Connect with District III on Facebook
In an effort to provide you with current information regarding women’s health, District III has joined Facebook. We are updating our page regularly with news specifically relevant to District III members. You can find us at facebook.com/ACOGDistrictIII.
ACOG national is also on Facebook at facebook.com/ACOGNational. If you’re a Facebook member, log in and click on the “Like” button on the ACOG national and District III pages. Then, you’ll be able to comment on and share any updates posted. You’ll also get ACOG national and District III news sent directly to your Facebook news feed.
Anyone can view Facebook pages, but only Facebook members can interact with ACOG national and District III. To become a Facebook member, sign up at facebook.com.
ACOG national is also on Twitter at twitter.com/acognews. To follow its feed, go to twitter.com and sign up as a member. You’ll be the first to hear ACOG news!
Chair’s report: Special issues sessions
Richard W. Henderson, MD
The District Advisory Council (DAC) met in early October in Philadelphia. It hosted three guests who shared important information on topics that have been focuses of discussion on the ACOG Executive Board: workforce issues, the Affordable Care Act (ACA), and continued collaboration with the American College of Nurse Midwives (ACNM).
William F. Rayburn, MD, MBA, has done a lot of work with ACOG to identify current and future workforce concerns that are and will continue to affect our specialty and the patients for which we care. Dr. Rayburn shared information with the DAC specific to District III and our US sections. I encourage you to read the article he submitted for this newsletter, “District III workforce update.”
For a more in-depth dive into the workforce issues facing ACOG, I highly recommend the monograph that was authored by Dr. Rayburn and ACOG, “The Obstetrician-Gynecologist Workforce in the United States: Facts, Figures, and Implications—2011.”
From Dr. Rayburn’s work and his presentation, it is clear that workforce issues are real and must be addressed. These issues will affect how care is delivered to our patients and the type of practices we will have in the future. Needless to say, it is imperative that we, as ob-gyns, the recognized leaders in women’s health, be engaged in the changes in our workforce and lead the conversation about how these changes will affect our patients and our specialty.
Affordable Care Act
Lucia DiVenere, senior director, ACOG Government Affairs, discussed the impact of the ACA on ACOG with the DAC. She explained that ACOG “reluctantly opposed” the ACA because it did not adequately address tort reform, meaningful changes in the calculation of the sustainable growth rate, or a repeal of the Independent Payment Advisory Board. However, ACOG continued to work with the administration and others as a partner to make sure many other things important to women and ob-gyns were included in the ACA.
Ms. DiVenere discussed the rationale behind the Supreme Court’s recent decision to uphold the constitutionality of the ACA and reviewed the pros and cons of the ACA from ACOG’s perspective. The pros include, but are not limited to:
- Mandated coverage of maternity and women’s preventive care, including all contraceptives approved by the US Food and Drug Administration
- Direct access for women to see ob-gyns that is not linked to having a primary care designation
- Insurance reforms, such as the elimination of preexisting condition exclusions
- Reimbursement for smoking cessation counseling
- Improved family planning coverage by Medicaid
- Standardization of health information technology requirements
- More research into postpartum depression
- Ob-gyn participation in medical homes for women
- The rescue of ob-gyn–performed ultrasounds from cuts in reimbursement
- The defeat of efforts to limit obstetricians to attending only high-risk deliveries
The cons are fewer and include:
- Probable increased integration, hospital employment, and larger group practices
- The increased inclusion of lay midwives in free-standing birth centers
- Abortion coverage restrictions in state exchanges that begin in 2014, including a continuation of federal prohibitions on the use of either federal subsidies or premium dollars to purchase coverage for abortions. The ACA also makes no changes to any existing state abortion laws regarding parental notification
By the time this newsletter goes to print, the presidential election may determine if the ACA survives as we know it now or is repealed by executive order.
Kate McHugh, CNM, MSN, ACNM region II representative, spoke to the DAC about the relationship between ACOG and ACNM. Ms. McHugh is the equivalent of an ACOG district chair for region II of ACNM, which includes Delaware, New Jersey, New York, Pennsylvania, and Puerto Rico. She was invited to attend the DAC meeting as part of a commitment at the national levels of ACOG and ACNM to build on efforts to improve communication and working relationships between our organizations. This commitment began as part of the presidential initiative of Richard N. Waldman, MD, on collaborative practice.
