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From the chair

Dr. Susan M. LemagieSusan M. Lemagie, MD

Alaska River RaftingWhat do Alaskans do in the summer? Many of us are gardeners, growing everything in our 19 to 24 hours of daylight from giant cabbages to miniature high alpine plants that flourish in our scree gardens. Biking and hiking our local mountains are popular, but the activity that gives the most thrills per minute is river rafting! When you come to visit, be sure to float the Matanuska, Talkeetna, or Denali River.

Interim District Advisory Council Meeting
I have just got to brag about District VIII. We held our Interim District Advisory Council Meeting in April, and, as always, I was so impressed with the enthusiasm and energy of our Fellows and Junior Fellows. They are full of ideas about improving health care for their patients and solving practice problems for our doctors.

District VIII has 15 sections and is one of the largest districts within ACOG. Our Advisory Council has a great diversity of physicians, from those who practice rural medicine in critical access hospitals to those who practice academic medicine in large university centers. We encourage conversations on whatever the hot-button issues are in our sections, ranging from reproductive rights to elective inductions. 

Women’s health care is always a newsmaker. Even Alaska got national coverage during our legislative session this year when State Sen. Pete Kelly (R-Fairbanks), while advocating for prevention of fetal alcohol syndrome, introduced a measure to put free pregnancy tests in bars. When asked why the measure didn’t provide free condoms instead, he replied, “Birth control is for people who don’t necessarily want to act responsibly.” Of course, ob-gyns tend to think the other way around: Responsible people use birth control!

One of the most popular sessions at our IDAC Meeting is the Fellow and Junior Fellow session, where we exchange thoughts on topics pertinent to all. This year, Laura T. Mercer, MD, District VIII Junior Fellow chair, presented on ACOG’s new Committee Opinion on breast density to aid us in defeating legislative attempts to mandate practice standards that are not consistent with scientific evidence. Dr. Mercer’s presentation led to a discussion on the pros and cons of screening mammography, which is the best we have, though far from perfect as evidenced by its false positives and negatives. 

Stella M. Dantas, MD, District VIII secretary, led a panel on career options, transitions, and satisfaction. Robert H. Palmer Jr, MD, District VIII vice chair, Tersh McCracken, MD, District VIII treasurer, Nicole E. Marshall, MD, District VIII young physician, and Dr. Mercer, described their varied careers. Sleep deprivation, covering call, and burnout were among the topics debated. A lively discussion on the rigors and satisfactions of ob-gyn practice, in which everyone in the room participated, provoked thoughtful suggestions on improving work-life balance.

Our keynote speaker, Sonja Lyubomirsky, PhD, professor of psychology at the University of California, Riverside, and author of The How of Happiness and The Myths of Happiness, primed us on the simple things we can do to increase our personal happiness. Timothy C. McFarren, MD, Nevada Section chair, took her at her word and provided us all with chocolate at our concluding session.

ACOG leadership in the 21st century
James T. Breeden, MD, past ACOG president and past District VIII chair, shared ideas about leadership at the IDAC Meeting, based on findings from his presidential task force. Looking at the major generational and gender shifts within our membership, he pointed out that the current 35% female representation on the ACOG Executive Board, including five female district chairs, is far better than the average of 10–15% on most national corporate boards. He noted that representation will likely increase as older generations retire and Generations X and Y, which are composed of more than 80% women, mature and step up to leadership positions.   

ACOG Fellow Demographics

The ACOG Executive Board approved a new diversity statement to help volunteers and leaders understand that their willingness to serve helps the board avoid organizational blind spots. A new, more comprehensive database also is being created to make sure the board is culturally competent. The Accreditation Council for Graduate Medical Education found that ob-gyn has the largest representation of female African Americans and the second largest representation of Hispanic women of any specialty. However, ACOG currently has no formal repository for this information. Alternative pathways to leadership are encouraged within ACOG, with positions for three young physicians, two Fellows-at-large, and representatives from the subspecialty organizations.

Time is the single biggest obstacle to leadership that our membership identifies, particularly time away from family and practice. Since 2000, participation in national committees has included more video conferencing, efficient meetings, and task forces and work groups with child care. We have adopted similar policies at the district level, to the delight of our Junior Fellows and young physicians. 

A practical way to get involved in ACOG is to attend the Congressional Leadership Conference in Washington, DC. The dates for the 2015 conference are March 8–10. Contact your section leadership if you would like to attend. Also, consider supporting ACOG’s federal political action committee, Ob-GynPAC. The PAC made national news in the 2012 election cycle by raising more than $1 million dollars for the first time, with an 85% success rate in electing candidates who support women’s health. (You will not be favored or disadvantaged by reason of the amount of your contribution or a decision not to contribute. Contributions from foreign nationals are not permitted.)

In addition to leadership in ACOG, remember there are opportunities in your local hospitals and communities that help you practice leadership skills. Reading a good book, such as The Leadership Challenge by James M. Kouzes and Barry Z. Posner, Women Lead the Way by Linda Tarr-Whelan, or The Female Vision by Sally Helgesen and Julie Johnson, can give you great tips. When you identify something that needs to be changed, clarify your vision by speaking out and involving others, and you’ll be on your way.

District VIII produces leaders! Congratulations to the following individuals, who received awards at the Annual Clinical Meeting in Chicago:

  • James R. Scott, MD, Luella Klein Lifetime Achievement Award
  • Luis B. Curet, MD, past District VIII chair, Arthur P. Gold Humanism in Medicine Award
  • Lynn M. Coppola, MD, International Service Award
  • W. Lawrence Warner, MD, Utah Section chair, Council of District Chairs Service Recognition Award
  • Tod C. Aeby, MD, Outstanding District Service Award
  • Maria Gaspar-Oishi, MD, Donald F. Richardson Memorial Prize Paper Award

Resources for patients and physicians
Check out the following new resources for patients and physicians:

2014 Annual District Meeting
Come to Napa, CA, at harvest time with Districts VI, VIII, and IX for the 2014 Annual District Meeting. The meeting will be held September 5–7 at the Silverado Resort. The program, “Scholars and Sommeliers: Learn from California’s Leaders,” will feature updates on environmental toxins and reproductive health, synthetic mesh complications, hormone therapy, and gynecologic oncology challenges. I hope to see you there!

 

From the editor

Dr. Stella M. DantasStella M. Dantas, MD, District VIII secretary

As we move into spring, District VIII continues to be active and productive. I am always so proud to be part of such an innovative and progressive group of Fellows, Juniors Fellows, young physicians, and medical students. I think you will understand and appreciate this feeling as you read through this issue of the Gazette.

One of the most energizing and inspiring events that takes place every year is the Congressional Leadership Conference (CLC). This year, District VIII had more than 60 attendees, with over 15 Junior Fellows in attendance. Our high attendance rate is in large part due to Tony Ogburn, MD, District VIII legislative chair, who organizes a legislative meeting for district members the morning before the CLC starts. The meeting encourages members to become legislatively active, covering topics such as the importance of advocacy, perinatal collaboratives, dense breast legislation, reproductive health issues, and home birth. Read more about the meeting from Dr. Ogburn and Suzanne Burlone, MD, District VIII Junior Fellow legislative chair, in their report on legislative activities.

In addition to thoughtful leaders, District VIII is grooming some outstanding actors. The Washington Section, which has been legislatively active and innovative for quite some time, decided it was time to share some of its secrets to success. Section leaders developed a humorous informational video, “Lobbying: The Good, the Bad, and the Ugly.” Judith M. Kimelman, MD, immediate past Washington Section chair and one of the stars of the video, shares more of her thoughts on lobbying in this issue of the Gazette.

Lastly, District VIII swept the awards at the CLC with the Montana Section receiving the Accomplishment in State Legislative Advocacy Award for its successful maternal mortality review legislation and the Hawaii Section receiving the Improvement in State Legislative Advocacy Award for its work on planned home birth safety and developing interest, enthusiasm, and action in legislative activities.

Our Junior Fellows, young physicians, and medical students are also keeping District VIII in the limelight. The Junior Fellows’ Central American Education Project is in its third year of existence and continues to gain momentum. Read more about Junior Fellow activities from Laura T. Mercer, MD, District VIII chair, in this issue. Also, Junior Fellows, check out her article on opportunities to get involved in ACOG.

