Message from the chair: Benefits of mentoring
Laurie C. Gregg, MD
The other day, my hospital’s Medical Executive Committee was preparing for a looming visit from the Joint Commission. The nurse director of integrated quality services tossed some sample questions out to the physicians. She encouraged experienced committee members to supplement answers that the new committee members had volunteered. As a seasoned committee member, I found myself doing a lot of supplementing. I could imagine one day soon that the newer members would be the experienced ones supplementing the answers of their less-experienced colleagues.
Though you may not always recognize it, mentor-mentee relationships are active in medicine every day. Studies have shown that there are tangible benefits from such interactions. They enhance the wellbeing of both mentors and mentees. Mentor-mentee relationships should be formally acknowledged and embraced.
Some institutions assign a mentor to each new physician coming on staff. Other times, a senior partner mentors a junior partner, a tenured faculty member mentors a junior faculty member, or a seasoned labor nurse mentors a medical student. I want to encourage all those who are experienced in medicine to share their knowledge in some form.
Assure your younger colleagues that they will develop the gut sense of whether or not a baby will deliver safely vaginally and that their pulse will no longer race when they place an abdominal trocar or pop through a tight internal os. Tell them that they will learn to sense when the bladder is in jeopardy or a postpartum hemorrhage is imminent. Know that the learners will one day be the teachers.
Hospitals should regularly match new physicians with senior staff members and work to satisfy the Joint Commission minimum of focused professional practice evaluation. Our next hospital-wide quality improvement project will be to encourage, endorse, or even mandate such partnerships.
I applaud ACOG for acknowledging the importance of mentoring with its Mentor Award. Additionally, attending ACOG meetings gives mentors a chance to share their knowledge and students a chance to learn. The next national ACOG meeting is the Annual Clinical Meeting in New Orleans, May 4–8. The next district meeting is the Annual District Meeting in Maui, HI, September 26–28.
Each of these meetings will be a unique experience. The ACM will be large and encompassing with a wide range of choices for learning. The ADM will be smaller with opportunities for education and mentoring in more personal settings. I’m sure that both meetings will satisfy students and allow mentors to share their knowledge. Make an effort to attend, and your physician wellness will be enhanced.
Interconception care improves current and future generations’ health
Diana E. Ramos, MD, MPH, District IX treasurer; ACOG President Elect Jeanne A. Conry, MD, PhD, immediate past District IX chair; and Laurie C. Gregg, MD, District IX chair
In 2010, there were 509,979 births in California. For many women faced with limited access to care and other health barriers, the postpartum visit is often their only appointment before another pregnancy. Therefore, it is the optimal time to address any medical problems that may have developed around or during pregnancy while providing women interconception assessment and counseling. Currently, the postpartum visit is underutilized with only 64% of Medicaid patients participating and 66% of private insurance patients participating. Meanwhile, 94% of Kaiser Permanente patients are seen postpartum.
The unintended pregnancy rate in California is 56%, one of the highest in the United States, and approximately 50% of pregnant women suffer at least one medical complication. It is important to recognize that women who have had a poor birth outcome in a prior pregnancy are at increased risk for having a poor birth outcome in a subsequent pregnancy. Hospital stays with pregnancy-related complications tend to be longer (2.7–2.9 days) compared with those without complicating conditions (1.9 days). In 2008, maternal stays with complicating conditions were 50% more expensive ($8,000) compared with those without complications ($2,600). Maternal stays with pregnancy and delivery complications accounted for $17.4 billion, or 5%, of total hospital costs in the United States.
The Interconception Care Project for California, led by District IX and the Preconception Health Council of California and funded by the March of Dimes, developed postpartum visit algorithms for providers and companion patient information to address the 10 most common pregnancy and delivery complications identified using ICD-9 discharge code data in California. In May 2012, the project was recognized with a national award for excellence by ACOG.