Ms. McHugh described the organizational structure of ACNM and highlighted the organization’s focus on the higher educational and training requirements that must be met and maintained to be a member of ACNM. She made a clear distinction between the educational and training requirements of other types of midwives who are not part of and are not represented by ACNM. Ms. McHugh also discussed possible opportunities for collaboration at the district and regional levels of ACOG and ACNM.
This session was an excellent introduction for our organizations and should provide a sound foundation on which to build moving forward. With regard to both women’s health and workforce issues, increasing our efforts and energies at collaboration with ACNM would be of benefit to both of our organizations and the women we serve.
Junior Fellow news
Holly W. Cummings, MD, MPH, District III Junior Fellow chair
District III Junior Fellows held their Fifth Annual Junior Fellow Day at Drexel University College of Medicine on October 5 during the combined District I and III Annual Meeting. Approximately 120 Junior Fellows and medical students from Districts I and III attended, hearing talks on the value of social media in medicine and participating in numerous simulation activities.
We were excited to have Vivian E. Von Gruenigen, MD, chair of ob-gyn and director of women’s health services, Summa Health System, Akron, OH, speak about her experiences with using social media as a practicing physician. Nathaniel G. DeNicola, MD, Robert Wood Johnson Clinical Scholar at the University of Pennsylvania, Philadelphia, spoke about the importance of social media for political advocacy.
Attendees participated in simulations on vaginal breech delivery, shoulder dystocia, loop electrosurgical excision procedure, hysteroscopy, amniocentesis, B-Lynch, episiotomy repair, intrauterine device placement, and manual vacuum aspiration. The highlights of the simulation activities were the laparoscopic pig lab and the cesarean delivery model. Everyone had a great time, and we look forward to the Sixth Annual Junior Fellow Day in 2013. Visit the District III Facebook page to view photos from the Junior Fellow Day and ADM.
During the ADM, Junior Fellows took part in a “PAC Wars” competition. Fifty-six District III Junior Fellows and eight medical students contributed a total of $1,445 to ACOG’s federal political action committee, Ob-GynPAC. We won the competition against District I, which had seven Junior Fellows contribute.
Our goal for 2013 is to increase Junior Fellow involvement in the ACOG Congressional Leadership Conference, The President’s Conference (CLC). We hope to find funding to allow more Junior Fellows from each section to attend this amazing conference. The 2013 CLC will be held March 3–5.
Junior Fellows in our section are participating in and planning great events around the district, from local legislative advocacy days to community service projects. Keep an eye out for announcements about upcoming events on the District III Facebook page. If you have any updates or announcements you’d like promoted on Facebook, contact any of our district leaders with information.
District III workforce update
William F. Rayburn, MD, MBA
As ACOG Fellows and Junior Fellows in practice, our goal is to ensure that women have access to the best health care. However, the gap between the supply of ob-gyns and the demand for women’s health care services is believed to be widening. The number of ob-gyn resident graduates has not increased significantly, the average number of ob-gyn work hours is declining, and more ob-gyns are retiring earlier or altogether from obstetrics.
Listed below are important workforce data to assist in health care planning:
- District III has 2,652 ACOG Fellows who serve a population of 11.6 million women
- Professional liability premiums in New Jersey and Pennsylvania remain well above the national average ($115,000 vs $99,500 per year in 2009)
- There are 2.4 ob-gyns per 10,000 women in District III and 5.0 per 10,000 women ages 15–45 (with the national average at 2.7 and 5.4, respectively)
- District III’s female population is expected to increase, but well below the national rate (5.1% vs 18% by 2030)
- District III has many ob-gyn residency programs (28), yet the number of graduates essentially has not changed since 1980
- District III has a high proportion of residents overall who are international medical school graduates, especially in New Jersey
- Nationally, District III has the lowest percentage of Fellows in rural settings (9%) and the highest percentage who are hospital employees (23%)
- Only 8% of all counties in District III (7 of 91 counties) have no ob-gyn, which is well below the national average (49%)
- The percentage of reproductive-age women who live within a 30-minute drive (95.1%) or a 60-minute drive (99.7%) of a maternity center is well above the national average (87.5% and 97.3%, respectively)
- Demand for ob-gyn services in District III is projected to not grow over the next 10 years
- The concentration of adult primary care physicians in District III is among the highest nationally
More information on District III can be found in the 2012 ACOG Workforce Fact Sheet for District III. For state-specific information, please consult fact sheets for Delaware, New Jersey, and Pennsylvania. The fact sheets describe workforce concerns, especially as they relate to health care reform. ACOG’s initiatives and actions that the US Congress can take are also mentioned as means to address future ob-gyn workforce issues.
