LEGISLATIVE RECEPTION EXCEEDING District 3 Member, Allen Vander, MD District 3 Alternate, Mark Hebert, MD District 4 Member, F

JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY VOL 173 | ISSUE 2 | SUMMER 2021

IN THIS ISSUE: Louisiana Legislature Adjourns Sine Die

HB 495, HB 442 - Legislative Timeline

Internal Medicine Residency Response to the COVID-19

Effects of the COVID-19 Pandemic on one Louisiana Medical School JOURNAL EDITORIAL STAFF

EDITOR D. Luke Glancy, MD CONTENTS

ASSOCIATE EDITOR VOL 173 | ISSUE 2 | SUMMER 2021 L.W. Johnson, MD

CHIEF EXECUTIVE OFFICER Jeff Williams 4 PRESIDENT’S MESSAGE JOURNAL EDITORIAL BOARD Vice Chair, K. Barton Farris, MD 5 LOUISIANA LEGISLATURE ADJOURNS SINE DIE Secretary/Treasurer, Richard Paddock, MD Anthony Blalock, MD D. Luke Glancy, MD 8 LEGISLATIVE TIMELINE L.W. Johnson, MD Fred A. Lopez, MD 9 SCOPE OF PRACTICE, NURSE PRACTITIONERS

LSMS 2021 BOARD OF GOVERNORS 10 ROLL CALL HB 495 OFFICERS President, Katherine Williams, MD 11 ROLL CALL HB 442 Past President, Lee Stevens, MD President-Elect, William Freeman, MD 12 COMMUNITY CONNECTOR PARTNERSHIPS Vice President, R. Reece Newsome, MD Speaker of the House, T. Steen Trawick, MD Vice Speaker, William “Beau” Clark, MD 14 PHYSICIAN COALITION OF LOUISIANA Secretary/Treasurer, Richard Paddock, MD Obstetrician-gynecologist Dr. Katherine Williams has Chair, COL, David Broussard, MD 15 INFORMING OUR LEGISLATORS trusted LAMMICO to provide her medical malpractice insurance for over 13 years. COUNCILORS 16 WHAT DO PATIENTS SAY? District 1 Member, George Ellis, Jr., MD District 1 Alternate, Anne Borreson, MD 18 WHITE COAT WEDNESDAY District 2 Member, Robert Chugden, MD District 2 Alternate, Gabriel Rivera-Rodriguez, MD 21 LEGISLATIVE RECEPTION EXCEEDING District 3 Member, Allen Vander, MD District 3 Alternate, Mark Hebert, MD District 4 Member, F. Jeff White, MD 23 LEGISLATURE BOOTCAMP EXPECTATIONS District 4 Alternate, Susan Veillon, MD District 5 Member, Adrienne Williams, MD 24 AN INTERNAL MEDICINE RESIDENCY RESPONSE District 5 Alternate, Gwenn Jackson, MD District 6 Member, Michael Roppolo, MD TO THE COVID-19 PANDEMIC IN LOUISIANA I left LAMMICO for lower rates that were offered at another medical malpractice District 6 Alternate, Azeen Sadeghian, MD insurer. I later learned that this other insurer had no follow up, risk management District 7 Member, Brian Gamborg, MD 28 THE EFFECTS OF THE COVID-19 PANDEMIC ON education or relationships. So I came back to LAMMICO. District 7 Alternate, Donald Higgins, MD THE UNDERGRADUATE MEDICAL EDUCATION District 8 Member, Lance Templeton, MD When I was faced with a claim, which can be a difficult experience District 8 Alternate, Michael Dole, MD EXPERIENCE AT LOUISIANA STATE UNIVERSITY for any physician, LAMMICO went above and beyond with claim District 9 Member, Andy Blalock, MD SCHOOL OF MEDICINE IN NEW ORLEANS support during the defense of the claim. I felt like they cared. District 9 Alternate, Vacant Throughout the claim process, LAMMICO fought beside me so District 10 Member, Nicholas Viviano, MD that I prevailed in court when they could have chosen a simpler, District 10 Alternate, Jeremy Henderson, MD Senior Physician Member, Robert McCord, MD less expensive path. Building Enduring Partnerships Senior Physician Alternate, Greg Lord, MD 800.452.2120 | lammico.com Young Physician Member, Amberly Nunez, MD LAMMICO maintains relationships that are far reaching and benefit Young Physician Alternate, Randall G. White, Jr., MD all physicians. They’re more than an insurance company. Resident/Fellow Member, Omar Leonards, MD Resident/Fellow Alternate, Ken Ehrhardt, Jr., MD – Katherine Williams, M.D., obstetrician-gynecologist Medical Student Member, Jacob Boudreaux, MD Medical Student Alternate, Dan Frechtling

J LA MED SOC | VOL 173 | SUMMER 2021 3 LEGISLATIVE UPDATE LOUISIANA LEGISLATURE ADJOURNS SINE DIE PRESIDENT’S MESSAGE Maria Bowen, LSMS - Vice President Governmental Affairs Independent Practice for Nurse Practitioners and Physician Assistants Louisiana’s 2021 regularly-scheduled, fiscal-only session of the is Bad Medicine for Louisiana. Legislature adjourned sine die on Thursday, June 10, at 6 p.m. For LSMS and our membership, the session was dominated by non-fiscal legislation, but we would be remiss in not sharing the passage of five bills pushed by legislative leaders with the backing of the business community.

