the BCMA, functioning as a core group of committed physicians, we can work together to avoid this sort of patient distress and miscommunication. We can help our patients all 4 BROWARD COUNTY MEDICAL ASSOCIATION the more, while balancing our professional and private lives. Let me take a brief moment to describe the history of organized medicine. When the medical societies were formed in the in the late 1800s and early 1900s, their function was to educate physicians, improve the quality of their practices, and regulate the profession with ethics and professionalism. The societies were not involved in the financial aspect of medical practice, which was left to free market forces. The medical societies even had the power to grant licenses, thus forcing medical men of those days to belong to those groups. The first medical school was created by the effort of a medical society in 1765 in Philadelphia. As the medical societies—for example, the Mayo Clinic—began to create the best medical education and lead the research in medical cures, the Government stepped in and started to chip away at the power of organized medicine, using tools such as Antitrust Laws. The result was the fragmentation of organized medicine. Multiple specialty groups and sub-specialty societies were formed, by educational institutions and related organizations, and included employed physician groups, varying certifying boards, and even ethnic medical societies. It was a time when most medical professionals were members of organized medicine. Today, only about one third of our colleagues belong to a national association. Consider this contrast: Most attorneys, if not all, belong to their respective Bar Associations. We all have heard the maxim, “Strength in Numbers.” It is the same with us. It is in the best interest of our profession and our patients, that we reclaim that sense of community, and use those connections to strengthen OUR status. Dr. Nathan Laufer, of the Maricopa Medical Society in Arizona, published an article titled, “Organized Medicine: why it Matters.” In Part One of the article, he states, “ If we have several wishes of our medical practices these are probably what they look like: we would like to continue to practice independently as small businesses, be fairly compensated for our work and years in school, have influence with legislators regarding healthcare issues, be in charge of quality care issues, maintain patient choice regarding doctors and hospitals, get rid of the roadblocks that are preventing collections from payers and most importantly to be allowed to organize and do collective bargaining (if needed Federal Trade antitrust exemption).” And I agree with that statement. By maintaining a strong and viable medical association, that vision is not just possible, it’s actually probable! The medical profession and all its attendant satellite professions and industries have evolved light years in the past several generations. It’s hard to believe that back in the 1800’s, medical men were laypersons that did not enjoy the prestige and status that we enjoy today. Thanks to the efforts made to organize our “industry,” it is universally considered a noble profession throughout the world. There are so many complicated and stress-inducing Issues facing today’s practicing physician: • L ow reimbursement for services with rates fixed by the government, • L oss of physician autonomy and medical staff issues, • Cumbersome new Medicare enrollment issues, • E scalating of costs in all areas of practice, from administration to insurance, legal fees, technical support fees, etc. • Electronic Medical Records issues, It also seems as if rules and regulations are changing more frequently than ever, and it’s becoming increasingly difficult to maintain a sense of being informed. Sometimes I think, “There’s only so many hours in the day. What’s more important, tending to the health and well being of my patients, or making sure mountains of paperwork are completed?” Well, we know what the answer should be. As the President of this fine organization, I will work with state and national associations to address some of these issues. But I need help from YOU, the members of this organization. We need active participation. We need to grow our ranks and bring more members to the house of medicine. As the organization grows, so will the benefits of belonging. Remember the expression, “Critical Mass.” As we grow, so will our influence and voice. The BCMA can be a force not only in this community, but throughout Florida, and even in the rest of the country! Never lose sight of who you are and how you’ve chosen to share your life, your knowledge and your compassion. The Physician still has the power… The power of the pen or the computer keyboard. As Physicians, you give people life, you tend to people through illness, and you sign the certificates of both birth and death. Every day we make hundreds of decisions that have indelible impact on the people trusted to our care. We took the Hippocratic oath, and we pledged our lives to care for others. In this day and age, we have choices. We can either accept conditions as they are, or we can choose to come together to strengthen our collective voice and have a positive impact on our practices and our patients. We have the ability to prolong the longevity of our society, and we have the ability to rally for positive change. Positive change can happen in the medical professions through the collective strength and participation of all of you: My Colleagues. Remember the words of Mahatma Ghandi. He said, “Be the change you want to see in the world.” Change only comes if we choose to proceed to change. Think what men with commitment can do: Gandhi winning independence from the British Empire; Martin Luther King catalyzing critical social change, George Washington leading and then winning a revolutionary war. We may not have that single-minded force, but collectively we can bring a change to the medical world for the common good. As you see, I’ve “stepped up to the plate,” and I am proud to see all of you as my teammates, united in promoting the health, stability and positive growth of the noble profession we’ve