AMA Alliance Today January/February 2008

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January/February 2008

Volume 68 | Issue 1

todayAMA AllianceFor Members of the American Medical Association Alliance

Balancing Personal and Professional Life

The Medical Marriage

January/February 2008Volume 68 Issue 1

OUR MISSIONThe mission of the American Medical Association Alliance, Inc., is to partner with physicians to promote the good health of America and to support the family of medicine. As the organization’s member magazine, AMA Alliance Today is committed to providing readers with the news and information most relevant to today’s medical families.

We welcome your suggestions, concerns and ideas. Please send all submissions to:

AMA Alliance TodayAMA Alliance515 N. State St., 9th FloorChicago, IL 60610Phone: 312.464.4470Fax: 312.464.5020E-mail: [email protected]

EXECUTIVE DIRECTORJo Posselt

EDITORRosetta Gervasi

MANAGING EDITORLeia Vincent

Senior EditorJennifer West

Contributing WritersMelissa Walthers

ADVISORY BOARDDianne Fenyk – PresidentSandi Frost – President-ElectNancy Kyler – SecretaryCarolyn Plested – TreasurerNita Maddox – Immediate Past President

Design and Layout Anna Matras

AMA Alliance Today (ISSN 1088-7393) is published six times per year by the American Medical Association Alliance, Inc., 515 N. State St., Chicago, IL 60610. The subscription price per year for members of the AMA Alliance is $3.50, included in annual membership dues. The subscription price for non-members is $7 in the United States and U.S. Possessions, $10 in all other countries. A single copy is $2.50. Printed in the U.S. Change of address may be made by sending old address (as it appears on your AMA Alliance Today) and new address with ZIP code number. Allow six weeks for changeover. POSTMASTER: Send address changes to AMA Alliance Today, American Medical Association Alliance, 515 N. State St., Chicago, IL 60610.

The inclusion of an advertisement in this publication does not indicate endorsement by the AMA Alliance for the products or services advertised.

© Copyright 2008 by the American Medical Association Alliance, Inc.

5 Balancing Personal and Professional Life for the Medical Family

10 2008 Editorial Calendar

11 The Medical Marriage

3

4

From Our Alliance Family to Yours

Editorial

16 County Alliance News

17 State Alliance News

9 Screen Out! News

14 Issues Watch

8 Member Profile

inside every issue

features

on the cover

18 Q&A

About our cover: Alliance member Gretchen Dupps from Bay Village, Ohio and her family (left to right) Adrianne, Christian, Alexandra, Gretchen and B.J. spend a relaxing day on the beach in Melbourne, Florida. Photograph by J.C. Sayler, Gretchen’s father.

January/February 2008 AMA Alliance Today 3

President’s Letter

In one of those art-life imitation scenarios, this issue of Alliance Today looks at the medical marriage and balancing work and home life for medical families at the very moment my own life as a physician’s spouse and employee is taking a new turn. After 25 years of solo private practice, my husband John is joining the faculty at the University of Minnesota and will practice there full-time. This change in our lives is a dramatic one for several reasons. I have always been John’s office manager, so this means I’ll become unemployed after March. Since we live three minutes from the office, we have always enjoyed the lunch hour at home together and a short commute, while the “U” is 30 minutes away. John has had Fridays off for years and we’ve been able to schedule vacations at our convenience. At the “U” he’ll be working full-time with vacations scheduled in advance. Perhaps the biggest change of all is that he will be giving up his autonomy as a private physician.

Will all of these changes put a strain on our relationship or strengthen it? In nearly 40 years of marriage, we have made many choices and adjusted to many changes— the decision to give up teaching middle school and go into medicine, going into solo private practice instead of an established clinic, my staying home with our girls when they were young, becoming empty-nesters, our volunteer time commitments and of course a 25-year history of professionally working together. I have no doubt that we are up for the challenges this opportunity brings. I also have no doubt that the road may be bumpy—at least for the first few months. The three things that concern me the most are the reduction in time we spend together and that I will not know the people and patients he’ll be seeing on a daily basis. Conversation will be different—we’ll lose much of the common bond we’ve shared for a very long time. And my number one concern? John’s adjustment to bureaucracy!

Many Alliance members work in their spouse’s offices. I suspect this has been a matter of convenience or economics for many of you, but I bet you are all grateful for the privilege of seeing your physician spouse through the eyes of others. John’s professionalism—both as a doctor and as an employer—is something I would never have witnessed had I not worked beside him. The respect I have for him as a person has dimensions that reach far beyond a wife-husband relationship. To be honest, it has not always been a cakewalk. I hate working the front desk and it took me a while to develop the patience needed to deal with insurance company clerks. The balance in our lives has come from the joy of being together, a shared partnership and an understanding that a career in medicine is more than a job, it’s a way of life.

I know every Alliance member understands what my concerns are, what is going through my mind as John and I take these next big steps. Many of you have faced similar situations in recent years—closing offices, merging clinics and hospitals, going into academia, retiring. You have not only faced the challenge of change, you have embraced it. You have made life in the family of medicine work for you and your family. I’d love to hear how you did it!

A happy, healthy, opportunity-filled 2008 to each of you!

Dianne Fenyk AMA Alliance President [email protected]

From Our Alliance Family to Yours

I’ve been conducting interviews for many years—often for association publications, sometimes for other types of magazines, Web sites or communications materials. Regard-less of the communication vehicle for which I’m doing the interview, however, I typically ask two questions among all the others. I always end the conversation by saying: “Tell me something that your colleagues around the country would be surprised to learn about you.” And when I’m interviewing someone who is the member of an association, I always ask: “What motivated you to join?”

I am invariably astonished by the fact that the former inquiry often opens the gates to engaging admissions and fascinating anecdotes that are characterized by their breadth and variety. Here are a few examples from the answers I’ve heard during recent interviews:

• “My colleagues would be surprised to learn that I can milk a cow by hand.”

• “I was diagnosed with an inherited condition that virtually always leads to death. There are only six families in the world that have it and everyone except me has died. Death is the norm for someone with my condition, so my long-term goal is to stay alive.”

• “Other members would be surprised to learn that I used to work with the real ‘Bad, bad Leroy Brown, the baddest man in the whole damn town,’ immortalized in the well-known Jim Croce song.”