Delaware Section report
Kirsten M. Smith, MD, section chair
The Delaware Section held its Second Annual Legislative Day in Dover on June 7. The day began with a session reviewing issues and current legislation concerning health care providers. We were fortunate to have Rep. Michael Barbieri (D-Newark), chair of the Health and Human Development Committee, join us.
Our afternoon was spent at Legislative Hall, where members met with Reps. Ruth Briggs King (R-Georgetown) and Joseph Miro (R-Pike Creek Valley); Sens. Dori Connor (R-New Castle) and Michael Katz (D-Centerville); Lt. Gov. Matt Denn (D); and Gov. Jack Markell (D). It was wonderful to have face-to-face time with our legislators. We were sure to leave our contact information with all of them.
The Delaware Section partnered with the Delaware Chapter of the March of Dimes to hold a CME event in Dover on the evening of June 7. Joseph C.L. Merola, MD, MPH, gave a presentation on eliminating non-medically indicated deliveries prior to 39 weeks’ gestation. It was well received. There were 53 professionals in attendance, including physicians, midwives, and nurses. By holding this event in Dover, we were able to attract providers from across the state.
Two bills that passed last year grant the State of Delaware power to regulate medical practice. One bill provides the Delaware Department of Health and Social Services (DHSS) with explicit authority to investigate and inspect unsanitary or unsafe conditions in facilities where invasive medical procedures are performed. It also gives DHSS the power to adopt regulations to strengthen oversight of facilities.
The other bill gives DHSS the authority to require accreditation for medical facilities that perform invasive medical procedures. It also allows DHSS to promulgate regulations for accreditation. The bill requires that DHSS work with stakeholders in the development of these regulations and outlines who those stakeholders should be.
Draft regulations have been developed in response to these bills. As the Delaware Section representative in the stakeholders group, I reviewed these drafts and provided comments. The most contentious issue was how to define “invasive medical procedures.” The regulations were supposed to be finalized by March 31, 2012. As I write this, the final version is not available.
The Delaware Section Advisory Council held a meeting on September 24. We analyzed the governor’s budgetary process and plans so we will be better informed in supporting the health programs in our state.
I am excited to announce that Audrey A. Merriam, MD, past Delaware Section Junior Fellow vice chair, is now serving as District III Junior Fellow vice chair. Samata K. McClure, DO, is our section’s new Junior Fellow chair, and Siobahn M. McCarty, MD, is section Junior Fellow vice chair.
Dominican Republic Section report
Milciades Albert-Fiorinelli, MD, section chair
The Dominican Republic Section participated in two academic events this year. The Central America and Caribbean Congress was held in April. Our contributions to this Congress were led by Alejandro A. Paradas-Caba, MD, section vice chair, and we were represented by Jose C. Figueroa-Mendez, MD, section treasurer; Luis Rojas, MD, Committee of Accreditation of the Dominican Republic and ACOG (CARDA) chair; and Jack Ludmir, MD, section coordinator. They presented on controversies in gynecologic practice.
The Congress of Maternal-Fetal Medicine was held in September. Julio G. Gonell-Morell, MD, section secretary, participated in the organization of this event. Dr. Ludmir presented several academic lectures with topics related to maternal-fetal health.
I spoke with Roberto J. Romero, MD, professor of ob-gyn at Wayne State University, Detroit, and chief of perinatology research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, at this Congress. He is interested in developing research with members of our section on the possibility of decreasing the rate of preterm birth by universal cervical length screening and vaginal progesterone.