all chosen as our life’s work. I invite all of you to join me in being the change we want to see, and I look forward to a year full of positive and impactful work for our community. I welcome all of you to participate! the record • spring 2012 5 FOR THE RECORD… Cynthia S. Peterson, Executive Vice President Just for the Record, on August 1, 2012, I will celebrate with joy my 22 years as your Executive Vice President. That means that I have worked for 22 Presidents and 22 Boards of Directors. There have been many changes over the years, some good, some bad for organized medicine. When I arrived, many doctors were not even using fax machines. Today, we are trying to wean doctors from fax machines to email. This has taken several years and we are still not 100% there. BCMA was one of the first medical associations in the state to have a web site, thanks to a past president, Dr. Barry Tepperman, who later moved out of the state. The web site went through reconstruction during Dr. Nigel Spier’s presidency in 2007 and now is going through another. Just bear with us for you soon can pay your dues online. If you are trying to share your office, sell your office, find a new partner, this can be posted on the web. www.BCMA.com. Everything takes time and money. So, thank you for continuing to pay your dues and for your continued support of the BCMA. A patient can go to the web site and see the Physician Directory. Our plan is; if you have a web site to place this under your name so that the patient can then click on the link to your web site. We will be sending out a note soon to see who has a web site. If you do not have a web site, we will give you the information for the company we use for the BCMA web site, Poweri. I know that times have been difficult the past 4 years. Your reimbursements from Medicare, Medicaid, and managed care usually never arrive on time. Sometimes not at all. If you are experiencing a problem being paid, please let me know. The BCMA Board has developed a relationship with many of the Medical Directors of the managed care companies as a direct contact. It really helps, but you have to let us know if you are having a problem. In the past few years, it is as if a hurricane has blown through the healthcare system and turned things upside down. So many changes occurring at one time. Is it possible for physicians and their patients to understand all the changes. Some are good for patients. Some are good for physicians. However, most of the changes have placed a huge burden on the practice of medicine. Members are still having problems with PECOS, E-Prescribing, and transitioning into EHR. What will be next? Well, the BCMA will be here looking out for you as we go on the journey with the Patient Protection and Affordable Care Act (PPACA), CINs, ACOs, PHOs, Tweets, Texts, Apps, and Facebook. Embrace your organization, get involved, or is your head in the CLOUDS? The Broward County Medical Association and Broward County Pediatric Society were part of the federal lawsuit, Wollschlaeger vs Farmer, challenging a new Florida law, prohibiting physicians from asking their patients questions, such as do you own a gun. U. S. District Judge Marcia Cooke held, “through this law, inserts itself into the doctor-patient relationship, prohibiting and burdening speech necessary to the proper practice of preventive medicine.” Special thanks to Thomas R. Julin, Esq, Chair of the First Amendment Litigation group of the international law firm Hunton & Williams, LLP, Miami. Don’t forget to call 954.714.9772 or email [email protected] if you need assistance. That is a Value Added Membership Benefit. We are here for you! Upcoming events: More Social Networking Events at BoneFish Grill, watch for the dates. Saturday, September 15 – “Time for Tough Choices at Your Practice: Get a Grip on Your Future” 9:00 am – 3:00 p.m., Sheraton Hotel, I-95 & Griffin Road Wednesday, October 17, 6:30 pm-8:30 pm, Women Physicians Dinner Meeting, Tower Club, Ft. Lauderdale Saturday, November 3, BCMA Annual Dinner, Hyatt Regency Pier 66, Dr. Dana Wallace will be installed as President (watch your email and fax for these notices) In the Fall, BCMA will begin a series of meetings on Coding and ICD-10 with Jean Acevedo as the expert speaker. The Broward County Medical Association Foundation and Broward County Health Department were approved for a grant from the Gragg Allman Hepatitis C Community Education Grant Fund. The purpose of the grant is to increase the number of providers in Broward County who care for people at risk for viral hepatitis. The grant was approved by the National Viral Hepatitis Roundtable, (NVHR). When Mr. Allman was in concert in Fort Lauderdale, the group met with him to tank him for the grant. L to R: Aaron Elkin, MD, Immediate Past President, BCMA; Paula Thaqi, MD, MPH, Director Broward County Health Department; Gregg Allman; Cynthia Peterson, EVP, BCMA 6 BROWARD COUNTY MEDICAL ASSOCIATION the record • spring 2012 7 The Power of Welcome…Hospitality Beyond Property Borders Roberta K. Nedry President and Founder, Hospitality Excellence, Inc. W hat makes us feel welcome, comfortable, appreciated in any environment? What kinds of emotions are triggered when we experience a welcoming feeling—and when we don’t? How do service providers instill a spirit of welcome in their teams and create a warm sense of belonging the moment their patients arrive? And how can the power of welcome move beyond borders and reach out to patients before they even set foot in the office or on the premises? Recently, I was in a doctor’s office and was overwhelmed by how welcome I felt and how comfortable the staff made me feel. Having felt quite the opposite, unwelcome and uncomfortable, in many doctor offices, I was actually stunned by this experience. What made this team at the South Florida Spine Clinic so different is that from the moment I opened the door, everyone I met, from the receptionist to the nurse and the doctor, greeted me warmly by name and with direct eye contact, and explained what would happen next. I felt special even though I was probably one of over 100 patients that day. I noticed that the doctor in charge, Jeffrey Cantor, was