Teaming Up with Our Nurse-Midwife Friends

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Earlier this month, I had the good fortune to attend the American College of Nurse Midwives (ACNM) annual meeting in Nashville, TN. What a fabulous meeting in a great location. The meeting program was diverse and holistic, with an emphasis on the same issues ob-gyns are struggling with: improving safety in our birthing centers, improving global women’s health, and changing the delivery of care right here at home so that we see healthier moms and babies.

An ACOG delegation—including myself, Executive Vice President Dr. Hal Lawrence, Past President Dr. Richard Waldman, and President Elect Dr. John Jennings—attended the opening ceremonies and were greeted with a thunder of applause, an acknowledgment that collaboration in improving women’s health and access to care is a shared goal of our organizations. ACNM also gave ACOG a very special award: the Organizational Partner Award for aiding in the development and practice of midwifery. This award was very meaningful to us. It was recognition that ob-gyns and nurse-midwives do collaborate, share delivery services, and very much depend on one another. The changing face of health care ensures that our professions will continue to interact, innovate, and work together.

Change is tough, because often it means separation from our comfort zone and having to adopt different behaviors or different approaches. Some physician practices have quickly incorporated midwives, and others have not. According to trends in the ob-gyn workforce, we do not have enough physicians in our specialty to meet the challenges ahead. The reality as we look toward the future? It is likely that many models of collaborative practice will be adopted by more and more physicians, both out of necessity and because it just makes sense. Expanding our access to patients with physician assistants, nurse-midwives, and nurse practitioners when possible both serves our patients and allows ob-gyns an opportunity to focus on the work that specifically requires our special skill set. We will need to look closely at how we provide care, and particularly on how we collaborate on the delivery of care, over the next decade. I’m personally looking forward to sharing more information on successful strategies to provide our patients with the best coordinated care we can.

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Guest Blog: My Life As A Gellhaus Fellow

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An introduction by Thomas Gellhaus, MD: ACOG has an incredible commitment to advocacy for our patients and our members. For many years, ACOG has offered programs—such as the annual Congressional Leadership Conference and the McCain Fellowship—that provide ob-gyns with an interest in advocacy an opportunity to learn more about the legislative process and speak to Congress about women’s health issues. However, there were no programs specifically geared toward our younger MDs, ACOG Junior Fellows, and ob-gyn residents.

I founded the Gellhaus Resident Advocacy Fellowship in 2010 to provide just such an opportunity. Since then, we’ve had 14 residents complete the program, and three additional residents have been selected for 2014. During their month-long advocacy and policy immersion experience with ACOG’s Government Relations division, residents complete a project and also write a short summary of their experience. Many, if not all, of the past Gellhaus Fellows have gone on to do further advocacy and policy work.

I was bitten by the advocacy bug in 1994, and hopefully many more ACOG members will with this opportunity. It is evident from Sara Tikkanen’s article below that she has also been bitten!

Sara Tikkanen, MD

Sara Tikkanen, MD

My Life as a Gellhaus Fellow

When I first found out I had been chosen as a Gellhaus Fellow, I was ecstatic. I was excited to go to Washington, DC, for a month during my chief year to learn more about ACOG, our government, and advocacy. After my initial excitement had settled, I was somewhat nervous, primarily because I wondered: “Do I know enough to make a difference?”

Soon after my arrival, I was put at ease by the fantastic staff at ACOG who gave me a crash course on women’s health advocacy. After attending my first few Hill meetings and other government relations events, it became clear that I indeed knew a thing or two about medicine, and I was in a unique position to provide a new and different perspective to the legislators who actually make decisions that directly impact our ability to practice medicine.

During my time at ACOG, I have mainly focused on the issue of the ob-gyn workforce as it relates to the Affordable Care Act. In my opinion, now is the time to focus on the impact that 10 million more women needing gynecologic care will have on hard-working physicians already stretched thin with time and resources. I have tried to highlight the importance of continued Graduate Medical Education funding so that we can increase our workforce. A great example of this is the The Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act which would help create more residency slots.

I have also focused on the importance of tort reform so that current practitioners can continue to provide care without the burden of high medical liability insurance premiums. I have participated in discussions addressing the implications of the Medicare Sustainable Growth Rate, the flawed formula used to determine physician payment rates, and the efforts to repeal it. A vast majority of the lawmakers I have spoken with agree that we need a fix. While few seem to have a concrete solution in mind, all are open and eager to discuss possible solutions.

My time here has been wonderful and eye-opening experience. It’s motivated me to become more involved as a resident at the University of Iowa, and upon graduating, as practicing obgyn in the great state of Wisconsin. I’d like to thank Dr. Gellhaus and the staff at ACOG for making this month possible.

