Information on the Medication Access and Training Expansion (MATE) Act Training Requirement – Information and FAQ’s
On June 27, 2023, a new one-time requirement will go into effect for all DEA prescribers to complete 8 hours of education on the treatment of management of patients with opioid or other substance use disorder.
The team at the Allegheny County Medical Society has worked with the DEA to put together some information and FAQ’s regarding the new training requirement.
What is the MATE Act and what does it mean for accredited continuing education?
The DEA now requires that the nearly 2 million DEA licensees nationally demonstrate that they have completed 8 hours of relevant accredited education before they obtain a new license or renew their current licenses.
What is the goal for the new requirement?
“Given the urgency of the nation’s overdose crisis, the importance of practitioners receiving training in substance use disorders (SUD) cannot be overstated. Incorporating training on SUD into routine healthcare will enable practitioners to screen more widely for substance use disorders, treat pain appropriately, prevent substance misuse, and engage people in life-saving interventions.” -SAMHSA (Substance Abuse and Mental Health Services Administration)
Who is responsible for satisfying this new training requirement?
All DEA-registered practitioners, with the exception of practitioners that are solely veterinarians.
How will practitioners be asked to report satisfying this new training requirement?
Beginning on June 27, 2023, practitioners will be required to check a box on their online DEA registration form – regardless of whether a registrant is completing their initial registration application or renewing their registration – affirming that they have completed the new training requirement.
What clinicians are deemed to have already satisfied this training requirement?
Physicians who are board-certified in addiction medicine or addiction psychiatry.
Practitioners who have graduated from their professional school within 5 years of June 27, 2023 or 5 years of their license renewal following June 27, 2023, and completed a curriculum that included at least eight hours of coursework regarding SUD during that time.
Practitioners who previously took training to meet the requirements of the DATA-2000 waiver to prescribe buprenorphine can count this training towards the 8-hour training requirements.
What is the deadline for satisfying this new training requirement?
The deadline for satisfying this new training requirement is the date of a practitioner’s next scheduled DEA registration submission – regardless of whether it is an initial registration or a renewal registration – on or after June 27, 2023.
This one-time training requirement affirmation will not be a part of future registration renewals.
Providers whose renewal expires June 30th and renew between now and June 26 will have to attest upon their next renewal, three years later.
How can practitioners satisfy this new training requirement?
There are multiple ways that practitioners can satisfy this new training requirement.
First, the following groups of practitioners are deemed to have satisfied this training:
- Group 1: All practitioners that are board certified in addiction medicine or addiction psychiatry from the American Board of Medical Specialties, the American Board of Addiction Medicine, or the American Osteopathic Association.
- Group 2: All practitioners that graduated in good standing from a medical (allopathic or osteopathic), dental, physician assistant, or advanced practice nursing school in the United States within five years of June 27, 2023, and successfully completed a comprehensive curriculum that included at least eight hours of training on:
- treating and managing patients with opioid or other substance use disorders, including the appropriate clinical use of all drugs approved by the Food and Drug Administration for the treatment of a substance use disorder; or
- safe pharmacological management of dental pain and screening, brief intervention, and referral for appropriate treatment of patients with or at risk of developing opioid and other substance use disorders.
Second, practitioners can satisfy this training by engaging in a total of eight hours of training on treatment and management of patients with opioid or other substance use disorders from the groups listed below. A few key points related to this training:
- The training does not have to occur in one session. It can be cumulative across multiple sessions that equal eight hours of training.
- Past trainings on the treatment and management of patients with opioid or other substance use disorders can count towards a practitioner meeting this requirement. In other words, if you received relevant training from one of the groups listed below – prior to the enactment of this new training obligation on December 29, 2022 – that training counts towards the eight-hour requirement.
- Past DATA-Waived trainings count towards a DEA registrant’s 8-hour training requirement.
- Trainings can occur in a variety of formats, including classroom settings, seminars at professional society meetings, or virtual offerings.
What accredited groups may provide trainings that meet this new requirement?