In contrast, the latter question is notable by its very lack of variety--the consistency of the replies it elicits:

· “Someone invited me to attend a meeting, and I loved the camaraderie I found when I got there.”

· “The mother of one of my good high school friends was president of the group and asked me to join. I found the group so warm and welcoming, an immediate bond was formed.”

· “A neighbor invited me to a meeting, and I liked what I saw. The group was friendly and inclusive, and I’ve made lasting friendships with the people I met that night.

In fact, the answer has been offered so consistently as a reply that it has become a litany in my brain whenever I pull out my notebook and pen.

Membership recruitment on any level can prove challenging these days, especially when it is viewed in the context of social trends and perceptions that seem to predict failure—marriages and relationships don’t last, people are constantly on the move, commitment is viewed as an outdated concept.

You’ll find scores of statistics that document the downward trend—that explain why membership is suffering across the spectrum and offer reasons why:

• People no longer view themselves as “joiners.”

• Members increasingly are busy, stressed and less able to donate time and energy to the association.

• There is increased competition from for-profit businesses for the advantages nonprofit associations offer members.

• There is greater competition among associations them-selves and from upstart entrants in the nonprofit field.

• There is a growing need to provide value-added, differentiated services in order to keep members.

Indeed, the declining membership base across the industry is a primary reason associations increasingly rely on nondues revenue to boost their operating budgets.

All the trends analyses notwithstanding, however, one essential certainty remains. The most important ingredient for membership recruitment and retention (for Alliance members at least) seems to be making a concerted effort to invite prospective members and providing a warm, receptive and inclusive atmosphere when they get there.

Benefits, advantages, programs—call them what you will—are all great ways to keep new members coming back, but remembering to invite them and making them feel welcome once they arrive is a critical first step.

And that may turn out to be the most astonishing truth of all.

Someone Invited Me and Made Me Feel Welcome When I Got There

Editorial

By Rosetta Gervasi

4 AMA Alliance Today January/February 2008


By Jennifer West

The pressure to maintain a balanced life can prove tough for most professionals. How-ever, factoring in long irregular hours and the stressful responsibilities, attempts to keep a healthy balance between pro-fessional and personal life can prove to be a particularly difficult feat for physicians and their families. Despite the challenges, prioritization, effective time management, focus on communication, making small changes and taking a pro-active role in life are small steps that can promote and support a balanced life.

According to the Bureau of Labor Statistics, more than one-third of full-time physicians worked 60 hours or more per week in 2006. Only 8 percent of all physicians and surgeons worked part-time, compared with 15 percent for all occupations. In addition, physicians and surgeons must travel frequently between office and hospital to care for their patients, often compromising personal time with family.

According to Robert Brooks, Ph.D., assistant clinical professor of Psychology at Harvard Medical School, who regularly treats physicians, there are key issues that can lead to an improper balance of work and personal lives. “Physicians are trained to help others so there is this wish to be available and accessible for their patients,” said Brooks, co-author of the book The Power of Resilience: Achieving Balance, Confidence, and Personal Strength in Your Life. “But this can be problematic because physicians also have a family, leading to a great deal of stress as they try to balance everything.”

Be True to Your Values When treating physicians, Brooks often asks the patients to make a list of things that are important in their lives. Most list their spouse, kids, family, health, religion and work. That notwithstanding, a number often report that they spend the least amount of time with the people and activities they assess as being most important to them. That’s where prioritization comes in, according to

Prioritization, effective time management, focus on communication, making small changes and taking a proactive role in life are small steps that can promote and support a balanced life.

Balancing Personal and Professional Life

For the Medical Family


Brooks. “I have many patients express that they sometimes feel estranged from their kids and are like strangers in their own homes. It is important to be true to your values to ensure that such situations are avoided.”

Brooks explains that being true to your values starts with small changes, noting that attempts to change many things at one time will likely produce unsatisfactory results. While making it home for dinner once a week may not seem like it will effect much change, it is the small things that set lasting results in motion, according to Brooks. He tells patients that it may entail scheduling time for their family, while at the same time learning to set certain limits and parameters on their obligations. “It could be as simple as trying to make it a point to attend the kids’ events—school conferences or sports activities. It is also important to start small to be able to fulfill those personal commitments.” He goes on to caution that it sometimes becomes difficult for family members, especially children, to cope if a parent commits to attending a function and cannot follow through.

Diane Halpern, Ph.D., professor of psy-chology at Claremont McKenna College, contends that achieving balance may require changing your own definition of what it means to be a “good parent,” creating ways to be close with the children on your own terms. “It is possible to make the two roles as parent and professional compatible,” says Halpern, co-author of Women at the Top: Powerful Leaders Tell us How to Combine Work and Family. “Redefining your definition of what it means to be a successful person in your careers can eliminate feelings of guilt and stress as long as you know and stick to rules and goals.”

Communication is Key Both Brooks and Halpern agree that communication is imperative when it comes time to initiating changes. Talking to your family to find out specifically what they expect and feel they need from you will make small changes meaningful by allowing you to focus your time efficiently. According to Marilyn Puder-York, Ph.D., a psychologist, professional/executive

coach and author of the book The Office Survival Guide. It is important for physicians to use exceptionally good communication skills when with their family members. Puder-York points out that both spouses have to agree on what expectations are with regard to a physician’s commitment to family involvement and sharing of personal time, especially since medicine is not a nine-to-five profession. If that’s not clear, there is a possibility for resentment to build. If a physician is focused on working and making money, and the spouse is inter-nalizing resentment, it can lead to long-term problems, according to Puder-York.

“It’s about understanding the needs, wants and preference from the person you’ve chosen to commit to,” she says. “Whether it’s medical school, residency or a long-term career, compromise is important and there has to be a proactive approach on both sides.”

A physician and his or her spouse must have an accurate definition of balance specifically for their family and understand that the effort to achieve balance is ever-changing. According to Puder-York, periodic communication with each other ensures that both parties are on the same page. Making sure children understand the situation is even more important, she says.

Don’t Forget the Kids Children can sense when something is going on. “There are ways to keep children informed by being as honest as possible with them, while respecting the child’s age,” says Brooks. Talking to them about what’s happening is especially important, he says, because kids may draw conclusions that are often more serious than what the reality is.

