2009 FMA Alliance STAT Magazine - Fall/Winter

&S TAT

F l o r i d a M e d i c a l A s s o c i a t i o n A l l i a n c e M a g a z i n e :

2 0 0 9 F a l l / W i n t e r

Burning the candle at both ends 8A l iving All iance legend 12Support for addictions in the family 14

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In sIckness In health

Identify and overcome family impairments

2 FMAA STAT 2009 Fa l l /Winter

What Does the A l l i a n c e D o ?

Now that you know

Advocated physician-friendly legislation such as the Assignment of •

BenefitsBill,SB1122

Influencedmajormotionpicturecompaniestoremovetobacco•

productsfromyouth-relatedfilms

Provided scholarships to medical students•

Representedthemedicalfamilyat15CountyAllianceand26state•

organizational events

Abetterquestionwouldbe,whatdoesn’ttheAlliancedo

for the medical family? The Florida Medical Association

(FMA)AllianceandyourlocalCountyAllianceunderstand

yourneedsbetterthananyotherorganization.Forover

80yearswehavesupportedFloridapatients,physicians,

andtheirfamilies.Wearephysicianspouseswhoadvance

health-related endeavors and engage in legislative

advocacy.Specifically,in2009theFMAAllianceandyour

localCountyAlliance:

whoweareandwhatwedo,pleaseconsiderbeing

apartoftheAlliance.Wearededicatedtomedical

familiesjustlikeyours.Moreimportantly,wearehere

foryousoyoucanbethereforthem.

To learn more about the FMA Alliance and your local County Alliance

call 800.762.0233 or visit www.fmaalliance.org

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3FMAA STAT 2009 Fa l l /Winter

S TATF l o r i d a M e d i c a l A s s o c i a t i o n A l l i a n c e :

2 0 0 9 F a l l / W i n t e r

4 FMAA Leadership 2009-2010 Elected Leaders

5 President Support and tools for the medical marriage

6 Granted Hillsborough keeps breast cancer awareness at the forefront

7 Executive Director Providing immediate information pertinent to you and your spouse’s profession.

18 AMAA: Healthy Lifestyle Foster the best environments necessary to maintain a healthy life, family, and profession.

Copyright © 2009

STAT is published bi-annually by the Florida Medical Association Alliance, Inc. located at 123 South Adams Street, Tallahassee, Florida, 32301. This publication is copyrighted by the Florida Medical Association Alliance, Inc. Views expressed in this issue represent those of the individual authors and may not necessarily represent the views of the Florida Medical Association Alliance, Inc. The Florida Medical Association Alliance, Inc. does not represent the accuracy or reliability of any of the advertisements displayed in this publication or endorse any of the advertisers in this publication.

p. 13

“It is hard for me to understand those that have no interest in participation

“8 Burnout

14 Addictive Medicine

Overworked, overstressed, and over come by life’s responsibilities - physicians, residents and medical students can find support from the all too common burnout.

Addiction effects more than the afflicted. Tendencies, prevention, and recovery of impairments are identified to help the ones we love and ourselves.

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12 Alliance Icon: Betty Jane Wilson

Starting a new life in new city, Betty Jane never realized that attending an Alliance event to meet fellow spouses would turn into a legendary experience.


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President-ElectShar Donovan, RN, Duval

First Vice PresidentJoni Routman, RN, Broward

TreasurerLissette Gorman, Esq., Palm Beach

SecretaryJoan Harmon, RN, Duval

NorthWest District Vice President Kathy Johns, Okaloosa

NorthEast District Vice PresidentBetsy Ponte, Clay

Central District Vice PresidentNimisha Chheda, BHMS, MPH, Hillsborough

South District Vice PresidentJanice Justiz, PT, Collier

Elizabeth BattagliaNimisha Chheda, BHMS, MPHKaren ChouinardJoan Harmon, RNKathy JohnsRosemary Xavier

Karen DehganSusan FlatenNancy JablonskiMary Macchiaroli

Nominating

Finance

Nominating Alternates

Lori El SanadiAnne Grenitz

During the 2009 FMA Alliance Annual Meeting, delegates to the House of Delegates voted to have the

following outstanding members as your 2009-2010 leadership:

2009-2010 FMaa

leadershIpB o a r d o f D i r e c t o r s C o m m i t t e e s


Much has been researched and written about the unique life of the medical marriage and our family of medicine. If you were to Google or Bing “Medical Marriage” there are over 57,000,000 links, articles, blogs and entries. Obviously, this much web activity demonstrates how important and timely this topic is. Current research shows committed relationships that span a lifetime transition through predictable stages from romance to mature love and success.

My marriage story is similar to many of a certain middle age. I was a critical care RN, met my husband at the hospital on the night shift while taking care of a patient. I still don’t know if it was the coffee, the lights of the hospital room or our desire to help someone, but we developed a mutual admiration and love for each other which has turned into a 22-year and counting marriage.