- The American Academy of Addiction Psychiatry (AAAP)
- American Medical Association (AMA)
- The American Osteopathic Association (AOA), or any organizations accredited by the AOA to provide continuing medical education
- The American Dental Association (ADA)
- The American Association of Oral and Maxillofacial Surgeons (AAOMS)
- The American Psychiatric Association (APA)
- The American Association of Nurse Practitioners (AANP)
- The American Academy of Physician Associates (AAPA)
- The American Nurses Credentialing Center (ANCC)
- Any other organization accredited by the Accreditation Council for Continuing Medical Education (AACCME) or the Commission for Continuing Education Provider Recognition (CCEPR), whether directly or through an organization accredited by a State medical society that is recognized by the ACCME or CCEPR
- Any other organization approved or accredited by the Assistant Secretary for Mental Health and Substance Use, the ACCME, or the CCEPR
Who can I contact with questions?
ACMS/PAMED will continue to keep you informed as this guidance evolves. If you have questions please contact email@example.com or firstname.lastname@example.org
Questions for the DEA? Contact ODLP@dea.gov.
Additional information can be found by visiting https://www.deadiversion.usdoj.gov/
POLST Legislation Introduced in PA Senate: What’s in the bill?
By: Lisa George, MPH, CHES – Jewish Healthcare Foundation
A significant step has been made toward establishing Pennsylvania Orders for Life-Sustaining Treatment (POLST) as law in the Commonwealth. On April 19, Senator Gene Yaw (R-23rd District) introduced Senate Bill 631, which would codify POLST for use by medical professionals across all healthcare settings to document treatment wishes for patients who voluntarily wish to execute a POLST order.
Although the bright pink POLST form has been used in Pennsylvania for decades to translate patients’ wishes for care into actionable medical orders, the lack of legislation on POLST has led to confusion and inconsistent use among providers. This bill aims to enhance clarity for providers regarding POLST usage and bolsters the protections for seriously ill patients to receive care that aligns with their care preferences regardless of the setting.
SB 631 amends Title 20 (Decedents, Estates, and Fiduciaries) of the Pennsylvania Consolidated Statutes), providing a legal basis for POLST forms to be used across care settings. It defines the appropriate population for POLST as “patients who are considered to be at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty.” It also clarifies for whom POLST is not appropriate and describes the elements of a properly executed POLST order. The lack of existing legislation poses particular challenges to EMS providers, who are presently only legally authorized to honor the state’s Out-of-Hospital Do Not Resuscitate order and must call Medical Command for authorization to follow a POLST. This can lead to patients having to endure medical interventions at the end of life that do not align with their wishes. SB 631 would allow POLST to be recognized and acted upon across care settings, inside and outside the hospital, and grants emergency medicine personnel the authorization to honor patients’ documented preferences for care without the need for Medical Command Physician authorization.
Further, this bill emphasizes the importance of POLST as part of a shared decision-making process involving a discussion of current clinical status and care preferences between a patient or surrogate and healthcare provider. The POLST conversation provides patients with an opportunity to speak with their loved ones and their providers about their preferences for care they wish to receive and not to receive. It gives providers clear direction regarding medical interventions, regardless of the care setting. Voluntary consent is essential, and patients have the right to refuse to execute a POLST, without consequences from a provider or insurer.
This bill also establishes a multistakeholder POLST Advisory Committee to advise the Pennsylvania Department of Health on POLST form revisions and POLST education.
POLST legislation is critical to ensure the appropriate use of POLST across the Commonwealth, in the appropriate populations, as part of a conversation about wishes for end-of-life medical care. It will benefit providers by contributing greater clarity and guidance on the POLST process.
Read the full text of SB 631 here. To voice your support for SB 631, contact your state senator. The Pennsylvania Medical Society supports this legislation and has launched an easy-to-use online form that allows you to contact your senator with just a few clicks.