In reflecting on my experience, the most important thing I’ve learned is that I have an obligation to be an advocate, not only for my patients but also for ob-gyns and physicians as a whole. Decisions which directly impact our ability to care for our patients and ability to practice medicine are being made by legislators who do not know nearly as much about medicine and the day-to-day challenges associated with being a physician as the physicians themselves. I challenge each Fellow and Junior Fellow to take an active role whether that be at a hospital, state, or federal level. Only by being involved can we make a difference.

Sara Tikkanen, MD, is an ob-gyn resident at the University of Iowa Hospital and Clinics.

Sara Tikkanen, MD, with Senator Tom Harkin

Sara Tikkanen, MD, with Senator Tom Harkin

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Smoking Cessation Front and Center with “Talk With Your Doctor” Initiative

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As “Physician to the United States,” the US surgeon general speaks with a strong voice about a variety of health concerns, with a focus on prevention and wellness. January 2014 will mark the 50th anniversary of the first surgeon general’s report to conclude that smoking cigarettes causes lung cancer. Five decades later, 43 million American adults continue to smoke, and cigarette smoking kills an estimated 440,000 Americans each year.

I was happy to represent ACOG last week, standing with Surgeon General Regina Benjamin, MD, the Centers for Disease Control and Prevention, and our colleagues at other physician organizations to launch “Talk With Your Doctor,” a campaign to encourage patients to come to us, their physicians, and learn how to succeed with smoking cessation. As ob-gyns, we need a strong voice here. We see the short- and long-term impact of smoking on women and on their families. It is imperative that we assist all of our patients in their efforts to quit smoking, especially our pregnant patients.

A woman who stops smoking at the start of a pregnancy can reduce her risk of pregnancy complications. We ob-gyns need to help our pregnant patients understand that smoking cessation brings immediate results and immediate successes.

The most important step is to ask, and then to respond. We need to treat smoking the same way we have treated vital signs—as a measure that we routinely screen for and assess—and be prepared to support patients who are ready to kick the habit. Surveys have shown that most of us ASK about smoking, yet only one-third provide assistance or a program. Cessation programs are most effective in helping people quit smoking.

When we see our patients, we all need to remember the FIVE A’s:

• Ask about tobacco use.
• Advise to quit.
• Assess willingness to make a quit attempt.
• Assist in quit attempt.
• Arrange follow-up.

ACOG has developed a smoking cessation during pregnancy guide for clinicians to help pregnant patients kick the habit. Check out this helpful resource and be ready when a patient says “I was told to ‘Talk With My Doctor.’”

Dr. Conry and "Talk With Your Doctor" Panel

Dr. Conry and “Talk With Your Doctor” Panel

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Farewell to Our Friend and Colleague, Dr. Sterling Williams

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ACOG is a great organization because we stand for women’s health, women’s reproductive rights, and the needs of our physicians. It is in supporting our physicians that we excel. We have developed some incredible leaders and departments at our national headquarters in Washington, DC, that really support these goals. ACOG’s education department is certainly one of the standouts.

I was so sad to hear news of the passing of Dr. Sterling Williams this week—ACOG’s Vice President of Education—because he devoted his life to education and helped each and every one of us ob-gyns. Just a few days before I became President, Sterling and I had lunch together. He was excited to share news of his family, the transition he was considering as he retired from ACOG, and to discuss all of the changes he was contemplating. He had invited me to participate in one of his great achievements this year, a simulation training program.

Sterling understood the many challenges in our profession as well as the importance of preparing residents for the future and of keeping ourselves up to date on advancements in practice to provide the best care for our patients. But Sterling did so much more. He was a true Renaissance man who glowed in the accomplishment of receiving his doctorate last year, who performed in a world-renowned chorus with his incredible baritone voice, who had television and movie roles with Bill Cosby and Spike Lee. And more than anything else, he was a man who wanted to see each and every ACOG Fellow succeed.

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A Lesson In Breasts, Starring Angelina Jolie

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Sometimes, public interest in the lives of celebrities helps us in medicine. For years, I have wished that a celebrity would champion the importance of contraception, planned pregnancies, and reproductive choices. Someone to share that planning for a pregnancy, optimizing health, taking preconception folic acid, and making healthy choices was fashionable. Alas, I’m still waiting for this to happen.

But this week, Angelina Jolie did a great service by bringing attention to the very difficult choices women face in the complex world of breast cancer, screening, prevention, and genetics. It was almost 40 years ago when First Lady Betty Ford openly discussed her breast cancer, mastectomy (surgical removal of the breast), and the importance of a screening mammogram. There was a surge in screening mammography after her revelations, and she personally helped Nancy Brinker get the Susan G. Komen Foundation started. It’s a great example of a well-known individual making a big impact on women’s health.