When young we had a bit of naïveté. We thought that we would stay in one place to build our life; instead we have lived in five locations across three states. We assumed that business partners were always honest and that malpractice lawsuits only happened to someone else. Reality showed us it was best to have good lawyers to protect from bad business practices and successfully defend against frivolous lawsuits. Being part of the political process was foreign to us but we learned if we were not part of it then we could not complain about its outcomes.

When we are at odds, the best answer for resolution is clearly provided, albeit not what we expected. For example when our two-year old daughter threw my husband’s beeper in the toilet while we were having an animated discussion. Actions always speak louder than words. Over the years we’ve learned to stop, listen and appreciate who we are as individuals and how we

can support each other even if we disagree. Our joys have been many and have provided a great tapestry of success in our marriage as well as in our careers. We have successfully raised two daughters, and as every parent knows, it has not been without experiences that strained our beliefs or made us stumble in our actions.

The medical couple is like no other; smart people who are married to equally smart people. They share a lifestyle where the unexpected is routine. All of us can relate to the delayed meals, usual absences or the feelings of being a single parent while married. Some of us made the decision to have our workplace in the home while others choose different career options. The balancing of family life can be complicated, fulfilling and stressful on any given day.

How we handle these stresses offer insight to the strength and resiliency of a committed relationship. All families experience difficult periods. How couples maneuver through these challenges can mean the success or failure of a relationship. Divorce rates among physicians have been reported to be 10-20 percent higher than those of the general population.1 This is a significant statistic and important to keep in the forefront.

I hope in this publication you will discover support and tools to help you and your family maneuver the landscape of daily living. A magazine focused on this subject would have helped my husband and me years ago. If anything, we would have learned to keep beepers away from impressionable hands who felt if they flushed the problem away all will be right with the world. Life events pass and new experiences occur although not as we expect nor envision.

1. Medscape Nurses http://www.medscape.com/viewarticle/410643_2

The Unexpected Routine

Medica l Mar r iage :

{ ann anderson, rn, president }


Hillsborough County Medical Association All iance received the

Health Policy Promotions Grant to further support their efforts

towards Breast Cancer Awareness.

Forty-thousand women die needlessly each year because breast

cancer is found too late. Early detection is imperative to reduce

this staggering number.

Geraldine Gutierrez, a 40-year HCMA All iance member, is

dedicated to the early detection and education of breast cancer.

She personally meets with local department store managers to

encourage their participation in offering customers early detection

pamphlets provided by the HCMA All iance.

“We know that when people are educated, they are able to receive

better medical care,” stated Ms. Gutierrez. “Countless women

wil l benefit from this project each year. Even i f one l i fe is saved I

would feel as i f i t was worthwhile.”

With permission from headquarters, the local Sears Department

Store has al lowed members of the HCMA All iance to provide

both English and Spanish versions of their early detection

pamphlets. Approximately 50 women shop each day in the Sears

Ladies Department and al l are encouraged to take a brochure and

distribute among their fr iends.

“HCMA All iance members are proud of the breast cancer awareness

project ,” expressed Blanca Crespo, HCMA All iance President. “It is

our hope to expand department store involvement not only to those

in our community and state, but also to the nation.”

B r e a s t C a n c e r A w a r e n e s s C o n t i n u e s i n H i l l s b o r o u g h

GrantedF M A A l l i a n c e G r a n t s A w a r d e d

there are many different grants the

FMaa currently has available for

alliance members.

such grants include:

ariel Goldman Memorial Fund •

disaster relief Fund •

health policy promotions •

Mission: tallahassee Grant•

FMaa health grants assist county

alliances that are in need of start-up,

support or survival for local health

programs.

Grant applications can be found on

the FMaa web site at fmaalliance.org.

You can also contact the FMa alliance

at 800.762.0233 or email

[email protected].

how to apply


The FMA All iance is committed to being the “go-to”

source for your medical family and County All iance

needs. Great strides have been made to offer up-to-

date information that effects you and your spouse’s

profession.

This issue of STAT provides you the latest research

on burnout, depression, and addiction within

the physician household. In addition to these

f indings, we offer current methods of rehabil i tation,

prevention and support.

FMAA’s A-mail is a monthly email that offers topics

of interest such as practice management and medical

coder communities, f inancial considerations to

physician retirement, and increasing residency slots

in Florida.

Twice a month FMAA President, Ann Anderson, RN,

updates members on her involvement with health

promotions, legislative highlights, and County

All iance instal lations and events throughout Florida.

Her message, Just Between You and Me , gives

members an opportunity to view the FMAA’s bigger

picture: how county, state, and national All iances

work towards the betterment of the medical family.