If you haven’t checked out the PA POLST Learning Center a library of on-demand trainings on POLST—all of which offer free continuing medical education and continuing nursing education credits. Please consider sharing with your staff to ensure they are educated on proper POLST use.
To stay up to date on POLST legislation, education, and resources, subscribe to the POLST Notes newsletter. Visit www.papolst.org to sign up. For more information or answers to your questions about POLST, contact email@example.com.
Lisa George, MPH, CHES is the PA POLST Coordinator and Senior Communications and Program Specialist at the Jewish Healthcare Foundation.
A Quick Guide: The End of the COVID-19 Public Health Emergency (PHE)
By: Jenny Bender, MPH, BSN, RN, CIC
We are now three years into the COVID-19 pandemic and the CDC reports that cases, deaths, and hospitalizations have been steadily declining, noting that much of the US population has some form of immunity (either due to natural infection or vaccination).1 Based on these trends, the Department of Health and Human Services (HHS) is planning for the federal Public Health Emergency (PHE) for COVID-19 to expire at the end of the day on May 11, 2023.2 In a statement by the Executive Office of the President, released January 30, 2023, the White House wrote: “an abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and, most importantly, for tens of millions of Americans.” That said, the end of the public health emergency (PHE) fortunately coincides with some additional policies that will make the transition out of the PHE less abrupt for healthcare, but it will still have a large impact on physicians, insurers, and patients in Pennsylvania.
The Centers for Medicare and Medicaid Services (CMS) has issued a fact sheet outlining the flexibilities that physicians and other clinicians were granted under the PHE to fight COVID-19. This fact sheet also outlines how the end of the PHE will affect all these flexibilities.
Some of the biggest changes in care provision of the PHE included services eligible for telehealth and how those visits were billed. This is one area where an additional policy is being introduced to bridge the gap. After the PHE ends, the Consolidated Appropriations Act of 2023 provides for an extension for telehealth flexibility through the end of 2024. In addition, some behavioral health telehealth visits are being approved permanently and without geographic restriction. Telehealth visits greatly expand the availability of behavioral health care and have been very successful.3
COVID-19 tests will no longer be available for free by mail-order to US addresses, and by law, Medicare does not generally cover over-the-counter services and tests. Current access to free over-the-counter COVID-19 tests will end with the end of the PHE. However, some Medicare Advantage plans may continue to provide coverage as a supplemental benefit. All states must provide Medicaid and CHIP coverage without cost sharing for tests through the last day of the first calendar quarter that begins one year after the last day of the PHE. This coverage requirement will end on September 30, 2024. For private health plans, many insurance providers will still reimburse the cost of over-the-counter tests purchased by enrollees, but the benefits will vary by plan.4
Specifically regarding COVID-19 immunizations – although these immunizations may eventually be paid under a different model, the timing will not coincide with the end of the PHE. The federal government plans to continue purchasing and distributing COVID-19 immunizations, and any federally purchased vaccine will be available at no cost to patients with both private and public health plans. Medicare and Medicaid will continue to cover the entire cost even after the government supply runs out. Private insurance providers will also continue to cover the cost, but there may be exceptions if the vaccine was provided out of network. For underinsured and uninsured Americans, free vaccines will be provided through a CDC program at their local health department.5
Here are a list of resources to help you learn more about the end of the COVID-19 Public Health Emergency:
U.S. Department of Health & Human Services
Centers for Medicare and Medicaid Services
Allegheny County Health Department – Office of Child Development & Early Learning
Jenny Bender, MPH, BSN, RN, CIC is a Clinical Science Liaison at PDI and she also serves as the Secretary of the Allegheny County Immunization Coalition.