The first four bills are a package including a constitutional For physicians, the 2021 session focused on two amendment that must pass a vote of the people prior to controversial issue areas: scope of practice and noncompete any taking effect: clauses. Incredibly, LSMS members delivered more than 75,000 messages through email and text to legislators on • SB 159 (Act 134) by Sen. Bret Allain (R-Franklin) is a the following bills. We thank you for your advocacy on Constitutional Amendment which would remove the behalf of your profession! requirement of a federal income tax deduction and Allowing non-physicians to provide physician-level care Medicare beneficiaries from 2003 to 2015, found ordering would cap the maximum individual income tax rate at On scope of practice, we had four pieces of legislation that would be a step in the wrong direction. We must continue increased substantially—more than 400% by NPs and 4.75 percent. It will appear on the October 9 ballot. we focused on: to educate legislators and encourage their oppostion PAs during this time frame. They further found greater to bills like HB 495 and HB 442, which risk patient safety, coordination in health care teams may produce better • SB 161 (Act 389), also by Sen. Allain, eliminates the • HB 495 by Rep. Barry Ivey (R-Baton Rouge) would have increase costs, and do not improve access to care. outcomes than merely expanding scope of practice. A 2020 federal income tax deduction and phases in lower granted full practice authority to advanced practice study published in the Journal of Internal Medicine found, franchise tax rates gradually as certain positive registered nurses. This legislation was the most The best way to ensure patient safety is to keep physicians that in states that allow independent prescribing, NPs were economic and tax revenue triggers are met. contentious bill of the entire session and finally died at the helm of the health care team. Patients deserve the 20 times more likely to overprescribe opioids than those on the calendar when the legislature adjourned. LSMS most qualified health care provider, and that is a physician, in prescription-restricted states. Furthermore, while the • HB 278 (Act 395) by Rep. Stuart Bishop (R-Lafayette) and other physician groups fought hard to educate who has unmatched training, education, and experience. number of NPs doubled between 2010-2017, there has eliminates the federal income tax deduction and legislators as to the dangers associated with the bill. been no noticeable increase of nurse practitioners within lowers individual income tax rates with similar tax As the legislature adjourned, the Louisiana Association Scope of practice changes do not decrease costs, nor do rural, underserved areas. A recent CMS study confirmed few revenue triggers. of Nurse Practitioners has already challenged its they increase access to care. Studies from the Mayo Clinic nurse practitioners choose to work in rural areas following membership to continue advocating and promised and JAMA found nurse practitioners (NPs) and physician graduation. It’s clear: scope of practice changes do not • HB 292 (Act 396) by Rep. Neil Riser (R-Columbia) to return next year. It is incredibly important for our assistants (PAs) are more likely to make unnecessary benefit patients, they benefit for-profit entities and non- reduces the number of tax brackets for corporate membership to remain engaged and work to educate referrals and imaging orders, resulting in higher costs for physicians. Legislators must see past the false promises income taxes, lowers rates and eliminates the federal your legislators on our concerns. patients. A study in the Journal of the American College and oppose continued legislative efforts to increase scope income tax deduction. of Radiology, which analyzed skeletal x-ray utilization for of practice for non-physician practitioners. ■ • HB 442 by Rep. Larry Bagley (R-Stonewall) would • HB 199 (Act 131) by Speaker Clay Schexnayder have changed how all physician assistants practice by (R-Gonzales) creating the State and Local Streamlined removing physician involvement from any requirement Sales and Use Tax Commission will also be on the October of oversight. This bill died on the house floor with a 39 9 ballot. If approved by the voters, this commission to 39 tie vote. will be tasked with the promulgation of rules aimed President at simplifying electronic filing and remittance of local • HB 181 by Rep. Dustin Miller (D-Opelousas) was Louisiana State Medical Society sales taxes. It will also serve as the entity to perform intended to provide mental health nurse practitioners audit functions for out-of-state businesses and develop the ability to admit patients to inpatient mental health rules to streamline the audit process for companies with hospitals among other items. The bill was amended a physical presence in Louisiana. to only allow these items to occur if authorized by a

4 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 5 collaborative practice agreement. The bill was signed by the Governor and became Act 373.

• HB 187 by Rep. Larry Bagley (R-Stonewall) allows nurse practitioners and physicians assistants to order home health. While LSMS did oppose the bill, it is reflective of changes made by CMS during COVID-19. The bill passed the legislature and became Act 181.

• HCR 94 by Rep. Stuart Bishop (R-Lafayette) and SCR 73 Louisiana Physicians: Have You by Sen. Patrick McMath (R-Covington) was requested by LSMS in response to many legislators who sought a different way to review scope of practice increases. Completed Your 20 Hours of CME? The resolution would have required all healthcare professional licensing boards to review processes Louisiana providers have trusted MI with their continuing education for more than utilized in other states and report back to the Health 20 years. That’s why we take pride in offering state-specific courses on litigation and Welfare Committees which ones would work for preparation, informed consent, and claims processes for our local practitioners. them and which ones would not work. After being egregiously mischaracterized in House Health and Welfare, the legislation was defeated by a vote of 2 to 10.

Noncompete clauses in physician contracts was the subject of two bills. Both bills addressed certain aspects of the clauses and were successful leaving the House before meeting increased opposition on the Senate side. Although Medical Interactive Community is a We target key areas of clinical risk HBs 483 by Rep. Mark Wright (R-Covington) and 561 by nationally accredited provider of CME: across multiple medical specialties: Rep. Larry Bagley (R-Stonewall) stalled out in the Senate Commerce Committee, Representative Wright has filed HCR 125 which directs a joint subcommittee of the House and • Auto Submit Credits to CE Broker Controlled Practice Senate Commerce Committees to study various aspects of • 95% of CME with MOC Part II Credit Substances Management noncompetition agreements relative to physicians in the state and to report the findings of the joint committee to • Accredited with Commendation by ACCME Diagnostic Professional Scan To Error Interaction the legislature prior to the convening of the 2022 Regular Session of the Legislature of Louisiana. Then, with less than Donate Documentation Provider thirty minutes left before Sine Die, Representative Bagley Burnout introduced HR 223 which directs a joint committee of the House Committee on Commerce and the House Committee Get your CME at Medical, Legal Regulatory & on Health and Welfare to study the issue and report their & Ethics Compliance findings to the House of Representatives. We look forward medicalinteractive.com to continuing to educate the members of the legislature Medication Quality on the negative impacts to patients and physicians of such Therapy Improvement provisions during the interim. If you have specific ideas or stories relative to noncompete agreements please feel free LAMMICO insured? Get all of your AMA PRA Category 1 Perinatal Risk & Claims to contact Lauren Bailey at [email protected]. ■ https://lsms.org/donations/donate.asp?id=13025 Credits free at lammico.com/online-education.

6 J LA MED SOC | VOL 173 | SUMMER 2021 LEGISLATIVE TIMELINE SCOPE OF PRACTICE NURSE PRACTITIONERS HB 495 HB 442 APRIL Representative Barry Ivey (R-Baton Rouge) 2ND House of Representatives heavily amends introduces HB 495 to provide nurse the bill and approves it by a 61-41-2 vote. practitioners with full practice authority.