The FMAA Legislative Loop is an email subscription

service for members that highlights emerging trends

and actions of Congress and state legislation. The

Loop was instrumental in motivating All iance

members to encourage Gov. Charlie Crist to sign SB

1122 into law. This service was used to support the

Safety Belt Law Enforcement Bil l HB1/SB 344, which

was also successfully signed into law.

Take a visit to the FMAA web site where you wil l

f ind grant opportunities to expand or begin a health

promotions project within your local community.

Your County All iance representative can be well

prepared for upcoming meetings by reviewing our

calendar of events

You and your family are our focus. We are here for

you so you can be there for them.

If you are not receiving these beneficial resources, please

email [email protected] or call 800.762.0233.

{All ison Finley, Executive Director}

@your fingertips


BurnoutWhile Colleen and her husband, Ben, were not used to seeing each for weeks at a t ime, the dynamics of the distance changed. The f irst and second medical school years were tough, seeing each other for only brief moments during the day, as t ime was dedicated to studying and interruptions were unwelcomed. “Ben may have been home, but as long as the off ice door was shut, I had to think l ike he wasn’t ,” said Colleen.

having been in a long-distance relationship, colleen cole can easi ly place a medical school marriage in the same category.


From the very beginning of medical school, Colleen noticed how Ben’s schedule kept him on the edge of burnout. “The schedule that needs to be kept is extremely packed,” states Colleen. “Lack of s leep, class schedules, and the necessary studying doesn’t al low for much relaxation.”

It starts small . Most students enter medical school with unparalleled academic success, accompanied by a passion to learn and aspirations of healing the world. That is , unti l they realize they are no longer at the top of their class, but rather the average and in some cases below. Unwavering confidence turns into a frantic race to keep-up, and the passion for learning is quickly replaced by indifference. Approximately 50 percent of students experience burnout and 10 percent experience suicidal ideation during medical school. 2

It grows . Residents, now at a higher level of education, feel the need to aggressively compete. Perfectionism leads to unrealist ic expectations, which results in inevitable fai lures. The frequency and consequences of depression among physician residents are

largely unknown. However, 76 percent of medical residents meet the criteria for burnout. Of these residents, 50 percent had depressive symptoms and 9 percent demonstrated at-risk alcohol use. Burned-out residents express higher rates of career dissatisfaction (41 percent vs. 11 percent) and report higher incidence of suboptimal patient care practices (53 percent vs. 21 percent). 4

It worsens . Burnout is common among physicians and is the single greatest predictor of satisfaction with career and specialty choice. Self- imposed demands, a main factor in st imulating professional fatigue, create a need for perfection, not only in the practice of medicine, but also in personal relationships and business ventures. The physician’s perception of responsibil i ty is a distortion of the rational. There is also the constant struggle for autonomy in the profession, the need to aspire to a stereotypical social status, and a tendency to set impractical career goals. Factors independently associated with burnout include a younger age, having children, area of special ization, number of nights on cal l per week, hours worked

Persistent irritability & anxiety•

Insomnia•

Forgetfulness•

Inability to concentrate•

Headaches and other •

complaints

Chronic sadness, depression, •

stomach or bowel problems,

mental fatigue, headaches

The desire to escape from •

friends, work, and even family

Perhaps the desire to commit •

suicide

Tardiness at work•

Procrastination•

Necessary three-day •

weekends

Decreased sexual desire•

Persistent tiredness in the •

mornings

Submitting work late•

Social withdrawal•

Cynical attitudes•

Resentfulness•

Increased coffee/tea/cola •

consumption

Increased alcohol consumption•

Apathy•

STAGESMIddle

late

earlY3

per week, and compensation determined entirely based on bil l ing. In a recent study of American surgeons, only 36 percent of surgeons felt their work schedule left enough t ime for personal and family l i fe, and only 51 percent would recommend that their children pursue a career as a physician or surgeon. 5

Many times burnout goes unnoticed, as physicians and their spouses often accept much of the emotional crises as the nature of the profession. So how do you know when your spouse has stepped over the edge and is fal l ing into the depths of depression? In his Diagnosis Burnout: 2009 Update , Jerry Will iamson, MD, FAAP, describes burnout characterist ics as: perfectionism; need for control; exaggerated sense of responsibil i ty; diff iculty asking for help; excessive and unrealist ic guilt ; suppression of feel ings; and diff iculty taking vacations or enjoying leisure t ime. Dr. Wil l iamson further

provides warning signs to help physicians, or their spouses, self-diagnose: when the profession isn’t fun anymore; loss of energy and motivation; a sense of paralysis about decisions; anger; relationship distress; depersonalization and negative effects on physician/patient relationship; quiet , isolated or introverted; over or under-eating; physical complaints; and substance abuse.

