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Members In The News

The MassAFP wants to celebrate the accomplishments of its members. That’s why we’re asking members to submit newsworthy articles regarding you, your practice and your commitment to the community. 

MassAFP Member Spotlight

Jim Ledwith, MD, FAAFP


MassAFP recognizes Jim Ledwith, MD, FAAFP for his dedicated service and contributions to the MCSTAP Program – MA Consultation Service on Treatment of Addiction and Pain.  Dr. Ledwith has been a Physician Consultant for MCSTAP for two years and is one of the initial consultants when MCSTAP started providing consultation services across Massachusetts in January 2019.  Dr. Ledwith states, “It appears that we all greatly enjoy this work assisting our colleagues with challenging cases.  We had zero attrition from the original team.” 

MCSTAP helps clinicians manage the care of patients with acute or chronic pain, substance use disorder, or both.  Physician consultants are on call Monday through Friday, 9AM to 5PM to take calls from physicians and allied health workers across Massachusetts.  Dr. Ledwith adds, “One calls our central number and our Resource and Referral Specialist takes some basic contact information and pages the consultant.  We strive to call back within 10 minutes unless on another call.  Some physicians arrange for the callback to occur at a more convenient hour, such as during their administrative time.  Family physicians respond to the needs of their patients and their communities unlike any other specialty.  We often have difficulty finding resources to assist our patients who struggle with conditions that are stigmatized in our society and substance use and pain pose special challenges.  My colleagues and I bring expertise in managing these patients to assist family physicians to clarify the issues in the assessment of patients, making a diagnosis, and planning next steps in treatment.  This is a complex and multistep process and it isn't unusual to have follow-up discussions of a case.  Before accepting my academic position at UMass, I was a rural community physician for 19 years and I bring that experience to the table along with my years of experience with medication for opioid use disorder and chronic pain.”

The Massachusetts Behavioral Health Partnership, which administers the program, sought consultants with subject expertise as well as familiarity with the challenges of practice.  Stefan Topolski, MD of Shelbourne Falls is also a MCSTAP Consultant.  Stefan worked with Dr. Ledwith for years as a community preceptor in the Fitchburg Family Medicine Residency Program and is an incredibly insightful family physician with a keen focus on community and patient-centered care.  Mia Sorcinelli, MD of Lawrence is also a consultant.  She has tremendous experience with primary care and pain management,  and with buprenorphine, naltrexone, and methadone for OUD.  She and Dr. Ledwith have been presenting on these topics during the MassAFP Spring Refresher for years.

Dr. Ledwith joined the UMass Family Medicine faculty in 2005, teaching and eventually serving as residency director in Fitchburg until 2016.  He then moved his practice to the school campus and served as Learning Community Mentor, but still supervised residents one day a week.  Dr. Ledwith adds, “My academic practice allows me to engage in projects as diverse as family medicine itself.  I teach components of our family medicine clerkship and now have about 25% of my time dedicated to consulting on opioid management for UMass Memorial Health, MCSTAP, and for MassHealth.  It's not all opioids.  For the past year I have also led a pilot project for screening patients with diabetes for diabetic retinopathy within our family medicine practices. In my spare time I volunteer as medical director one of the Worcester free care programs and serve as faculty advisor for the student organization.  The Epworth free care program is open on Monday evenings, 6-8PM and assists the marginalized new MA residents and other uninsured individuals with basic health care needs.  Often we see fully insured individuals who need a work physical to start a new job as a minimum wage CNA or PCA but needing the exam immediately and unable to wait to see their own family doctor.  

The Worcester Free Care Collaborative is about to emerge as a regional nonprofit organization that will advocate for and coordinate services in the 7 programs that currently provide free health services one evening a week in the greater Worcester area. Dr. Ledwith serves as the faculty advisor for the student section which engages him in student-led initiatives to improve and expand services.

“I also serve as Faculty Advisor for the students' Crisis and Emergency Preparedness Committee that coordinates student volunteer projects that have responded to the COVID pandemic. That role has taken me to COVID vaccination sites in addition to assuring that students have appropriate safety precautions in place, plenty of PPE, and training and supervision in their volunteer activities.”