Nicole E. Marshall, MD, and Sarah W. Prager, MD, District VIII young physicians, actively listen to their membership and turn suggestions into action, as seen during the 2013 Annual District Meeting in Maui. In addition to trying to make meetings more family friendly, they worked with the Junior Fellow leadership to offer the first District VIII mock oral board session. The session proved successful and will be offered again at the 2014 ADM in Napa, CA. Drs. Marshall and Prager are continuing their efforts to create meeting formats that meet the needs of the changing demographics in our specialty. Read about their many ideas in their young physician report.

Medical students are an active part of our district and sections. In particular, I would like to highlight a student who attended the 2013 ADM, Michael Hsiao, from British Columbia. After attending the ADM, Michael was inspired to organize an educational advocacy event for medical students. Petra A. Selke, MD, section chair, shares Michael’s story and others in her British Columbia Section report.

In addition to all the informative section reports, please make sure to read the featured articles in this issue on dense breast notification, the Choosing Wisely campaign, and social insurance and health care (a pensive essay by Jerry Kopelman, MD, immediate past District VIII chair).

In closing, I would like to congratulate the Utah Section on winning a Council of District Chairs Service Recognition Award for its outreach initiative to rural hospitals. The award is a well-deserved recognition of the tremendous efforts of W. Lawrence Warner, MD, Utah Section chair.

Please contact me at maddogcoutu@yahoo.com if you have feedback, article suggestions, or questions on how to become more involved in the district or your section. I would love to hear your opinions and experience. Best wishes for a joyous spring and summer.

 

Junior Fellow news

Dr. Laura T. MercerLaura T. Mercer, MD, District VIII Junior Fellow chair

The third year of the Central American Education Project is in full swing. Junior Fellow section officers are busy fundraising to secure adequate resources for the 2014 grant recipient, which will be selected at the Annual District Meeting in September. Central American Junior Fellows can apply now!

Hospital General San Juan de Dios 

Luis B. Curet, MD, past District VIII chair, demonstrates a laparoscopic endotrainer for Guatemalan residents.

Past recipients of the project’s grant are:

  • The Honduras ob-gyn residency program in 2012. The program used the grant to implement an audiovisual classroom capable of teleconferences. Residents have been participating in regular educational conferences with the University of New Mexico

  • The Hospital General San Juan de Dios in Guatemala in 2013. The hospital purchased a laparoscopic endotrainer for increased laparoscopic education with the grant

CREOG representative
Congratulations to Casandra A. Liggins, MD, from Banner Good Samaritan Medical Center in Phoenix, who has been selected as one of two Junior Fellow CREOG representatives. Her three-year term began after the Annual Clinical Meeting in April.

Ob-Gyn Reporters
We had nine residents from seven programs apply to be Ob-Gyn Reporters at the ACM this year. Reporters are funded through an educational grant from Teva Women’s Health Inc that covers all reasonable expenses. Due to decreased funding this year, only three residents could be selected for the program. The District VIII Ob-Gyn Reporters were Audrey M. Moruzzi, MD, from the University of Washington in Seattle; Carmen A. Lafia, MD, from the University of Nevada in Reno; and Maritza Gonzalez, MD, from the University of Arizona in Tucson. Katie K. McGuire, MD, from the University of Hawaii in Honolulu, served as an alternate.

Arizona Section Health Day   

Arizona Section Junior Fellows at the Annual Women’s Health Day at the Arizona State Capitol

Legislative activities
I’m thrilled to report that we had more than 15 District VIII Junior Fellows at the Congressional Leadership Conference in Washington, DC, this year. Suzanne Burlone, MD, District VIII Junior Fellow legislative chair, has been working with the section Junior Fellow legislative chairs to promote legislative advocacy in each state. Our ultimate goals are for every US section to have a Junior Fellow legislative chair and to host a lobby day. Big congratulations to the Arizona, Colorado, Hawaii, New Mexico, and Washington sections for organizing lobby days for women’s health in their states.

Oral board preparation and practice
The inaugural mock oral board session at the 2013 ADM was really successful. The best part? The session was included in conference registration fees with no extra charge! The program will be featured again at the 2014 ADM in September. Many sections are working to implement mock programs at the state level as well. Stay tuned for more information on how to sign up for these opportunities.

Medical student initiatives
Recruitment of the next generation of ob-gyns continues with procedure nights, social hours, beeper walks, shadow programs, and more. We are so appreciative of the support from District VIII and its sections for Junior Fellows to continue with these programs.

ACOG highlights District VIII mentors
Congratulations to the following District VIII Fellows who were named ACOG Mentors of the Year. These individuals were recognized by Junior Fellows and young physicians for their dedication to and excellence in mentoring:

  • William “Buzz” Brown III, MD, Denver, CO
  • Erin A.S. Clark, MD, Salt Lake City, UT
  • Michael R. Foley, MD, Paradise Valley, AZ
  • Judith M. Kimelman, MD, Seattle, WA
  • Michael B. Schneider, MD, Fort Collins, CO
  • Valerie A. Sorkin-Wells, MD, Phoenix, AZ
  • Michael A. Urig, MD, Phoenix, AZ

 

Young physician report

Dr. Nicole E. MarshallDr. Sarah W. PragerNicole E. Marshall, MD, and Sarah W. Prager, MD, District VIII young physicians

The 2013 Annual District Meeting in Maui was great. Innovations suggested by young physicians to make meetings more family friendly were met with appreciation. The conference hall included a breastfeeding area and a kids’ row in the back of the meeting room. The biggest success for young physicians was the introduction of mock oral boards. Participants were grateful for the experience, requesting the session earlier in the conference and with more examiners.

Planning is already underway for the 2014 ADM. If you haven’t planned your trip, the meeting will be held at the Silverado Resort in Napa, CA, September 5–7. It is a combined meeting with Districts VI and IX. There will be a number of events specifically for young physicians. We plan to repeat the mock oral exam session and hope to offer it on Friday to allow more examiners to participate. If anyone is interested in helping with this session, please contact us

We’re also planning another mentorship luncheon for medical students and residents. We hope to have one young physician and one more senior Fellow to provide mentorship at each table. Again, if you’re interested in participating, please let us know. 

We still want to incorporate some changes to meetings that are reflective of the lifestyles of our younger ACOG membership. Some of the issues we have identified are listed below. If you have other suggestions, please do not hesitate to contact us. 

Annual District Meeting suggestions

  • Choose locations with family-friendly activities
  • Time meetings around school schedules
  • Provide child care options during main sessions
  • Offer a back row in meeting rooms for parents with children
    • Provide coloring supplies, books, quiet toys, etc
  • Consider a separate play room in which lectures are broadcast
  • Provide breastfeeding rooms at all large meetings
  • Offer scheduled play group activities for parents to network
  • Provide openings in the schedule to allow for family time and activities during meetings
  • Encourage family participation with low-cost child registration fees and child-friendly food options
    • Make it clear that we welcome and encourage family participation
    • Engage children and parents to promote future attendance at other ACOG meetings

Interim District Advisory Council Meeting suggestions

  • Choose locations with family-friendly activities
  • Time meetings around school schedules
  • Provide child care options during main sessions
  • Offer low-cost child registration fees and child-friendly food options
  • Minimize guest costs, especially for Junior Fellow guests
  • Make it a “no-frills” meeting
    • Choose locations with easy transportation
    • Streamline meetings to minimize time away from family and practice
    • Encourage members to come early or stay late if additional vacation time is desired
  • Combine with the Annual Clinical Meeting, especially when it’s in a family-friendly location

I think we’ve addressed or started to address some of these elements, and we’ll keep striving toward the others as long as they are endorsed by the young physician contingency. As your young physician representatives, we want to continue to increase young physician and Junior Fellow involvement in ACOG, create room at the table for all constituents, and serve as a model for all ACOG districts. 

Don’t forget to check out the ACOG Young Physician website for additional helpful resources. If any young physicians have issues to bring forward, or if anyone has issues pertaining to young physicians, please don’t hesitate to contact us. 

 

Legislative activities update

Dr. Tony OgburnDr. Suzanne BurloneTony Ogburn, MD, District VIII legislative chair, and Suzanne Burlone, MD, District VIII Junior Fellow legislative chair

The Congressional Leadership Conference (CLC) was a great success this year—bigger and better than ever. District VIII was well represented with more than 60 attendees, which was the second most of any district! Thanks to all those who attended and the section leaders who supported them.