1. COVID Data Tracker Weekly Review. Centers for Disease Control and Prevention. Published April 10, 2020. Accessed March 31, 2023. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
2. Fact Sheet: COVID-19 Public Health Emergency Transition Roadmap. HHS.gov. Published February 9, 2023. https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html#:~:text=Based%20on%20current%20COVID%2D19
3. Department of Health and Human Services. Telehealth Policy Changes After the COVID-19 Public Health Emergency. https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency
4. Centers for Medicare & Medicaid Services. CMS Waivers, Flexibilities, and the Transition Forward From the COVID-19 Public Health Emergency. https://www.cms.gov/newsroom/fact-sheets/cms-waivers-flexibilities-and-transition-forward-covid-19-public-health-emergency#:~:text=Testing%3A%20After%20the%20expected%20end,depending%20on%20the%20health%20plan.
5. Pennsylvania Department of Health. COVID-19 Vaccine FAQs. https://www.insurance.pa.gov/coronavirus/Pages/covid-vaccine-faqs.aspx
ACMS Foundation Spotlight: Nutrition Classes at Light of Life Rescue Mission
By: Jocelyn Buhite, Light of Life Rescue Mission Communications Coordinator
Light of Life Rescue Mission realized that our clients typically don’t understand that an unhealthy diet is a risk factor for depression, anxiety and other health issues that many of them face. So, with the help of the grant award funds provided by the Allegheny County Medical Society Foundation, we implemented Cooking Matters, a six-week, hands-on course that teaches clients and graduates of the Mission’s long-term recovery programs easy and low-cost ways to improve their health through nutrition. The classes are taught by nutrition education professionals from Adagio Health and focus on teaching families at risk of hunger how to shop for and cook affordable, delicious and healthy meals.
Cooking Matters is SNAP-Education approved and an evidence-based intervention that can effectively improve participants’ food security, attitudes toward cooking, and fruit and vegetable consumption. Research from the ConAgra Foods Foundation shows that low-income families are cooking dinner from scratch at home and are highly interested in making healthy meals, but the cost of healthy groceries is a significant barrier for them to consistently make nutritious and delicious meals.
“Diet is potentially the most powerful intervention we have. By helping people shape their diets, we can improve their mental health and decrease their risk of psychiatric disorders,” said Psychiatrist Drew Ramsey, MD, assistant clinical professor at Columbia University.
Participants are provided with groceries to take home after each class so that they can implement the skills and practice the recipes they learned that day in their own kitchens. They also receive a kitchen starter kit and means to obtain produce for an additional eight weeks following the completion of the course. All of this is to ensure that participants are able to continue using the knowledge they gained, even after they finish the Cooking Matters course. The hope is that these skills are passed down to the participants’ children so that a generational knowledge of smart nutrition is developed.
To learn more about Light of Life Rescue Mission, visit their website at: https://www.lightoflife.org/
National Nutrition Month – Incorporating Healthy Habits into a Busy Schedule
By: Devon L Kroesche, MS RDN LDN – Director of Marketing & Registered Dietitian Nutritionist at Case Specific Nutrition
Did you know that March is National Nutrition Month? National Nutrition Month® is an annual campaign created 50 years ago in 1973 by the Academy of Nutrition and Dietetics. During the month of March, everyone is invited to learn about making informed food choices and developing healthful eating and physical activity habits.
As a physician, you appreciate the importance of nutrition in your daily practice. You may even preach the necessity of eating well to your patients on a regular basis. Why then, can it be so challenging to implement some of these behaviors on an individual level?
Consider your daily schedule: maybe you are running between exam rooms seeing high volumes of patients, charting, and fielding phone calls from other providers. Perhaps you are up quite early or unbelievably late covering a unit or in surgery. Unexpected detours in your day can make prioritizing nutrition feel impossible. To complicate matters further, high levels of stress can suppress your body’s natural hunger cues, making attention to nutrition of utmost importance.
Modeling good self care by eating properly is a prerequisite to giving the best patient care possible. Not only will it offer you better mental focus, it will reduce those feelings of burnout and resentment because you are putting yourself first.