If there is a breakdown in communication, children may feel that they are not as important to their parents as their work. Even when things get very busy, children need to know that there will be time that is just for them. It need not necessarily be a big chunk of time, says Brooks, but it’s the short precious moments that can be most important. He also advises that parents be proactive in building good times. “Leading a balanced life makes it easier for them to be involved. Conversely,

When treating physicians, Brooks often asks the patients to make a list of things that are important in their lives. Most list their spouse, kids, family, health, religion and work. That notwithstanding, they often report that they spend the least amount of time with the people and activities they assess as being the most important to them.


it can become difficult to raise resilient kids if their parents are not capable of handling setbacks.”

Taking Control Most experts agree that conscientious efforts to change should be coupled with a resolve to lead a more controlled life. It is proven that people are more resilient when they feel they have a sense of control of their lives.

According to Brooks, “We are the author of our own lives. There are things we can put into place before it spirals out of control.” For physicians, it is important to figure out how time spent not on call or working will best be used, he says. “Will it be used to do more work or to spend time doing things that make one truly happy?”

AMA Alliance member Nancy White is familiar with the ongoing stress medical families face. As the spouse of a physician for 41 years, she says, “It is difficult because the medical profession is not as respected as it used to be and combined with the stresses of modern living, the negative messages from society serve to devalue the consistent, dedicated efforts physicians make in trying to help their patients. When doctors’ best efforts are not appreciated, families who see how much dedication is involved tend to feel resentful of public anti-medicine attitudes.”

It Starts with Personal Fulfillment There are many stresses and challenges in today’s world, says Brooks, but one of the most important coping mechanisms we can develop is a plan for dealing with them. He notes that the ability to cope, become a good problem solver, react better to situations and make a contribution to the lives of others but not at the expense of their own health will translate to personal and professional fulfillment. When a person is engaged in helping others, he says, it gives them more meaning, purpose and passion. But it is important to not give so much to others that they neglect their own lives.

“Learning to balance your life can be very difficult, but think of what life will be like if it’s not addressed,” said Brooks. “I’ve counseled heart attack patients and those with children in drug rehab programs who wish they had addressed imminent problems before the situation got desperate.”

The experts interviewed agree that while it’s difficult to promote and achieve balance, there are no viable alternatives to trying. The reality is that there are many variables which we have no control over, but many which we can address. Being the author of your own life and making the changes slowly to produce the best results is possible, says Brooks. “By partaking in things that give you the greatest joy, you will be in a better position to be productive,” he states.

“There always needs to be a tradeoff,” adds Puder-York. “It’s not going to be perfect, but you have to find what works for you. There is the illusion that doctors are smart enough to connect the dots. But it can be difficult to bring it all together.”

Most experts agree that conscientious efforts to change should be coupled with a resolve to lead a more con-trolled life. It is proven that people are more resilient when they feel they have a sense of control of their lives.


Ruth Parry: Building a Sense of Community

Ruth Parry doesn’t remember what she was expecting to get out of her Alliance member-ship when she joined 35 years ago, but she feels being a part of the association has exceeded her expectations just the same. “I was struck by how warm the people at the meeting were—how they welcomed me. It proved a great way to make friends.”

Parry has never had a profession outside the home, but she’s made volunteering in her community a career. Over the years, she held a number of offices on both the county and state level, including serving as district and state president. Currently, she is the Meals-on-Wheels coordinator and also edits the newsletter for her state Alliance. The South Dakota State Medical Association Alliance (SDSMAA) was the first group in the area to adopt the community service program that provides meals to men and women who are elderly, homebound, disabled, frail or at risk, and has been operating the program for more than half a century.

Another initiative that’s close to Parry’s heart is the orientation for the local medical college, where her husband is the dean. Parry works with the college to coordinate the annual event for new students. “It helps build a sense of community,” she says. We encourage the students to make friends so they have support over the next year, which can be difficult, and from that we also get members, which is very satisfying.”

Parry is also gratified that her son is a member of the Alliance. “My son Eric is married to a physician,” she says. “He’s a stay-at-home Dad and is very active. Currently, he’s trying to set up a play-date program for other Alliance members. Next spring, he is also planning to run in the breast cancer run.” He’s organizing a group of runners who will participate in the race sporting their Alliance shirts en masse. Eric Parry also works with his mother to put out the newsletter (he’s the computer expert on the project) and he helps her with Meals-on-Wheels duties.

Says Parry, “He’s interested in helping other medical spouses deal with being a ‘single’ parent when your spouse is very busy. I think one of the reasons he’s so active now is that when he was growing up, he was always with me when I was volunteering; he was in the back seat going with me on all the Alliance projects I worked on.”

She adds that although Alliance members pride themselves on accomplishing goals within their community, they shouldn’t lose sight of their primary collective goal: “Helping each other—building a sense of community.”

It didn’t take much motivation. I wanted to be part of something. The medical community in this area was growing and I wanted to connect to the people my husband mentioned from work. -R.P.

Do you ReMeMBeR what MotivateD you to join the aLLianCe?

Member Profile

Something my

Alliance friends

across the country

may not know

about me is that I

grew up on a farm

and know how to

milk a cow by hand.

”“

Take Action! February 18-24 marks International Week of Action

Smoke Free Movies International Week of Action is part of a global movement of more than 15 countries on four continents to raise aware-ness about smoking in youth-rated films around the world. This effort is organized the week before the Oscars to bring special attention to the issue. Our Screen Out! campaign plays a major role in creating this awareness in the United States through AMA Alliance members.

During the week of February 18 through February 24 we need Alliance members to organize Screen Out! events in their local communities to make the international voice even stronger. Use the week to create a petition drive, letter-writing event or gain organizational endorsements from local partners in your community. Here are two simple actions we are asking Alliance members to take:

1. Collect 20 petition signatures per member of your local Alliance. (example, if your county Alliance has 25 members, collect 500 signatures).

2. Obtain one organizational endorsement for the four solutions to getting smoking out of movies.

If you achieve each of these goals and report your successes back to the national office March 10, 2008, your Alliance chapter will win three movie posters and other Screen Out! promotional items to use for future events.

Help make the family of medicine’s voice loud this week by joining groups around the world in bringing attention to this issue so that Hollywood can hear this message and save lives: Get smoking out of youth-rated films now!

Materials to assist International Week of Action activities are available online at: http://www.screenout.org/events/index.html

Scholarships to attend the National Advocacy Conference in Washington, D.C.