Colleen, her husband, and new son, receive much support from the University of Florida College of Medicine “Signif icant Others” event, which is promoted through the Office of Student Counseling and Development. Beverly L. Vidaurreta, Ph.D., affectionately cal led Dr. V. by students, is the Assistant Professor and Program Director. Dr. V works with spouses, partners, and friends of second-year medical students to create this networking event for new students during orientation week. This gives f irst-year medical students

the opportunity to meet and social ize with second through

fourth-year students. And, the “signif icant others”

from each class are able to connect;

sharing t ips

on how to survive the f irst year, offering information on places of interest in the area, even sharing contact information to stay in touch.

Resources are available to raise student mental health awareness and to provide student-to-student support. Active Minds (www.activeminds.org) is an organization that serves as the young adult voice in mental health advocacy on over one hundred college campuses nationwide. American Medical Student Association Mastermind Project , init iated by a second-year medical student in New Jersey, is an Internet-based grassroots endeavor designed specif ical ly for “getting students to help students” 6.

Colleen also seeks refuge in the FMA All iance. “The All iance gives me a chance to see what is to come, and be mentored by men and women who know the same struggles and joys.” The FMA All iance also helps her see the perpetual l ight at the end of the tunnel. “We may be absorbed in the stresses of work, school, and a new family, but we’re able to connect with those who have prevailed and now have successful careers and great families. This is what we have to look forward to!”

“Friday night, date night, is

sacred,” states Colleen. Being new

parents, Friday night has remained

the one night a week she and Ben

get together to enjoy each other’s

company without interruption. “We

may not get out of the house or get

a babysitter every Friday, but the

options are always open.” Even i f

S U P P O R T

p r e v e n t I o n


Brandes, V., DD Terris, C. Fischer, MN Schuessler, G. Ottowitz, G. Titscher, JE Fischer, JF Thayer, Research Program 1. MusicMedicine, and Paracelsus Medical University, Salzburg, Austria. “Music programs designed to remedy burnout symptoms show significant effects after five weeks.” Annals of the New York Academy of Sciences 1169 (2009): 422-25. NCBI PubMed. Web.

Dyrbye, MD, Liselotte N., Matthew R. Thomas, MD, F. Stanford Massie, MD, David V. Power, MD, Anne Eacker, MD, 2. William Harper, MD, Steven Durning, MD, Christine Moutier, MD, Daniel W. Szydolo, BA, Paul J. Novotny, MS, Jeff A. Sloan, PhD, and Tait D. Shanafelt, MD. “Burnout and Suicidal Ideation among U.S. Medical Students.” Annals of Internal Medicine 149.5 (2008): 334-41. Annals of Internal Medicine. Web. 5.

FMA Legal & Ethical Implications in Medicine. Tampa, FL. 27 June 2009. Diagnosis Burnout: 2009 Update. Print. 3.

Shanafelt, MD, Tait D., Katharine A. Bradley, MD, MPH, Joyce E. Wipf, MD, and Anthony L. Back, MD. “Burnout and Self-4. Reported Patient Care in an Internal Medicine Residency Program.” Annals of Internal Medicine 136.5 (2002): 358-67. Annals of Internal Medicine. Web.

Shanafelt, TD, CM Balch, GJ Bechamps, T. Russell, L. Durbye, D. Satele, P. Collicott, PJ Novotny, J. Sloan, JA Frischlag, 5. May Clinic, Johns Hopkins Medical Institutions, and Johns Hopkins University. “Burnout and career satisfaction among American surgeons.” Annals of Surgery 250.3 (2009): 463-71. NCBI PubMed. Web.

Tomaselli, Kathleen Phalen. “Medical student stress and burnout leave some with thoughts of suicide.” Amednews.com. 6. American Medical Association News. Web.

i t is only an hour over dinner, al low time to discuss the important things happening in both your l ives.

When the stresses of medical school,

residency or the profession begin to

take over, make it a priority to focus

on what matters most versus what is

expected from the l i fe of a physician.

It is the simple and sometimes

obvious things that can prevent your

spouse from becoming disenchanted

with his/her profession:

Studies have demonstrated that •music can signif icantly reduce

burnout symptoms after f ive

weeks. 1

Remind your spouse that he/she •is not merely a provider but a

partner in the relationship.

Encourage your spouse to •create realist ic and obtainable

expectations for his/her

professional and personal l i fe.

Help your spouse learn to say •“No” to things that would further

sacrif ice his/her personal l i fe.

Encourage a healthy and •supportive home and workplace.

Create a healthy l i festyle with •diet, regular exercise, and rest .

The demands of balancing the

medical profession and a personal

l i fe never cease. However, this is

the only l i fe we have. It should be

protected, nurtured and enjoyed.