26 states and the District of Columbia APRIL have independent practice HB 495 passes out of the House Health and 22ND 24 states do not have Welfare Committee by a vote of 10-6-1 independent practice with Representatives Kenny Cox, Raymond Crews, Julie Emerson, Jason Hughes, Travis Johnson, Wayne McMahen, Dustin Miller, Pat Moore, Joseph Stagni and Chris Turner APRIL 28TH all voting for the bill. HB 442 passes the House Health and Voting with the LSMS and the Physicians Welfare committee by a vote of 13-4 with NURSE PRACTITIONER BILLS FILED IN LOUISIANA 2010-2021 Coalition of LA – Representatives Robby Representatives Larry Bagley, Roy Daryl Carter, Michael Echols, Ed Lavadain III, Bob Adams, Kenny Cox, Raymond Crews, Julie Year Bill Author(s) Summary Action Owen, Thomas Pressly, and Larry Selders. Emerson, Jason Hughes, Travis Johnson, Authorized a NP to provide health care to a minor without 2010 HB1046 Wilmont Voluntarily deferred Chairman Larry Bagley did not vote, and Ed Lavadain III, Wayne McMahen, Dustin the consent of the minor's spouse, parent or guardian Representative Roy Daryl Adams was Miller, Pat Moore, Joseph Stagni and Chris 2012 HB951 Wilmont Exempted certain NPs from a collaborative practice agreement Never heard absent from the committee. Turner all voting for the bill. Moved NPs under the jurisdiction of the Louisiana Voting with the LSMS and the Physicians 2013 SB192 Erdey Voluntarily deferred State Board of Medical Examiners Coalition of LA – Representatives Robby Called for a study group between the LSBN and MAY Carter, Michael Echols, Thomas Pressly, and 2014 HR199 Johnson Never heard LSBME to look at NP's in underserved areas House of Representatives heavily amends 5TH Larry Selders. the bill and approves it by a 61-41-2 vote. 2015 HB416 Barrow Exempted certain NPs from a collaborative practice agreement Never heard The LSBME cannot limit an NPs ablity to practice Never heard in senate 2015 HB486 Johnson via a collaborative practice agreement committee Created a study group to make recommendations concerning Never heard in senate 2016 HCR86 Hoffman MAY the creation of a scope of practice review committee committee HB 495 heavily amended yet again and 19TH 2016 HB620 Wilmont Exempted certain NPs from a collaborative practice agreement Never heard passes out of the Senate Health and Welfare Committee by a vote of 4-3 with 2016 SB187 Barrow Exempted certain NPs from a collaborative practice agreement No House floor vote Senators Regina Barrow, Gerald Boudreaux, 2016 SB206 T. Carter Exempted certain NPs from a collaborative practice agreement Never heard Bob Hensgens, and Jay Luneau voting for Created a study group to make recommendations concerning 2017 HCR59 Hoffman Never heard the bill. the creation of a scope of practice review committee Voting with the LSMS and the Physicians Exempted NPs in hospitals and nursing homes Coalition of LA – Senators Patrick McMath, 2018 HB483 Stagni Voluntarily deferred MAY from a collaborative practice agreement Beth Mizell, and Rogers Pope. Chairman 11TH The House of Representatives rejects the Exempted NPs in hospitals and nursing homes Fred Mills did not vote. 2018 SB435 Mills Died on Senate floor bill with a final vote of 39-39-27. from a collaborative practice agreement 2019 HB276 Johnson Provides NPs with broad-based global signature authority Died on House floor

MAY 2020 HB864 Ivey Removes the collaborative practice agreement in its entirety. Died in House committee 20TH HB 495 reported with amendments to the 2021 HB495 Ivey Removes the collaborative practice agreement in its entirety. Died on Senate floor full senate where it sat for three weeks 2021 HB181 Miller Expands the scope of practice for psychiatric nurse practitioners Passed with amendments never to be debated as it was DOA. There Allows nurse practitioners to write home health was simply too much opposition to the bill 2021 HB187 Bagley Passed with amendments orders without a physician's approval and members did not want to vote. ■

8 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 9 HBS FINAL PASSAGE HBS FINAL PASSAGE HB 495 BY IVEY HB 442 BY BAGLEY ROLL CALL HB 495 FINAL PASSAGE ROLL CALL HB 442 FINAL PASSAGE SEQUENCE: 269 SEQUENCE: 392 2021 REGULAR SESSION DATE: 5/05/2021 2021 REGULAR SESSION LOCKOUT VOTE TIME: 6:32:03 PM DATE: 5/11/2021 TIME: 8:09:20 PM

YEAS YEAS

Mr. Speaker Deshotel Hughes Marcelle St. Blanc Mr. Speaker Duplessis Ivey Marino Pierre Adams Duplessis Ivey Marino Stagni Amedee Edmonds Jefferson McCormick Riser Amedee Edmonds James McCormick Stefanski Bacala Edmonston Johnson, T. McFarland Schamerhorn Bacala Edmonston Jefferson McMahen Tarver Bagley Emerson Jordan Miller, D. Stagni Bourriaque Emerson Jenkins Miguez Turner Brass Firment Larvadain Miller, G. Turner Brass Firment Johnson, M. Miller, D. Wheat TOTAL TOTAL Carpenter Gaines Lyons Mincey White Brown Frieman Johnson, T. Miller, G. White Carter, W. Horton Mack Nelson Willard Bryant Gaines Jones Mincey Willard Cox Hughes Marcelle Newell Carpenter Glover Jordan Moore Wright Carter, G. Goudeau Kerner Nelson 61 39 Carter, W. Green Lyons Pierre Cox Hollis Mack Romero Crews Horton Magee Schamerhorn

NAYS NAYS

Bagley DeVillier Geymann McKnight Selders Adams Coussan Gadberry McMahen Selders Beaullieu DuBuisson Harris Muscarello Thomas Bourriaque DeVillier Garofalo Miguez Tarver Bishop Echols Hodges Newell Thompson Brown DuBuisson Geymann Muscarello Thomas Butler Farnum Huval Orgeron Villio Bryant Echols Harris Orgeron Thompson Carrier Fontenot Illg Owen, C. Zeringue TOTAL Butler Farnum Huval Owen, R. Villio TOTAL Carter, R. Freeman LaCombe Owen, R. Carrier Freeman Illg Phelps Wheat Cormier Freiberg Landry Pressly Carter, R. Freiberg LaCombe Romero Wright Coussan Gadberry Larvadain Riser Cormier Frieman Landry Schlegel Davis Garofalo McFarland Seabaugh 41 39

ABSENT ABSENT

Hilferty Phelps Beaullieu Fontenot Hollis Magee St. Blanc Bishop Glover James McKnight Stefanski Carter, G. Goudeau Jenkins Moore Zeringue Crews Green Johnson, M. Owen, C. TOTAL Davis Hilferty Jones Pressly TOTAL 2 Deshotel Hodges Kerner Seabaugh 27