very interactive with his staff, greeted and laughed with them, and kept a level of positive energy going at all times, even with a demanding schedule. Dr. Cantor made his staff feel special, too, and that impacted the way they treated each patient. In any service or healthcare environment, the spirit of welcome is so important in creating a strong foundation for the patient experience. Every employee can add to the “welcoming” experience for patients! A welcome goes beyond words. It creates a feeling of caring and gives a sense of reassurance. A sincere welcome pulls patients in to the care environment they have chosen, and makes them confident they made a good choice. Written or telephone communications to confirm appointments can begin the welcoming process. Adding a welcoming statement to the correspondence helps establish a warm feeling for each pending visit. The patient feels the doctor and his staff all care. Children offer all sorts of opportunities for unique welcome strategies. I always appreciate an office that acknowledges and welcomes my 8 year old son at the same time they welcome me. When parents have no other care/babysitter options, they may have to bring children with them in order to make their appointment. A small gift of something, like tic tac toe sheets or other games, or even a treat can help occupy the child’s time while parents focus on their own health issues. On the other hand, an unwelcome feeling is very easy to create as well. Looking down while speaking, no introduction 8 BROWARD COUNTY MEDICAL ASSOCIATION or use of names, rushed and robotic gestures, efficient yet discourteous service – all of these can dismiss any hope of a welcoming feeling. When a feeling of welcome is not there, it makes patients feel uncomfortable and question their healthcare or business choice. Patients become less inclined to come back to that office, or refer others to the practice. There are many ways to use the power of welcome as a business strategy. As a starter, keep the following tips in mind: • R ecognize how to make patients feel welcome. Direct eye contact, smiles, and sincere words at each point of contact will generate positive emotional responses. • Introduce yourself. By giving your name you extend your welcome, and it makes patients feel relaxed. This includes each person and point of contact in the patient experience • K eep checking on patients and evaluate if they seem to feel welcome or if they appear uptight or uncomfortable. • S trategize on ways to reach out and invite patients to feel welcome before they set foot on the premises. • C onsider extra touches to build on a feeling of welcome. Brainstorm for ideas with managers and their teams, then involve them in the process. • E nsure that employees feel welcome in their own work space, and welcome them each day. Post signs in break rooms and around the property and make sure that all staff meetings begin with a sense of welcome. Creative use of the spirit and power of welcome can help both patients and employees feel more comfortable at those stressful and anxious moments that can occur in any medical practice. Welcome a welcoming strategy into each patient experience, and then welcome the referrals, repeat business, and additional income that will follow! Roberta Nedry is President of Hospitality Excellence, Inc., leaders in guest experience management. Ms. Nedry has developed a unique 3D Servicesm methodology to take guest, customer and patient service to the next level. Her firm focuses on guest, customer and client service, the concierge profession and service excellence training for management and frontline employees in all industries. To learn more about Hospitality Excellence programs, exceptional service and the new 3D Servicesm Online training program - a New Dimension in Service Excellence, visit www.hospitalityexcellence.com Ms. Nedry can be contacted at 877.436.3307 or roberta@ hospitalityexcellence.com. Physician Assistants: Working Side-by-Side with Physicians and State of Florida Healthcare Organizations Gregory L. Burns, MMS, PA-C Associate Director of Clinical Education-Barry University PA Program Board of Director-Broward County Medical Association Immediate Past President-Florida Academy of Physician Assistants W hen I graduated from Physician Assistant School at Nova Southeastern University-Ft. Lauderdale Campus, I never imagined myself becoming a leader in the only State-recognized PA Organization: Florida Academy of Physician Assistants (FAPA). Don’t get me wrong, I had aspirations to become some sort of leader after Nova but I did not know what would come out of it. After graduation and studying for my PA Board Exam, my brain turned into tapioca pudding. However, I did have a wonderful mentor in PA school that convinced me to get more involved in the PA Profession sooner rather than later. That mentor was FAPA Past President Michael Funk, PA-C. Through his guidance and expertise, he educated me to become a Regional Director leader within in FAPA and then led me to be voted in as the President of FAPA in 2010. Michael also led me to become a member of the Board of Directors of the Broward County Medical Association (BCMA) in 2008. Since then, I have had the pleasure of attending BCMA Board of Director Meetings working with Physicians and with Executive Vice President, Cynthia Peterson. Thanks to the help of BCMA, PAs can now be members of other County Medical Associations such as the Palm Beach Medical Society (PBMS), Dade County Medical Association (DCMA), and Pinellas County Medical Association (PCMA). It is our hope to include more Florida counties in the near future. Over the past five years, FAPA has progressively strengthened its alliances with not only county medical associations, but also with state-wide organizations such as the Florida Medical Association (FMA), Florida Osteopathic Medical Association (FOMA), and Florida Academy of Family Physicians (FAFP). Together, we have worked with these groups to lobby for the passing of a law requiring a Central Monitoring system for controlled substance prescription acquisition implemented last year by the State of Florida. With the strong support from