The evidence-based provider algorithms and companion patient education materials were developed by a panel of obstetric and health experts throughout California. The provider algorithms were developed so they could be used by non-obstetric and mid-level providers, knowing that patients may miss their postpartum visit and that their next medical visit may not be with their prenatal care provider.
The algorithms were reviewed by various types of health care providers throughout California to assess their content and utility. Patient handouts in Spanish and English were reviewed by Spanish- and English-speaking patients. The patient materials provide simplified explanations of medical conditions, address implications for future pregnancies, and emphasize the importance of planning for future pregnancies, maintaining communication with health care providers, and obtaining early prenatal care. All of these resources are free to download, print, and distribute. They can be found at everywomancalifornia.org.
Our hope is that providers and patients throughout California will find these resources valuable and use them as a bridge between postpartum health and the future health of mothers and their babies. Together we can work to improve the health of postpartum women in California and make their next pregnancy healthier.
Laws protecting pregnant workers
Sharon Terman, Legal Aid Society–Employment Law Center senior staff attorney, and Mia Munro, Equal Rights Advocates staff attorney
Laura, a program counselor for people with disabilities, was pregnant with her first child. Her doctor gave her a note recommending that she refrain from bending and twisting when tying down wheelchairs to a bus. Laura gave the note to her supervisor, who promptly forced Laura to take an early unpaid pregnancy leave, even though Laura was perfectly able to continue working for several more months with the modification her doctor advised.
Thankfully, Laura works in California, where the law requires employers to provide reasonable accommodations to pregnant workers. She contacted a lawyer, who informed her employer of its legal obligation, and Laura was returned to work and granted the accommodation she needed.
California law requires employers to provide reasonable accommodations to workers who are pregnant or who recently gave birth, such as allowing workers to sit on a chair or stool instead of standing, take frequent bathroom breaks, drink water or eat a snack during a shift, change their hours, or avoid lifting heavy objects or being exposed to toxic fumes. These accommodations allow women to continue working and supporting themselves and their families while maintaining healthy pregnancies.
Unfortunately, most women in the United States lack this basic entitlement. Last year, the Pregnant Workers Fairness Act (PWFA) was introduced by both houses of the US Congress. The PWFA would require employers to grant pregnant workers the same accommodations that employers are already required to provide to workers with disabilities under the Americans with Disabilities Act.
Because pregnancy is not considered a disability, pregnant women from around the country are regularly denied the accommodations that employers provide to those with disabilities. The PWFA would close this gap in the law and enable pregnant women who need modest adjustments at work to continue in their jobs while remaining healthy. The bill is supported by women’s rights and health groups across the nation, including ACOG.
For free information or technical assistance regarding legal protections for pregnant women and new parents in the workplace—including pregnancy modifications, leaves of absence, and lactation accommodations—contact the Equal Rights Advocates’ Advice and Counseling Hotline at 800-839-4372 or the Legal Aid Society–Employment Law Center’s Work and Family Helpline at 800-880-8047.
Dr. Jeanne A. Conry recognized as Environmental Health Champion
John P. McHugh, MD, District IX newsletter editor and Section 7 chair
On January 8, ACOG President Elect Jeanne A. Conry, MD, PhD, District IX immediate past chair, was honored with the Pacific Southwest Region’s 2012 Children’s Environmental Health Champion Award at a ceremony at the University of California, San Francisco (UCSF). Jared Blumenfeld, US Environmental Protection Agency (EPA) regional administrator, presented Dr. Conry with the award. Prior to the ceremony, Dr. Conry led a grand rounds session on “Reproductive Health and the Environment: Well-Women Care and Preconception Health on the National Agenda.”
Lisa Jackson, former US EPA administrator; ACOG President Elect Jeanne A. Conry, MD, PhD, District IX immediate past chair; and Jared Blumenfeld, US EPA regional administrator
“The EPA applauds Dr. Conry for her national leadership to promote better health for babies and women by preventing harmful chemical exposures during pregnancy,” Mr. Blumenfeld said. “She has made reproductive environmental health a key new emphasis for the obstetric community.”