The conference was held March 2–4 in Washington, DC. It was a bit snowy, as a blizzard on Monday shut down most everything in the city except for our conference. As usual, one of the highlights of the meeting was the District VIII legislative meeting held the Sunday morning before the CLC started. More than 50 Fellows and Junior Fellows attended and participated in a lively and informative discussion of the hot-button issues in state legislatures in our district. 

Susan M. Lemagie, MD, District VIII chair, started the meeting with an inspiring talk about the importance of advocacy in women’s health. Then, Kathryn Moore, ACOG state legislative and regulatory affairs director, and Kate Vlach, ACOG state legislative and regulatory affairs manager, gave a great overview of important issues at the state level. Kathryn and Kate are tremendous resources, and we encourage anyone with a question about state legislative issues to contact them for assistance at stateleg@acog.org.             

Eve Espey, MD, MPH, and Robert H. Palmer Jr, MD, District VIII vice chair, led a discussion about perinatal collaboratives. The New Mexico Section sponsored a bill in its state to provide funding to establish a collaborative. Its efforts were unsuccessful, but the bill will be reintroduced next year. If you don’t have a collaborative in your state, consider starting one!

Laura T. Mercer, MD, District VIII Junior Fellow chair, Steven C. Holt, MD, Colorado Section vice chair, and Judith M. Kimelman, MD, immediate past Washington Section chair, shared their experiences with dense breast legislation—a challenging topic that has the potential to cause a lot of anxiety for patients, increased work and risk for providers, and significant added cost without any proven benefit. 

Dr. Espey, Kate Vlach, and Aaron M. Lazorwitz, MD, led a spirited conversation on reproductive health issues. The New Mexico Section has worked successfully with its state’s Medicaid program to provide coverage of long-acting reversible contraceptives, both the device and insertion fee, for patients in the hospital following delivery. If you are interested in working on this issue in your state, contact Dr. Espey at eespey@salud.unm.edu for more information.

Stella M. Dantas, MD, District VIII secretary, and Greigh I. Hirata, MD, Hawaii Section vice chair, gave an update on ongoing issues with home births. The Oregon Section has partnered with patients and other advocacy groups to pass legislation for reasonable regulation and oversight of home births.      

The highlight of the entire session was the instructional video, “Lobbying: The Good, the Bad, and the Ugly,” by the Washington Section. Starring Dr. Kimelman and Judith A. Jacobsen, MD, Washington Section chair, the video is informative and entertaining. It’s great tool for sections to use at their meetings or lobby days.

Most of the District VIII sections have a designated section Junior Fellow legislative chair position, with all sections excited about spearheading legislative developments and activities within their section as joint Fellow and Junior Fellow efforts. As legislative advocacy is now a CREOG learning objective, it’s exciting to see more enthusiasm for Junior Fellows to become involved with advocacy activities.

Among the legislative activity goals for District VIII is for each section to organize a state or province lobby (or legislative) day. Congratulations to the Hawaii and Colorado sections for hosting their first lobby days in 2014! The Arizona, New Mexico, and Washington sections have also been active in organizing similar events. We hope that even more states will organize a lobby day for 2015.

Additional and alternative legislative activity goals for individual sections of District VIII include communicating and meeting with legislators apart from designated lobby days, letter-writing campaigns to legislators throughout the year, and ongoing sponsorship and support for Fellows and Junior Fellows to attend the CLC and State Legislative Roundtable conference. We look forward to supporting and working with you all as you work towards these goals!

 

ACOG helps ob-gyns ‘choose wisely’

Dr. Sandra KochSandra Koch, MD, ACOG Committee on Patient Safety and Quality Improvement vice chair

The Choosing Wisely campaign is an initiative of the American Board of Internal Medicine (ABIM) Foundation designed to help patients and physicians engage in conversations about the overuse of tests and procedures and to support physician efforts to help patients make smart and effective care choices. Leading specialty societies have created lists of evidence-based recommendations that should be discussed.

The campaign recognizes that patients often ask for tests or treatments that are not necessarily in their best interest and that physicians often struggle with decisions about prescribing tests and procedures as a way of covering all possible outcomes. It was launched to create and disseminate evidence-based lists of five tests and/or procedures by specialty whose necessity should be questioned by both physicians and patients.

The Choosing Wisely campaign has received a lot of attention and created a unique opportunity for ACOG to improve health care literacy. ACOG has already submitted the following five evidence-based recommendations to Choosing Wisely:

  • Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age
  • Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable
  • Don’t perform routine annual cervical cytology screening (Pap tests) in women 30–65 years of age
  • Don’t treat patients who have mild dysplasia of less than two years in duration
  • Don’t screen for ovarian cancer in asymptomatic women at average risk

Recommendations currently under consideration for a second list are:

  • Don’t use terbutaline for more than 48 hours to prevent preterm labor
  • Don’t use robotic surgery when it is not indicated
  • Don’t perform keepsake ultrasounds
  • Don't perform pelvic ultrasounds in asymptomatic, non-pregnant women
  • Don’t perform urodynamic testing in a woman with simple urinary stress incontinence
  • Don’t prescribe bed rest during pregnancy
  • Don’t use a fetal fibronectin to test for preterm labor in asymptomatic pregnant women
  • Don’t routinely transfuse for hemoglobin over 7 g/dl

If you have an idea you would like ACOG to consider for submission to the Choosing Wisely campaign, please email it to me at koch-mcfarren@sbcglobal.net.

 

Opportunities for Junior Fellow involvement

Dr. Laura T. MercerLaura T. Mercer, MD, District VIII Junior Fellow chair

If you are interested in becoming more active in ACOG, consider applying to be a district or section officer. District VIII is looking for a Junior Fellow vice chair (three-year term) and Junior Fellow secretary (one-year term). To apply for vice chair, you must have at least one year of ACOG leadership and/or service experience. Learn more about officer responsibilities and the application process. The deadline to apply is June 1. Please also feel free to email me with questions at lauratmercer@gmail.com.

Each District VIII section represents one state or province, except for our Central America Section, which encompasses the whole region. Each section is looking for a Junior Fellow vice chair (two-year term) and Junior Fellow legislative chair (one-year term). Some sections are also looking for a Junior Fellow chair or Junior Fellow secretary (one-year terms). Talk to your current section Junior Fellow chair or email me for more details.

Good with a pen? Interested in being published in the Green Journal?
ACOG is now accepting submissions for this year’s Junior Fellow Essay Contest. The theme is “Life of a Junior Fellow in the 21st Century.” The winner will receive a $100 gift certificate to the ACOG Bookstore, and their essay will be published in an upcoming issue of the Green Journal. Essays must be submitted by June 1.

Apply to be on an ACOG Committee
Have you ever wondered who writes the ACOG Practice Bulletins and Committee Opinions? ACOG Committees do! The application process will start in June with a deadline of August 1. Be on the lookout for more details on the ACOG website soon. In the meantime, check out the list of ACOG Committees.

Connect with ACOG on social media

  • Like ACOG Facebook pages (ACOG national, District VIII, and ACOG medical students)
  • Follow ACOG on Twitter (@acognews)
  • Use hashtags to get trending. Here are some examples:
    • #PauseBeforeYouPost (increase awareness of professionalism in social media, and check out the ACOG video on the subject)
    • #BestSpecialtyEver (for all things ob-gyn related, but especially medical student events and activities
    • #ObGynBootCamp (for medical student trainings and intern orientations)

 

Reflections on social insurance and health care

Dr. J. Joshua KopelmanJ. Joshua Kopelman, MD, immediate past District VIII chair

As we enter the first full year of ob-gyn practice under the Affordable Care Act, I am celebrating the 50th anniversary of my graduation from the New York University School of Medicine. Because I have a long-term perspective of the social insurance aspects of US health care, I would like to share my thoughts on the subject. It already has and will continue to dramatically affect the manner in which medicine will be practiced by the majority of ob-gyns in District VIII and throughout the nation.

I had just completed an internship in straight medicine and started my residency in ob-gyn in 1965 when Medicare legislation was enacted to insure the health care of America’s senior citizens age 65 and older. The reaction of the private practice community, with few exceptions, was extremely negative. I had little opportunity to participate in the rollout of Medicare as I was drafted out of residency and served as a general medical officer on active duty until 1967. When I resumed my residency training, which I completed in 1971, Medicare was functioning well and also funding postgraduate medical education in teaching hospitals across the country.