Section officers also made contact recently with Luis A. Villatoro, MD, Central America Section chair (in District VIII), and Hernan Munoz, MD, Chile Section member (in District I). We hope to exchange ideas with them regarding section statutes.
The Dominican Republic Section website is under construction. Its completion is set for this month. Section officers are committed to using the website as a means of communication with members across the country.
The website will feature:
- The history of our section
- Our section statutes, so members will know their rights and responsibilities
- A list of members with their contact information
- A guide, in Spanish, on how to pay dues
- Information, in Spanish, about ACOG and District III academic activities, seminars, conferences, and meetings
We are proud to announce that two hospitals have been approved for accreditation by CARDA. We have approximately 100 applicants from these hospitals to become members of our section. The first test for applicants was scheduled for this month, but there have been unforeseen delays with the accreditation process. We hope to have these issues resolved soon.
The Dominican Society of Obstetrics and Gynecology will hold its XXI Congress in April 2013. We will be presenting during the academic exchange and welcome all members of District III to attend.
New Jersey Section report
Joseph L. DeStefano, MD, immediate past section chair
The New Jersey Section Advisory Council met on September 19 and November 19. Our council continues to be involved with the New Jersey Maternal and Child Health Consortia and March of Dimes and actively collects data from the New Jersey Maternal Mortality Committee.
Thomas Westover, MD, section secretary-treasurer, will represent New Jersey at a Centers for Disease Control and Prevention meeting this month to help create national standards for maternal mortality review. Dr. Westover attended the ACOG State Legislative Roundtable in September, along with Sharon B. Mass, MD, section chair, and our section lobbyist. Our lobbyist is following several bills of importance to ob-gyns, including legislation regarding ambulatory surgery centers, out-of-network payments, medical liability reform, and false advertising of board certification and scope of practice.
The New Jersey Department of Banking and Insurance adopted regulations that permit the reimbursement of maternity services on an installment basis. The regulations went into effect in January, and the transition was smooth. New Jersey physicians were able to choose whether they wanted to use the installment payment system or not. Few ob-gyns have opted to be a part of it.
The 2013 New Jersey Obstetrical and Gynecological Society (NJOGS) Annual Meeting (cosponsored by our section and the Association of Women’s Health, Obstetrics, and Neonatal Nurses New Jersey Section) will take place June 23–24 at the Trump Plaza Hotel in Atlantic City. If you are interested in attending or would like more information, please contact Linda Bartolo at 973-597-0938 or firstname.lastname@example.org. All are welcome, so please join us!
Pennsylvania Section report
Sherry L. Blumenthal, MD, section chair
The Pennsylvania Section is working on several legislative issues. We hired a lobbyist, John Milliron, to increase our effectiveness in Harrisburg. He is a past state representative and now works with medical specialties in Pennsylvania.
Mr. Milliron helped the American College of Emergency Physicians write a bill that will increase the requirements of plaintiffs who bring a liability action against a physician in an emergency room or emergency labor and delivery situation, especially if the patient is unknown to the physician. I attended a legislative briefing in Harrisburg in October to testify in favor of this bill with our emergency room colleagues.
Our section is working with Pennsylvania Medical Society (PAMED) lobbyists to defeat a bill requiring a fetal ultrasound before abortion on the grounds that it is medically unnecessary in some cases. The bill had 132 sponsors as of March, about half of whom withdrew sponsorship when protests about using vaginal probe ultrasounds began. We are unsure when the measure will be reintroduced, but suspect that it will be.
We are also supporting a bill PAMED authored that will simplify and modernize application and requirements for hospital privileges. It states that “medical staff” consists of physicians, dentists, and podiatrists, which is stipulated in existing regulations. Certified registered nurse-midwives in our state have mounted a campaign against the bill, arguing for independent staff privileges. Current law in Pennsylvania requires a written collaborative agreement with a physician for a midwife to practice at a hospital. We oppose changing the requirement due to patient safety considerations and physician liability concerns.