10 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 11 COMMUNITY CONNECTOR PARTNERSHIPS Humana (humana.com) Well-Ahead Louisiana (wellaheadla.com) Community Connector, our partnership program, provides exclusive offers, services and solutions to our members. The LSMS partners Humana Inc. is a leading health and well-being company focused Well-Ahead Louisiana is an initiative started by the Louisiana with trusted companies to build exposure and make connections with the health care community and members across the state. on making it easy for people to achieve their best health with Department of Health aimed at improving the health and wellness If you’re interested in learning more about our Community Connector Partnership Program, contact [email protected] clinical excellence through coordinated care. The company’s of Louisiana residents. strategy integrates care delivery, the member experience, and clinical and consumer insights to encourage engagement, behavior change, proactive clinical outreach and wellness for the millions of people we serve across the country. Today Humana serves more than 433,000 Louisianans through our Medicare Advantage (MA), LAMMICO (lammico.com) TRICARE, and commercial health insurance programs. Advantage Physicians Purchasing Alliance LAMMICO is a policyholder-owned insurance company that Medical Interactive Community, LLC (medicalinteractive.com) (advantageppa.com) provides unparalleled service and comprehensive medical Medical Interactive Community (MI) is an online collection of up- In August of 2020, Advantage Physician’s Purchasing Alliance professional and general liability coverage at actuarially sound rates. to-date interactive and educational tools for medical providers. (Advantage PPA) partnered with the Louisiana State Medical With our personalized claim handling, aggressive legal defense Expertly developed by physicians, nurses and risk management Society (LSMS) to build a purchasing organization that reflected and high quality risk management education, our policyholders professionals, these products and services aim to augment the diverse needs of Louisiana’s medical practices. can focus on what matters most: their patients. LAMMICO is patient safety and experiences throughout the medical process Primary Care Plus (primarycareplus.com) Advantage PPA is the first PPG built exclusively for Louisiana’s the largest medical professional liability (MPL) insurance carrier – and, ultimately, prevent claims. Medical Interactive Community Primary Care Plus providers specialize in senior care and know how medical professionals, providing real, local savings on everyday domiciled in Louisiana and the only “A” (Excellent) rated Louisiana offers CME, CNE and MOC credit courses, litigation preparation to treat the health challenges that arise with aging. Because we products and services used by practices. domiciled MPL insurance carrier insuring physicians, hospitals videos and hospital and facility education. MI is a wholly-owned specialize in seniors, our providers see about half of the patients and facilities. LAMMICO is licensed to underwrite insurance in subsidiary of LAMMICO. of a typical primary care doctor. This allows your provider more Louisiana, Arkansas, Mississippi and Tennessee. Coverage is also time at every appointment to get to know you, to understand available in these and other states through the LAMMICO Risk your unique health goals and to provide effective and highly Retention Group (RRG). The LAMMICO RRG supports out-of-state personalized healthcare at every opportunity. practice expansion of existing and new LAMMICO policyholders Practice Solutions by providing a mechanism for coverage in states beyond those where LAMMICO is licensed. The LAMMICO RRG is licensed and Practice Solutions domiciled in Washington, D.C. and registered to write business (lammico.com/practice-management) in Alabama, Arkansas, California, Georgia, Louisiana, Mississippi, Practice Solutions was created to help LAMMICO insureds mitigate Oklahoma, Tennessee and Texas. their malpractice risk as well as navigate the regulatory and financial burdens on physicians and their practices. 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12 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 13 LOUISIANA PHYSICIAN PHYSICIAN COALITION COALITION LOUISIANA PHYSICIAN-LED ∙ KNOWLEDGE DRIVEN

INFORMING OUR LEGISLATORS EXAMPLE OF MATERIALS SHARED WITH LEGISLATORS

Before and during the session, the Physician Coalition of Louisiana educated legislators on the significant differences in the education and training requirements between physicians and other health care professionals.

OUR HISTORY OUR VISION

The Physician Coalition of Louisiana formed in 2019 as a The vision of the coalition is to ensure that physicians partnership between the Louisiana Academy of Family continue to help shape decisions that affect patients, Physicians and the Louisiana State Medical Society to serve physician practices and the practice of medicine. as a unified voice for all physicians and physician medical associations in the State of Louisiana. Our partner groups OUR FIRST CAMPAIGN – MEDICAL SCHOOL MATTERS consist of more than 7,000 practicing physicians, residents in training, and medical students. Nurse practitioners (NPs), and now Physician Assistants (PAs), want Full Practice Authority, also called, Optimal OUR MISSION Team Practice, which is an aggressive, unrestricted increase in the scope of practice for NPs and PAs. Despite Our mission is to provide a unified voice for all physician proposals is to destroy the medical team by removing groups across Louisiana by educating patients, lawmakers, the need for physician oversight. Medical School Matters and the public and by influencing policy and legislation. was a collective effort by 20 physician association across Louisiana working together to defeat HB 495, which would have given NPs full practice authority and HB 442, which would have removed physician supervision over PAs.

WORKING TOGETHER TO KEEP PHYSICIANS IN PATIENT CARE

Louisiana State Medical Society Louisiana Dermatological Society

Louisiana Academy of Family Physicians Louisiana Society of Interventional Pain

LA Chapter – American Academy of Pediatrics Louisiana Eye Physicians and Surgeons

Louisiana Orthopaedic Association Louisiana Medical Association

Louisiana Osteopathic Medical Association LA Chapter – American College of Surgeons

Louisiana Psychiatric Medical Association LA Chapter–American College of Emergency Physicians Medicine Louisiana LA Chapter – American College of Physicians Louisiana Society of Anesthesiologists LA Chapter – American Congress LA Chapter – American Academy of Otolaryngologists Obstetricians and Gynecologists Louisiana Pathology Society Radiological Society of Louisiana ■ Louisiana Society of Addiction Medicine

14 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 15 Physicians bring economic health to Patients are often confused about the di erences between various types of health care providers but statistics show they place a high value on physician-led teams. Louisiana’s communities.

Beyond their role in safeguarding the health of our communities, physicians in Louisiana are a major driver of the state economy, spurring economic growth and creating jobs across all industries.

Louisiana physicians hire locally, buy locally and support the local economy. Through the creation of jobs with strong wages and benefits paid to workers across the state, physicians empower a high-quality, sustainable workforce that generates state and local tax revenue for community Patients want access to investments. Physicians’ economic output—the value of the goods and services provided—helps other the highest quality care businesses grow through their own purchasing and through the purchasing of their employees. Each at an a ordable price. dollar in direct output applied to physician services supports $1.85 in economic activity in Louisiana, 3/4 and physician-driven economic activity is greater than legal services, home health care, higher Solutions to the primary education, and nursing home and residential care. care shortage must consider patient View the 2018 American Medical Association Economic Impact Study to learn more perspectives and the about the contributions physicians make to the health of Louisiana’s economy at high value they place PhysiciansEconomicImpact.org. on physician-led teams. VITAL SIGNS: THE ECONOMIC IMPACT OF PHYSICIANS IN LOUISIANA1

Jobs 119,515 Direct jobs ...... 48,336 Indirect jobs ...... 71,179 Average jobs supported by each physician ...... 11.9 Economic activity $ 19.9 billion Direct economic output ...... $10.7 billion Indirect economic output ...... $9.1 billion Percent of total GSP/GDP2 ...... 8.3% Average economic output generated by each physician ...... $2.0 million Wages and benefits $8.9 billion Direct wages and benefits ...... $5.9 billion Indirect wages and benefits ...... $3.0 billion Average wages and benefits supported by each physician ...... $888,745 State and local tax revenue $646.5 million Average state and local tax revenue generated by each physician ...... $64,254 1. The economic impact of physicians in Louisiana (QuintilesIMS, January 2018). 2. US Bureau of Economic Analysis: Current-Dollar GDP by State, 2015. 2018 AMA ECONOMIC IMPACT STUDY

Family medicine physician Dr. Stephen Jones operates an urgent care clinic and nine school- based clinics. He trusts LAMMICO to provide his medical malpractice insurance.

White Coat Wednesday is an opportunity for our members to join colleagues for a day of advocacy at the Louisiana State Capitol. This is their chance to wear a white coat and be a part of the advocacy team. Members learn more about issues their profession faces at the legislature, gain a better Pictured left to right: Jeff Williams, LSMS EVP & CEO; Katherine Williams, MD, LSMS President; Matthew appreciation of what goes on at the Capitol, meet their Giglia, MD, LSMS Member; Lindsey Fauveau, MD, legislators, and advocate for their profession. LSMS Member; P. Page Cortez, President of the Senate

When I came to LAMMICO for medical malpractice insurance, they helped me identify ways to minimize risks in my practices. I didn’t want to be reactive if there were problems, so LAMMICO helped me be proactive in preventing risks.