Hopefully, Ms. Jolie’s announcement will have a similar effect. She has taken the key message of preventive health, and used a very important term, “empowerment.” Clearly, her decision to have a double mastectomy in order to lower her cancer risk was not made lightly—it was made with a collaborative team that factored in her family history, risk factors, and the individual options available to her. In describing her experience, Ms. Jolie addressed the concerns many women have about their family support, family impact, and perception of self. She discussed how rare BRCA gene mutations increase a woman’s risk of developing cancer and the health disparities that stand in the way of more screening and treatment for women with these inherited risk factors. These are the issues our ACOG Fellows face daily—determining which patients need a comprehensive screening approach, providing the appropriate care, and having a team well-versed in genetics and risks to tailor the care to the individual.

Quite frankly, we as ob-gyns can’t know it all, but we sure can get a team that collectively does! We need to be knowledgeable in the appropriate screening protocol (ACOG recommends routine screening for hereditary breast and ovarian cancer). We also need to be prepared to counsel patients with elevated risk, and to call on the expertise of geneticists, surgeons, oncologists, and radiologists to collaboratively manage a patient’s care. It is up to us to be aware of risks for our patients and develop the best available system to help them make personal decisions.

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Finally, Women’s Health Gets Its Due

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It is an amazing time for women in the US. The recent passage of the Affordable Care Act (ACA) shows that women’s health has been embraced as a national priority. Implementation of this landmark legislation will improve and expand health care for millions of women. From yearly well-woman visits to cancer screenings and domestic violence screening and counseling, to breastfeeding support and contraceptive coverage, more women’s health services will be accessible and affordable than ever before.

It’s with this backdrop that I take the reins as president of The American Congress of Obstetricians and Gynecologists, and I couldn’t be more excited. As a nation, we’re finally recognizing that health care is about more than solving accute health crises. It’s about promoting wellness to prevent disease. For ob-gyns, providing top-notch health care includes having meaningful interactions with women and providing them tools not only to maintain their physical health, but to improve their physical, mental, and emotional health, too.

Ob-gyns will be greatly affected by the new law, but we’ll also have a chance to make a great impact. We will be gaining new patients and collaborating with colleagues to optimize their health. We should strive to make the most of these patient-doctor visits and encourage women to put their health first—take advantage of the services ACA offers; get preexisting health conditions under control; make time for eating right, exercise, and the stress-relieving activities that they enjoy. These are fundamental health reminders that we must convey to every woman, every time.

As an ob-gyn, I believe that no medical specialty knows women’s health better than we do. We have a duty to speak up in the best interest of women’s health. During my year as ACOG president, I plan to take every opportunity to advocate for women. I challenge ACOG Fellows to let your voices be heard as well. Talk to your legislators and your community about women’s health, but most of all, talk to your patients. Working with them one-on-one to build the foundation for a healthier future is where we can make the biggest difference.

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Time Flies When You’re Having Fun

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What a ride this past year has been! As I wind down my time as ACOG president, I’m proud of our accomplishments—we remained a strong and vocal supporter of women’s reproductive rights, made strides in standardization of care and patient safety, and moved forward in communication and technology, including the introduction of the new ACOG app for ob-gyns.

Two main themes during my presidential year have been the essentialness of contraceptive access for all women and the importance of having women in leadership roles. For the “grand finale” of my presidency—the President’s Program on May 6 at ACOG’s Annual Clinical Meeting (ACM) in New Orleans—I’ve assembled a roster of phenomenal speakers that will offer their unique spin on these topics.

I’m happy to welcome Malcolm Potts, MD, chair of population and family planning at the University of California Berkeley’s School of Public Health. Dr. Potts has studied extensively the positive societal changes that come when women can make their own reproductive health choices. In a recent speech, Dr. Potts said “If you’re working in cancer or orthopedics or pediatrics, you make people healthier by trying to relieve pain and suffering. What we’ve done in gynecology is change civilization.” His lecture “Sex, Ideology, and Religion: How Family Planning Frees Women and Changes the World” is one not to be missed.

Next, I’ve invited two exceptional leaders, colleagues, and ACOG vice presidents, Sandra A. Carson, MD, and Barbara S. Levy, MD, to present “Your Personal Path to Leadership: The Road Less Traveled.” They’ll discuss their own not-so-traditional journeys to becoming leaders in our field and the need for diversity in leadership.

Rounding out the program, Gary Chapman, PhD, author of The Five Love Languages, will present his speech “The Five Languages of Apology.” His insightful presentation will discuss the importance of apology in developing, maintaining, and repairing relationships.

Though my year as ACOG president is coming to a close, my involvement will continue. I’m looking forward to supporting our new president, Jeanne A. Conry, MD, PhD, in her endeavors and continuing to be an outspoken advocate for women. I’m also looking forward to more time for family and mountain biking in Nevada! Many thanks to ACOG Fellows and staff for your support and friendship throughout this amazing year.

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