The attitude of organized medicine toward Medicare rapidly changed to acceptance, and even enthusiasm, as it became clear that the previously underinsured or uninsured elderly were now a source of increased income to physicians and hospitals. Over time, Medicare expanded to cover younger patients with chronic end stage renal disease and amyotrophic lateral sclerosis. Eventually, it expanded to cover disabled patients of any age. Prescription coverage for Medicare enrollees became an additional benefit in 2008.

Unfortunately, due primarily to lack of adequate oversight in the initial legislation and the greed of unscrupulous providers, Medicare rapidly became the victim of massive fraud and abuse. In addition, with changing age demographics in our country, the increasing cost of advancing medical technologies, and several downturns in the nation’s economy, the viability of Medicare became tenuous, and its ability to support graduate medical education was considerably eroded.

Congress came up with programs like managed care and the sustainable growth rate (SGR), which were supposed to control costs by reducing physician reimbursement for the care of both privately insured and Medicare patients. SGR turned out to be the source of an unsustainable, never-to-be-implemented loss rate, which Congress has yet to repeal because it cannot (or chooses not to) fund the $117 billion it will cost to end and replace the program.

Despite the unsolved fiscal problems posed by Medicare, to say nothing of Medicaid, Congress and the Obama administration proceeded to pass the Affordable Care Act. The patient protection aspects of the act will, I believe, improve patient safety and broaden access to health insurance to the majority of the uninsured in our country. It will do so at great expense and after separating providers of health care into those who may no longer care for their clients as hospital inpatients and those who provide care exclusively in the hospital setting.

Whether or not those legally bound to purchase the proposed insurance deem it affordable is another matter. Moreover, there will be substantial numbers of newly insured patients who discover that they cannot afford to pay, out of pocket, the deductible amount required for the affordable care they hope to obtain.

I foresee the government needing to subsidize not only postgraduate medical training, but medical school as well. Perhaps those costs and the huge student loans with which most newly minted physicians in this country are now saddled will be forgiven by the federal government in exchange for agreements to provide care to underserved (ie, remote and undesirable) areas of the nation for specific periods of time.

These young doctors are likely to be relatively poorly compensated, as are many rural primary care practitioners today, and will have limited ability to move to other areas, except as employed physicians in large hospitals or insurance-owned provider groups. This will eventually benefit the population poorly served by our current health care system.

As I enter retirement, I continue to believe that medicine remains a noble calling, attracting women and men who, like those of us who have volunteered time and talent to the work that ACOG does, remain strong advocates for our patients and the high quality of care that they deserve.

Change is inevitable, and realistic expectations combined with careful planning will allow our members to continue to provide high-quality women’s health care. But this statement will only be true as long as physicians, not politicians, remain in control.

 

Dense breast notification controversies and guidelines

Dr. Laura T. MercerLaura T. Mercer, MD, District VIII Junior Fellow chair

We’ve heard much about dense breasts in the last several years, from Connecticut to California. In District VIII, legislation about dense breasts has surfaced in many states. At both the Congressional Leadership Conference in March and the Interim District Advisory Council Meeting in April, District VIII officers discussed this issue.

Radiologists classify breasts into one of four categories of breast density:

  • Almost entirely fatty
  • Scattered areas of fibroglandular density
  • Heterogeneously dense
  • Extremely dense

The reasoning behind legislation mandating dense breast notification is that the sensitivity of mammography decreases as the density of one’s breasts increases. At the same time, there is a modest increase in risk of breast cancer in women with dense breasts. Most legislation mandates lay notification of breast density when a woman’s breasts are in either of the last two categories mentioned above. Fifty percent of women’s breasts fall into those categories.

Arizona recently became the 15th state to pass dense breast notification legislation. The law requires the following notice be sent to women with heterogeneously dense or extremely dense breasts from the institution or facility that performed their mammogram:

“Your mammogram indicates that you have dense breast tissue. Dense breast tissue is common and is found in 50% of women. However, dense breast tissue can make it more difficult to detect cancers in the breast by mammography and may also be associated with an increased risk of breast cancer. This information is being provided to raise your awareness and to encourage you to discuss with your health care providers your dense breast tissue and other breast cancer risk factors. Together, you and your physician can decide if additional screening options are right for you. A report of your results was sent to your physician.”

Physicians are left with how to counsel patients who receive this information and how to answer their questions. Unfortunately, the data on breast density and breast cancer is scarce, and we have little to guide us on what the next best steps should be for women in these categories. ACOG published a Committee Opinion in the April Green Journal that addresses breast density. It states that “ACOG does not recommend routine use of alternative or adjunctive tests to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors.”

Wondering what those additional risk factors might include? Check out guidelines from the National Comprehensive Cancer Network or the National Cancer Institute to determine who should go on to have genetic counseling or other screening tests.

More studies are examining just how effective (and possibly harmful) breast cancer screening can be for women. Additionally, studies examining how to determine who, when, and at what intervals we should be screening are increasing. The discussion on breast cancer screening, mammography, and breast density is far from over.

 

Planned home birth concerns in Hawaii

Dr. Lori E. KamemotoLori E. Kamemoto, MD, MPH, Hawaii Section chair

The Hawaii Section received the Improvement in State Legislative Advocacy Award at the Congressional Leadership Conference in March. The award recognizes states who have demonstrated impressive growth in legislative advocacy. The Hawaii Section was honored for its many legislative endeavors, including its efforts to make planned home birth safer in the state.

The Hawaii Section is greatly concerned about planned home birth safety. Multiple neonatal deaths associated with planned home birth have occurred in Hawaii. Several of these neonatal deaths have been associated with the planned home birth of known high-risk pregnancies, such as breech presentation and twin pregnancies. Nationally, when compared to midwife hospital births, planned home births are associated with a four-fold increased risk of neonatal death.

Although planned home births have been performed by certified professional midwives (CPMs) in Hawaii for more than 15 years, there is no licensure, educational requirements, safety regulations and rules, informed consent requirement for patients, or data collection to ensure home birth safety. In addition to CPMs, planned home births are also performed by naturopaths, certified nurse-midwives, cultural practitioners, and others. 

During the 2014 Hawaii legislative session, a home birth safety bill was introduced to address some of these concerns. The bill was heard in the Senate Health Committee and met with opposition by the CPM, naturopath, and cultural practitioner communities. Physicians testified on cases of neonatal death and serious maternal complications that were transferred to the hospital after laboring or delivering at home. The bill was replaced with a task force bill that was not heard in its next committee. 

Local news coverage of the hearing, including newspaper and television coverage, started public education on this issue. A non-scientific poll was conducted soon after the Senate Health Committee hearing by the Honolulu Star-Advertiser on February 11. It asked, “Should midwives be licensed with training and other requirements regulated by a medical board?” Eighty-three percent of respondents answered “yes” (2,225 votes), and 17% answered “no” (458 votes). In speaking with the general public, many are surprised that although their manicurist and hair stylist, for example, are required to have a license and meet minimum educational requirements for safety’s sake, the same is not required of home birth providers.

To avoid preventable deaths or harm, mothers who plan a home birth need to know that it should not be considered for high-risk pregnancies. They should also be aware that the availability of a provider with formal education in obstetrics, ready access to consultation, and safe transport to a hospital are crucial to having a safe and happy birth outcome. We will continue to work on this issue to ensure the safety of all Hawaii's mothers and newborns.

 

Lobbying in Washington: The good, the bad, and the ugly

Dr. Judith M. KimelmanJudith M. Kimelman, MD, immediate past Washington Section chair

“I don’t have time to get involved.” “Doctors are not supposed to be political.” “I don’t know enough to talk to my legislator.” These are some of the many reasons physicians are reticent to get involved in political advocacy. But, as we tell the participants of the Washington State Legislative Day, if you don't get involved, politicians will have no trouble getting involved in how you practice medicine.

The Washington Section started its Legislative Day five years ago to teach residents about advocacy and to give them the experience of lobbying about issues important to their patients and their ability to practice medicine. We wanted the next generation of physicians to feel it was their responsibility to be involved. We were met with great enthusiasm from residency directors because advocacy training had just become a CREOG objective. But even better, the residents loved the experience. It only took the first year to realize it could be valuable to all ob-gyns, regardless of where they were in their careers.

The Legislative Day takes place at the Capitol in Olympia, which is a fun field trip for everyone. The day begins with attendees learning the basics of the legislative process from the Washington State Medical Association’s legislative team. Then, we have a speaker talk about the importance of advocacy, and our Junior Fellows inform the group about the issues on which we will be lobbying. Finally, we spend time practicing our five-minute spiels before meeting with legislators.