The Screen Out! campaign will be offering five $1,000 scholarships to Alliance members to attend the Alliance Capital Conference/AMA National Advocacy Conference (NAC) in Washington, D.C. from March 31 through April 2, 2008. All members who have shown exceptional participation and action on the Screen Out! campaign in their local communities are encouraged to apply. Applications are due by February 20, 2008. To download an application, please visit www.screenout.org and send all applications, questions or concerns to [email protected].

This edition of Screen Out! News was written by Melissa Walthers, Screen Out! Project Coordinator.

Screen Out! News

Screen Out! News

Op-Ed article written by Cindy Ackerman of the Muskegon County Medical Society Alliance in coordination with the local medical society, published in December 2007 by Muskegon Chronicle.

•MedicalDynasties--Multi-PhysicianFamilies

•ManagingthePractice

•OurRegularFeaturesandDepartments

Watch your mailbox for the March-April issue of Today, with:


Regular departments and columns…· President’s Message· Editorial· Letters from Our Readers· Screen Out! News· State and County News· Q&A· Member Profile· Project in Focus

Key Topics in each Issue…

March-April 2008Cover Story: Medical Dynasties—

Multi-Physician FamiliesFeature: Managing the Practice

May-June 2008Cover Story: Students and Residents—

Making the TransitionSide Bars: Services Most in Need—

What Students, Residents and Their Spouses Are Saying

Feature: The AMA Foundation: Supporting our Own

Feature: Domestic Violence and Abuse

July-August 2008Cover Story: Teen Issues in your

Community—From Drug Use/Addiction to Violence

Sidebar: Meth Abuse Sidebar: Smoking and Chewing

Tobacco Feature: The YouTube.Com

Phenomenon

September-October 2008Cover Story: Women’s Health—Today’s

Research: The Woman’s Health Initiative and the Nurse’s Health Study

Sidebar: Women’s Health Specialists Feature: Caught in the Middle:

The Sandwich Generation

November-December 2008Cover Story: Healthy Lifestyle Solutions Sidebar: How to Be a Proactive

Medical PatientFeature: Health Literacy

January-February 2009Cover Story: Underserved/Underinsured

Populations and Why We Should Care

Sidebar: Free Clinics Supported by Physician Families

Sidebar: Infant MortalityFeature: ERs: The New GPs?

March-April 2009Cover Story: MRSA Sidebar: The New Infections:

An Update--Avian Flu, West Nile and Killer Colds

Feature: Oral Health and Total Health—the Infection Connection

Future Topics To Be Used as Space Permits· Looming Shortage of Physicians:

Truth or Fiction· Mental Health· Gun Violence/Street Gangs· Financial Makeover for the

Medical Family

Subject to change without notice at the discretion of the publisher.

No magazine can be all things to all readers. On one level, all magazines are a reflection of their readers and the world in which they function. But any good magazine also takes readers beyond who they are and what they do and gives them glimpses of who they can be and what they can accomplish. It helps them consider the impact that news and issues has on their lives and the lives of their families. It explores their place in the larger world and motivates them to examine their position and priorities.

Today is no exception. We strive for balance in our reporting and our editorial mix. The impact of each issue we cover on the medical family is an important component of every story we write. We offer news and issues, profiles of Alliance members, success stories from our state and county Alliances, letters from our readers, events to note on your calendar, and resources to help readers—personally and in their work for the community.

But we are more than that. Our goal is to represent our readers’ world, but also to encourage them to question the way things are and to prompt reflection—to offer them the promise and the possibility of the future.

2008editorialcalendar


Romantic comedies are a huge high-grossing genre with the film industry. And there is a reason a large percentage of the population flocks to the movie theaters to see these types of movies: They leave the viewer with the notion that love is a fairy tale. The problem is that these kinds of movies don’t show what happens after the “happily ever after” part. The hardships and growing together are what a marriage is all about, and in a medical marriage, in particular, it takes both parties working together and sacrificing for each other to make it work.

The Glass Half-Full DilemmaMost people can be categorized broadly into basic personality types that color how they view the world—optimistic and pessimistic. Some people look at the situation and focus on the positive, while others analyze every potential negative contingency in advance. According to Linda Miles, Ph.D. and wife of Robert Miles, M.D., co-author with her husband of The New Marriage: Transcending the Happily-Ever-After Myth: “One is a style of pleasure, and the other is one that sorts away from pain. Both people want to be happy, but because most physicians are so used to seeing accidents and serious illness, they will choose to sort away from pain.” The Miles have been married for 18 years and have practiced couples therapy together for 25. An example from their personal life is a boat trip they took. While Linda was excited about the open seas and relaxing in a secluded place, all her husband, the physician, could think about was the fact that there might be a storm and that he needed to make sure everyone wore their life vests. “We sometimes take this worry home with us into the marriage,” says Robert. “And it can lead to misunderstanding each other.” Linda goes on to explain that it is important to accept each other’s differences. She realized long ago that having her husband always thinking about the contingencies provided safety for the family and allowed them to focus on creating happy and meaningful experiences. She realized that though they had different perspectives, neither was right or wrong, but contributed to their sense of safety and joy for a happy and lasting relationship. “You have to learn not to judge each other and avoid shame and blame,” Linda says. Her husband adds, “And above all, avoid right-and-wrong games.” It all comes down to seeing how the personalities work together and working to keep the balance. Keely Hunsaker, an Alliance member, dentist and spouse of Jerry Hunsaker, M.D. for the past 22 years concurs, “He is always over prepared and I am always looking at the bright side of things thinking ‘everything will be ok.’ But when something goes wrong, he is always prepared with tools or whatever is needed to fix most situations.”