Also at the ceremony, Tracey Woodruff, PhD, MPH, professor and director of the Program on Reproductive Health and the Environment at UCSF, pointed to studies that show virtually all pregnant women in the US are exposed to chemicals. She also mentioned a recent survey of ACOG Fellows that found ob-gyns often feel underprepared to address this issue with their patients.
“We nominated Dr. Conry because of her commitment to teaching her patients and colleagues the importance of avoiding exposure to toxic chemicals during pregnancy,” Dr. Woodruff said.
Congratulations to Dr. Conry for this recognition of her ongoing role in highlighting environmental health in obstetric clinical practice!
Medi-Cal payment rates update
Shannon Smith-Crowley, JD, MHA, District IX director of government relations
Medi-Cal payment rates to California physicians and the state’s per capita spending on Medi-Cal beneficiaries are among the lowest in the nation. The low rates have created a climate in which only half of physicians accept new Medi-Cal patients.
California expects to add another 2 to 3 million Medi-Cal beneficiaries to its current 6.8 million as part of the Affordable Care Act implementation beginning in 2014. Significantly increasing the number of Medi-Cal patients is concerning at a time when we are facing insufficient physician payment rates and physician program participation.
Given the backdrop of the massive state budget deficits in California over the last few years, Gov. Jerry Brown looked everywhere for savings. Significant portions of the state budget are locked into formulas, and areas where cuts can be made are limited.
In 2011, the governor cut Medi-Cal rates by 10%. Since then, the cuts have not been implemented due to legal maneuvering by the California Medical Association and others. The last legal ruling in December 2012 of a three-judge panel of the Ninth Circuit Court of Appeals would allow California to proceed with the cuts, which would apply retroactively to June 1, 2011.
The legal appeals continue. One hope is that by the time legal appeals are exhausted, even if the state is given legal authority to proceed, its fiscal house will be in order and the cuts may not be necessary. However, it would be wise to be circumspect and plan for the potential rate changes and recovery of previous payments.
Please let District IX know how the Medi-Cal payment rate uncertainty and potential cuts affect your practice. Email me at firstname.lastname@example.org.
District IX task force works to increase chlamydia screening
John P. McHugh, MD, District IX newsletter editor and Section 7 chair
I had the opportunity to speak with Debra R. Gierut, MD, who serves as Section 7 vice chair, a physician at Kaiser Permanente Orange County Women’s Health Services, and a representative on the District IX Task Force to Increase Chlamydia Screening and Treatment.
Dr. Gierut, what purpose does the District IX Task Force to Increase Chlamydia Screening and Treatment serve?
The task force’s primary goal is to increase the chlamydia screening rate in California. We know that undiagnosed chlamydia harms women’s entire reproductive lives. Women with ectopic pregnancies, infertility, and chronic pelvic pain may have had untreated and undiagnosed chlamydia for years despite multiple visits to their ob-gyns.
Where does the work start with such a tremendous public health problem?
First and foremost, we need to understand what’s happening in physicians’ practices today. We know there are barriers to screening, but what are they? Screening for chlamydia is a simple test from the doctor’s point of view—all we need is a urine sample. Still, even in the best health care systems, patients who need the test may only be getting it half the time.
The task force recently conducted a survey of California physicians. Can you tell me more about it?
The survey covered a good cross section of California physicians. Forty percent of physicians surveyed recognized that they were not doing the best screening they could do. Many expressed a concern that the billing statements naming chlamydia testing go to the patient’s home and may be read by partners or family members. They don’t want to put their patients at risk. Some physicians also noted that the chlamydia rate is low in the patient population they serve. For this reason, routine screening is not being done.
What is next for the task force?
Task force members represent a variety of different organizations. We plan to meet soon and look for ways to address barriers to screening as we sift through data. Patients, providers, and payers all recognize that lack of screening is a substantial public health problem. A targeted response to each barrier is needed. Stay tuned for more information and resources to help your patients.