Have we been successful lobbyists? It is hard to measure success. Some of the bills we have lobbied for have passed, though many have not. More importantly, residents and practicing physicians in our community are more involved. When an issue arises, ob-gyns no longer passively wait to see what will happen. Instead, they try to figure out what they can do to advocate for change. Legislators recognize us when we come to talk to them year after year, and lobbyists from groups we care about (eg, Planned Parenthood, March of Dimes, and Legal Voice) contact us for our support or to testify at the Capitol.

The Washington Section had a lot of fun this year developing a humorous informational video, “Lobbying: The Good, the Bad, and the Ugly.” The seven-minute video was filmed with State Rep. Ross Hunter (D-Medina) playing himself and putting up with Judith A. Jacobsen, MD, Washington Section chair, and me bumbling through a meeting with cell phones going off and a long drawn-out patient example using mostly medical terminology. The video got lots of laughs at our Legislative Day, at the Congressional Leadership Conference, and from many lobbyists in our state. Anyone is welcome to use it, or create your own!

 

Montana Section recognized for legislative success

Dr. William J. PetersWilliam J. Peters, MD, past District VIII chair and past Montana Section chair

The Montana Section received the Accomplishment in State Legislative Advocacy Award at the Congressional Leadership Conference in Washington, DC, in March. The award recognizes states who have demonstrated an impressive legislative accomplishment. The Montana Section was honored for its efforts to establish a formal maternal mortality review process.

Montana Section Bill Signing

Gov. Steve Bullock signs the Fetal, Infant, and Child Mortality Review Prevention Act amendment into law.

In 2011, increasing maternal deaths nationally and in Montana inspired the Montana Section to pursue a legislative initiative to amend the state’s Fetal, Infant, and Child Mortality Review (FICMR) Prevention Act to include maternal mortality review. The legislation, sponsored by State Rep. Liz Bangerter (R-Helena), passed the Montana House and Senate. Montana Gov. Steve Bullock signed the amendment into law on March 18, 2013.

The decision to seek an amendment to the existing FICMR Prevention Act rather than creating a new, separate maternal mortality review bill was important to the initiative’s success. By adding a maternal “M” to FICMR, a budget neutral bill was attained, which pleased the Legislature and the Department of Public Health and Human Services (DPHHS). Additionally, the FICMR legislation had existing non-disclosure, confidentiality, and peer review clauses built in, as well as an existing statewide infrastructure of 28 FICMR case review teams.

The successful two-and-a-half year endeavor was a result of Montana Section officers’ time, energy, and commitment and legislative expertise from ACOG, DPHHS, the Montana Medical Association, and our Montana Section lobbyist team provided by the Billings Clinic, Bozeman Deaconess Hospital, and the Montana Medical Association.

 

Council of District Chairs honors Utah Section

Dr. W. Lawrence WarnerW. Lawrence Warner, MD, Utah Section chair

The Utah Section won a Council of District Chairs Service Recognition Award for its outreach initiative to rural hospitals. The award is given to an ACOG district or section in recognition of an outstanding activity it has contributed to the field of ob-gyn.

Two years ago, Utah Section leaders recognized a need to improve communication with ACOG members in the state. We began sending emails to members about various clinical and legislative issues. One of our goals was to promote the principles of standardization and minimization of variation among practitioners, as these concepts have shown to improve clinical outcomes. 

We soon realized that greater than 50% of the counties in Utah do not have an ACOG Fellow practicing in their communities. We felt a need to reach out to the dedicated and hard-working family physicians and certified nurse-midwives who provide needed obstetric care in rural areas. We contacted the nursing director of obstetrics at 18 rural hospitals throughout Utah and set up an email contact system with them. An introductory letter was sent to them to explain our intentions, and we asked the nursing directors to present this letter and future communications to their obstetric providers, both physicians and nurses.

Since the initial outreach, we have sent out 11 emails covering various patient safety subjects and standardized clinical protocols. We have sent handouts on the standardized terminology and management of fetal heart rate tracings, the standardized management of hypertensive disorders in pregnancy, a chorioamnionitis protocol, and other recommendations based on ACOG resources. The nursing directors forward this information to their obstetrics staff, and we encourage them to discuss the topics and attached materials at a joint physician-nurse meeting to see if there are areas they can improve and standardize.

To date, I have personally visited 15 of the 18 hospitals and have given lectures on patient safety initiatives and the importance of standardization with minimization of variation. The feedback has been overwhelmingly positive. We hope that our rural maternity providers feel they now have a resource for current obstetric information.

The Utah Section has started working on a third component of its outreach and communication efforts. We are compiling a list of the obstetrics department chairs at each of the other, non-rural hospitals in Utah and are obtaining permission to send the communications we send to individual section members directly to them as well. This contact will facilitate these topics being discussed at their department meetings and help further our efforts to reach all obstetric providers in the state. We will continue to encourage each site to work toward standardization of protocols within their facility to reduce physician and nursing errors that result from having multiple ways to care for a particular condition.

We are also promoting the concept of each hospital labor and delivery unit having an Emergency Physician Reference Notebook with multiple divider tabs where they can place all of their policies, protocols, order sets, and check lists for quick and easy reference.

Copies of the documents we have created and used in our outreach efforts will be available soon on the District VIII website.

 

Section reports

Alberta SectionAlaska
Matthew A. Lindemann, MD, section chair

First of all, we had leadership changes in the Alaska Section. After more than a year of service as section chair, Kathryn M. Ostrom, MD, has stepped down. I am now section chair, and Wendy S. Cruz, MD, is section vice chair. We appreciate Dr. Ostrom’s passionate leadership and are sorry to see her leave. She will remain a valuable resource for us.

The most pressing issues in Alaska are on the legislative front. A parental notification bill, passed by the legislature in 2010, has worked its way through the court system and was recently brought before the State Supreme Court. Jan E. Whitefield, MD, past section chair, and Susan M. Lemagie, MD, District VIII chair, offered testimony in the lower court proceedings. It could be a year before we get a ruling, so we’ll keep everyone posted.

Last year, a bill making requirements for Medicaid funding of abortion much more restrictive was passed. Previous regulations were vague and allowed abortions to be paid for when a doctor determined the procedure was medically necessary. The bill lists specific criteria for which the state will pay for terminations, most importantly leaving out psychological considerations. Separate from the political issues, this bill is dangerous in that it represents encroachment of legislators into the doctor’s office. We believe that medical decisions should be left to health care providers and their patients. There is a trial pending on this issue.

Our dream of having an ICD-10 coding conference for the section this spring fell through, though we hope to still do it later this summer. The goal is to not only provide needed information, but to incorporate the many new Junior Fellows who arrived this past summer and provide a forum for Fellows across the state to network. Alaska is a big state, of course, with few roads, which presents challenges. We also have three significant parallel health systems—military, native, and private—that don’t often interact. Dr. Ostrom is now serving as ob-gyn chair at Providence Alaska Medical Center and hopes, with her new role, to organize an ob-gyn grand rounds that can be attended virtually by Fellows.

The medical center also has accepted a proposal for a laborist program. Local doctors are not involved at this point, though there will likely be opportunities for us to work for the group. The program would provide 24-hour in-house coverage for emergencies and also decrease the burden on private obstetricians to be in-house for vaginal births after cesarean delivery, thus potentially increasing their availability.

I have been participating in the Healthy Alaskans 2020 campaign, serving on a committee addressing barriers to prenatal care and how we can increase the number of people accessing care in the first trimester. The committee has recognized several areas of concern, and it should issue a final report soon.

 

Alberta SectionAlberta
Martine N. Roy, MD, section chair

After three years of freezes, Alberta physicians received a 2.5% fee increase on April 1, in a climate of 4.5% inflation. The Alberta Health Services leadership structure is still in a state of transition.

The birth rate in Alberta remains high, and some areas of the province are still waiting on upgrades to provide enough services. Red Deer Regional Hospital should be getting labor and delivery operating rooms in the next three years. Currently, patients still need to be taken to the main operating room for emergency cesarean deliveries. In Edmonton and northern Alberta, we have had to send newborns out to Calgary or other provinces because we lack neonatal intensive care unit (NICU) capacity. Misericordia Community Hospital will be getting a new level 2 NICU, though I’ll believe it once it is open. We’ve been this close before.