Changes Over Time: Role ReversalsOver the past 30 years, the Women’s Movement has toppled traditional gender roles. Today, female physicians are a norm, but the changing demographics can have an effect on a marriage. “Problems can arise when a person with a role of being in charge at work, male or female, has to come home and share leadership,” notes Robert Miles. “And if two people of this particular kind are married, trouble can occur if everyone doesn’t learn how to shift gears when they come home at night.” In Keely and Jerry Hunsaker’s situation, there are two people who are used to being in charge in the marriage, which could lead to disaster. “We have to re-program to live together because we are both bosses in our respective domains,” says Keely. “As long as he does everything I say, we are okay,” she jokes, going on to explain that it helps that Jerry teases her and uses humor because it works to help her realize how a lot of things she may focus on are not a big deal. He confirms her assessment that he’s a “jokester” by lightheartedly saying, “She has the pleasure personality as long as she is causing me pain.” Robert Miles notes that when he was growing up, he didn’t see feelings being expressed often. He grew up with the expectation that the man brought home the “bacon” and was not involved in much of the daily family life, while the woman was the homemaker. “The view was that homemakers have no work experience or knowledge, but only work to keep up family life,” he says. “However, raising

MedicalMarriage

the

BY LEIA VINCENT



children takes knowledge and skill building that can be used to do just about any job. And it takes the spouse who has a traditional job acknowledging this and not putting down or belittling the role of homemaker.” Many spouses in the medical marriage are lucky to get to work with one another, including Keely and Jerry Hunsaker. They visit each other’s offices a least once a week, sometimes more, and Keely still files the electronic claims for Jerry’s practice. “This allows us to have a better respect of what the other does with their time, and allows for more understanding and flexibility when it comes to missing those aspects of daily family life for work matters,” Keely explains. The evolution of gender roles is only one aspect of change that can affect medical marriages. Another is changes in the institution of marriage itself. The Drs. Miles state that at the turn of the century, an average marriage only lasted eight and a half years due to early deaths from infectious disease, complications of childbirth and other hardships. “Marriage and relationships go through more stages now than they once did, as we now live longer and require more skills and flexibility,” says Linda.

Simple Problems That Can Lead to DemiseToday, when men and women are on equal footing, there needs to be a greater emphasis on working together and talking conflicts through, according to the Drs. Miles. They coined the phrase the “Four Horseman of the Apocalypse,” to refer to four tactics that can spell trouble for a marriage, based on scientific research by John Gottman, Ph.D.:· Criticism: Being critical of the other person/condemning

them, name-calling; separate from general complaining which is normal in small doses.

· Contempt: Smart couples know how to get under one another’s skin; walk in front of the other person, raise eyebrows at just the right moment, put each other down, etc.

· Defensiveness: Don’t listen to the other’s reasoning, just jump on the defensive.

· Stone-walling: Putting a wall up between the couple so they can no longer reach one another.

Emma Borders, an Alliance board member, also shared insight into her marriage of 38 years to Robert Borders, M.D. She notes that a great percentage of their very few arguments

over the years have been about child rearing. She explains that she is the more conservative parent and he the more lenient. In one instance, she explains how Robert, who has two sons from a previous marriage, told their eight-year-old son that he could watch the movie “Terminator,” which he had heard about from his friends at school. Emma, being familiar with what the movie was about and feeling it inappropriate, disagreed. She soon realized that their son was being given mixed messages and that she was being portrayed as the “mean parent.” At first, she was furious, but then realized that Robert just didn’t know much about the movie when he gave his permission. “Once I explained it to Bob, he accepted my decision, and all without heated implications,” says Emma. She added with a laugh, “Most of the time he just needs to be given the facts.” Most marriages don’t end over one huge blow up or irreconcilable difference, as they do in the movies, but over a series of small, unresolved issues. And since a medical marriage can fall victim to an even greater number of stressors, physicians can become preoccupied and not notice the dissatisfaction of their partners. “One day, the spouse of a physician announces that it is over,” says Linda. “The physician is crushed and ready to do what it takes to save the marriage, but there may be too much damage. This is a sad situation that can be avoided.”

“Couples need to repair their problems in a timely way,” she adds. “What seems sudden is generally the build-up of unresolved issues. A loving and lasting relationship requires compassionate listening and the ability to dialogue with a conflict. Love is a practice.” Keely Hunsaker shared an example of this—how, over time, a couple learns how to

approach each other and when to back off. Recently after she had entertained her husband’s family for four days over the holidays, she decided it was only fair to go see her own family. Her husband’s reply was, “No, there are only six more days left in hunting season.” While it hurt her feelings, she didn’t bother him any more about it, figuring she would give him some time to think about it. The next morning, he woke and asked, “So when are we leaving to go see your family?” Keely believes that sometimes the best retort is “just knowing when to shut up.” “Love and marriage are like the practice of medicine, and we now have scientific knowledge of what makes marriages work,” says Robert Miles. “Like medicine, it can only be perfected to a certain extent.” But the Drs. Miles agree that the “Four Horseman” above, used regularly, will slowly ruin any relationship. Emma Borders adds, “Robert understands and once a decision is made, he moves on and does not look back or use past instances in current problems.” Hanging on to past issues without communicating a problem to the partner can also lead to a build-up of resentments and unresolved issues.

Is Love Really All We Need?The experts with whom we spoke said no, but combined with solid techniques, it can sustain a lifetime of happiness with another person. This is not to say there won’t be bumps along the road, but the formula is simple enough to follow and takes the effort of both parties involved. “Over time, after you have been through enough together, issues that arise can’t do as much damage, and the time to repair is much less,” says Linda. “At some point in a healthy relationship, you begin to realize that you can’t change one another, you can only change yourself, and if you can live with that, you will make it through.” She adds that she and Robert believe that the two necessary compliments to love in a marriage are respect and flexibility. “Each person should be respected and if the couple is not in agreement, the disagreement should be of a constructive nature and not lead to an attack by any of the ‘Four Horseman.’” Also, in any relationship, as people get to know one another, they learn how to repair differences over time. One spouse should never try to diminish the role of the other. “It doesn’t matter what the roles,” Robert says. “As long as there is mutual love and respect, different marriage models can work.” Flexibility is a major factor in any relationship, according to Drs. Miles. A person goes from being one person to part of a couple, meaning that they should now be living for two people instead of only for themselves. “In a medical

marriage, flexibility, humor and the ability to discover new remedies for problems help heal us as individuals and

families,” says Linda. A prime example of all three of these

qualities in action can be demonstrated in Keely and Jerry Hunsaker’s family,

with their five children. They make the extra effort to coordinate the schedules of seven people to go to their family ranch on a regular basis. “It is the one place where we are truly a family first. We are 100 miles from home, no landline, limited cell reception, and no

influence from school friends or colleagues,” according to Keely.