these groups, FAPA has been able to pass a Physician Assistant Bill in the State of Florida since Michael Funk was President in 2007. In 2009, the elimination of parenteral and antipsychotic medications from the list of medications that PAs cannot prescribe was finally put into place by rule. Also, FAPA was instrumental in getting legislation passed that deleted the mandatory co-signature of medical records of PAs. Physicians now determine what is best for their practice in regards to co-signature of medical records. In 2010, FAPA helped passed a bill that eradicated the rule of having to wait three months in order to write for any prescriptions under physician supervision upon PA employment or switching medical specialties. In March 2012, FAPA passed one of the only scope-of-practice, or rather, streamlining of licensure, bills to be approved this year. The bill deletes a duplicative second license that is currently required of a Physician Assistant to gain prescribing authority – a requirement shared by no other prescribing practitioner. The bill further deletes a requirement for an unnecessary threehour prescribing course to be taken every two years. The bill stipulates that the Florida Board of Medicine may establish rules relating to the cost of a prescriber number, which may be the same as the PA license number. This bill should put Physician Assistants on more equal footing with other prescribing practitioners. As an organization, FAPA will continue to strengthen our alliances with these important healthcare organizations and perhaps, work jointly together on future projects or bills. We feel that the Physician-PA Team Approach to Medicine will be the Key to providing exceptional healthcare to the patients of the State of Florida in the near and distant future. the record • spring 2012 9 Surviving Healthcare: Challenges of Physicians Robert Cline, M.D., Past President Florida Medical Association & Broward County Medical Association A t first glance, the title of this article suggests that we are going to provide you with “pearls of wisdom” regarding practice management and organizational skills to help build and maintain a successful medical practice in today’s hostile environment. There are abundant books and medical business journal articles that offer excellent advice about office management, record keeping and contract negotiations with hospitals and third party payers. Aside from this, there are, however three attitudes and habits which can have a tremendous influence on your survival and, in many cases, are more important than the business management of your practice. If you do not pay attention to these three items you may not have much business to manage! The first and probably the most important of these is COMMUNICATION, communication with patients, staff, colleagues, and business consultants. Patients love a doctor who communicates in a clear and timely fashion and listens to their problems and concerns. By the same token, your colleagues want you to communicate regularly about the patients you share. You must take time from your busy office schedule to provide verbal and written reports about your plans for their patients. It is also known that many malpractice cases result from inadequate or improper communication by physicians and staff. Many burdensome lawsuits can be avoided by simple, timely, and accurate communication. In addition, many Board of Medicine cases arise from communication errors or deficiencies and result in lost time or worse dealing with these issues. Just as important is number two: AVAILABILITY. There is a recent emphasis in medical training programs to provide abundant time for rest and study. But this can rob the trainee of learning how do deal with continuity of care: they’re unavailable when their patients need them most. It’s certainly a terrible habit when embarking on a demanding practice, and it leaves future doctors unprepared for the availability their hospitals and patients will require. Doctors can’t just relegate their obligations to other staff and extenders when they are the ones who are needed. Furthermore, availability should not be based on reimbursement, but on the specific need at hand at the moment. We must always reach out to a colleague or hospital when we are needed. Be available and your practice will be rewarded. It is tragic that so many of us have forgotten the Oath we took upon graduation from medical school. Finally, AFFABILITY is an invaluable, somewhat intangible trait that must be cultivated to promote a successful medical practice in today’s environment. When our lives seem filled with disgruntled patients, unhappy staff, and unreasonable payers and regulations, it comes as a real delight for everyone to work with an affable, friendly, polite and caring physician. Your attitude and social behavior can put you at the top of other doctors’ lists when considering a referral. At the same time, your patients will receive optimal care when nurses see you as a considerate and affable physician. Remember, a little kindness goes a long way. These three simple habits and behaviors, COMMUNICATION, AVAILABILITY, and AFFABILITY are vital for your survival in the disturbing economic and professional times we are facing. Cultivate these skills and you will find success and peace with your patients, your staff, your hospital, and most importantly—with yourself. 