Successful medical couples, those

that have reached retirement and

celebrate double-digit anniversaries,

can reflect on the strengths that

helped guide them to the present:

confidence; a posit ive network of

fr iends; nurturing the abil i ty to

f ind joy in al l things; having a good

laugh; and building the ski l ls to set

reasonable priorit ies and l ive l i fe

accordingly.

h av e I G I v e n s u F F I c I e n t t h o u G h t to w h at I wa n t – F ro M M Y j o b , M Y c a r e e r , M Y l I F e o v e r a l l ?

Do I /Can I a l low my values to InFluence my wor k?

I s the wor k that I ’m doing expressIve oF MY core values ?

aM I doInG all that I ’M Good at?

A m I g o o d a t w h a t I d o ?

Can I f ind a way to change so that I am doInG More oF what I l Ike ?

what Is It that I l Ike and don’t l Ike?

Do I reallY lIke what I ’m doing?

ask3


Following two years at the

Orlando Naval Hospital, Cecil

opened his private practice of

Internal Medicine in Winter Park.

At the time I did not know many

local people and wanted to become

acquainted with other medical

families.

A neighbor took me to my first

Alliance meeting . At the start I

found the fellowship irreplaceable. I

was impressed by the health-related

projects that the Orange County

Medical Society Auxiliary (now the

OCMS Alliance) were sharing in

the schools as well as adult-related

projects.

From the beginning I enjoyed

being involved on committees

and served on the OCMSA Board in

different positions. I still remember

the day the Chair of the Nominating

Committee called to ask if I would

accept the role of County President-

Elect. What an honor!

Serving as County President-

Elect and then President, I began

attending the FMAA state meetings.

I think the turning point of wanting

to continue being involved on the

state level began when I was elected

as an FMAA Delegate to the AMAA

Annual Meeting in Chicago, Illinois.

My first AMAA meeting left

me in complete awe . I was so

impressed by the ladies that were

running the business of the national

Alliance. From that day on I was

actively involved at both the county

and state level.

One of the first FMAA positions

I held was Education Chair (a

two-year position). Our focus was

to help pass legislation requiring

health education in grades K-12.

The FMAA joined forces with a

teachers’ group. After many trips

to Tallahassee, with help from FMA

lobbyists, we promoted a bill that

miraculously passed in both the

House and Senate its very first year.

betty jane wilson65th FMAA President, wife of AMA President-Elect, Cecil Wilson, MD

With husband Cecil Wilson, MD at the 2009 FMA & FMAA Annual Meeting in Boca Raton, FL.

allI ance Icon


My year as FMAA President will always be remembered as one of the most enjoyable and hard

working years of my life. I enjoyed every minute!

With Health Care Reform at the center of all news, it is a very contentious year . Calls, emails,

interviews, etc. never cease. But all of this makes for a

very interesting year and Cecil and I never run out of

things to talk about at home.

The important thing is not to take any criticisms personally and to keep things in the correct

perspective. Besides, there are lots of accolades to

balance out the negative. Cecil feels that this is a most

exciting time to hold the AMA President-Elect position.

Being actively involved in organized medicine

is important for the profession and for our own

life’s work. I believe it was important to support the

activities which represented our family’s livelihood. We

have worked together for a common goal. Through the

FMA and the FMAA we have been able to achieve that

goal.

I do have to admit , however, that the best thing to

come out of our involvement with FMA and FMAA has

been the many wonderful friends that we have made,

and remain close to, over the years. That, without

a doubt, is the extra plum along with the work and

participation.

It is hard for me to understand those that have no interest in participation , since the FMAA

has been a positive experience for me. Being active

in the Alliance, members are not only helping their

own families, but also the medical community and

consequently, the community at large. Those who are

unable to actively participate should remember their

dues will go far to assist with various meaningful

projects, such as legislation backed by the physicians.

It can be contagious. The more you do the more you

want to do. One way to stay engaged is to volunteer

for committee work. Involvement makes the value and

rewards of Alliance membership more meaningful.

allI ance Icon

the MedI-FIle card can save Your lIFe800.762.0233•fmaalliance.org

Betty Jane (pictured in green & white) is recognized with FMA Alliance Past Presidents at the 2009 Annual Meeting.

Call to receive your FREE Medi-File Cards today!**A $5.00 shipping charge will be required.


Anyone who is married to a doctor understands the demanding nature of the medical

profession. It can strain a marriage, distance the bond between parent and child, and

sometimes even destroy the refuge and sanctity of the home. Stress at work, added to the

weight of family responsibilities, can become overwhelming. It is always unfortunate when

we recognize too late that the one we love is suffering more than we ever imagined. It is even

more tragic when we discover that they felt the only way to cope was through substance abuse.

“the life of a physician can be a mixed blessing,” according to lissette Gorman, esq., FMa alliance treasurer. the lifestyle lends itself to luxuries that many people don’t ordinarily experience. however, for some of these physicians, the cost of enjoying such advantages can be steep.

addIctIon

In MedIcIne“I have physician friends who

have an addiction problem,” said

Gorman. “Why would they put their

future and family at r isk? There

are a lot of people out there going

through similar crises. We have to

encourage people to connect with

others and to seek help when they

need it . I f the fear of losing their

l icense to practice medicine doesn’t

make physicians stop and think,

maybe the fear of losing their

family and friends wil l .”

