President's Update

By Sterling N. Ransone, Jr., MD, FAAFP
MSV President

Top Three Issues in the Coming Year

As the new Medical Society of Virginia (MSV) President, there are three topics which I would like physicians to address over the upcoming year: physician satisfaction, maintenance of the patient-physician relationship and (I’m sure it’s no surprise to those of you who know me well) political advocacy. The first two of these are intimately related and the third is the mechanism by which we will affect change and achieve our vision.

Physician Satisfaction

I feel as if I have the best job in the world. I live in a lovely home, have a fantastic family and get to help numerous people have better and healthier lives on a daily basis. I truly feel as if I am blessed. Several years ago, a colleague and I discussed the joy of medical practice, when he remarked how good it feels to close the door to the examination room, to see a patient and simultaneously shut out the worries of the world, how good it feels to make a child feel better, to alleviate the pain and suffering of an elderly lady, to solve the puzzle of seemingly unrelated symptoms in a young man or to ease the anxiety of a new mom. If we could just bottle and sell that feeling to the world, there would be no need for a war against drugs. Everyone would want it and though addicting, it would be a pleasure to prescribe.

Unfortunately, that feeling ends when we step outside the exam room or surgical suite. The harsh realities of modern medicine then raise their ugly heads. Insurance companies refuse to honor the prescription just given to your last patient without multiple pages of justification of your clinical decision making. Efforts to secure the best care for a patient so she can rehabilitate and have a speedy recovery are questioned. Roadblocks are set up to hinder the investigation of a malady to which may have several causes. Documentation must be created explaining the minutia of your thought process and the counseling given to the patient. All the while striving to achieve so-called meaningful use of a computer system which really wasn’t wanted in the first place, under the watchful eye of government, administrators and potentially the medical malpractice attorneys who are always trolling for business.

It’s no wonder that some of our colleagues feel as if their dream of helping other people has abandoned them. At best, this can lead to cynicism with the system, with associated apathy when dealing with our patients. At worst, it can lead to burnout, depression, substance abuse and possibly suicide. Yearly, in the United States, approximately 400 physicians decide to end their life by their own hand. That is over two medical school classes removed from our ranks yearly while in the primes of their careers. I cannot fathom the despondency and isolation that those colleagues of ours must have felt when reaching that decision. This hits home with me, because several years ago a classmate and frequent study-mate of mine from medical school decided to end his life after more than ten years of practice.

We as a profession, cannot sit idly by while our brethren suffer. It is in our nature as physicians to help those who are ill, yet frequently we are unable to see those who are wilting by our sides. We need to explore how we as an organization can assist those for whom the practice of medicine is no longer a joy.

In an October 2012 study, published in the Archives of Internal Medicine, 45.8 percent of physicians reported at least one symptom of burnout, using the Maslach Burnout Inventory finding substantial differences by specialty, with the highest rates among physicians at the front line of care access (family medicine, general internal medicine and emergency medicine). The literature detailing physician burnout is substantial and unsettling with the American Medical News reporting that 50 percent of all physicians suffer from burnout and the British Medical Journal reporting a 34 percent overall burnout rate with 25 percent of physicians feeling dissatisfied with their job. In other survey data, 49.6 percent of medical students felt burned out, 77 percent of physicians reported feeling pessimistic about the future and 58 percent of physicians reported having told their children to not go into the practice of medicine. In one medical school, a dean polled his freshman medical school class and reported that 80 percent of those students were advised by at least one physician to avoid the profession.

This type of dissatisfaction and disillusionment comes from difficulties dealing with some of the realities of our profession. I find it sad that those whom are experiencing burnout no longer feel that joy and contentment when entering the exam room and when returning home. We need to teach ourselves how to achieve work-life balance to benefit both our health and that of our patients. To that end, next Spring, in conjunction with the MSV Foundation’s Evolve Leadership Program, MSV will sponsor a program which will address the problem of physician burnout, show us how physician satisfaction is directly linked with medical outcomes and suggest strategies to combat this pervasive problem.