Tips for Eating Well as a Busy Physician:
• Establish routine meal times and stick to them as much as possible. Set reminders on your phone if you have to! Optimizing your meal timing, sometimes referred to as chrono nutrition, can have a significant impact on your overall metabolic health. In fact, a 2023 meta-analysis of randomized controlled trials (RCTs) compared higher caloric intake earlier in the day with higher caloric intake later in the day. Researchers found that those consuming more energy earlier in the day reported greater weight loss (when relevant), reductions in LDL-cholesterol, fasting blood glucose levels, and a reduction in markers of insulin resistance. This demonstrates the importance of fueling during the day rather than skipping meals, which often results in over eating hyper-palatable, hyper-caloric foods in the evening.
• Identify a short list of healthy convenient options you can keep available in a pinch. Examples: hand fruit, protein shakes, meal replacement bars with whole ingredients, heat & eat meals that are lower in sodium, and energy dense snacks such as nuts and dried fruit. Keep these snacks either in your lab coat, in your locker, or at your desk for easy access.
• Consider investing in a meal delivery service, such as Case Specific Meal Prep, for busy work weeks. When life gets busy, that’s when we need the support of a good diet more than ever. Having fresh healthy meals, designed by dietitians, and prepared for you in advance can massively simplify your life.
• Lean on the experts! Registered dietitians are trained to support you in making all types of healthy lifestyle changes. They design individualized plans to achieve your health and wellness goals.
• Start playing offense rather than defense with our nutrition! Planning ahead and curating your environment to make healthy choices easier is the key to long-term success. Remember, we need to don our own proverbial oxygen masks before we can help others!
Want to learn more? Visit http://www.casespecificnutrition.com to get connected with a dietitian via telehealth or at one of our various locations around Allegheny County!
Case Specific Nutrition is a Pittsburgh based group of registered Dietitians and Personal Trainers with significant experience, a passion for wellness, and a commitment to helping clients make changes that last.
Specialty Group Spotlight: Allegheny County Immunization Coalition
Introduction by: Melanie Mayer, ACMS Marketing and Administrative Assistant
Blog by Vice President of the ACIC Ashley Ayres MBA, BS, CIC
Director, Infection Prevention
UPMC Presbyterian Shadyside Infection Prevention and Control
The Allegheny County Medical Society provides association management support to several specialty associations. ACMS staff members provide administrative support and resources to these smaller groups who do not require a full-time staff member to support their operations. Recently, the Allegheny County Immunization Coalition (ACIC) signed a contract to receive administrative services from the ACMS. The ACIC is a great resource for many physicians in Allegheny County. We asked Executive Committee member Ashley Ayers to share the history of the Immunization Coalition and how ACMS members can get involved in this local organization.
Ashley Ayers: The Allegheny County Immunization Coalition (ACIC) was formed 17 years ago in 2006, after separating from the southwest coalition. Since then, this group has focused its time and energy on understanding the current needs of immunization, educating individuals on the importance of immunization, and helping provide services to those needing to receive immunizations. The focus of this organization is to ensure the the citizens of Allegheny County are informed and protected from preventable diseases. Members of this coalition are physicians, nurses, pharmacists, teachers, and other health service staff.
The ACIC supports ongoing educational efforts to ensure that the public and healthcare providers are informed on the most up to date information. Since 2006, the ACIC has hosted an annual conference. This conference provides a great educational opportunity to learn from experts in the field about vaccination and the science behind where it is needed. Past conferences have included medical representatives from the CDC, nationally recognized vaccine expert, Dr. Paul Offit, Allegheny County Health Department experts, and well-known local vaccine providers. We look forward to announcing our 2023 Conference date in the coming weeks (tentative for the beginning of October 2023 at the Doubletree Monroeville).
In addition to the Conference, the ACIC spends time working with the underserved populations in Allegheny County, as well as children in schools, to help improve the vaccination rates. Year over year the nation has seen a decline in vaccination rates in school age children. The ACIC helps review the data that the county receives to help align resources where vaccine education is needed, and then coordinate ways to share the education with those communities.