The Risk Management team has an amazing level of knowledge for risk mitigation. LAMMICO is a leader in this space. They maintain a solid knowledge base and provide important communications, especially during crises like COVID-19.

The LAMMICO team provides me with an abundance of valuable resources to ensure my needs as a physician are continuously met. I trust LAMMICO. As a LAMMICO insured, you Building Enduring Partnerships know someone has your back. 800.452.2120 | lammico.com

– Stephen Jones, M.D., family medicine physician

18 J LA MED SOC | VOL 173 | SUMMER 2021 LEGISLATIVE RECEPTION Physicians and guests with the Physician Coalition of Louisiana gathered the evening before White Coat Wednesday with members of the Louisiana Legislature.

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J LA MED SOC | VOL 173 | SUMMER 2021 21 LEGISLATURE BOOTCAMP LSMS LOOKING FOR PHYSICIAN CANDIDATES FOR OFFICE

LSMS is developing a one day “boot camp” for physicians interested in seeking political office. Why? Today, Louisiana has no physician representing medicine in the state legislature. As several groups traditionally opposed to physicians have members in the legislature, this has undermined our efforts LSMS during session. If you or a physician peer has an interest in running, please LEGISLATOR consider attending our “boot camp.” Below are two charts that represent the current makeup of the Louisiana legislature in profession and demographics. These are the people making the decisions on your profession and on the BOOTCAMP publics healthcare. Get involved, and help us help you!

WHO’S MAKING THE DECISIONS

Chemical Industry / Nursing Home Attorneys Realtors 43 8 Oil&Gas 3 1 Administrators Businesspeople / Insurance Farmers / Foresters RN/APRN 38 Consultants Attorneys 8 3 1 Military / Public Servants/ Retirees Religious Chiropractors 28 7 Law Enforcement 2 1

14 Educators 5 Financial Services 2 Funeral Home Operators

Communications / Non-Profits / Social Work Veterinarian 12 Consulting 4 2 Engineers / Retailers Pharmacy 8 Contractors 3 2 WANTED: PHYSICIANS TO DO THEY REPRESENT YOU?

HOUSE SENATE LEGISLATURE VOTERS STATE

90% 85% 82% SERVE IN THE LEGISLATURE 81% 80% 74% 74% 74%

70% 69% 66% 65% 63% 63% 60% 55% 51%

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22 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 23 AN INTERNAL MEDICINE RESIDENCY 400 COVID-19 RESPONSE TO THE COVID-19 CASES 200

PANDEMIC IN LOUISIANA 0 Seth M. Vignes, MD; Brittany L. Boudreaux, DO; Shane E. Sanne, DO; Catherine M. Hebert, MD; and Lee S. Engel, MD, PhD APRIL JULY OCTOBER 2021 Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans MONTH FIGURE 1: COVID-19 Cases in New Orleans March 2020 to February 2021 (Centers for Disease Control data: https://covid.cdc.gov/covid-data-tracker/#county-view) ABSTRACT

The novel human coronavirus disease, COVID-19, was first identified in Wuhan China in December 2019 and quickly spread to the entire two interns and a cap of twenty patients’ maximum on would need more medicine teams devoted to COVID-19 planet. While New Orleans enjoyed Mardi Gras in February of 2020, we were unaware that the ongoing mix of tourism and gathering of each team that took call every four days. A separate night patients. At this point, to meet the demands of the rapidly large crowds would fuel the spread of the COVID-19 pandemic to our city and state. New Orleans saw its initial and largest COVID peak to float resident and intern managed admissions from the increasing number of patients with COVID-19, we shifted date in early April 2020. At the peak, all the hospitals in the greater New Orleans area quickly became inundated with patients affected by Emergency Department and general floor call. There was from a reactionary model to a proactive model that would COVID-19. The goal of this article is to share our experience, our designed responses to the multitude of issues facing our internal medicine no cap on new patient admits because there was no other allow us to care for a maximum capacity of patients, cohort residency program, and the lessons we learned during the COVID-19 pandemic. hospitalist service available. The medical intensive care unit patients, cohort at-risk house officers and faculty (those (MICU) was a closed unit with resident teams from LSUHSC who were pregnant or had underlying health issues, etc.), internal medicine programs, Tulane internal medicine and reduce the need for continual schedule changes. We programs and the LSUHSC emergency medicine program. created two more medicine ward teams, giving us six ward INTRODUCTION first few months after evaluating genome sequencing We also had residents and interns on ambulatory rotations, teams (Teams 1 to 6). Team 1 was staffed by faculty and and cell phone tracking data.2,3 As of this writing, there consult rotations, quality improvement/patient safety residents who were either pregnant or had underlying The novel human coronavirus disease, COVID-19, that have been over four hundred thousand cases of COVID-19 rotations, and interns on emergency medicine rotations. reasons that put them at greater risk of adverse outcomes was first identified in Wuhan China in December 2019, with over nine thousand deaths in Louisiana. The largest from COVID-19, and we designated this the non-COVID represents the fifth documented pandemic since the 1918 peak in the New Orleans area occurred in April 2020 with Pre-pandemic at Touro Infirmary (Touro), LSUHSC internal team. Team 1 admitted all patients who tested negative flu pandemic.1 The initial rapid ascent of COVID-19 in New other smaller peaks in July 2020 and January 2021 (Figure medicine had four medicine ward teams with one resident for COVID, clinically did not appear to have COVID, and had Orleans and Louisiana was likely the result of a combination 1). Here we share the responses that the internal medicine and one intern each that took call every four days and clear alternate diagnoses. Teams 2 thru 6 admitted all the of increased global tourism in our city and the gathering of residency program at Louisiana State University Health one night float intern on Monday through Friday. We COVID patients on a rotating call system. We went from an large crowds for the Mardi Gras celebration that occurred in Sciences Center (LSUHSC) in New Orleans made to the only had enough residency cap positions to maintain the every fourth night call to an every sixth night call. The call February 2020. With the subsequent availability of testing, pandemic with regards to resident/intern-delivered patient ward services. We did not have any residents on consult or team took admits from the Emergency Department (ED) the first reported case of COVID-19 in Louisiana occurred care, communication, resident/intern education, resident/ elective rotations at that site due to cap limitations. and transfers from the MICU. Patients with COVID-19 took on March 9, 2020 at the Veterans Administration Medical intern wellness, residency recruitment, and the COVID-19 longer to improve; therefore, one unforeseen benefit of Center in New Orleans. By the following day, there were vaccination efforts that have ensued since March 2020. Pre-Pandemic at Ochsner-Kenner Medical Center (OKMC), the every sixth night call schedule was that the medicine two more cases at separate New Orleans area hospitals. LSUHSC internal medicine had four medicine ward teams teams were able to achieve more patient dispositions prior The World Health Organization declared coronavirus a PATIENT CARE AND RESIDENCY STRUCTURE with one resident and one intern each took call every to their next call. These early days were characterized by pandemic on March 11, 2020. Reported coronavirus cases AT OUR TEACHING HOSPITALS PRE-PANDMIC four days. There were two night float interns who rotated fear of transmission, feelings of helplessness over patients rapidly increased and the first Louisiana death was reported AND DURING THE PANDEMIC every three days. We also had five other house officers on who were decompensating, and lack of available testing. on March 14, 2020. During the following ten days, schools consult rotations. Resident and intern wellness benefited from the decrease closed, hospitals limited visitors, bars and restaurants PRE-COVID-19 PANDEMIC STRUCTURE in call-day frequency. UMC brought in a private locums shut down, and drive through testing sites opened. INITIAL COVID-19 PEAK RESPONSE AND hospitalist group towards the end of April, which helped Confirmed cases increased to over one thousand, and a Residents and interns from the Internal Medicine Residency MODELS reduce the burden on our academic ward teams. “stay at home” order was issued for Louisiana. By the end program at LSUHSC in New Orleans rotate at three hospitals of March, there were over four thousand COVID-19 cases for inpatient ward rotations (University Medical Center, Pandemic response at UMC The MICU took direct admits from the ED and floor transfer in Louisiana and a few states set up interstate checkpoints Touro Infirmary, and Ochsner-Kenner Medical Center) in for patients who required more care than could be provided to prevent travelers from New Orleans from entering. On the greater New Orleans area that includes Orleans and Following the first reported case of COVID-19 in New on the medicine wards. Patients who were stepped up to April 1, 2020, Louisiana had the highest per capita deaths Jefferson Parishes. Orleans on March 9, 2020, a rapid increase in cases occurred the MICU, would usually go back to the same medicine from COVID-19 in the U.S. A pre-publication report by at all three of our hospital sites. The initial rise COVID-19 at team when stabilized. The cap for the residents and interns researchers at Scripps Research Institute, Tulane University, University Medical Center (UMC) is unique in that it is UMC occurred during the third week of March, 2020. At first on the medicine teams remained at twenty. However, and LSU Health Shreveport proposes that the coronavirus an academic training hospital, where both LSUHSC and we responded by cohorting all the patients with COVID-19 at times more than twenty patients were admitted to most likely arrived in New Orleans about two weeks before Tulane Health Sciences Center have independent internal on one Medicine ward team. Two days later, we had two the medicine teams and these patients were seen by the Mardi Gras2. These researchers suspects that one case medicine rotations. Pre-pandemic, LSUHSC internal medicine teams that were devoted to COVID-19 patients faculty attending physician without the residents to abide source exploded into 50,000 confirmed cases over those medicine had four ward teams each with one resident and and by the fourth week of March we quickly realized we by ACGME regulations. Similar to previously published