10 BROWARD COUNTY MEDICAL ASSOCIATION Medical Care Today Octavio E. Prieto, M.D., Chair BCMA Board of Trustees A s I was thinking about what to write for the The Record, I was going over all the changes in medicine. In my specialty of primary care, government-based insurances, third party insurance companies, slow payers, etc., are destroying offices. A few years back I had one-stop medicine in my office. I provided lab work, x-rays, EKG’s, ultrasounds and CT scans. I was saving the insurance companies thousands of dollars by not sending patients to the hospital for diagnostic testing or emergency rooms. There is not a doctor today who still has a lab set up in his office or a CT machine. I still provide x-rays, EKG’s, ultrasounds, and Holter monitors. I like comparing Primary Care with other professions. If we were carpenters building a house, wouldn’t we require the proper tools? We would need hammers, nails, and saws to get the job done. Primary Care physicians need tools of their own, to make timely diagnoses in our offices at the time of service. Doctors should not have to send a patient to a lab to have blood drawn and then have to wait days for results. But today we’ve become referral doctors: If a patient presents with chest pain, we refer them to the ER; if a patient needs blood work done, we refer him to a lab. In both cases, we have to wait for results. The main factor, though, is that what would probably cost less than $200 in an office setting will now cost thousands if done in the emergency room. Let me demonstrate how things have turned upside down using the stories of a couple of my own patients. Not long ago, an overweight patient presented with leg pain, and I felt he needed an ultrasound of the leg to rule out DVT. My ultrasound technician is no longer available every day, unlike in the recent past, but even if he had been, the patient’s insurance company did not allow this test to be done in a doctor’s office. I had to refer him to the insurance company’s diagnostic center. Being that it was a Friday, the test was rescheduled for Monday, when the DVT was found. After receiving this information, I referred him to the emergency room immediately. By the time the patient got there later that day, he already had bilateral pulmonary emboli. However, the story doesn’t end there. Only two days later the physician advisor from the insurance company began pressing me as to why the patient was still in an ICU? That, when the patient was still on a heparin drip! Another example is a patient I saw at 3 PM in my office with positive right lower quadrant pain. Not having labs in my office to check his WBC and other tests, I had to refer him to the ER. Around 8:30 PM, as I was in a doctors’ meeting, I suddenly realized I had not heard anything from the ER about this patient. Calling the hospital, I found out he was still getting worked up, was in line for a CT of the abdomen. Good thing he did not perforate as he had a positive appendix. In the “old days,” having had the tests available in my office, he probably would have been in surgery by 4 PM.That, friends, would have been better medical care. Doctors, we NEED to unite! Large groups today are getting much better treatment than solo practices, with better contracts and fewer denials. There IS strength in numbers. Join us today at the Broward County Medical Association, attend our meetings, speak your mind and maybe we will all survive. the record • spring 2012 11 Routine HIV Testing in Clinical Settings Paula Thaqi, MD, MPH Director, Broward County Health Department G. Stephen Bowen, MD, MPH Medical Epidemiologist, Broward County Health Department Introduction Highly Active Antiretroviral Therapy (HAART) has transformed treatment of HIV infection by HIV specialist physicians, has substantially reduced AIDS-related mortality and has made this a chronic manageable medical condition. People who are diagnosed early in their disease course can be treated before their immune systems deteriorate and before opportunistic infections such as tuberculosis and HIV-related malignancies occur. Undiagnosed recently infected people have high viral loads and may often transmit HIV to others. People with HIV who are actively engaged in care, fill their prescriptions on time, take their medications as prescribed, have their Population-based HIV Testing 1. National Health Interview Survey (NHIS) and National Health and Nutrition Examination Survey (NHANES) data indicate that less than 50% of adults age 18-64 and 34% of 18-24 year olds have ever been tested for HIV. More than 20% of infected people are unaware; for high risk men the proportion unaware is 45%. Unaware people are more likely to transmit HIV (Ref: Marks et al, AIDS 2006; 20, 1447-50). 2. Each year since 2004 Broward County has the highest or 2nd highest newly diagnosed AIDS rates among United States urban areas. Since 2008 this is also true for new HIV case rates. In Broward County, it is estimated that more than 16,000 or approximately 1 in 100 people 18 years of age or older are diagnosed and living with HIV/ AIDS and 3000+ people are infected, but don’t know. Most adults visit one or more health care facilities, offices or clinics for years without being tested before being diagnosed. Most will have blood drawn for other reasons, but HIV testing was not done. Most patients will agree to be tested if their doctor recommends it. 12 BROWARD COUNTY MEDICAL ASSOCIATION viral loads and CD4 counts monitored and, as a result, have undetectable viral loads are much less likely than are untreated people with HIV to transmit HIV to their babies perinatally or to their sex partners. (Ref: Cohen, MS et al; Prevention of HIV1 Infection with Early Antiretroviral Therapy; New Eng J Med: 2011, 365 (6) 493-505). We now have the tools in hand to substantially reduce the epidemic of HIV/AIDS because early diagnosis and treatment is an important aspect of prevention. This is dependent on people getting tested and knowing their HIV status. The Centers for Disease Control and Prevention (CDC), after consultation with diverse medical specialty organizations and representatives from a large number of clinical settings, since 2006 recommends HIV testing to be a routine part of medical care in most medical settings including private practices, clinics, hospital emergency departments and for inpatients in hospitals. A detailed rationale is found in Branson, BM et al; Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health Care Settings, MMWR, Sept. 22, 2006 55/RR14; 1-17. CDC recommends that adolescents and adults 13-64 years of be tested and that people at high risk such as men who have sex with men, spouses or sex partners of HIV positive people and injection drug users be tested at least annually. Many health systems including two in south Florida, 6 hospitals in Washington DC, and diverse systems in Oakland, California, New York City, Los Angeles, San Francisco, Massachusetts, and Denver, Colorado have demonstrated