When asked what brings the greatest satisfaction in working with medical students?  Dr. Ledwith replied, “In the big picture, my small practice touches a few thousand lives over the years, perhaps multiplied by the friends and family members that are affected by the care provided to my patients.  I know I have an impact on developing a patient-centered, compassionate approach to care in the students that I teach and mentor.  At this point in my career I appreciate the "compound interest" on my efforts for the community.  The students also keep me honest.  I am led to clearly explain why a given situation warrants deviation from a guideline, and whether some guidelines are appropriate in my community practice at all. Only a fraction of my students will become family physicians, but the future specialists will better understand the needs of the family physicians who refer to them. I'd encourage every family physician to consider offering to host a student for a clerkship or elective.  With a little pre-planning the students will energize the office with only a modest amount of added effort each day.  If a 4-5 week clerkship is too intense a commitment, UMass and other schools have introductory programs (the Longitudinal Preceptorship Program at UMass) during which students observe learn history and exam skills in half-day sessions 5-6 times per semester.”

Dr. Ledwith’s final thoughts, “Approach the chronic pain patients with a systems approach and lay out long term treatment goals. I encourage all to obtain a buprenorphine waiver.  If we are going to treat with opioids for pain, a few of our patients will develop a use disorder.  Be ready to offer a solution to that problem.”

 

Six Ways to Practice Family Medicine

Full-scope Fulfillment - Posted March 18, 2021 by MaryAnn Dakkak, M.D., M.S.P.H.

MassAFP member, MaryAnn Dakkak, M.D., M.S.P.H., practices full-scope family medicine and is a clinical assistant professor at Boston University Medical Center. She is Women’s Health Director at Manet Community Health Centers. Her views do not represent those of the organizations with which she is affiliated.

During my second year of residency, while I was in my HIV continuity clinic, a third-year resident told me, “Watch out or the only patients you’ll have are women, their babies and LGBTQ patients.”

I didn’t respond, but I was actually really excited at that prospect.

Seven years later, my panel is mostly women (and their children). I am the director of women’s health at a federally qualified health center and do the majority of family planning, colposcopy, ultrasound and prenatal care. I share the gender-affirming care panel with one other physician, and I’m the lead clinician for pregnant patients with opiate dependence in our outpatient-based addiction treatment program. My panel is diverse, and I get to speak two or three languages a day.

I am fortunate to be able to train Boston Medical Center family medicine residents in my clinic, as well as Boston University medical students.

When I’m not spending my 20 hours a week in my clinic, I am both a hospitalist and a laborist at Boston Medical Center. I cover labor and delivery for an average of one shift a week, and I do full-spectrum obstetrics, including cesarean sections and high-risk pregnancy care.

In some ways I feel like I’ve extended residency because I still get to do everything! I may still work longer hours than many of my colleagues who have chosen to narrow their career adventures, but they are hours that I enjoy.

In my third year of residency, a co-resident warned me, “You won’t be able to do everything forever!” She may be right, although I can’t imagine changing my scope. I get to work with so many teams at the hospital, giving me a larger practice community. I get to work with the most fun residents and medical students across a diverse scope of care. It keeps me engaged and excited to go to work, and fulfills my purpose of treating every patient to the best of my abilities.

The last 12 months have shown how important full-scope family physicians can be to an emergency response. At Boston Medical Center, family physicians were found in every corner, helping with hospitalist teams, palliative care teams, obstetrical teams, urgent care and our longer-term respite and recovery sites. Choosing family medicine was just the start of the adventure. Finding the right job has supported my scope and strengths and been key to maintaining my balance and happiness.

Being an FP Means Always Stretching Your Scope, Knowledge

Posted March 16, 2021 by MaryAnn Dakkak, M.D., M.S.P.H.

MassAFP member, MaryAnn Dakkak, M.D., M.S.P.H., practices full-scope family medicine and is a clinical assistant professor at Boston University Medical Center. She is Women’s Health Director at Manet Community Health Centers. Her views do not represent those of the organizations with which she is affiliated.

When I told my neonatologist-turned-pediatric-anesthesiologist dad that I wanted to be a doctor, he was confused.

“You’ll be so bored,” he said.

My dad is a quiet man and creature of habit. He is excellent at his job, his coworkers love him and the once poor Egyptian immigrant has found a path to prosperity in the United States. Unlike me, he likes repetition. He knows me well, and I don’t thrive when staying in the same environment. I thrive on constant challenge, a bit of chaos, using my brain in diverse ways and a good dose of human contact.