Last year, the American Medical Association hired the Rand Corporation to assess the drivers of physician satisfaction and barriers to achieving the same. Their report was published about two weeks ago and showed that while there are multiple causes of dissatisfaction, three issues rose to the top which correlated with physician satisfaction. First was time with patients, second was autonomy – the control and influence over our practice environment, and third was maintaining a stable and predictable source of revenue. These issues are ones which we must address as a profession and as a society to move towards our vision.

This year, I plan on convening a task force to examine the data and determine solutions to the issues which cause dissatisfaction of physicians with medical practices in Virginia. We will work with all interested parties to determine strategies to improve the overall practice environment and increase physician satisfaction. We will also determine how MSV can lend a helping hand to those of our ranks who need it most.

Maintenance of the Patient/Physician Relationship

This year, the Virginia legislature again extended its reach into the exam room when it mandated physician behavior in the care of their patients when it enacted the Lyme Disease notification language. It may not seem like much to those who do not have to pass out these notices, but I, personally, seethe each time I am required by law to distribute the poorly worded, ill conceived handouts to my patients. I am sure that my radiologist colleagues feel similarly when they are forced to give mandated language to their patients with dense breast tissue or our gynecological colleagues who are forced to perform a potentially unnecessary procedure on a woman because it is proscribed by law—which was the first such action in Virginia compelling a physician to perform aprocedure on a patient since forced sterilization of the mentally incompetent between 1927 and 1979. What will be the next mandate to step between us and our patients?

Will I have to hand a piece of paper to each patient on whom I perform an EKG stating that even though it looks normal, they may still have heart disease? Will we have to provide disclaimers for each of our services rendered?

I have a grave concern that emotion and pseudoscience may replace scientific rigor and logic in determining the standard of care for our patients.

This year, we will further the efforts to build a coalition of healthcare providers, from physicians in various rooms of the house of medicine, to our allies the physician-assistants, to those non-physician healthcare workers who will also be affected by legislative encroachment. What affects the physical therapist or optometrist today may well affect the physiatrist or ophthalmologist tomorrow.

Political Advocacy

The ancient Greek philosopher General Piracles once stated that, “Just because you do not take an interest in politics, does not mean that politics will not take an interest in you.” What was true over 2,000 years ago is still true today. As we defend the most sacred relationship of our profession, we must also advocate for our patients’ well being and our own income. In our work with MSVPAC over the past few years, we have tried, in a totally non-partisan manor, to help our friends and those that support our goals while defeating those who don’t. Too often, advocacy efforts are seen as being tough and occasionally negative. We could be seen as wearing the black hat of the society, for much of what we fight in the advocacy arena is defensive – to stop the intrusion of legislators into the exam room, to cease adding to the regulatory burden and to prevent cuts in what is already insufficient pay. While these are the frequent fights that we are forced into, it is the proactive, good fights for which we are remembered. The fight for clean air in restaurants, the preservation of the medical malpractice cap, the maintenance of physician leadership of the healthcare team. These are the types of advocacy for which we can all be proud, yet these are the issues that would not have reached fruition had not the ground work been done by our Political Action Committee. I ask that over the next eight months each of you look at the roadblocks to good patient care, examine the frustrations with which you have to contend in your offices and think of possible solutions. Why eight months, you ask? That is when our next legislative summit will occur and when we will generate the ideas for our next legislative agenda. I would love to see your new idea at the top of that list.

Dr. Ransone is a family physician in Deltaville, Virginia and has been a MSV member since 1993.

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State Medical Society and PAC Elect
New Officers and Directors

The Medical Society of Virginia (MSV) and MSV Political Action Committee (MSVPAC) elected new officers and directors during its annual meeting from Oct. 25 to 27 at The Homestead Resort in Hot Springs, VA. MSV elected a new president and MSVPAC elected a new chair.

Sterling N. Ransone Jr., MD, FAAFP of Riverside Fishing Bay Family Practice was inaugurated as the new President of MSV. As President, Dr. Ransone hopes to place emphasis on the realm of physician burnout along with protection of the patient/physician relationship and enhancement of political advocacy by physicians.
In addition to working with his patients in his Deltaville practice, Dr. Ransone is an assistant clinical professor of family medicine at Virginia Commonwealth University. He has served as President and Board member of the Virginia Academy of Family Physicians and President of the Mid-Tidewater Medical Society, as well as in leadership positions in several other professional organizations, including the American Academy of Family Physicians and American Medical Association. He also has served MSV as a member of the Board of Drectors and as Chair of multiple committees and task forces.