“We try to go up there every weekend we can with the kids because it is our

way of keeping connected.” Some matters require both respect and

flexibility. Emma Borders shared another story about her husband’s decision to buy a house without consulting with her. “He enjoys seeing my surprise when he makes major purchases, but he doesn’t realize I want to participate in the decision process too,” says Emma. “I want to look over all the choices.” That house contract was cancelled and they instead found a house with the full family’s blessing. “All it took was for me to point out the things I didn’t like, such as the kitchen and general layout, and he knew he had to get out of the deal,” says Emma. Love is not a fairy tale and marriage takes hard work and compromise. And a medical marriage can be especially difficult, but worth the effort.


how do you keep your medical marriage working?

email us your secrets (100 words or less) for a future

issue. Send your comments to [email protected].

Linda Miles: · “Arguments usually begin and end with the same tone of

voice, so always try to begin in a normal tone.” · “In a relationship, if both people work on themselves,

things will work out because that means there are two people 100 percent committed to the partnership.”

Robert Miles: · “Celebrate every day together.” · “Create family rituals. Linda and I, before we go to bed,

have a spiritual practice and then share with one another one thing we appreciated about each other that day.”

· “These rituals help when arguments erupt because memories of all the good things that the other appreciated are like a positive bank account.”

Emma Borders: · “Learn from each experience.” · “Know that better understanding does not mean

there will be no more disagreements.”

Keely Hunsaker: · “We tell each other ‘I Love You’ about 10 times

a day, and it still feels special.” · “We always kiss each other before we leave.

I am hurt if he leaves without kissing me goodbye. It’s the little things that matter.”

Advice From the Experts According to all the experts in this article, love is a practice, and “Practice makes perfect,

or almost perfect.” Here is some advice from those that are still practicing a healthy marriage.


Issues Watch

On Dec. 19, Congress passed legislation that would replace a scheduled 10.1 percent cut in 2008 Medicare physician payments with a 0.5 percent increase through June 30, 2008.

According to AMA’s eVoice, AMA led a $3 million grassroots campaign to avert the scheduled payment cut. As a result, Congress increased spending for Medicare physician payments by $3.1 billion.

Aggressive AMA lobbying and advertising generated more than 50,000 phone calls and 500,000 contacts by physicians and patients to Congress. There were also 8,200 targeted television commercials; 6 million Internet impressions; 13 AMA-AARP op-ed pieces placed in key states; six published letters to the editor, including two in the Wall Street Journal; and a media campaign that resulted in 267 million media impressions, including a satellite media tour that reached 15 million people, and a radio news release that reached 82 million told medicine’s story. Despite AMA’s efforts, the association is disappointed according to the publication, in the failure of Congress to provide—at minimum—a two-year payment update that is paid for and that creates a pathway for the long-term replacement of the flawed payment formula. The AMA will work with state and specialty medical societies to execute strategies next year that will achieve this goal.

At the same time, Congress sent the President a bill extending SCHIP. Here are some highlights of the legislation:

• Replaces 10.1 percent cut with 0.5 percent increase through June 30, 2008. If Congress fails to take action before the end of next June, physicians will face a cut of approximately 10.6 percent.

• Authorizes an additional 1.5 percent bonus for Medicare physician quality reporting initiative (PQRI activities) through Dec. 31, 2008, and extends floor for work-geographic adjustment and physician scarcity bonus through June 30, 2008.

• Includes budget offsets that remove $1.5 billion from Medicare Advantage stabilization fund; eliminates physician payment fund carried over from 2006 Medicare package and reduces payments for some Part B drugs.

• Extends therapy cap exceptions, pathology billing exception and premium assistance for some low-income seniors for six months.

• Extends SCHIP funding through March 31, 2009 and provided additional funding for current enrollment.

Key policies that were debated during the Congressional SCHIP deliberations, but were not included in legislation approved at the eleventh hour:

• Place limitations on physician-owned hospitals.

• Establish electronic prescribing requirement or reductions in payments for paper scripts.

• Establish imaging provisions to reduce payments, mandate accreditation or establish appropriateness demonstration projects.

• Change the direction of Medicare’s Quality Improvement Organization (QIO) program to focus on enforcement and require changes in QIO Boards.

• Adopt provisions to alter or supplant the role of the Relative Value Update committee and provide Medicare with authority to make arbitrary payment cuts for rapidly growing services.

• Create specialty specific expenditure targets.

For more information on the Congressional SCHIP deliberations over the past few months, visit http://www.amaalliance.org/site/epage/54591_625.htm.

Medicare/SCHIP Update


Issues Watch

Talking to your Legislators

Want to stay informed about legislative issues by email? Visit http://www.amaalliance.org/site/epage/42196_625.htm to sign up for our grassroots advocacy network and register to receive our e-newsletter Advocacy Connection.

For more on why Congress passed only a six-month Medicare physician payment package and AMA’s vision for 2008,go to http://www.amaalliance.org and check out the Legislative News section under Advocacy Programs.

Want to learn more about talking to your legislator? Check out AMA’s A Guide to Communicating with Members of Congress at http://www.ama-assn.org/ama1/pub/upload/mm/399/communicate.pdf.

Want to Know More?

Legislative visits, where constituents have the opportunity to talk with the elected U.S. senators and representatives one on one, are the bedrock of most national advocacy campaigns, but it can be intimidating to tackle the personal approach. Here’s some advice:

• The time is here when we can’t deny the need to communicate successfully with our legislators at the local, state and national levels. In the past we have let our medical societies, medical associations, lobby staff, physicians and Alliance members in leadership roles do our lobbying for us. However, that is no longer enough! We need all of our voices to be heard; we need your voice.

• It is easy to communicate with your legislator when you have an established relationship back home. How to do that? Work in his/her campaign, go to a fundraiser, make a visit to the district office. No time? Go vote. You are a constituent no matter where you live. You have elected representatives in legislative offices working for you.

• Communication is easy. Tell a story about how an issue affects your quality of life, or your spouse’s way of practicing quality medicine. Our issues always relate back to our own families health care, the senior citizens or children in your family. We don’t squawk about the little stuff, we roar about the big stuff--access to care for our seniors, our children and ourselves. We care about having enough educated physicians to take care of our families.

• These are not inconsequential issues. These are important issues. We can make a difference in every state in this country. So please, get involved. If you have limited time, the least amount of participation is to go vote. Try to stay educated through your county medical Alliance, state medical alliance or through the national Alliance.