On a positive note, the new Calgary South Campus Health Centre opened their ob-gyn department in September 2013. The Alberta Perinatal Health Program is working on addressing preventable hypoxic intrapartum and neonatal deaths. Maternal mortality also remains low in the province.

The Alberta Section Annual Meeting was held in Lake Louise on March 28, in conjunction with the Society of Obstetricians and Gynaecologists of Canada West/Central CME, March 27–29.

 

Arizona SectionArizona
Maria Manriquez, MD, section chair

The Arizona Section Women’s Health Day at the State Capitol in February was a wonderful success. Attendees met with State Rep. Eric Meyer (D-Paradise Valley) and State Sen. Kelli Ward (R-Lake Havasu City).

The section cosponsored a statewide Resident Research Day in April. Two residents from each program presented research and competed for cash awards. The Phoenix and Tucson programs at the University of Arizona matched 13 students into ob-gyn. Recruitment for our specialty continues.

After the Annual District Meeting in September, Ilana B. Addis, MD, MPH, section vice chair, will become section chair; Laurie P. Erickson, MD, will become section vice chair; and Julie B. Kwatra, MD, will continue to be our awesome treasurer. I have accepted the position of ACOG representative to the Association of American Medical Colleges Council of Faculty and Academic Societies.

Arizona Section Junior Fellows have been hosting procedure nights and resident panels for medical students. Other activities include fundraising for Latin America, organizing maternity clothing drives, and writing legislators to protect graduate medical education funding at the national level and to advocate for women’s health issues at the state level.

Increased dues are covering the expense of a section lobbyist. We plan to host an expanded Women’s Health Day next year and an educational meeting at the time of the Resident Research Day. With our improved budget, we have been able to send additional students to regional and national events, as well as sponsor more Fellows and Junior Fellows to attend the Congressional Leadership Conference in Washington, DC.

 

British Columbia SectionBritish Columbia
Petra A. Selke, MD, section chair

The British Columbia Section has taken inspiration from the ACOG tradition in which the incoming president announces an initiative for his or her year in office. British Columbia’s initiative under the current leadership is “Engaging the ACOG Fellows of Tomorrow,” recognizing District VIII’s staunch advocacy of Junior Fellow and medical student involvement in the organization.

British Columbia Advocacy Night

“Advocacy in Women’s Health” organizers and attendees

The section’s sponsorship of medical students to attend ACOG events has helped confirm their interests in the field of ob-gyn. Devon Rasmussen and Jennifer Yan attended ACOG meetings in 2012 and described their experiences as inspirational. The following year, they matched with their first-choice ob-gyn residency programs.

Michael Hsiao attended the 2013 Annual District Meeting in Maui, HI, and called it one of his top three most exciting experiences in medical school so far. The other two experiences were his first delivery and recognizing twin-twin transfusion syndrome on an ultrasound. He plans to apply for ob-gyn residency programs when he finishes medical school next spring.

Michael was particularly struck by ACOG’s role in patient advocacy and how little British Columbia medical students learn about the topic in school. To this end, he was moved to organize a Canadian Federation of Medical Students’ educational evening titled “Advocacy in Women’s Health” shortly after the ADM. Speakers were Brian Fitzsimmons, MD, immediate past section chair, and me.

Dr. Fitzsimmons spoke about the moral imperative of women’s reproductive choice and the problems surrounding this issue locally and internationally. I spoke about accountability—the importance of analyzing and acting on health outcomes to improve patient safety and care.

We look forward to the energy, enthusiasm, and ideas brought to the section by our “Fellows of Tomorrow.” 

 

Central America SectionCentral America
Eduardo Cordova, MD, section chair

The new Central America Section officers are:

  • Eduardo Cordova, MD, chair, El Salvador
  • Floridalma Rivas, MD, vice chair, Nicaragua
  • Flory Gonzalez, MD, secretary, Costa Rica
  • Cesar Reyes, MD, treasurer, Guatemala
  • Tomas Arias, MD, vocal 1, Panama
  • Ruben Dario Fernandez, MD, vocal 2, Honduras

The officers held their first meeting during the Central American Federation of Associations and Societies of Obstetrics and Gynecology Meeting in Guatemala in March. We discussed how to increase participation of section members in district and national ACOG activities and how to promote Fellow and Junior Fellow section membership. We also talked about improving the relationship between section Fellows and Junior Fellows and ideas for new activities and sessions to offer in Spanish during ACOG meetings for Latin American sections.

 

Colorado SectionColorado
Kimberly D. Warner, MD, section chair

The Colorado Section had a tremendous presence at the State Capitol this year. We hosted a wildly successful Resident Lobby Day, with 12 legislators and about 20 residents present. Lauren Miller, MD, section Junior Fellow chair, Steven C. Holt, MD, section vice chair and legislative chair, and Dick Brown, our lobbyist, planned this event.

Two major bills being monitored this session focus on breast density notification and cost containment. A few anti-abortion and personhood-like bills have not gained any traction.

The dense breast notification bill requires that each mammography report provided to a patient include information that identifies the patient’s breast tissue classification based on the breast imaging reporting and data system established by the American College of Radiology. If the health care facility that performed the mammography determines that a patient has dense breast tissue, the facility is required to notify the patient of the determination using specific language. The section has many concerns with this bill, including creating unnecessary fear in patients and the lack of evidence around offering any other screening tests instead of or in follow-up to dense breast notification.

The cost containment bill creates the Colorado Commission on Affordable Health Care and tasks the commission with studying and making recommendations regarding health care costs, focusing on evidence-based cost controls, access, and quality of care. The governor and legislative leadership from both houses and parties are to appoint the 12-member commission, assuring representation from across the state with expertise in various subject areas, including health care administration, finance, delivery, and consumption.

Additionally, the commissioner of insurance, the executive directors of the departments of public health, environment, human services, health care policy, and finance, and an administrator from the all-payer health claims database are to serve as ex officio, nonvoting members of the commission. The commission would make recommendations regarding legislative and regulatory modifications that could make health care affordable while improving access and quality of health care.

The Colorado Section Annual Summer Educational Symposium will be held in Vail, June 13–14, at the beautiful Sonnenalp Resort. Please join us! 

 

Hawaii SectionHawaii
Lori E. Kamemoto, MD, MPH, section chair

The 26th Annual Hawaii Section Ob-Gyn Update Meeting was held November 9–11, 2013. It was a successful education meeting that was highly rated by attendees and financially solvent. The 27th Annual Hawaii Section Ob-Gyn Update Meeting will be held November 8–10, 2014, at the St. Regis Princeville Resort overlooking beautiful Hanalei Bay on Kauai. Everyone is welcome!

The Hawaii Section held its Annual Dinner Meeting on April 9. We hosted speakers on accountable care organizations and the Affordable Care Act. The dinner is free to our members.

The Hawaii Legislature was in session from January to May. Bills of interest include a home birth safety bill, which was not passed. The section continues to work on this important issue. A bill that would establish a maternal mortality review panel in Hawaii passed the Senate and one House Committee in 2013. It was still alive during the 2014 session, but did not pass. Bills to establish an infant mortality board also did not pass.

Multiple bills exempting breastfeeding mothers from jury duty were introduced. The section submitted testimony in support of the bills. One of the bills passed the Senate and the House, but it was held up in conference committee. The section also submitted testimony in support of reinstating the Department of Health Child Death Review positions, which would provide administrative support for a maternal mortality review panel.

The Hawaii Section held its first Legislative Day on February 14. Seventeen people attended, including Fellows, Junior Fellows in practice, and residents. The half-day event started with lectures and discussions, which were followed by scheduled appointments and cold calls with legislators. 

Our legislative agenda has sufficiently grown to the point where we felt we would benefit from a part-time lobbyist. Therefore, the Hawaii Section hired its first lobbyist, Lauren Zirbel, who started this session. We are lucky to have her on board as she has a lot of legislative experience in addition to medical organization experience. She has been helpful in providing valuable advice and administrative support to the Hawaii Section Legislative Committee. 


The Hawaii Section was awarded the Improvement in State Legislative Advocacy Award at the Congressional Leadership Conference in March. Mahalo to the ACOG Government Relations Committee for this award, our District VIII officers for their support, and to our hardworking Legislative Committee for its legislative activities.

The Hawaii Section Practice Subcommittee held its first meeting on July 18, 2013, and has held monthly meetings since then. This subcommittee works on practice issues of importance to our members.