24 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 25 reports on reorganizing a medicine residency program in telemedicine capacity for trainees during the COVID-19 response to COVID-19 and on internal medicine resident pandemic demonstrated that a successful program required work absence during the COVID-19 pandemic4,5, coverage development of technical proficiency, virtual information for our extra medicine ward teams was accomplished by gathering (inclusive of history, collateral information, and TABLE 1: Program Patient Care: Comparison of Pre-COVID, COVID-19 First Peak, and COVID-19 Post First Peak pulling residents and interns off most consult services, physical exam), and interpersonal communication skills.6 ambulatory rotations, and quality improvement rotations. Our house officers were able to overcome these challenges COVID-19 First Peak: COVID-19 Post First Peak: We added more house officers to the pulmonary consult and continue to provide care to their clinic patients during PRE-COVID-19 service and the infectious disease consult service. We this time. March-May 2020 June 2020- February 2021 maintained a resident on the cardiology service. Interns University that were previously assigned to the ED remained on that Pandemic Response after the initial COVID-19 peak • 4 ward teams • 6 ward teams • 4 ward teams Medical Center service. The medical and surgical ICUs quickly filled and a decreased • Call every 4 days • Call every 6 days • Call every 4 days third MICU unit, supervised by faculty from critical care, was • 20 patient cap/team • 20 patient cap/team • 14 patient cap/team created with the use of residents and interns from programs We maintained this new organization for patient care at • MICU step down team • Initiation of private • Private hospitalist service such as oral maxillofacial surgery, emergency medicine, all sites through May and transitioned back to our pre- • 1 MICU team hospitalist service • Cohort COVID-19 patients medicine/pediatrics, general surgery and vascular surgery. COVID structure in June 2020 as the number of patients • Subspecialty consult • Cohort COVID-19 patients on specific units hospitalized with COVID-19 decreased significantly and rotations on specific units • MICU step down team Pandemic response at Touro continuity clinic activity returned. UMC maintained the • Ambulatory rotations • 2 MICU teams • 1 to 2 MICU teams locums private hospitalist service and supported LSUHSC • Qualityimprovement/ • Opened extra MICU • Subspecialty consult At Touro, we maintained the same pre-pandemic structure to develop a direct care hospitalist service that was not patient safety rotations • Subspecialty consult rotations that had been in place since we only had enough graduate reliant on residents or interns. A comparison of the internal • Emergency room rotations rotations limited to • Ambulatory rotations medical education residency cap positions to maintain medicine residency program’s patient care services pre- • Continuity clinic patient pulmonary, infectious • Quality improvement/ the ward services and we did not have any residents on COVID-19 and through the pandemic is included in Table visits for all residents and disease, and cardiology patient safety rotations extras services at that site. The hospital administration 1. Although we have had two additional peaks in COVID-19 interns • Emergency room rotations • Emergency room rotations decided that all COVID patients would be admitted to activity, neither was severe enough to require changes to • Continuity clinic limited • Continuity clinic patient either our resident ward teams or to two other private our patient care coverage. to telemedicine and visits for all residents and hospitalist groups. prescription refills with interns COMMUNICATION only 4 ambulatory Pandemic response at OKMC residents A key to successful management of patients and physician At OKMC, we maintained the four inpatient medicine ward well-being during a pandemic or other disaster is teams with one resident and one intern each that took call communication. Communication is essential to maintain Touro Infirmary • 4 ward teams • 4 ward teams • 4 ward teams every four days and two night float interns rotating every community and a sense of normalcy.7 Wayne State University • 14 patient cap/team • 14 patient cap/team • 14 patient cap/team three days. We added one extra intern, who was pulled off School of Medicine developed a ‘Virtual Conversation • Cohort COVID-19 patients • Cohort COVID-19 patients the consult services, as a “float” intern who would assist Series” to connect students with physicians on the on specific units on specific units the ward teams with the highest number of the most COVID-19 frontlines. 8 Learners positively rated this method complicated patients as requested by the hospitalist faculty of communication and this study demonstrated that at that site. This was a simple solution to offload teams on a information on patient experiences, resource shortages, Ochsner-Kenner • 4 ward teams • 4 ward teams • 14 patient cap/team day to day basis without having to constantly adjust house and mental health challenges could be disseminated Medical Center • 14 patient cap/team • 14 patient cap/team • Cohort COVID-19 patients officer schedules. We shifted the remaining house officers through the use of this ZOOM-based platform.8 • Subspecialty consult • Extra float intern on Wards on specific units on the consult services to either pulmonary/critical care or rotations team • Subspecialty consult infectious diseases teams. Several methods and levels of communication were used • Cohort COVID-19 patients rotations to update leadership, faculty, residents and interns on the on specific units Pandemic response in our continuity clinic COVID-19 pandemic trends, testing, treatments, rotation • Subspecialty consult changes, didactic education opportunities, wellness rotations limited to Prior to the COVID-19 pandemic, all internal medicine initiatives, and vaccinations. Each of our hospital partners pulmonary and infectious residents and interns had a half-day per week continuity established COVID-command centers and held weekly Disease clinic. At the onset of the pandemic, the medicine clinic meetings to provide hospital workers, medicine faculty closed to patient visits and effectively ended our continuity and house officers updates on topics such as COVID-19 clinics by April 2020. During this time, we assigned three hospital census, personal protective equipment supplies, to four house officers on ambulatory rotations to the medication availability, wellness, and, more recently, medicine clinic to manage telemedicine patient visits and vaccinations. At each site we would send a representative TO READ THE FULL ARTICLE prescription refills. Challenges to telemedicine and virtual to this meeting who would report back to the internal VISIT WWW.LSMS.ORG/JLSMS patient encounters included the technical aspects such medicine faculty and house officers. The electronic health as computer system requirements for both the patients record system, EPIC, was amended with a COVID-19 and medical trainees. A published case study on building information tab. This site contained information on