Doctors, with addictive tendencies,

often f ind it diff icult to resist when

their environments are fraught

with temptations, particularly

easy access to pharmaceuticals.

Anesthesiologists receive second-

hand fentanyl inhalation and

can acquire a dependence on

opioids. 3 Emergency Medicine

(EM) residents are chronical ly

s leep deprived and may regularly

use alcohol, antihistamines, s leep

adjuncts, benzodiazepines, or

muscle relaxants to help them fal l

or stay asleep. 4 Abuse of marijuana

and alcohol is also increasing

in EM residents. 5 Physicians in

general can actually experience

some aspects of impairment

without the act of substance abuse.

Depression, stress, and burnout

may drive disruptive behaviors

in the workplace and result in

patterns of unprofessional conduct

similar to what is seen with

substance abuse. 1

As a family member, you must

separate the i l lness from the

person while refraining from

judgment. Acknowledging

that there is a problem and

knowing how and when to

seek help is crucial . There are

institutions available that can

provide rehabil i tation as well as

support for family members and

friends. Such organizations offer

confidential , trustworthy advice

and provide supportive networks.

“Florida plays host to one of the

best, i f not the best, professional

health program currently running

today,” states Raymond M. Pomm,

MD, Medical Director of the

Professionals Recovery Network

(PRN). PRN was established

to maintain the integrity of the

medical profession in its role of

serving the public by supporting

physicians who suffer from one or

more of the fol lowing conditions:

Chemical dependency •Psychiatric i l lness •Psychosexual i l lness, including •boundary violations

Neurological/cognitive •impairment

Physical i l lness •HIV infections/AIDS •Behavioral disorders•

Physicians are treated with respect

and without discrimination.

Recommendations for any fol low-

up treatment, counseling, testing,

or assessment are confidential . As

long as the physician satisfactori ly

participates in the program,

no regulatory action would be

anticipated by the Board of

Medicine. Resumption of practice

is often contingent upon continued

successful participation in PRN.

PRN serves as the consultant to

the Department of Health (DOH)

and the Department of Business

and Professional Regulation

(DBPR) on matters relating to

practit ioner impairment. While

working with DOH and DBPR,

PRN also works closely with their

Legal Departments in regards to

impairment related mitigation

factors during disciplinary

proceedings. 6

When a physician becomes a

patient, often he or she must

reduce or stop practicing. Patients

may have to use retirement plans,



l i fe savings, etc. , to continue

paying for l i fe ’s necessit ies

while undergoing treatment.

PRN understands this hardship

and offers treatment grants or

scholarships. “We use a cadre of

centers around the state that do

good work for PRN,” states Dr.

Pomm. “Everyone involved is doing

something to help al leviate the

costs.”

Most admitted physicians have

families who’ve been l iving in an

impairment situation for years.

Those closest to the problem wil l

rationalize the addiction and are

less l ikely to remain objective

about the risks involved. The

PRN Family Component (FC) was

established to provide support and

education to the medical family

once the physician is admitted.

“When the physician is taken from

a family ’s l i fe - they wil l not work

for an indefinite period of t ime and

may not be seen by their families

for a period of t ime – fear and

anger comes over family,” said Dr.

Pomm. “They experience reality

vertigo.” The PRN FC remains

involved with the family from

admission up unti l f ive years after

release.

“The family is already under stress

from their loved one’s impairment.

Compound it with having to l ive

without that person and their

additional income,” states Karen

Chouinard, PRN Board Member

and Past FMA All iance President.

The FMA All iance, an organization

comprised of physician spouses,

empathetical ly views the PRN

FC as a signif icant area of need.

“Each year the All iance donates 20

percent of proceeds from holiday

fruit sales specif ical ly to this

section of PRN.” All iance members

receive a fruit catalogue beginning

in late October/early November or

they can download it by going to

the FMA All iance web site at

www.fmaall iance.org.

PRN also treats students through

contractual funding from Florida

medical schools. “Unfortunately,

they [medical schools] aren’t at

a point of identifying students

who are using that wil l develop a

dependence vs. those who use and

won’t have an addiction,” states

Dr. Pomm. “The only t ime they

refer is when it impacts student

performance.” Florida medical

schools provide impairment

information to students,

encouraging them to contact or

report individuals suspected of

addiction to PRN or the school ’s

Program Director, Chairman, or

Associate Dean.

The PRN web site, www.flprn.org,

offers answers to frequently asked

questions relating to impairment

and the services i t provides.