that routine HIV Testing is acceptable to patients and health practitioners and is feasible to implement during normal operations. The recommendations for routine HIV testing are consistent with recognized criteria for screening programs: a) HIV is a serious disorder that can be diagnosed before clinical symptoms begin; b) HIV can be detected by reliable, inexpensive and non-invasive patient-acceptable tests; c) Early treatment preserves health and prolongs life; d) Costs are reasonable in relation to benefits. Conclusion: Broward County Health Department and Broward County Medical Association urge medical practitioners to make routine HIV testing for patients age 13-64 including testing new patients at their initial or second medical visit to be a standard of care in Broward County. the record • spring 2012 13 What’s New with the Florida Board of Medicine: I By Crystal A. Sanford n 2011, the Florida Board of Medicine underwent many changes. One of those changes was a complete overhaul of our website based on comments received from our licensees as well as the general public. This article will provide you with an overview of the website so you can find information when you need it. The web address for the Division of Medical Quality Assurance (MQA) is www.doh.state.fl.us/mqa. This site is the overview site applicable to all health care providers and from this site you can access many things: Renew your license Update your Practitioner Profile Update your address D esignated yourself as a controlled substance prescriber C reate a relationship between yourself and a pain-management clinic Request a duplicate license Request a license verification A ccess information on counter-proof prescription pad and approved vendor list New changes in law And much more… Coming soon - The Board of Medicine’s licensure applications will soon be online. This will allow applicants to complete the application and submit the fee with the application online. 14 BROWARD COUNTY MEDICAL ASSOCIATION The Board of Medicine web site can be accessed from the MQA site or by typing in the web address which is www.doh.state.fl.us/mqa/medical. To access it from the MQA web site, simply click on Health Care Professions and select Medicine. Everything on this site is related to physicians. Below is a list of the categories available on this site and the types of documents that can be found under each category: Apply for License As mentioned earlier, this is where an applicant would go to access online applications. This section also contains information on licensure requirements, fees and other forms. Board Meeting Information This section includes meeting dates and locations, the actual agenda materials, minutes and audio of the meetings. You can also find information on the Board Members in this section. Contact Information This section provides the Board of Medicine address, telephone number, facsimile and email address. Continuing Education This section provides the continuing medical education requirements necessary for renewal of your license. Petitions for Declaratory Statements This section is a link to a searchable database of Final Orders on Petitions for Declaratory Statement. A Petition for Declaratory Statement is a legal mechanism for physicians to request clarification Introducing Changes to the Board’s Website from the Board on a particular law as that law relates to that particular physician’s circumstances. Professionals Resource Network (PRN) This section provides contact and other information for PRN, Florida’s approved impairment program. Profession Updates This section contains alerts from the Department of Health, Board of Medicine and DEA. Also available in this section are the current and older versions of the Messages from the Chair and the Board’s Annual Reports. Registration/Inspection This section has links to the Office Surgery Registration and Inspection Program and the PainManagement Registration and Inspection Program. All information related to these two programs can be found here. Renewal This section provides renewal dates. You can also link to MQA Services where you renew your license. There is also information about renewing through the mail instead of online. Remember that renewing online is faster and you can print confirmation of your renewal. Laws and Rules This section of the web site lists all pertinent laws and rules as well as links to access them. There are a few specific laws highlighted in this section as well. responsibility form; relinquishment forms; address change forms; dispensing practitioner registration forms; and many more. All forms can be completed online, printed and mailed to the Board Office. A great option, for physicians to receive information as it occurs, is to join our Interested Parties List (Mailman). Emails will be sent directly to you with information we are posting on our web site. By using this tool, your email address is not readily available for public viewing on your Practitioner Profile. You can join the Mailman by clicking on its link on the Medicine web page or by going to http://www.doh.state.fl.us/mqa/medical/ me_mailman.html. As always, if you cannot find the information you are looking for on our web site, we will be glad to assist you. You can send us an email at MQA_Medicine@ doh.state.fl.us and we will respond within 24 hours. Ms. Sanford is currently a Program Operations Administrator in the Board of Medicine and has worked in the Board for over 20 years. Forms/Information This section houses all of our forms except applications for licensure. This includes the financial the record • spring the record 2012 15 Accessing the Florida Prescription Drug Monitoring Program T he Florida Prescription Drug Monitoring program (PDMP) was signed into law in June of 2009 and went live online in mid-October. The website is simple to use and the information is displayed in an easy to read format. A query into the database is not cumbersome and only takes a few seconds. By law, dispensing providers must submit to the database within seven days of dispensing. In reality, the data obtained from the PDMP is variable. Based on my personal experience, reporting from within