Pat Hyer, Chair of the Alliance’s Legislation Committee, was a contributor to this edition of Issues Watch.

Call to Action Inspired by something in this issue? Here are a few ways to take action:

• Register for the Alliance Advocacy Network at www.amaalliance.org to gain access to legislative alerts at the same time as the nation’s physicians. You’ll also receive access to Alliance Alerts, which provides options for your state or county.

• Learn more about managing the medical marriage with one of our most popular publications, The Medical Marriage. Available at www.amaalliance.org this publication offers an enlightening and compassionate look at the partners in a physician relationship.

• If you haven’t yet renewed your Alliance membership, do so now by visiting the Alliance Web site or completing and returning the renewal form on the back cover.

• Download a Screen Out! petition from www.amaalliance.org and circulate it in your community. Better yet, enlist a new physician family in your area to help you gather signatures!

Other ideas? Successful programs to share? We’d love to hear them. Please send them to:

Editor AMA Alliance Today 515 N. State Street, 9th Floor Chicago, IL 60610


County News

In 2007, the Sonoma County Medical Association Alliance Foundation (SCMAAF) organized its 54th year of the “Give-a-Gift” program, assembling holiday gifts for foster children of the Sonoma County Human Services Department. Children and emancipated youth of all ages in the foster care system have been separated from their families. The separation is particularly painful during the holidays. At age 18, a foster child is considered “emancipated” from the state and is no longer eligible for funds which allow them to stay with the foster family or in a group home, however the SCMAAF decided, due to the overwhelming generosity of their donors, that the extra funds would go toward funding computers for college-bound emancipated youth.

“Each year the program reaches more and more households in our community, therefore increasing our success in donations and contributions,” said Shawn Devlin, co-chair of the “Give-a-Gift” program. “It is for this reason and the sounds of those children outside the conference room, that keeps me going year after year.”

SCMAAF’s efforts brought in a grand total of $28,078 in cash and gifts and provided 246 children with the exact gift they “wished for.” Ten children received a bike helmet and bike lock, and enough money was collected to purchase 7-10 com-puters for emancipated youth.

For more information contact Lindsay Mazur at [email protected].

Sonoma County Alliance Holds Holiday “Give-a-Gift” Event to Surprise Area Children

Bexar County Medical Society Alliance (BCMSA) members and Bexar County Medical Society Foundation members co-hosted the annual Christmas gala on December 14, 2007, at the Westin La Cantera Resort and Hotel in San Antonio, Texas.

“The event’s purpose is simple—to raise funds for nursing scholarships,” Merrill Ellis, 2008 BCMSA President stated.

“Last year the Alliance and Foundation awarded more than $76,000 in nursing scholarships to students within the San Antonio area. We feel that this is our opportunity to nurture the health care industry within our city.”

The Foundation was created in 1995 by the Bexar County Medical Society and the Bexar County Medical Society Alliance as the philanthropic arm of the society. The organi-zations’ shared mission is to support health care issues in the San Antonio community and increase educational opportunities in health-related careers.

Since its inception, the Foundation has awarded hundreds of thousands of dollars in scholarships to area students pursuing careers in medicine, nursing and other health-related fields; as well as the awarded grants to community organizations.

This year’s gala theme was “Holiday Around the World.” Alliance members were responsible for assembling approxi-mately 48 gift baskets that were displayed as silent auction items for attendees to bid on during the evening.

“Our baskets included an array of items for a variety of tastes—from San Antonio Livestock Show and Rodeo tickets complete with Stetson hats, to a basket with bottles of Champagne and a diamond necklace. You name it, we had it wrapped up in the baskets,” Ellis explained.

For more information contact Merrill Ellis, BCMSA President, at [email protected].

The Bexar County Medical Society Foundation and Alliance Gala that took place on December 14th at the Westin La Cantera Resort and Hotel in San Antonio, Texas. The theme of this year’s gala was “Holiday Around the World.” Pictured in the photo are (left to right) Rebecca Waller, 2009 President Elect of BCMSA; Mia Price, 2007-2008 President of Texas Medical Association Alliance; Sherry Shillings, 2006 BCMSA President; and Merrill Ellis, 2008 President of BCMSA.

BCMSA and BCMS Gala Raises Money for Foundation


State News

Editor’s Note: For months, we have been inviting readers, exhorting them in fact, to share their thoughts, opinions, concerns and success stories with us. Here’s a perfect example of a success story that can be adapted and implemented successfully on a county or state level.

County Alliances in the Minnesota Medical Association Alliance (MMAA) had put on health fairs for years. But finding volunteers to staff the health fairs became increasingly difficult. So, last year instead of bringing kids to the health information, MMAA decided to take the information to kids and published a variety of health resources.

Zumbro Valley Medical Society, in the South-eastern part of the state, had published a “Be Size Wise!” placemat about food serving sizes and decided to distribute a supply within the community. The MMAA wanted to give away health resources, too. Grocery stores were the answer. They wrote a Nutrition and Wellness

Outreach Proposal with the objectives: 1) Get kids to read nutrition labels; 2) Help kids understand and use food label information; 3) Raise awareness of appropriate food servings.They took the proposal and sample health resources to Lyndsay Rypkema, a dietitian at Hy-Vee grocery store in Rochester, Minn. The proposal included an action plan and the titles of the resources that would be distributed:

• Food Label Detective, a nutrition activity book for kids in grades 3-5.

• Detective de Nutrientes en las Etiquetas de Alimentos, the Spanish version of Food Label Detective.

• Catching the Exercise Thief, a physical activity book for kids in grades 3-5.

• Cracking the Health Words Code, a health literacy activity book for kids in grades 3-5. Publication of the book was financed, in part, by a grant from the AMA Health Literacy Foundation.