Addiction is nothing new in the

medical profession, yet physicians

have but recently been able to

special ize in i ts study. It has only

been thirty-four years since doctors

f irst off icial ly recognized and

treated addiction as an i l lness. 7

The f ield is relatively young, and as

Those closest to the problem will rationalize the addiction and are less likely to remain objective about the risks involved


Brown, SD, MJ Goske, and CM Johnson. “Beyond substance abuse: stress, burnout, 1. and depression as causes of physician impairment and disruptive behavior.” Journal of American College of Radiology 6.7 (2009): 479-85. NCBI PubMed. Web.

“Fellowships in Addiction Medicine.” ASAM - American Society of Addiction 2. Medicine. Web.

Gold, MS, RJ Melker, DM Dennis, TE Morey, LK Bajpai, and R. Pomm et al. 3. “Fentanyl abuse and dependence: Further evidence for second hand exposure hypothesis.” Journal of Addictive Diseases 25.1 (2006): 15-21. NCBI PubMed. Web.

Handel, DA, A. Raja, and CJ Lindsell. “The use of sleep aids among Emergency 4. Medicine residents: A web based survey.” BMC Health Services Reserach 6.E136 (2006). NCBI PubMed. Web.

McBeth, BD, FK Ankel, LJ Ling, BR Asplin, EJ Mason, TJ Flottemesch, and RM 5. McNamara. “Substance use in emergency medicine training programs.” Academic Emergency Medicine 15.1 (2008): 45-53. NCBI PubMed. Web.

PRN Impaired Practitioners Program of Florida. Web. <http://www.flprn.org>. 6.

“Turning Points in Establishing the Medical Specialty of Addiction Medicine.” The 7. American Society of Addiction Medicine. Web.

resources

www.f lprn .or g

www.webenet .com/impa i redpract ioner s .htm

www.a l -anon .a la teen .or g

www.nar-anon.or g

prn

Florida Impaired practitioners program

al-anon

nar-anon

a result only three of the seven medical schools in

Florida offer Fel lowships in Addiction Medicine:

University of Florida College of Medicine,

University of Miami Mil ler School of Medicine and

University of South Florida College of Medicine. 2

Although addiction medicine is a relatively new

specialty, physician impairment has affected

our families, fr iends, communities and nation

longer than we care to admit. All iance members

should consider i t their duty to raise the level

of awareness. If you suspect that someone you

know is experiencing impairment, do not fai l to

acknowledge the problem. It wil l not go away on

its own. The f irst step is to seek help. Reach out

to fr iends and family. Read more about the issue,

familiarize yourself with available resources, and

when cal led upon offer a non-judgmental helping

hand to those in our family of medicine that may

be affected by this i l lness.

Proceeds of fruit purchases go towards the Entrusted Fund of

the FMA Alliance, in our effor t to suppor t programs that help

impaired individuals & protect against untreated impairments.

Call 800.713.7848 ext. 6500 and mention your order is for the

FMA Alliance.

Holiday gifts that benefit a greater cause


We are not superheroes. We are constantly fed images of the perfect spouse, parent, employee and human being. This relentless pressure to perform and stay on top of everything can prove detrimental to our overal l health. What does it mean to l ive a healthy l i festyle? The common misconception of leading a healthy l i festyle is that i t s imply consists of eating well and exercising. While these are two important components, they are not the sole definit ion. According to the World Health Organization, “Health is not only the absence of infirmity and disease but also the state of physical , mental and social well-being.”

Of course there are different ways to describe a healthy l i festyle. But, for the most part i t means l iving l i fe in a way that helps you to be both physical ly and emotionally healthy. The Center for Reintegration puts i t s imply: many things go into creating a healthy l i festyle; the main ones include posit ive relationships, appropriate exercise, proper nutrit ion and adequate rest .

The Center for Reintegration, a nonprofit organization committed to helping people pursue a meaningful l i fe, maintains that wellness involves both choice and action. According to the Center, the choices you make each day, and the actions you take with those choices, can lead to a healthier l i festyle. Making posit ive choices in the areas of physical f i tness, stress, work, relationships, medication, and nutrit ion—and then acting on those choices—promotes a sense of accomplishment and well-being.

The Plate-SpinnersAs parents, spouses, employees and friends, i t often becomes diff icult to keep al l of the quintessential elements together that al low us to l ive healthy well-balanced l ives. Imagine the plate-spinning performers, a circus manipulation art where a person spins multiple plates or other f lat objects on poles, without them fal l ing off . The key to keeping the gig going is to make sure that each plate remains spinning. If one plate stops spinning it comes crashing down and ult imately ruins the entire trick. That is how people often l ive their l ives, constantly trying to maintain the spinning plates.