Dr. Ransone completed his undergraduate work at the College of William and Mary, where he also received a master’s degree in biology. He received his medical degree from Medical College of Virginia/Virginia Commonwealth University School of Medicine in Richmond. Dr. Ransone earned the distinction of being a Fellow of the American Academy of Family Physicians in 1998.

Dr. Ransone volunteers his time in a variety of community activities, including being sideline physician for the Mathews High School football and soccer teams as well as serving as a Scoutmaster for Troop 124, Boy Scouts of America. He is a founding Board member and medical director for Hospice Support Services of Middlesex County; and member of ConnectVirginia, the statewide health information exchange (HIE) governing body. He is board certified by the American Board of Family Medicine and the National Board of Medical Examiners. He is married to MSV member and former President of the Virginia Board of Medicine, Karen A. Ransone, MD. They have three children, Elizabeth, Katherine and Scooter.

Other MSV Officers Who Were Elected Include:

William C. Reha, MD, MBA of Woodbridge, President-Elect
Bhushan H. Pandya, MD of Danville; Secretary-Treasurer
Kurtis S. Elward, MD, MPH, FAAFP of Charlottesville; Speaker
Arthur J. Vayer, Jr., MD of Stafford; Vice Speaker

Newly-elected and Re-elected Directors Are:

Hasan B. Ahmad, DO, of Blacksburg
John F. Butterworth IV, MD of Richmond
Clifford L. Deal III, MD, FACS of Richmond
Byrd S. Leavell, MD of Charlottesville
Ibe O. Mbanu, MD, MBA, MPH of Richmond
Larry G. Mitchell, MD of Richlands
Jonathan A. Page, MD, MPH of Fairfax
Pradeep K. Pradhan, MD of Danville
Timothy L. Raines, MD of Yorktown
George L. Weidig, MD of Harrisonburg
Alan H. Wynn, MD of Woodbridge

Newly-elected and Re-elected Associate Directors Include:

Michael S. Amster, MD of Warrenton
David E. Berry, DO, PhD, Blacksburg
Sheela R. Damle of Richmond
James R. Dudley, MD, MBA of Tappahannock
Jacqueline M. Fogarty, MD of South Boston
Richard A. Szucs, MD of Richmond
T. Joey Tiwari, MD of Richmond
Chi Young, MD of Gainesville

Newly-elected Officers to Serve the MSVPAC Include:

David K. Chow, MD, MPH, FACS, CFP of Reston; Chair
Joel T. Bundy, MD, FACP, FASN of Hampton; Vice Chair
Susan D. Hundley, MD of Boydton; Secretary
Cort Kirkley of Richmond; Treasurer

The Following Directors were Elected to Serve on the MSVPAC Board for a Second Term:

William M. Carr, MD of Prince William
Catherine Daniel, MD of Roanoke
Joe Hutchinson, MD of Lynchburg
Peter J. Kemp, MD of Chesapeake
Reza Omarzai, MD of Hopewell
John “Chris” Paschold, MD, FACP of Newport News
Alan Wagner, MD, FACS of Virginia Beach

Emily Onufer of Richmond, Albert Hsu, MD, of Norfolk and Gerard Filicko, MHA, CMPE, of Richmond were elected to serve as the student, resident and medical Group Manager Directors of the MSVPAC Board, respectively.

The Medical Society of Virginia (MSV) is the professional association for physicians in the Commonwealth. Dedicated to supporting physicians in the practice of medicine, MSV advocates on their behalf to ensure physician influence on healthcare legislation and policy improvements and provides a variety of educational and support activities that assist physicians in the practice of medicine.

The MSV Political Action Committee (MSVPAC) is the political arm of the Medical Society of Virginia. It is a bipartisan, voluntary, non-profit organization which represents more than 18,000 Virginia physicians and approximately 1,000 Alliance members.