The subcommittee brainstormed and hosted an ICD-10 coding practicum on February 15. It was an all-day session with lectures and practice problems. The event had 175 registrants, which included physicians, nurse practitioners, and office staff from Hawaii and Guam. We surveyed attendees about possible insurance problems and will try to use this data to approach insurance companies in the future.

Rosie Monardo, MD, section Junior Fellow vice chair, is working with University of Hawaii faculty on health insurance coverage for the provision of long-acting reversible contraception postpartum and with other procedures. They are putting together materials to present to insurance companies. The Hawaii Section plans to help arrange meetings and supports this issue.

Thomas Shieh, MD, the section’s Guam representative, has worked for years on expanding the provision of epidural anesthesia in labor on the island. As a result, the hospital there has recently started to provide it. However, Guam insurance companies, including Guam Medicaid, do not support payment for epidurals in labor, saying they are not medically necessary. We have been in contact with ACOG and district leaders to formulate a plan to support payment for this service.

Dr. Shieh was nominated for the ACOG International Service Award. As president of the Guam Medical Association, Dr. Shieh planned and attended several multi-disciplinary medical missions to provide medical relief for the victims of Philippine Typhoon Haiyan. On his first medical mission tour, he was accompanied by John Lee, MD, section treasurer. We are very proud of both of them for their commitments to helping others. Dr. Shieh also was recently honored with Guam’s 2014 Small Business Association Person of the Year Award for his many community service activities. He will represent Guam at their annual award ceremony at the White House later this year. Congratulations, Dr. Shieh!

The Hawaii Section continues to be involved in community committees and meetings to improve women’s health care. Members have participated in meetings with the National Governors Association Learning Network on Improving Birth Outcomes; Hawaii Pregnancy Risk Assessment Monitoring System Board; Hawaii Department of Health Collaborative Health Initiative; Hawaii Medical Service Association; Hawaii Women’s Coalition; and Hawaii State Commission on the Status of Women.

 

Idaho SectionIdaho
Steve W. Robison, MD, section chair

Greetings from the Gem State! The past six months have been a time of transition for the Idaho Section. We would like to welcome Cynthia R. Hayes, MD, as the new section vice chair. I have spent time learning my responsibilities as section chair.

I had the opportunity to attend the Montana Section Meeting in January in Big Sky. The meeting was informative, and the skiing was great. I would like to look at hosting a combined Idaho and Montana Section Meeting next year.

I also attended the Congressional Leadership Conference in March in Washington, DC. It was an excellent meeting that taught me about the legislative process. I met with the staff of our Idaho senators and representatives to discuss relevant issues related to women’s health. I hope more of our members can participate in this meeting in the future.

I have established contact with some of the legislators in Idaho. To my knowledge, there aren’t any current major legislative issues at the state level that would have an impact on women’s health. 

 

Montana SectionMontana
Tyler J. Bradford, MD, section chair

Did you know that Montana is the home of the world’s shortest river? The Roe River spans just 200 feet, although there is fierce competition with our fellow Oregonians and the D River in Lincoln City.

Montana now has a formal maternal mortality review process, thanks to the work of William J. Peters, MD, past District VIII chair and past section chair. Dr. Peters spearheaded efforts to pass a bill amending the state’s Fetal, Infant, and Child Mortality Review Prevention Act to include maternal mortality review. The section received the Accomplishment in State Legislative Advocacy Award at the Congressional Leadership Conference in March for its work on this issue. The Maternal Mortality Review Working Group will give their first report to the Legislature in June.

Shaun J. Gillis, MD, section vice chair, organized another successful Montana Section Meeting in January in Big Sky. We plan to continue these meetings, as they have been a great way to stay educated and network with the community of ob-gyns across the state.

 

Nevada Section Nevada
Timothy C. McFarren, MD, section chair

Nevada’s health insurance exchange has been troubled. Signups for private insurance are lagging due to persistent computer and billing errors. Meanwhile, Nevada’s Medicaid enrollments have soared. Approximately 150,000 new people are now covered through managed care plans under Medicaid. Though, this increase has presented its own problems. There is a backlog of 60,000 applications because the state doesn’t have enough staff to process them. Additionally, there are not enough providers to see all the new Medicaid patients. Many patients may still use the emergency room for their health care needs. That state expects 300,000 people to be covered by Medicaid by the end of next year.

 

New Mexico SectionNew Mexico
Sharon T. Phelan, MD, section chair

The New Mexico Legislature was in session for just 30 days this year. Linda Siegle, section lobbyist, continues to be effective in helping our members promote various bills. The Legislature passed a bill requiring the addition of newborn screening for cyanotic congenital heart disease via oxygen saturation screening prior to discharge from the hospital. We petitioned against this bill in support of pediatric providers who were concerned about the high rate of false positive results. The section got the commitment of the New Mexico Department of Health to wait to implement the requirement until a safe, effective triage structure is created.

New Mexico Section Lobby Day

New Mexico Section Lobby Day participants

Bills offering gross receipt tax deductions for health care practitioners for payments received through a health care insurer or managed care provider and comprehensive programming to prevent births among adolescents also did not pass.

As part of the legislative session, we hosted the Fourth Annual New Mexico Section Lobby Day at the New Mexico Roundhouse in January. The section sponsored four members to attend the Congressional Leadership Conference in Washington, DC, in March. Tony Ogburn, MD, also attended as District VIII legislative chair.

Over the past six months, the New Mexico Section has worked hard with representatives from the New Mexico Department of Health, New Mexico Hospital Association Hospital Engagement Network, and providers from pediatrics, family medicine, midwifery, and ob-gyn to establish a perinatal collaborative. We held an initial kick-off meeting in September 2013 with Barbara Rose, MPH, Ohio Perinatal Quality Collaborative program director. After much discussion and debate, we chose two primary topics to focus on—eliminating early elective deliveries and reducing neonatal abstinence syndrome.

New Mexico Perinatal Collaborative 

New Mexico Section members work to establish a perinatal collaborative.

The section sponsored a bill to provide funding to establish a collaborative. Our efforts were unsuccessful, but the bill will be reintroduced next year. Overall, the feedback we received from legislators on this issue was positive.

The Annual Women’s Health Symposium was held February 21–22 as a collaboration of the New Mexico Section and the New Mexico chapter of the American College of Nurse-Midwives. The keynote speakers were Jeffrey F. Peipert, MD, PhD, from the University of St. Louis in Missouri, and Lisa Low, PhD, CNM from University of Michigan in Ann Arbor. Dr. Peipert spoke about long-acting reversible contraceptives, and Dr. Low spoke about physiologic approaches to labor and birth. Our Junior Fellows hosted a Stump the Professors session that was well received and a lot of fun.

Eve Espey, MD, MPH, was recently selected as the new chair of ob-gyn for the University of New Mexico School of Medicine. Dr. Ogburn is the Region 5 CREOG Council representative, as well as incoming CREOG chair. Suzanne Burlone, MD, is the new District VIII Junior Fellow legislative chair. William F. Rayburn, MD, MBA, has assumed the position of associate dean of CME for the University of New Mexico School of Medicine. 

 

Oregon SectionOregon
Marguerite P. Cohen, MD, section chair

The Oregon Section had four Fellows and three Junior Fellows attend the Congressional Leadership Conference this year. Participants met with Sen. Jeff Merkley (D-OR), Rep. Suzanne Bonamici (D-OR), and staff for six of the seven members of Oregon’s congressional delegation. The conference inspired two of our Junior Fellows to work on developing a section lobby day for the 2015 session of the Oregon Legislature.

As you probably know, Oregon has been working on Medicaid expansion and health reform for more than 20 years. The creation of the Oregon Health Plan was innovative, allowing women to access prenatal care and markedly decreasing the number of obstetric patients in our state who were truly uninsured. We also prided ourselves on being part of the Silicon Forest, ready to have our own state exchange, Cover Oregon—an online marketplace where individuals can compare and contrast insurance policies. Consumers could then have their eligibility for federal subsidies assessed and shop for the insurance policy that would match their needs.  

Oregon expected to lead the nation in expansion of access to health insurance promised by the Affordable Care Act. Oregon contracted Oracle to build the online marketplace. We greeted October 1, 2013, with great hopes that were soon dashed. The website was not ready to be used, and, in fact, it was not functioning at all. For a time, we were even ranked number 49 out of 50 in states getting the uninsured signed up. With time, the ability of consumers to assess insurance options has improved, but they can only sign up for policies with a paper application. Oregon officials recently decided to discontinue Cover Oregon and switch to the federal system. They acknowledged that the state exchange was too expensive and too troubled to fix.