The ACIC has provided so much to many individuals in Allegheny County, but it has also meant a lot to those who are members of the organization. I asked some of the other leaders of the ACIC what this group has meant to them. One of the key takeaways from several of the longtime members, was the value of working with interdisciplinary teams in other professional environments to help figure out the barriers in lack of compliance with vaccination. First and foremost, this organization has helped the community and increased vaccine awareness, but secondary to that, it has helped our members develop professional relationships with colleagues they would not normally work with. It has created meaningful connections and better communication amongst those who truly wish to make a change in the way we discuss vaccinations in the county.
Seventeen years seams like a long time, and this group has done so much with that time, however there is much more that can be done to help promote the importance of vaccination. Membership is free and any interested person can become a member by visiting the ACIC website. Together we can prepare the next generation to be safe and protected from preventable diseases.
For more information on the ACIC, contact Melanie Mayer at firstname.lastname@example.org.
FTC Proposes a Rule to Prohibit Non-Compete Agreements
Article written by: Jeremy V. Farrell, Esq., Ryan James, Esq. and Michael A. Cassidy, Esq. of Tucker Arensberg, P.C.
On January 5, 2023, the Federal Trade Commission (FTC) took a dramatic step by proposing a new rule that would prohibit companies from entering into non-compete agreements with its workers. The proposed rule, if approved, takes sweeping action to prohibit employers from entering into non-compete agreements with both employees and independent contractors. And the proposed rule does not stop there. It would also require that employers take affirmative steps to rescind existing non-compete clauses and explicitly inform workers that the contracts are no longer effective.
As of right now, the FTC’s rule (available here) is merely a proposal, and the agency is soliciting public comments on whether any changes should be made before it is finalized. Litigation challenging the enforceability of the rule is almost sure to ensue, and the U.S. Chamber of Commerce has already threatened to sue to FTC over its proposed non-compete ban.
Regardless of whether or not the FTC rule is adopted, physician non-compete agreements are closely scrutinized in Pennsylvania under a multi-tiered analysis because of the value of doctors’ services to the public. Initially, the covenant in order to be enforceable must be “reasonably related to the protection of a legitimate business interest*.” As recognized in Wellspan, this type of interest includes showing that a non-competition provision is necessary to protect such things as trade secrets and confidential information, unique or extraordinary skills, customer goodwill, patient relationships, patient referral bases, and investments in an employee’s specialized training. If a post-employment covenant merely seeks to eliminate competition and is not designed to protect a legitimate business interest, it will not be enforced.
If the threshold requirement of a protectable business interest is satisfied, courts will then balance the employer’s interests against that of the employee to find other work in her field and earn a living. Under this factor, the temporal and geographic restrictions imposed on a former physician must be reasonably limited**. If not, the non-compete provision will not be upheld.
After the second step, the interests of the public will be assessed as they are of “paramount importance in the context of non-competition covenants for physicians.” This in essence means that courts will examine whether there is a shortage of physicians in the particular practice area in the relevant geographic region. If patient demand in the geographical area exceeds the ability of appropriately trained physicians to provide expeditious, skilled treatment, the public interest supersedes a right to enforce a non-compete agreement. Following Wellspan, courts in Allegheny County have viewed this factor as critical*.
As we can see, even without the implementation of the FTC rule, an employer faces significant hurdles in attempting to enforce a physician non-compete agreement.
Furthermore, many early comments suggest the FTC proposal would not apply to non-profit healthcare systems, based upon the FTC’s actual jurisdiction and the definition of “employer” in the proposed rule itself. Given the prevalence of non-profit healthcare systems nationwide, and especially in Pennsylvania, it remains to be seen whether this rule would have any significant impact in the healthcare arena.
The Allegheny County Medical Society has been collaborating with various Pennsylvania state legislators over the past few years to restrict or eliminate physician restrictive covenants. The most recent legislative action was the introduction of HB 681 of 2019, the Healthcare Practitioner Non-Compete Agreement Act, which has not been passed. This was an effort to limit this scope and impact of physician’s non-competes. However, as the trend of employing physicians increases, with tens of thousands of physicians employed by healthcare systems rather than private practices in Pennsylvania, there is less support for eliminating restrictive covenants. Organized medicine actively supports and enforces the use of restrictive covenants even the relatively few remaining private practices seem to utilize restrictive covenants.