seven days to no reporting at all is occurring. The information provided by the PDMP gives physicians and pharmacists valuable insight into patients’ prescription activity. Physicians who prescribe controlled substances to manage chronic pain should utilize risk management strategies to mitigate adverse outcomes to patients and ourselves. I have found the PDMP fills a void in my risk management toolbox. If you have not registered for the Florida PDMP, it is relatively easy. The following website allows licensed Florida physicians to register in the database: http://www.hidinc.com/flpdmp Click on registration for practitioners/pharmacists and follow the directions. Use your DOH ID and password that come with your license renewal. Once you have been given access, you will be asked to create a unique username and password to access the website. A query will require the patient’s name, gender and DOB. You can obtain their entire controlled prescription history in the state for at least the past 3 months. Sanford M. Silverman, MD, President-Elect Florida Society of Interventional Pain Physicians Secretary, BCMA Some Pathways are Treacherous. Let Us Help. are you self-insured or bare? Did you know gulf atlantic legal Defense insurance offers many options to protect your medical practice from the risk of litigation? • our policy pays up to $100,000 per claim in attorney fees, expert witness, court reporter and most other fees associated with a medical malpractice claim. (higher limits are available.) • Medicare / Medicaid and ahca endorsements available. • group Discounts, separate corporate coverage, shared limits and higher per claim, group and aggregate limits available. • choose From over 40 Firms specializing in Medical Malpractice. • licensed, regulated and annually audited to ensure Financial stability. For more information, contact us at (800) 839-2944 or visit our website (www.gulfatlantic.com) where you will find more information on our legal defense insurance product. Gulf Atlantic Legal Defense Insurance, Inc. 2549 barrington circle • tallahassee, Fl 32308 • [P] 800-839-2944 • [F] 800-357-0652 www.gulfatlantic.com basic coverage limits are $100,000 per claim, $200,000 annual aggregate. gulf atlantic legal Defense insurance, inc. is a Florida legal expense insurance company licensed under chapter 642, Florida statutes. 16 BROWARD COUNTY MEDICAL ASSOCIATION Steven D. Wexner, M.D. has been elected an active fellow of the American Surgical Association, making him one of just 460 in the nation and the only one in Broward County. Dr. Wexner is currently President of the American Society of Colorectal Surgeons and is the immediate past president of the American Board of colon and Rectal Surgeons. He is also serving his first three-year term as a representative on the prestigious American College of Surgeons‘ Commission on Cancer. Dr. Wexner is Chairman of the department of Colorectal Surgery, Chief Academic Office and emeritus Chief of Staff at Cleveland Clinic Florida. We are pleased to acknowledge that Dr. Wexner has been an active member of the BCMA for 24 years. Winner of the pedicatric societies logo design, Brittania Carnevali with Professor Linda Weeks, MFA, Advertising and Graphic Design, The Art Institute GOLDBERG, DDS of Fort Lauderdale. HOWELL A GOLDBERG, DDS, FAGD Diplomate, American Board of Dental Sleep Medicine Member, American Academy of Sleep Medicine Member, American Academy of Dental Sleep Medicine Treating Snoring and Sleep Apnea with Oral Appliance Therapy Since 1994 Medical Insurance Coverage for Most Patients Diagnosed and Physician Referred Fountains Dental the record • spring 2012 17 Vestigial Knots IN THE HUMAN DESIGN One medical student’s perspective on our quirky heritage …what a hodge-podge design the whole affair is: 20,000 single genes coding for a menagerie of organs, duct-taped together, often inefficiently, by connective tissue… I By Will Jaffee n the first two years of medical school, students are buried in the basics of anatomy, physiology, biochemistry, and the like. “Buried” even seems an understatement; “having one’s mind blown open while fitting in thousands of new terms, 3D structures, and empty French presses” is a bit closer to the truth. Nonetheless, when we get time to reflect on the knowledge we’ve gained thus far, and are able to take even a five foot view of the whole body, rather than five nanometer (in bioche mistry) or five centimeter views (in anatomy lab), many of us reach the same hackneyed conclusion. We then sum it up at the Thanksgiving dinner table to our curious family: “Uh, yeah, the body is really beautiful and complicated. It’s amazing how well designed it is!” While a cursory viewing of any mammal would lead one to think this, the devil is in the details. As such, I’ve been thinking about what a hodgepodge design the whole affair is: 20,000 single genes coding for a menagerie of organs, duct-taped together, often inefficiently, by connective tissue. Things go wrong all over the place, and we’ve got a police squad (immune system) that’s often ill-funded (as in 70+ immunodeficiencies), or overfunded (as in the lymphomas/leukemias). Sometimes it’s just far too aggressive (as in the hypersensitivity disorders, e.g. allergies to shellfish, which deprive their hosts the insurmountable pleasure of ingesting the tail of a Maine lobster). Further, our evolutionary heritage shines through in designs that were quite helpful for, say, a 18 BROWARD COUNTY MEDICAL ASSOCIATION fish, yet horribly inefficient for us (as in the route of the infamous recurrent laryngeal nerve, which takes a circuitous path from the brainstem down to the aorta and back up to the larynx. Fish don’t have necks, it’s a direct shot for them. Giraffe’s have it the worst: a 15ft detour.) Even when we look at the molecular scale, students still reach the same odd conclusion: that because it’s complicated, it’s well designed. Yet, we have cells that are often blind enough to let an enemy (virus) into their house (cell membranes) and use their kitchen to cook up a batch of 100,000 more enemies. “Sure! Use my polymerases! You seem trustworthy! Go on, date my daughter-I just telophased her