As 2020 marks both the beginning of a new decade and the 184th year of organized medicine in St. Louis, no one could have predicted the challenges that physicians would be facing during this arduous time, including COVID-19, prior authorizations, and bureaucratic healthcare systems. But one thing remains constant: the St. Louis Metropolitan Medical Society (SLMMS) continues to advance its mission “to support and inspire member physicians to achieve quality medicine though advocacy, communication and education.” The Society is inspired to move forward by its vision and purpose, “physicians leading healthcare and building strong physician-patient relationships.”
Challenges are met with strong leadership, and SLMMS has been fortunate to be guided by physicians who are committed to working to overcome them. In 2019, Ramona Behshad, MD, a SLUCare dermatologist, served as President of the Society, becoming its first female leader in over 20 years, and only the third in its long history. In her inaugural address, Dr. Behshad noted how it was both an exciting and challenging time for medicine. Exciting due to the advancements in treatment, pathology, and public health, but challenging because the patient-doctor relationship is threatened and weakening. “Despite all of the technology and science we bring to the bedside,” she noted, “I believe our humanity, our caring, and our concern is the ultimate measure of success. Contrary to this, success is currently measured with metrics, computer systems, encounter numbers and satisfaction scores.”
Dr. Behshad’s term as SLMMS President was notable for helping to build understanding of the power of organized medicine, increasing participation and encouraging advocacy, particularly among younger physicians. She was named to the St. Louis Business Journal’s 2019 “40 Under 40” class, an honor recognizing young professionals who are already making their mark on the St. Louis business community. Her objectives as president included engaging more medical students, providing mentorship, and combating burnout through community.
“Advocacy cannot be someone else’s problem,” she stated. “We need to be present to improve the system, and our local medical society is a great place to start. The successes of organized medicine prove that we are stronger together; when we are working in unity, there is no limit to what we can accomplish.”
Choosing Wisely
SLMMS has continued to build upon the momentum created from its 2018 physician-driven insurance survey, designed to capture physician assessment of insurance company performance. SLMMS leaders were invited to present the study findings to the boards of directors of both the St. Louis Area Business Health Coalition and the Midwest Health Initiative (MHI). The subsequent dialog led to a partnership with MHI to analyze Choosing Wisely opportunities in the St. Louis market. The objective of the project is to meaningfully improve adherence to recommended care and reduce low-value care in the region, through an engaged, multi-stakeholder approach using measurement, education, and aligned, coordinated interventions. SLMMS members have been working with MHI committee physicians to offer input and direction on shared opportunities identified by the program.
2019 White Coat Rally.
Top: SLMMS members - Edmond Cabbabe, MD, Inderjit Singh, MD, Samer Cabbabe, MD, and Toniya Singh, MD, with State Senator Jill Schupp.
Bottom: SLMMS members and medical students in the Capitol rotunda.
Issues Advocacy
SLMMS continues to use its collective voice on key issues that impact the practice of medicine. In recent months, the Society has tackled many issues, including air ambulance coverage, surprise billing, and barriers impacting prior authorization. SLMMS actively opposed the medical marijuana ballot issues in Missouri, given that risks to the patient supersede the lack of any extensive research studies demonstrating its health benefits. SLMMS members have brought forward resolutions at the state level addressing prior authorization for opioid use disorders, the healthcare needs of children of incarcerated parents, and ensuring affordable insulin. The Society has supported the continued development of St. Louis County’s Prescription Drug Monitoring Program as it has been adopted more widespread across all of Missouri.
St. Louis Metropolitan Medicine
SLMMS continues to publish its bi-monthly member magazine St. Louis Metropolitan Medicine. Each issue addresses a specific theme, and the journal has provided a platform for discussions on the use of artificial intelligence in medicine; accountable care organization (ACO) collaboration and results; and emergency department use. The magazine also encourages regular commentary contributions from SLMMS members. In 2019, the magazine sponsored a survey on electronic health record utilization to reveal areas where improvement is most needed. The majority of physicians responding felt the EHR system they use is better suited to enhancing billing and coding, and less inclined to improve patient care.
Continuing Education
The Medical Society sponsors or supports a number of physician continuing medical education programs. The annual Hippocrates Lecture tackled drug pricing transparency in 2018, giving members the opportunity to engage in conversation with a pharmacy benefits manager. In 2019, the lecture focused on Medicare for all, and a discussion with an advocate from physicians supporting a national health program. Through our relationship with the League of Healthcare Experts, recent programs have been presented on changes to tax laws and physician burnout.
Navigating Change
Radiologist Jason Skyles, MD, a fellowship-trained mammographer with West County Radiology group providing services to Mercy Hospital St. Louis, assumed the role of SLMMS President for 2020. At his installation, Dr. Skyles spoke on the accelerated rate of change in the practice of medicine. “It’s an exciting time, but also a scary time,” he said. “In the next 20 years we will likely see the implementation of technologies like genomic editing and the use of artificial intelligence. As physicians, we should be the ones leading the discussion on all issues related to medicine and helping to direct policy for the betterment of the medical profession, and ultimately for the benefit of our patients.”
Dr. Skyles enumerated issues that physicians need to address, including fighting the anti-vaccination movement, protecting the role of physician in scope of practice discussions, tort reform, and working with insurance companies to improve access. “Organized medicine gives us the strong unified voice to tackle these things, and allows the local physician to get involved,” he stated. “We need to ensure that physicians maintain an active role in helping to shape future policy.”
SLMMS in the Community
SLMMS continues to connect with medical students and residents, with student liaisons from both Saint Louis University School of Medicine and Washington University School of Medicine participating on the SLMMS Council. Grants from the Society’s charitable foundation, the St. Louis Society for Medical and Scientific Education (SLSMSE), have supported the innovation incubator programs (SlingHealth at Washington University and MedLaunch at Saint Louis University) at both schools. SLSMSE also supports other physician and community activities such as the Greater St. Louis Science Fair, World Food Day, the SLU Primary Care Symposium, the Missouri Physicians Health Program, and the SLMMS Alliance. The Alliance continues to play an integral part of fulfilling the SLMMS mission through community health education, charitable projects and legislative advocacy. Two St. Louis Alliance members are making their mark at the state and national levels as well, with Gillian Waltman finishing two years as the MSMA Alliance President, and Sue Ann Greco assuming the presidency of the AMA Alliance in June of 2020.
SLMMS is also proud of three physician members serving in visible leadership roles: Sam Page, MD, moved from chair of the St. Louis County Council to serving as St. Louis County Executive in 2019; Emily Doucette, MD, a current member of the SLMMS Council, was named acting co-director of the St. Louis County Department of Public Health in 2019; and George Hruza, MD, a SLMMS past president, was recently elected the 2020–2021 President of the Missouri State Medical Association.
Looking Forward
The practice of medicine has been disrupted this year by the COVID-19 pandemic. SLMMS has served as a conduit for providing information to its members and the St. Louis physician community, dedicating publication space to public health responses, summarizing the impact on physician practices, and creating an online resource page. COVID-19 has taught us some very tough lessons, and elevated concern for the health and well-being of medical professionals on the front lines of treatment. Dr. Skyles, SLMMS President, addressed members saying that “all of us can play an important role in education. Most of us are not infectious disease or public health experts, but as physicians our patients, friends and families look to us for guidance and assurance. In times of crisis such as now, we all need to not only come together, but to work smartly and efficiently for the benefit of all.”
Footnotes
Left, 2020 SLMMS President - Jason Skyles, MD, MSMA member since 2011; right, 2019 SLMMS President - Ramon Behshad, MD, MSMA member since 2012.