So when I decided on family medicine, he had to do some research. At first, he considered it similar to an unspecialized generalist physician in other countries where he had lived. But after talking to U.S. colleagues and looking at the training, he said, “That will be good for you. You won’t be bored.”

And he was right.

In December 2019, our federally qualified health center just south of Boston made a commitment to expand our five-site FQHC to provide comprehensive primary care for LGBTQ+ patients. Our clinic already had an infectious disease program, including HIV and hepatitis care, as well as robust family planning and teen programs. As director of women’s health, I sat with our urgent care director and CMO, and we created a team to start additional training on gender-affirming care.

We discussed the biases that exist, even within our own health care teams, and prioritized finding staff that wanted to provide gender-affirming care. One study showed that although 85.7% of primary care clinicians were willing to provide primary care for transgender patients,(www.annfammed.org) only 69% felt capable of doing so. Another study showed that only 50% of primary care physicians were willing to continue prescribed gender-affirming hormone therapy in transgender patients.(academic.oup.com) The AAFP has endorsed a recommended resident curriculum in LGBTQ+ care, including hormone therapy for gender-affirming care, but there is a broad spectrum of how such training is implemented.

I found appropriate CME and trainings for staff, including our phone receptionists, medical assistants, front desk staff, nurses and physicians. The trainings were aimed at two goals: making all staff more aware of bias and developing comfort providing LGBTQ+ care, and specifically training teams to directly provide that care. We used grant money to get training and created a website.(www.manetchc.org) We were revving and ready to go.
AAFP Resources
Transgender Health Resources

Care for the Transgender and Gender Nonbinary Patient

LGBTQ Health Toolkit
And then came the pandemic. Our FQHC became one of the primary partners with our county’s public health department for south shore testing and triage. Two of the three leads providing gender-affirming care were redeployed to provide almost 100% COVID-19 care. I got pulled into full-time inpatient medicine and obstetrics care. Our urgent care director became focused on COVID-19 testing and triage care. The outside trainings were canceled (though we continued to provide Lunch-and-Learn lectures on LGBTQ+ topics), and our expansion of services to include gender-affirming care were put on hold.

Regardless of how the priorities of the clinicians involved shifted, the new website was launched, and shortly, patients started seeking care.

And that’s how I met Liberty. I was working a day of clinic every two weeks. She sent a message through our patient portal that included a paragraph about how she’d been searching for a nearby clinic to provide gender-affirming care. She was specifically looking to start estrogen therapy and testosterone-blocking therapy. Her note covered her anxiety and history of depression, and mentioned that she didn’t have means to make the commute into the city for transgender care. She wrote that she realized that in-person visits were few and far between, but she really wanted to see me. Someone forwarded me the message, doubtful I could book her in because my schedule was always stacked with in-person procedures and high-risk obstetrics patients. I said of course we would fit her in.

Congratulations to Michael Richardson, MD - One of The National Minority Quality Forum's 40 Under 40 Leaders in Health in 2021

The National Minority Quality Forum is proud to announce the selection of the 2021 40 Under 40 Leaders in Minority Health. After receiving hundreds of applications from healthcare professionals across the country, these 40 represent the next generation of thought leaders in reducing health disparities.

“Here at the NMQF, we are truly excited about this next class of honorees and recognizing them at our annual leadership summit,” stated NMQF President & CEO Dr. Gary Puckrein. “The winners are doing amazing things that both better and diversify the healthcare marketplace. They serve as positive role models for our next generation of leaders in minority health.”

MassAFP's Dr. Michael Richardson Speaks Up About the Importance of Flu Shots in 2020

September 4, 2020: Beware, flu season is coming!  This year could be particularly sickly: Though we don’t yet know how deadly this strain of influenza will be, it will start infecting people at the same time as cases of the coronavirus will likely surge.

“We always recommend getting the flu shot early, that’s in September, October. That’s because flu season comes around in October. There’s no exact date, just when it gets cold,” Dr. Michael Richardson told The New York Post. “It peaks between December and February and it can honestly last until May, it usually starts to beat out around March.”

“We want to prevent at least one deadly virus this year,” said Richardson. “The health care system is already so strained with COVID. Having another epidemic on top of that is not going to help the health care system at all.”