*Wellspan Health v. Bayliss, 869 A.2d 990 (Pa. Super 2005).
*** See Allegheny Specialty Practice Network v. Joseph J. Colella, M.D., GD No. 09-006813 (C.C.P. Allegh. Co.) (Ward, J., Opinion entered on Sept. 9, 2009, p. 27) (noting that a physician non-compete was enforceable because there was no shortage of bariatric surgeons in Allegheny County).
“Physician, Heal Thyself”
By: Natalie Gentile, MD – Family Medicine Doctor
With the new year inevitably comes new year’s resolutions. By definition, resolutions are resolute, finite, inflexible. On the other hand, there are intentions. These are more fluid ideas and goals toward which we can aim. If we don’t reach those goals, intentions can be readdressed and reset. Resolutions are either kept or not. This black and white, all or none mentality is so common in our society – and, especially in high achieving, type A individuals (like many physicians) it is the norm. When we pigeon-hole into wellness resolutions that are not sustainable, it can feel hopeless and discouraging. This, coupled with the minimal amount of time we all have for ourselves in the first place, worsens the uphill battle to check off the self-care box on our endless to-do list.
We use this term “self-care” because it is catchy and all-encompassing, but what does it really mean? The Oxford dictionary definition of “care”: the provision of what is necessary for the health, welfare, maintenance, and protection of someone or something. So, theoretically, if you are caring for yourself, you are seriously considering your health and welfare. This is what we are doing for patients everyday, but when the tables turn and we look in the mirror, how much consideration do we have leftover to give to ourselves?
“Physician heal thyself”. The quote popped into my head the other day while sitting down to write this post. I couldn’t remember where it originally came from, so I did some digging. Turns out (and maybe if you’re reading this, you’re saying “duh, Natalie”) it comes from the Bible. The excerpt in Luke where this quote resides highlights the challenge for healers to turn the healing back onto themselves. If we can’t heal ourselves, then how can we be expected to heal others?
Unfortunately, most physicians have little to no control over their work schedules. The traditional healthcare model lends itself to inflexibility when you’re at work, and immense amounts of work you then take home to play catch-up. In my direct primary care practice, where I work for myself, it allows for significantly more control over my own schedule, but even then I have to make self-care a priority. If we don’t fight for that time, then we will quickly get bulldozed over with work, family, and life commitments.
I’ve often felt like my self-care routine is like a fire drill. A day comes around that I suddenly have a block of time available, and I frantically call every massage therapist and salon in town asking for a last minute appointment. Inevitably, there never is a last minute appointment available. And I’m left feeling defeated and embarrassed. Mainly embarrassed that I didn’t plan ahead enough to carve out time for myself.
So what are some ways that we can make self-care less of a pie-in-the-sky fire drill, and more of an appointment with ourselves that we hold as sacred as a patient visit. First, I recommend scheduling it like any other commitment. Planning your workout, meditation session, hair salon visit, date-night, etc. in your calendar increases the chances you’ll stick to it. Second, know your worth in the workplace when it comes to your wellbeing. Most employers, especially in healthcare, aren’t going to go out of their way to make your self-care time a priority. But they need you more than you need them. Advocate for yourself and for your input about your schedule. Lastly, have self-compassion. The shame we feel when we don’t take care of ourselves is not going to get us anywhere. Recognize that you are not alone and that it is hard for most of us physicians to heal ourselves. The journey to self-care is non-linear. The intentions we set need to be flexible, malleable, and most importantly: realistic.
Follow Dr. Gentile on social media via @nataliegentilemd on Instagram and on Facebook. Learn more about Rebel Wellness at rebelsinwellness.com and @rebelwellnessllc on Instagram.