So is the Affordable Care Act a success or a failure? Without a doubt, the act has improved Oregonians’ access to health insurance, especially for those with preexisting medical conditions that prevented them from buying insurance on the individual market. Young people are able to remain on their parent’s policies until age 26. And the guarantees for annual women’s wellness exams and contraception will benefit ob-gyns.

In the past, the Oregon Legislature was in session every other year for about six months, with additional special sessions as needed for specific issues. But three years ago, the state instituted a short session lasting five weeks starting in February every other year. In this year’s short session, there were relatively few bills introduced that would impact the practice of medicine our state.

One bill dealt with legislative interference, prohibiting public bodies from adopting rules, enacting ordinances, or instituting policies that require health care practitioners to provide medically inaccurate information or medical services inconsistent with appropriate and evidence-based standards or that prohibit health care practitioners from providing medical services consistent with appropriate and evidence-based standards. Unfortunately, the bill languished in committee at the end of the session.

Another bill requiring insurers to provide full coverage of diabetes without any copays for women who are pregnant was passed.

The 22nd Annual Oregon Section Meeting was held in Portland on April 12 at the Oregon Medical Association Foundation Educational Center. For many years, we held the Annual Meeting at the Sunriver Resort in Central Oregon. Because of declining enrollment, it became economically unfeasible to continue to hold the meeting there. 

The meeting was also changed to a compressed, single-day format. Local experts spoke on the Choosing Wisely campaign, management of the benign fallopian tube for risk reduction for serous cancers, classification of lower genital tract neoplasia, ova preservation for aging patients and those undergoing chemotherapy, quality measurement in obstetrics, facilitating home to hospital transfers, the role of simulation in training residents and practicing physicians, and an update on the state of the Oregon health insurance exchange.  

The meeting was well attended, fiscally sound, and a grand way to spend a sunny spring day in Portland. We will begin planning next year’s meeting soon. Please consider coming to Portland for an exciting weekend of education and fellowship! 

 

Utah Section

Utah
W. Lawrence Warner, MD, section chair

The Utah Section sponsors three educational dinner events each year. Our first dinner of the year was on January 16 and featured Alan T.N. Tita, MD, PhD, from the University of Alabama at Birmingham, who gave a presentation titled “Care of the Obese Gravida: Challenges and Opportunities.”

February 5 was Doctor’s Day at the Utah State Legislature, and I represented our section. Attendees met with state senators and representatives to ask for their support on three bills regarding:

  • Pharmaceutical dispensing of non-scheduled drugs in physicians’ offices
  • Charity care amendments to expand the Good Samaritan Act
  • The requirement of health care providers to clearly identify their license type in a clinical setting and prohibition of any deceptive or misleading representations by providers

A bill to repeal a law that was passed last year lowering the definition of stillbirth from 20 weeks’ gestation to 16 weeks will be introduced. The law was introduced and passed in the last moments of the 2013 legislative session and was not well thought out as to impact and cost. The Utah Medical Association and the Utah Section had no opportunity for input prior to its passing. Once we had the opportunity to give our input and educate legislators, the sponsor of the original bill agreed to sponsor the repeal.

In preparation for the 2014 legislative session, Christopher V. Hutchison, MD, section vice chair, has been representing our section at the Utah Medical Association Legislative Committee meetings.

We are still working on our outreach initiative to rural hospitals in the state. The most recent email we sent was an outline summary of the ACOG Task Force Report on Hypertension in Pregnancy. Since the last district meeting, I visited the hospital in Kanab, which is on the Utah-Arizona border. We continue to receive notes of appreciation from these hospitals for our efforts to keep them up to date with best practices in ob-gyn.

At the encouragement of District VIII leadership, the section applied for a Council of District Chairs Service Award for our outreach efforts. We are pleased and honored to have received this award. It was presented to the section at the Annual Clinical Meeting in Chicago.

Finally, at the 2013 Annual District Meeting in Maui, I shared a copy of the Emergency Physician Reference Notebook that I put together for the hospital where I practice. This simple idea has gained significant traction since then. The notebook provides a quick, easy reference to hospital protocols and best practices, thus encouraging minimization of variation among practitioners.

 

Washington SectionWashington
Judith A. Jacobsen, MD, section chair

The Washington Section had a busy six months, planning the Washington State Legislative Day with ferocity. Our new project this year was the creation and filming of an information video, “Lobbying: The Good, the Bad, and the Ugly.” Overall, the Legislative Day was a huge success. We had eight new attendees, with many private doctors now interested in getting involved.

Washington State Legislative Day 

Washington State Legislative Day participants

The legislative focus was again to gain support for the Reproductive Parity Act. This legislation would uphold the Washington State law requiring that any insurance company providing maternity care also be required to cover pregnancy termination. The act robustly passed in the House, but for the third year in a row was held up by the Republican-controlled Senate Health Committee.

The national tide of proposed laws requiring breast density notification also arrived in Washington, and we opposed the legislation. ACOG national was helpful with data and legislative toolkits. This bill passed in the Senate, but died in the House. Budget issues in this session overrode other issues getting attention.

The section is developing an electronic welcome packet to send to new Fellows entering practice in Washington. For now, we are relying on word of mouth about new doctors in our state, but I am looking for a way to have ACOG national automatically notify us. The welcome packet includes links to the Washington State Medical Association enrollment site and information about the Washington State Obstetrical Association (WSOA) and the Seattle Gynecological Society (SGS). We financially support the WSOA and SGS yearly conferences. They serve as our educational meetings, and we hold our yearly business meeting at the WSOA conference.

The Washington Section will be nominating a candidate for the ACOG International Service Award. Stayed tuned for more updates.

 

Wyoming SectionWyoming
Susan M. Sheridan, MD, section chair

Greetings from Wyoming! We are excitedly escaping a long, cold, and windy winter here and have high hopes for the spring.

I am sad to report that Lisa Williams, MD, resigned as section vice chair due to the demands of her private practice. She previously served as section chair. Dr. Williams is a solo practitioner in a busy community, and her time and commitment for several years was greatly appreciated. The section is currently seeking a new vice chair. I have placed a few phone calls and will be sending an email to section members to elicit interest. We are few in numbers here in Wyoming, but we are recruiting interested Fellows who want to get involved and may not know how to get started. In the meantime, I have committed to continuing as section chair for another term.

The section has made significant progress with Wyoming Medicaid in regards to its policy on induction of labor. The current policy, which expired in July 2013, stated that no inductions would be allowed without a medical indication. Furthermore, medical indications were not delineated. The policy put restrictions on elective or social inductions after 39 weeks’ gestation. In a rural state like Wyoming, those restrictions can place a burden on patients and their families and, particularly in rural areas with limited practitioners, on physicians. 

With the help of a political consultant, we were able to address the issue. The consultant had meetings with the director of the Wyoming Department of Health, who is aware of concerns regarding the policy. Meetings with the state director and medical director of Wyoming Medicaid were also held.

We recently presented information, including new studies and ACOG Committee Opinions, to the physician advisory group for Medicaid. We discussed the importance of limiting inductions prior to 39 weeks to those with clear medical indications, while revising the policy to remove the limitations on inductions after 39 weeks. Amid much discussion regarding the cost of inductions, risks and benefits of inductions, and legal ramifications for Medicaid, there was unanimous agreement to revise the policy in our favor. This has been my first encounter with effecting policy change, and I was elated with the outcome. Our political consultant was an enormous help in this endeavor. In the future, her expertise may serve the section well, and I hope to advocate for financial support should the need arise.

 

Calendar of events

2014

June
13–14
Colorado Section Summer Educational Symposium
Sonnenalp Resort
Vail
Contact: 303-355-8848 or colo.acog@gmail.com

September
5–7
Annual District Meeting (with Districts VI and IX)
Silverado Resort
Napa, CA
Contact: Linda Kinnane, 202-314-2332

November
8–10
Hawaii Section Ob-Gyn Update Meeting
St. Regis Princeville Resort
Kauai
Contact: Lori E. Kamemoto, MD, MPH,
lkamemot@hawaii.edu  

2015

March
8–10
Congressional Leadership Conference
Washington, DC
Contact: Stacie Monroe, 202-863-2505