Congratulations to MassAFP's Lauren Ciszak, M.D. - Family Medicine Discovers RapSDI 2020 Scholar!

Last year, the AAFP Foundation and the AAFP National Research Network partnered to launch the Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation initiative. The program's objective was to recruit family physicians who were interested in conducting clinical research -- but who lacked the time or money to move forward with their idea -- and provide selected candidates funding and assistance to complete their projects. Those projects were intended to find meaningful solutions to real-world clinical questions facing FPs and others in primary care.

In September 2019, the initiative began accepting applications from FPs interested in becoming RapSDI scholars. After an application process that spanned several months, the program has selected two winners for 2020.

One of those winners was MassAFP's Lauren Ciszak, M.D.  Dr. Ciszak, a practicing family physician with the South End Community Health Center in Boston, received a $39,212 grant for her research project, "Medically Tailored Meal Kits as a Means of Decreasing ED visits and Hospitalizations in Primary Care Patients with Chronic Disease." She told AAFP News that she has had a longstanding interest in nutrition and primary care, but that one patient turned that interest into something more.

"I had a particular patient who had end-stage renal disease and received meal deliveries at home, but often when she would travel with her family she didn't know what foods to prepare or choose and three times in one year ended up hospitalized on family vacation due to choosing the wrong foods with too much sodium," Ciszak told AAFP News. "I thought to myself, 'If she received a meal kit that she or her family prepared rather than food that was already prepared and just handed to her, maybe she would learn which foods she could choose when cooking or dining out with her family. And if we could prevent even one hospitalization per year, a meal kit would be cost-effective.'"

Ciszak said that she hopes to prove that such a meal kit delivery service can help better manage the health needs of patients with nutrition-related chronic diseases, which, in turn, would reduce or prevent hospitalizations and emergency department visits. Given enough evidence, she said, it may be possible to demonstrate that such a meal service should be covered by Medicare and Medicaid.

"I also hope to show how access to healthy foods can support health in general," Ciszak added. "Our clinic has a robust office-based addiction treatment program, and I am excited to see if access to healthy foods may help patients with substance abuse disorders have extra time and mental resources to focus on their recovery."

Overall, she concluded, "I hope that this will help push us to focus more and more on the importance of adequate nutrition and understanding that access to healthy and easily available food can help patients with multiple chronic diseases, is cost-effective and could and should be a covered service."

The grant will help mitigate project-associated costs and/or offset the time and salary needed to develop and complete their project within 12 months. Dr. Ciszak also will receive support and mentorship from NRN staff to refine research protocols, perform related project activities and analyze study data.

The expected start date for each research project is June 1. On completing the research, Dr. Ciszak will have the opportunity to participate in one or more research conferences and author a manuscript in a peer-reviewed journal.

For AAFP members interested in becoming FMD RapSDI Scholars, the 2021 application period will open July 1, 2020. Members must be practicing FPs in any post-residency career stage to apply. Potential applicants are encouraged to visit the FMD RapSDI webpage often for periodically updated application information.

More From AAFP
AAFP Foundation: Signature Program: Family Medicine Discovers

American Family Physician: Community Blog: Guest Post: AAFP Family Medicine Discovers!

Excellent Article in January’s 2020 Special Opioid Edition of JABFM by Core Faculty Members Joshua St. Louis and Nick Weida

Why Are Early Career Family Physicians Driving Increases in Buprenorphine Prescribing?

The opioid crisis in the United States has reached epidemic proportions. The most recent data from the National Center for Health Statistics show that overdose deaths continue to increase drastically, from 8050 in 1999 to 70,237 in 2017.1 Medication-assisted treatment with either methadone or buprenorphine has been shown in numerous high-quality trials to decrease mortality, largely due to a significant reduction in fatal overdose.2,3 Despite these clear patient-centered benefits, only 10.6% of patients with opioid use disorder are on medication-assisted treatment.4 Family physicians are solidly positioned to provide this treatment due to their broad scope of care and geographic distribution across the country. Using data from the American Board of Family Medicine, Peterson et al5 show that while buprenorphine prescribing by family physicians increased significantly from 2016 to 2018, that increase was disproportionately driven by early-career physicians with essentially no change in prescribing practices by mid- and late-career family physicians.

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