According to Nina Atwood, an Executive Coach who works with executives and their teams to assist them in producing breakthroughs in performance and results, “At t imes, I have felt that was me—running over to the plate cal led ‘business and career’ and spinning it , then rushing over to the plate cal led ‘ family and friends’ and spinning it , then careening over to the one labeled ‘health and exercise, ’ and so on. The whole t ime, I felt ineffective at them all and fearful that at any moment one of them might spin out of control and go crashing to the f loor.”

With the pressure of that common point of view, i t is easy to forget what i t means to lead a healthy existence. A healthy l i festyle begins with taking care of yourself in al l aspects of your l i fe, physical ly, mentally and emotionally, which wil l ult imately al low you to give your best in l i fe to those you care about and those who depend on you.

{Article Submission by the AMA All iance}

HEALTHy LIFESTyLE

WHAT ExACTLy IS A


It Starts With YouIn order for us to put our best foot forward we must start from the inside out. A healthy l i festyle starts with a healthy mindset. Jennifer Mrozek Sukalo, MS, is the owner and founder of Healthy Lifestyle Solutions, a company dedicated to educating, motivating and empowering individuals to start l iving well and loving it . As a motivational and educational speaker and writer, she helps people identify the largest road blocks in their l ives that prevent them from being the best they can be.

“It starts with self- investigation, because ult imately people have al l the power to create the posit ive changes needed to l ive a healthy, balanced l i fe with the tools already in their possession,” said Sukalo. “There are things that take place that affect so many parts of l i fe . People often have a diff icult t ime taking care of themselves because they believe that f irst and foremost they are caregivers, so family, household duties and the job take priority and then we take what’s left over. The better we take care of ourselves the more we’re able to give to others in our l ives.”

Reaching that realization is the catalyst of truly l iving a healthy l i fe. It al l comes down to self responsibil i ty, one of the most crit ical aspects of wellness. It ’s important to accept responsibil i ty for your health, happiness and overal l wellness. Once in the driver ’s seat, you must determine your priorit ies and develop sustainable goals, added Sukalo.

Navigating the Physical

According to the U.S. Food and Drug Administration,

“A physical , healthy l i festyle includes eating a

healthy diet , maintaining a healthy weight, exercising

regularly, quitt ing smoking (or not starting) and

minimizing stress.”

Excess body fat leads to health problems such as type

two diabetes, high blood pressure, high cholesterol ,

heart disease and cancer. The National Health and

Nutrit ion Examination survey estimates that three out

of four Americans die of heart disease or cancer each

year and approximately 80 percent of those deaths are

associated with l i festyle factors, including inactivity.

Excess weight and physical inactivity account for

more than 300,000 premature deaths each year in

the United States, second only to deaths related to

smoking, says the Centers for Disease Control and

Prevention.

It is recommended to get at least one-half hour

of exercise three t imes a week, but any amount of

exercise is better than none at al l ! I f you do not or

cannot go jogging or swimming, try going for a brisk

walk with a fr iend, working vigorously in the yard, or

r iding your bike to work.

The reduction of stress and getting plenty of rest

are also key factors in overal l health and happiness.

Eliminating stress is rarely practical or feasible, but

there are many ways to reduce its impact. Consider as

many rel ief options as possible.

Perpetuating Positive Partnerships

In order for a healthy l i festyle to be well-rounded, i t

must resonate in al l areas of your l i fe including the

relationships that you have with your partner, family

and friends. According to Sukalo, having meaningful

relationships with people who stimulate you and challenge you emotionally and physical ly is extremely important. You should regularly take t ime to have meals with family and friends and surround yourself with people who challenge and support you and foster personal growth.

Cutting ties on negative non-reciprocating relationships wil l propel you into a different realm of happiness and self-fulf i l lment, she said. You want to be yoked with people that believe in you and support you. “Support is so important because we, as humans, tend to need other humans; we need support from others who are

helpful and encouraging,” said Sukalo. “It ’s a matter

of accepting the fact that we can’t do everything on

our own.”

S TATF l o r i d a M e d i c a l A s s o c i a t i o n A l l i a n c e :

P . O . B o x 1 0 2 6 9T a l l a h a s s e e , F L 3 2 3 0 2

P R S R T S T DU S P o s t a g e

P a i dP a n a m a C i t y , F L P e r m i t N o . 2 3 0

FLORI

DA M

EDIC

AL

ASSO

CIATION ALLIANCE, INC.

ESTABLISHED

192

6

EVEN

TS January 29-30, 2010

south regional all iance conf.

embassy suites crabtree vil lage

raleigh, nc

April 23, 2010

spring FMa all iance

board of directors

& leadership Meeting

June 13-15, 2010

aMaa annual Meeting

chicago Marriott downtown

chicago, IlAugust 13-15, 2010

FMa & FMaa annual Meeting

hilton orlando bonnet creek

orlando, Fl

FLO

RID

A M

EDIC


C.

ESTABLISHED 1926

Documents

2009 FMA Alliance STAT Magazine - Fall/Winter