out yesterday!” So, while this complicated epidermal bag of electrolyte-rich fluid called a “human body” has a mind-bogglingly complicated set-up, clearly it needs some help (cue lights for healthcare team!). I hope we continue to appreciate our heritage in other mammals while progressing through our medical education, and recognize that a complicated system can be both as semi-dysfunctional and beautiful, as we like to think it is. As such, I’ll add a little twist to the traditional medical student perspective: “Given the obvious blind watch making of evolution, it’s also amazing that I may live to see 90+ years, largely thanks to medicine.” The human body continues to amaze me in its complexity, but also in the richness of its genetic heritage, and all the quirky inefficiencies that came along for the ride. the record • spring 2012 19 MEMBERS The Record: BCMA COMMUNITY BCM A W ELCOMES NE W MEMBE R S : William R. Alexis, MD Interventional Cardiology 954.437.9116 Pembroke Pines Man Q. Le, MD Anesthesia 561.955.7246 Boca Raton Richard J. Paley, MD Emergency Medicine 954.415.4993 Deerfield Beach Stuart Bernstsein, MD Pulmonology 305.937.4400 Aventura Ridwan Lin, MD Neurology 954.786.5151 Deerfield Beach Payal Patel, OMS Medical Student Nova Southeastern University Valentina R. Bradley, MD Dermatology 954.634.1595 Ft. Lauderdale Alexander Llanos, MD Cardiology/ Interventional 954.772.2136 Ft. Lauderdale Shirley E.Campbell-Mogg, MD Pediatrics 954.577.0321 Plantation Basil Mangra, MD Internal Medicine 954.484.6440 Lauderdale Lakes Jose J. Diaz, DO Physical Medicine+Rehabilitation 954.985.3932 Hollywood Luis Mesa, MD Pulmonology 305.937.4400 Aventura Parham Eftekhari, DO Nephrology 954.463.0112 Ft. Lauderdale Baaz Mishiev, MD Gastroenterology 954.961.8400 Hollywood Alix Gay, MD Internal Medicine/Geriatrics 954.927.0108 Hollywood Ian J. Morales, MD Internal Medicine/Pulmonary 305.978.7482 Plantation Michael Halle, MD Pediatrics 954.835.2111 Sunrise Nils Mueller-Kronast, MD Neurology/Neurointerventional 561.499.7551 Delray Beach Karen Kennedy, DO Hospice/Palliative Medicine 954.267.3800 Ft. Lauderdale Alexandra Oleinik, OMS Medical Student Nova Southeastern University Robin G. Schugar, MSPAS, PA-C Assistant Professor 954.262.1281 Nova Southeastern University Luis A. Orihuela, MD Cardiovascular Disease 954.721.6666 Tamarac Nandita Shankar, MD Neurology/Neuromuscular Diseases 954.475.1735 Plantation Lindsay La Corte, OMS IV Medical Student Nova Southeastern University 20 BROWARD COUNTY MEDICAL ASSOCIATION Samir Peshimam, MD Critical Care Medicine (Intensivist) 954.265.9976 Hollywood Lina Ramirez, MD Pulmonology 305.937.4400 Aventura Richard A. Reines, MD Family Practice 954.987.7230 Hollywood Mara R. Sanchez, MMS, PA-C Assistant Professor 954.262.1261 Nova Southeastern University Heidi Schaeffer, MD Internal Medicine 786.303.9492 Pembroke Pines Barry H. Schiff, MD Cardiology 954.628.3802 Pembroke Pines BCM A MEMO R I A M BCMA extends their heartfelt sympathy to the families on their loss Andrew C. Shatz, MD Ophthalmology 954.653.0100 Sunrise Stanley E. Skopit, DO Dermatology 888.540.9660 Pompano Beach Kenneth R. Stein, MD Radiology 561.452.4110 Ft. Lauderdale Peter P. Ventre, MD Psychiatry 954.561.6222 Ft. Lauderdale Bernd Wollschlaeger, MD Family Practice 305.940.8717 N. Miami Beach Luis M. Albuerne, MD June 9, 2011 Howard J. Schlitt July 4, 2011 Jeffrey Caron, MD March 6, 2011 Marvin Harold Schultz, MD September 27, 2011 Harold Conn, MD October 9, 2011 Roger Schnell, MD June 23, 2012 Jefferson R. Edwards, MD July 23, 2011 Morton Nathan Schwartzman, MD January 19, 2012 Harvey Keese, Jr., MD January 30, 2012 Calvin Hylton Shirley, MD June 23, 2012 Homer L. Marquit, MD February 4, 2012 Janee Steinberg, MD June 11, 2012 Bohdan Moroz, MD July 24, 2011 Lawrence Stempel, DO July 1, 2011 Guillermo Rodriguez, MD December 13, 2011 Steven F. Woodring, DO Anesthesiology 239.349.2604 Naples Jacob W. Zeiders, MD Pediatric Otolaryngology 954.888.8997 Ft. Lauderdale the record • spring 2012 21 2012 Inauguration Dinner Kutty Chandran, MD Amie Chandran, RN Blanca Perper-Greenstein Joshua Perper, MD Carolyn Husband and Eddie Hernandez from MDinTouch Payal Patel, OMS, NSU; Milla Kviatkovsky, OMS, NSU; Gene Cash, Ph.D; and Dana Wallace, MD Sangeetha Chandramohan, MD Kirk Kreis, ProAssurance 22 BROWARD COUNTY MEDICAL ASSOCIATION Thea Burrell, Leena Moran from BlueCross BlueShield of Florida Mark Rosen, Esq. and Debby Rosen Lubell & Rosen Friends from BB&T Bank Joni Routman, RN, President - FMA Allliance and Kathy Molinet, ARNP, Past President - FMA Alliance Susan Flaten, RN; Mark Swerdloff, MD and Gertrude Kloep Milla Kaviatkovsky, Alex Oleinik, Payal Patel, Alice Lin and Lena Virasch, Osteopathic medical students from NSU Ashley Boxer Dailey, Jacqueline Cananles, Marcus Suchecki, Pedro Fernandez, MD from Baptist Health South Florida the record • spring 2012 23 Inauguration Dinner Sunil Kumar, MD; Vandana Kumar, MD; Peter Johnson, MD; Shirley Johnson, MD; Alberto Casaretto, MD and Caren Singer, MD Richard Steinman, MD and Mela Steinman Alan Routman, MD; Joni Routman, RN; Pearl Goodman and Stanley Goodman, MD Stacy Frankel, MD and Ralph Zagha, MD 2012 Tony Prieto, MD and Lynne Prieto University of Miami Hurricane Bhangra Dance Team Talia Elkin, Gil Bronner, Michal Elkin, Pinchas Elkin, Aaron Elkin, MD and Judy Elkin 24 BROWARD COUNTY MEDICAL ASSOCIATION “As physicians, we have so many unknowns coming our way... One thing I am certain about is my malpractice protection.” Medicine is feeling the effects of regulatory and legislative changes, increasing risk, and profitability demands—all contributing to an atmosphere of uncertainty and lack of control. What we do control as physicians: our choice of a liability partner. I selected ProAssurance because they stand behind my good medicine and understand my business decisions. In spite of the maelstrom of change, I am protected, respected, and heard. I believe in fair treatment— and I get it. Proudly Endorsed by Professional Liability Insurance & Risk Management Services ProAssurance Group is rated A (Excellent) by A.M. Best. COUNTY MEDICAL ASSOCIATION 4 BROWARD ProAssurance.com • 800.222.5115