• “Be Size Wise!” placemats. “I love this idea,” Rypkema exclaimed! “We’ll be glad to give out healthy snacks – probably apples.” She asked the MMAA to hand out its health literacy activity book because “you need to be health literate to understand nutrition information.” Two Hy-Vee stores agreed to participate in the project and the Alliance agreed to publicize it.MMAA delivered the press release and sample health resources to the Minnesota Post-Bulletin. Several days later a reporter called to say the newspaper would cover the story. “Thanks for

letting us know about this,” he said. “One of the reasons we’re covering the story is that you’re giving away free resources.” A display about the state and local Alliances was set up in each store. Twelve volunteers (six for each store) passed out health resources. Instead of waiting for shoppers to come to the displays, Alliance volunteers roamed the stores and talked with parents and children. The grocery store project was a huge success and for good reason. It was easy to do, required few volunteers and was adapted to local needs. How did shoppers respond? The MMAA received a variety of comments and all of them were positive:

• “Thank you for doing this.” • “I can’t believe you’re giving these away!” • “These resources are great.” • “I’m going to tell my school about these resources.” • “My grandchildren will learn something.” • “You should do this again.” • “Thank you, thank you, thank you!” • “Good job!”

In a recent issue of Today President Dianne Fenyk wrote about the Alliance family. “Isn’t family what the Alliance is all about?” she asked. She went on to say that an “instant family” comes with Alliance membership. The grocery store project linked the Alliance family with other families. Indeed, it was a real life example of Fenyk’s letter, “From Our Alliance Family to Yours.”Does your Alliance want to focus on a health issue or project? If so, think about taking it to grocery stores. You’ll meet interesting people and have a chance to talk with them face-to-face. This project was a “win” for the stores and a “win” for the Alliance. “I’m so glad I agreed to do this,” said Zumbro Valley volunteer Char Hepper. “It was a lot of fun and I had a great time.”To view the full kit online, go to the AMA Alliance Web site at www.amaalliance.org. Submitted by Harriet Hodgson, Co-Chair, MMA Alliance Health Promotions To receive a free kit email [email protected] or call 507-252-5939.

Success Story: Grocery Store Project Links Alliance Family With the Community

MMAA has compiled a grocery store project kit for state and county Alliances. Contents include:

1. Sample Nutrition and Wellness Outreach Proposal2. Sample press release3. Mini poster about state/county Alliances4. Mini poster about the MMA Alliance Web site5. Sample photo release form6. “How To” page with the main message, volunteer

responsibilities and materials list7. Sample thank you letter8. Article from the Rochester, Minnesota Post-Bulletin


Where I was born… Evanston, Ill., while my father was attending Garrett Theological Seminary and my mother was attending Northwestern, getting a master’s degree.

Where I call home… Los Gatos, Calif. Los Gatos is a little town next to San Jose and about 50 miles south of San Francisco. We have lived here and my husband has practiced cardiology here for 31 years.

My current profession/occupation… I am currently a full-time volunteer focusing on my responsibilities as Membership Chair for the Santa Clara County Medical Association Alliance, President-Elect for the California Medical Association Alliance (CMAA) and a member of the Membership Advisory Committee and the Strategic Advancement Advisory Committee for AMAA.

How long I’ve been a member of the Alliance… Twenty-eight years.

What motivated me to join… The members of the Alliance had similar interests and goals to mine. I felt welcome in the group.

What I do for fun or relaxation… I escape with my husband to our condo on the beach in Watsonville, Calif. near Monterey, just 40 minutes from home.

The last good movie I saw… “Casablanca.” My husband and I watch it at least once a month.

A book that has changed my point of view about myself, an issue, or my view of the world… French Women Don’t Get Fat. I recommend this book to anyone who is interested in making positive changes in their life.

An issue close to my heart… Promoting healthy lifestyles. One of the things I plan to do during my year as president of the CMAA is distribute bilingual health-related educational materials to clinics, hospitals, jails and schools throughout the state. We are currently doing this in Santa Clara County.

My Alliance colleagues across the country would be surprised to learn that… I am a professional harpist. I learned to play the harp when I was in college and have soloed twice with a local orchestra. I also teach piano and harp lessons.

Q&A

Do you know an interesting candidate for a Q&a?

Nominate yourself or another member by emailing your/their name and contact information to [email protected].

Debbi RicksLos Gatos, Calif.

Last Chance for Nominations . . . At the 2002 AMA Alliance Annual Meeting, the House of Delegates opened up the Nominating Committee process to allow for increased participation by the members of the organization. The Qualified and Eligible Candidates Standard Form–2008-09 Year–will help provide the opportunity for any state, county or individual member to make their voices heard. To access this form go to www.amaalliance.org in the Leadership Portfolio section. The form should be completed, signed and returned to National Headquarters, c/o Nancy Battaglia, no later than February 10, 2008, so the forms can be reviewed by the Nominating Committee at its meeting in Chicago, February 23-24, 2008. Only the official Standard Form will be accepted by National Headquarters; submissions made in any other fashion will not be accepted.

A portion of the Bylaws and a list of those who are eligible with a record of service are also available on the Alliance Web site, www.amaalliance.org, so that you can familiarize yourself with eligible leaders and the requirements for service.

Please note that only the individuals listed on the Record of National Service are eligible for office.

We are always growing and expanding the family of medicine and we are requesting your help. We ask that you introduce a non-member colleague to the Alliance membership network. An application for membership can be found on the Web site at www.amaalliance.org by clicking on the “Become a Member Today!” button. Help start the new year off right with new members!

Become a Member


This year is going to be the year of sales for AMA Alliance publications. From now until the end of March, activity book packs of 25 will be discounted from $15 per pack to $10 per pack, a savings of 33 percent on each pack bought!

From now until the end of March, choose:• I Can Be Safe activity book (pack of 25)• I Can Be… activity book (pack of 25)

But the sales don’t end there. Make sure to check out the online store at www.amaalliance.org often for new deals and sales. Throughout the year, your favorite AMA Alliance publications will be offered at a huge discounted rate!

Come and get ‘em!

Discounted Publications!

important Membership Renewal Notice

Please help us to continue making a difference in our communities by renewing your AMA Alliance membership today. Doing so also will ensure that you don’t miss a single issue of AMA Alliance Today or your other valuable membership benefits.

To renew, mail in your dues with this statement or visit www.amaalliance.org to pay online If you have recently paid your dues, please disregard this notice.

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Send your dues with this statement to:AMA Alliance, 515 North State Street, 9th Floor, Chicago, IL 60610

Renew your membership in your state and county Alliance too—for more information, call 312.464.4470 or email [email protected].

Thank you for helping to build healthy communities across America!

AMA Alliance Today January/February 2008

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Transcript of AMA Alliance Today January/February 2008