26 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 27 THE LOSS OF IN-PERSON INTERVIEWS THE EFFECTS OF THE COVID-19 PANDEMIC ON THE UNDERGRADUATE ceremonies were cancelled: Match Day, the ritual at which WARRANTED CREATIVE SOLUTIONS, SUCH students discover their residency locations, and graduation. AS MAKING INFORMATIONAL VIDEOS ABOUT MEDICAL EDUCATION EXPERIENCE AT LOUISIANA STATE Instead of celebrating their years of hard work surrounded RESIDENCY PROGRAMS AND NEW ORLEANS UNIVERSITY SCHOOL OF MEDICINE IN NEW ORLEANS by classmates and family, students opened an email AND CREATING QUIET ‘INTERVIEW ROOMS’ ON from the National Resident Matching Program (NRMP) CAMPUS FOR OUR STUDENTS TO INTERVIEW Cathy Lazarus, MD; Hamilton Farris, PhD; Kia Sayers, M4; Nancy Tran, M4; Robin English, MD in solitude. This represented a great disappointment for WITH RELIABLE INTERNET ACCESS. students, families, and faculty who deserve commendation for quickly adapting to a new harsh reality. The traditional ABSTRACT graduation ceremony was originally scheduled for May 14, with another school, as close as possible in the same 2020. Per LSU SOM NO tradition, the day before graduation geographic region, to allow only one rotation per student The COVID-19 pandemic affected students at Louisiana State University School of Medicine in New Orleans (LSU SOM NO) as it did at many is precommencement. Members of our Student Affairs in the given discipline. Accordingly, LSU SOM NO partnered other medical schools around the world. School administrators, faculty, and students had to adjust their teaching, learning, and assessment office, in conjunction with our Information Technology with LSU Shreveport to offer rotations for students in strategies in a matter of days to weeks to complete training requirements and ensure continuing education. Four classes of students and the staff, quickly created a virtual precommencement event, three disciplines. Additionally, residency programs were incoming matriculating class of August 2020 faced an array of unique and universal challenges. Guidance from the American Association of which was conducted via Zoom and streamed on YouTube advised that all interviews were to be conducted virtually. Medical Colleges (AAMC) and the Liaison Committee on Medical Education (LCME) shaped the approach taken by course directors, clerkship for family and friends. As per our tradition, student awards National specialty organizations offered guidance to directors, and faculty within the Offices of Undergraduate Medical Education and Student Affairs to ensure compliance with national were given, and students were symbolically hooded by program directors in their disciplines to make the process recommendations and accreditation standards. Here we describe our efforts and the challenges that lie ahead. student-selected faculty or family members with terminal more transparent and uniform across the country.7 This doctoral degrees. The class president and other class directive required a quick pivot for programs to develop officers worked tirelessly to make the event meaningful for virtual materials and to design ways to connect virtually their peers, including delivering ceremonial goody bags with prospective applicants. These necessary and to the students’ residences without in-person contact. We proactive measures provoked anxiety in both students INTRODUCTION for students who were in a limbo status, being unable to have promised the Class of 2020 the best reunion ever, and program directors, but the relevant parties adapted, officially start residency training until July 1. Following once in-person gathering is possible again. and the virtual interview process took place with similar In early March of 2020, cases of patients with COVID-19 guidance issued by the AAMC, stating that any student timing to previous interview seasons. The loss of in-person surged in the New Orleans metropolitan area. The participation in the care of patients with COVID-19 interviews warranted creative solutions, such as making COVID-19 stay at home order for Louisiana was issued on should be voluntary2, we quickly developed a new senior THE CLASS OF 2021 informational videos about residency programs and New March 22nd.1 This necessitated a comprehensive shift in year elective so that students who were interested in Orleans and creating quiet ‘interview rooms’ on campus educational strategies for students in their pre-clerkship contributing to local medical volunteer activities could When the stay at home order was issued in New Orleans, for our students to interview with reliable internet access. and clerkship phases. Faculty leaders in the Offices of participate and receive credit. Due to PPE shortages, these the third-year students were removed from conventional, The medical education community looks on in interest Undergraduate Medical Education and Student Affairs activities were limited to research, community testing with in-person clinical rotations. Our clerkship and site directors to see the impact this will have on match outcomes and utilized guidance from our hospital partners and national supervision, following up with patients with COVID-19 worked closely and swiftly with members from the Offices on the residency application process going forward. It organizations, such as the AAMC and LCME, to craft a plan who had been discharged from the hospital or sent home of Undergraduate Medical Education and Student Affairs has certainly saved applicants and programs a great deal for continuing education while keeping our students safe from the emergency department, and serving at our city to transition clerkship didactic activities to virtual sessions of money. and compliant with city and state regulations. Hospital convention center, which was converted to a treatment and allow students to participate in telemedicine visits. partners and national organizations recommended that site. Most student participation involved analyzing patient Approximately 8 weeks after transitioning to all-virtual The cancellation of USMLE Step 2 CS for seniors was medical students cease clinical work in the immediate charts and data from our hospitals’ intensive care units, participation, our hospital partners allowed students to referenced above, but the administration of USMLE Step weeks following the stay at home order, primarily because contributing valuable skills to the creation of some of the return to in-person clinical duties, seeing patients on a 2 CK (Clinical Knowledge) examinations, which are taken of the shortage of Personal Protective Equipment (PPE). New Orleans early evidence-based ICU protocols for care limited basis. The lengths of clerkships were adjusted, and after the junior year, was also severely disrupted. Prometric This article outlines the changes initiated by class in of these patients.3 we met with students and clerkship faculty frequently test centers, which administer these examinations, closed addition to the overall changes to the medical school to ensure that core clinical conditions and clerkship nation-wide and were only allowed to re-open on a case by experience. All classes encountered different challenges, The United States Medical Licensure Examination Step 2 requirements were met in accordance with accreditation case basis pending the viral activity and restrictions within including curriculum variations in the pre-clerkship phase, Clinical Skills Examinations (USMLE Step 2 CS) has historically standards. This was achieved for nearly all of our third- their geographic regions. This generated widespread postponement or cancellation of important rituals and been required for graduation from our school. In response year students by the end of the year, with few exceptions cancellations and rescheduling of Step 2 CK, leading to ceremonies, and alterations in the residency interview and to the pandemic, the National Board of Medical Examiners completing requirements in the beginning of their significant anxiety for students in this class. Despite the match selection process. (NBME) suspended, and subsequently discontinued, Step senior year. disruption, and at the time of this publication, student scores 2 CS testing.4,5 During the initial suspension, several of our on this examination have not deviated from prior years. students were scheduled for but had not yet taken the The disruption came at a critical point in the third-year THE CLASS OF 2020 examination. The school moved forward with its defined timeline: at the end of the third year students prepare Similarly to the class of 2020, traditional Match Day process through the Academic Standards Committee to for away rotations, take USMLE Step 2 examinations, and activities for this class have been cancelled. Match Day Faced with graduation only weeks after the onset of the waive the requirement of Step 2 CS for those graduating begin work on residency applications. The AAMC issued will be a brief virtual ceremony prior to the distribution COVID-19 outbreak in the United States, like many schools students. The state licensure boards took similar action guidance, that quickly became normative across the of match results. Students who oversee planning of this around the country, the possibility of an early graduation with respect to licensing requirements. country, recommending that all away senior rotations be event are utilizing various social media platforms to for senior year medical students was considered. Leaders cancelled, with the sole exception of students applying increase the opportunities for students to interact with at LSU SOM NO decided against pursuing the option Changes for the class 2020 were not limited to clinical to residencies in disciplines not available at their home their classmates. Final decisions regarding graduation and given concerns about licensure, supervision, and safety and testing responsibilities, however. Two important schools.6 In such cases, schools were instructed to partner precommencement are still pending.