John Gallagher, MD, Section Advisory Council member, and I held a briefing in June at the State Capitol at the request of a nonprofit organization in Washington, DC, addressing the benefits of expedited partner therapy (EPT). ACOG supports prescription of antibiotics to the sexual partner of a woman diagnosed with gonorrhea or chlamydia by the woman’s physician or clinic. In Pennsylvania, there is no law specifically prohibiting this, but many physicians fear liability should the partner have a reaction to the medication (though no such case has actually been reported). Illinois has a statute protecting the prescribing physician from liability. We will be working to write similar legislation and obtain bipartisan sponsorship.
“The OBesity Project,” a collaborative project of members of our section and District III, is now a part of resources being assembled by the ACOG Task Force on Obesity. The project reviews the effects of obesity on patients in all the subspecialties of ob-gyn. Its intent is to educate ob-gyns more thoroughly and promote communication with obese patients to motivate them to lose weight.
Eva Chalas, MD, District II chair, is chair of the task force, which has held three conference calls so far. Ann L. Honebrink, MD, District III secretary, and I are on the task force, as well as ACOG officers from New York, California, Ohio, and Vermont. Dr. Chalas will be presenting our work to all the district chairs at their next meeting.
The Pennsylvania Section will be submitting “The OBesity Project” for the Council of District Chairs Service Recognition Award, with a recommendation from Richard W. Henderson, MD, District III chair. I have presented the project four times, and improvements continue to be made. I am working on adding sections on surgical technique and office instrumentation issues.
The Pennsylvania Section Nominating Committee approved a slate of officers for the term beginning in October 2013. Kurt T. Barnhart, MD, current section vice chair, will serve as section chair; Lynne M. Coslett-Charlton, MD, current section treasurer, will serve as section vice chair; Stephen J. Smith, MD, current section secretary, will serve as section treasurer; and Amanda B. Flicker, MD, current District III young physician, will serve as section secretary.
In July, Abington Health, where I practice, announced a planned merger with Holy Redeemer Hospital. Abington Health, which previously had been committed to all reproductive health options for women, agreed to stop performing abortions as a condition of the merger.
The response from the medical community to this decision garnered attention very quickly. At the request of my department’s chair, I composed a letter to the hospital’s board, expressing concerns about the medical welfare of our patients and reiterating the position of ACOG on access to reproductive care, including abortion. The letter was circulated on the internet and widely read.
The press covered the issue intensively, and our medical staff and residents did interviews for The Philadelphia Inquirer, Ms. magazine, The Jewish Exponent, Physicians News Digest, WHYY radio, various community papers, and several blogs. The nonprofit Catholics for Choice asked me to write a letter-to-the-editor for their magazine, Conscience, detailing the experience. The letter is in the latest issue of Conscience on page four.
2013 ACM: Join ACOG in New Orleans
The 61st Annual Clinical Meeting will be held in New Orleans, May 4–8. Attendees can expect to participate in a wide variety of hands-on courses and educational and interactive sessions related to ob-gyn practice. Visit the ACM website now for more information.
2013 ACM educational session topics include:
- Updates in contraception
- Noninvasive prenatal testing
- Cervical cancer diagnosis guidelines
- Endometrial cancer staging
- Global health
- Maternal mortality reduction
- Environmental exposures to the unborn child
- Cultural and religious perspectives on abortion
The ACM program will also feature sessions on work-life balance, family and professional relationship building, and leadership skills. The President’s Program will focus on the themes of patient safety, women’s health care advocacy, communication and technology, and practice and leadership in the 21st century. New this year will be three interactive surgical tutorials on pelvic anatomy, laparoscopic surgery, and techniques in abdominal wound closure. You won’t want to miss these outstanding presentations!
New Orleans is known for its rich history, culture, and traditions. The French Quarter (including the St. Louis Cathedral and Bourbon Street), New Orleans Botanical Garden, Audubon Zoo of New Orleans, and Audubon Aquarium of the Americas are just a few of the attractions attendees can look forward to visiting.
Save the meeting dates, and join thousands of ob-gyns and other women’s health care professionals at the ACM. It will be an experience to remember!
Calendar of events
Congressional Leadership Conference, The President’s Conference
Annual Clinical Meeting
New Jersey Obstetrical and Gynecological Society Annual Meeting
(cosponsored by the New Jersey Section)
Trump Plaza Hotel