POLST Legislation and Education Are Key to Successful Implementation
By: Lisa George, MPH, CHES – Jewish Healthcare Foundation
The POLST (Pennsylvania Orders for Life-Sustaining Treatment) form has been used in Pennsylvania since 2010 (and the Oregon POLST form in use from 2000 to 2010)—providing a standardized way to translate patients’ wishes for care into actionable medical orders. Given this long history of use, it may be surprising to many that the Commonwealth does not have legislation on the books related to POLST. That, however, may soon change.
Pennsylvania State Senator Gene Yaw (R – District 23) announced that he will be reintroducing POLST legislation, previously SB 572 of the 2021–22 session, in the Pennsylvania Senate this session. The legislation will update and revise Pennsylvania law (Title 20) to include the codification of “Pennsylvania Orders for Life Sustaining Treatment (POLST)” to be used by medical professionals across all healthcare settings for patients who voluntarily wish to execute a POLST order. It also would result in discontinuation of the Out of Hospital Do-Not-Resuscitate orders. POLST legislation is critical to ensure appropriate use of POLST across the Commonwealth, in the appropriate populations, as part of a conversation about wishes for end-of-life medical care. More information on Senator Yaw’s plans for reintroduction is available here.
A crucial part of effective POLST implementation, whether POLST is codified into legislation or not, is standardized education for healthcare providers on appropriate use of POLST. The PA POLST Learning Center is a new continuing education resource that provides access to a library of on-demand trainings on POLST—all of which offer free continuing medical education and continuing nursing education credits. Developed by a multidisciplinary, statewide curriculum committee, the training equips healthcare providers with tools to hold conversations with seriously ill patients and their loved ones about treatment options near the end of life and to document the patient’s wishes via a POLST form—translating their wishes into portable medical orders. Previously, the only option for POLST education was via in-person trainings. The new on-demand virtual curriculum enables providers to gain valuable skills in having POLST conversations when and where it is most convenient for them. Topics include an introduction to POLST and advance directives, POLST conversations, POLST tools, POLST implementation, Medicare reimbursement for advance care planning conversations, case-based conversation scenarios, POLST and EMS, pediatric considerations, and cultural humility. This project was supported by a grant from the McElhatten Foundation to enhance access to POLST education and resources for healthcare providers and personnel throughout Pennsylvania.
To stay up to date on POLST legislation, education, and resources subscribe to the POLST Notes newsletter. Visit www.papolst.org to sign up. For more information on the POLST educational offerings or answers to your questions about POLST, contact email@example.com.
Lisa George, MPH, CHES is the PA POLST Coordinator and Senior Communications and Program Specialist at the Jewish Healthcare Foundation.
Supporting Caregivers of Patients with Dementia
By: Amy Kowkinsky – Director, Dementia360 Program
It’s challenging for doctors to give family caregivers the support and guidance they need during infrequent and brief office visits, especially if the person living with dementia is there.
Though your actual patient may be the person with dementia, it’s likely that it’s the family caregiver who is most in need of your support. Often they feel unprepared, alone, and overwhelmed with the role of caregiver for a loved one with dementia.
First, let them know that life does not prepare anyone to be a dementia caregiver and, secondly, they don’t have to face this alone—it’s never too early or too late to ask for help. Everyone is impacted by this disease in a different way. Finding answers and solutions to the challenges of daily life with dementia is a very personal journey, a journey no one should have to go on alone.
Dementia360 Can Help
Designed specifically for the family caregiver, the highly skilled Care Coordinators at Dementia360 provide the support, resources, connections, and ongoing coaching caregivers need to keep people with dementia at home – living comfortably and safely, for as long as possible.
Dementia360 helps families wherever they are on their journey to:
- Understand and accept a new dementia diagnosis,
- Develop good habits to shape the disease as it progresses,
- Overcome behavioral challenges,
- Have a life that is better because they have the confidence, skills, and support to be successful.
To learn more about Dementia360 or to make a referral, call 412.435.8950, email Dementia360@SrCare.org or visit our webpage at PSCNDementia360.org.