28 J LA MED SOC | VOL 173 | SUMMER 2021 J LA MED SOC | VOL 173 | SUMMER 2021 29 With respect to starting clerkships, the class of 2022 started their clerkships on time, and except for brief interruptions to take the Step 1 examination and quarantine restrictions, Local Experts, students have not been removed from clinical activities due to increasing COVID 19 cases in our communities. National Leaders THE CLASS OF 2023

As with the class of 2022, within 3 days of the stay at home order in New Orleans, we quickly transitioned to a virtual Your Partner in Gastrointestinal Health format, including all lectures and TBL sessions. Thus, this class of students did not have a significant disruption to THE CLASS OF 2022 their educational and curricular continuity. Indeed, they are GastroIntestinal Specialists, A.M.C., is the largest independent gastroenterology group in Northwest expected to take the Step 1 examination before starting Louisiana. Our 14 physicians and 11 mid-level practitioners are dedicated to providing personalized care Within 3 days of the New Orleans stay at home order, we their clerkships and will start their clerkships on time in July transitioned all classes for the sophomore students to a of 2021. for patients experiencing problems related to the digestive tract. virtual format, using Zoom as the platform. Our Information Technology department played a vital role in helping us This continuity notwithstanding, there are two notable Our physicians have more than 150 years of combined experience, specializing in Biliary Disease and modify our strategies, including working out licensure exceptions that were disruptive for this class. The first is Transplant Hepatology. issues, training faculty, and providing space and support a valued clinical experience, the Longitudinal Selective for classes. New formats for Team-Based Learning (TBL) (LS), which allows our second-year students to spend Services Available: sessions, which are a core piece of our interactive learning time in clinical or research experiences. This did not occur curriculum, were also shifted to a virtual platform, wherein for this class due to concerns about student safety and • CT • Clinical Drug Research • Infusion Center students formed their own Zoom small groups and hospital concerns about numbers of learners in clinical •Ultrasound • Hemorrhoid Banding • Capsule Endoscopy then joined a ‘large group Zoom’ for clinical application environments. The second is the opportunity for some • FibroScan® (non-surgical) • Bravo™ pH Testing exercises, similar to how in-person TBL sessions in our TBL students to participate in clinical preceptorships in our ® classroom were conducted previously. Area Health Education Center (AHEC) programs around • BioFire Stool Test for • Oﬃce Lab Louisiana, which normally occurs in the summer between Chronic Diarrhea The same USMLE examination cancellations described first and second years. This was not available that summer. above also occurred for the class of 2022 with respect to the To make a referral, call 318-631-9121. Step 1 examination, which is taken at the end of the second Another opportunity for students between their first and year. Typically, students are given several weeks to dedicate second years is research. We were able to offer virtual basic Our Doctors study time and take this examination prior to starting their science and clinical research projects, and participation in third-year clerkships. The cancellations produced a delay in these was higher than in previous years. This expands the taking the examination for many of our students, changing potential for students to engage in research activities in their preparation and compounding more anxiety on the future. the common nervousness surrounding the examination. While most students were eventually able to reschedule their examinations before their clerkships, some traveling THE CLASS OF 2024 far distances to do so, approximately one quarter of the class had to take the examination at some point during The group of students who started medical school in their clerkships. It is difficult to fully attend to clerkship August of 2020, in addition to having a virtual first year of responsibilities and prepare for Step 1, so there have school, had orientation virtually, significantly limiting their been more students than usual taking time out of clinical ability to meet their classmates in person and gather as a duties to take the examination. In some cases, this means a class. We were very concerned about welcoming them to delayed start to their senior year. We are evaluating the full LSU SOM NO and helping them build connections with our Humberto Aguilar, MD Sathya Jaganmohan, MD David Philips, MD impact on scores, although, as with Step 2 CK, the average faculty, our administrative staff, senior students, and their John Bienvenu, MD L. Webster Johnson, MD Arthur Poch, MD for students taking it so far has been similar to prior years. peers. Leaders from the class of 2023, who are responsible Natravis Cox, MD John Kirkikis, MD J. Mark Provenza, MD for planning orientation activities, did a spectacular job of David Dies, MD Nicolas LaBarre, MD Douglas Rimmer, MD James Hobley, MD Abby Linzay, MD

TO READ THE FULL ARTICLE VISIT WWW.LSMS.ORG/JLSMS CENTRAL PIERREMONT SOUTH SHREVEPORT BOSSIER MINDEN 3217 Mabel Street 8001 Youree Drive 8383 Millicent Way 2400 Hospital Drive 216 West Union Street Shreveport, LA 71103 Suite 540 Suite B Suite 370 Suite B Shreveport, LA 71115 Shreveport, LA 71115 Bossier City, LA 71111 Minden, LA 71055 30 J LA MED SOC | VOL 173 | SUMMER 2021