PRESIDENT'S MESSAGE
Colleagues:

It’s a new decade and the Pennsylvania Rheumatology Society continues to grow. I am excited about plans for the Annual Scientific Meeting September 26-27 again at the Hershey Lodge in Hershey. Phil Dunn is the program chair. See his update in this newsletter. We outgrew the previous Sheraton venue. Last year’s meeting was larger with over 120 registrants. We had over 20 display tables and the support of 10 Corporate Partners. As we grow, we will be growing our activities. We will continue to offer up to $1000 “Fellow in Training” scholarships for FIT members who attend our Annual Scientific Meeting for expenses attending ACR meetings.

New this year, we have formed an Advocacy Committee chaired by Paul Killian. See his note in this newsletter. We hope to take a more active role advocating for our patients and our specialty in Harrisburg partnering with the Arthritis Foundation. We will be offering support for patients to go to Harrisburg in the form of lodging and travel expense reimbursement for Advocacy Day in April. Please encourage your patients to consider going to Harrisburg and meeting their legislators. Information about this will be distributed soon.

Also new this year, the Board will be considering the development of a scholarship program for Advanced Practitioners to take American College of Rheumatology training courses designed for Advanced Practitioners (APs). This might take the form of a benefit offered to PRS members who are considering hiring and training APs or a benefit to a new AP considering rheumatology as a career. The shortage of rheumatology providers will only continue to worsen, and this scholarship would help attract APs to rheumatology and relieve some of the burden of training rheumatology skillsets. In addition, we are looking for volunteers to get involved in the formation of an “Insurance Committee”, a committee to address conduct of carriers in our state.

I want to welcome Dr Lisabeth Scalzi to an officer position. She is a pediatric rheumatologist at Hershey who is now Secretary/Treasurer. Dr. Irene Tan is Vice President and now is at Einstein in Philadelphia. Also, special thanks to our staff at the Pennsylvania Medical Society: Rebecca Doctrow, Executive Director; Brendan Leahy, Deputy Executive Director; Janelle Witters, our Annual Scientific Meeting Manager: and Rayna Canidate, Member Service Specialist. If there are issues you feel affect your patients and/or your practice that should be addressed, please contact me and PRS will help ( [email protected] ). 
Al Denio, MD
PRS WEBSITE UPDATE VOLUNTEERS
Do you have a passion for website design? If so, PRS is looking for you! We are looking for one or two members that are interested in working with PRS Staff to provide feedback on our website, parheumatology.org . Send an email to [email protected] to apply .
WELCOME NEW MEMBERS!
Catherine M. Teskin, DO
VOLUNTEERS TO EXPAND RHEUMATOLOGY ACCESS RESOURCE FROM ACR
The American College of Rheumatology is pleased to share a new resource designed to help rheumatology providers find volunteer opportunities and improve access to rheumatology care for the under and uninsured. 
 
The Volunteers to Expand Rheumatology Access (VERA) microsite was developed by a task force of rheumatologists and rheumatology health professionals. You can access it by visiting VolunteerRheumCare.org. There you will find answers to Frequently Asked Questions and a list of clinics and organizations that seek to provide rheumatology care to their patients or educational support to primary care providers. 

Visit VolunteerRheumCare.org for more information.
ADVOCACY UPDATE
This year, the Pennsylvania Rheumatology Society started an active advocacy committee. We are working with the Arthritis Foundation and the American College of Rheumatology to support and advocate for issues at the state and federal levels that enhance patient care and lessen the burden that physicians encounter caring for their patients. This necessitates yearly trips to Harrisburg and Washington DC. We will be working with the Arthritis Foundation for an Advocacy Day on April 7th in Harrisburg, with a trip to our nation’s capital later this year.

During the Advocacy Day in Harrisburg, the following topics will be covered: step therapy, prior authorizations, mid-year formulary changes, and site of infusions (home vs infusion center.) Due to time constraints, not all of the issues can be covered during the visits, but other advocacy issues facing rheumatologists include biosimilar substitution by the pharmacist, boosting DXA reimbursement, NIH funding, part B drug payments, pediatric subspecialty loan repayment, prevalence of arthritis in the military, the role of pharmacy benefit managers in prescription drug pricing, and the pending rheumatology workforce shortage.

Our members should feel free to bring advocacy issues to our attention. If you are looking for more information, the American College of Rheumatology and the Arthritis Foundation are excellent resources. Finally, if you are interested in participating in advocacy with PRS, you can contact PRS ( [email protected] ) or me ( [email protected] ).

Paul Killian, MD
Chair, PRS Advocacy Committee
SPECIALTY LEADERSHIP CABINET REPORT
The Specialty Leadership Cabinet of the Pennsylvania Medical Society met on Tuesday, February 4, 2020. The meeting did not pass any significant action items but was dominated by a legislative update report as well as a presentation by State Senator Kristen Phillips–Hill from the Pennsylvania 28th Senate seat in Southern York County who is sponsoring a prior authorization bill.

Our members from Philadelphia should be aware that the issue of malpractice tail coverage for residents and staff who have been affected by the Hahnemann Hospital bankruptcy is still not solved. The Pennsylvania Medical Society and AMA are representing the interests of these individuals in negotiations with the State Legislature, Pennsylvania Licensing Board, as well as the bankruptcy court. However, a number the parties are hesitant to provide a financial solution for the problem until the bankruptcy court acts to avoid letting the institution off the hook for its responsibilities for covering these costs.

During the legislative update seven legislative issues were reported as being the primary focus of the Pennsylvania Medical Society for the upcoming year. The #1 issue is still related to the scope of practice issue. With the retirement of Mike Turzai, Speaker of the House, and a strong supporter of physician interests related to scope of practice there is concern that physicians in this state may not be in as strong a position related to any upcoming legislation on this issue.

Perhaps of greatest interest to our PRS membership, and a priority of our advocacy committee, was a discussion of Senate bill 920 related to prior authorization, which is being sponsored by state Senator Kristen Phillips-Hill. The Senator explained that this bill is in the early stages of development and she is engaging with multiple interested parties in an attempt to create a fair bill including input from physicians as well as patient groups and insurance companies. There are a number of groups that are interested in influencing this legislative issue: radiology and surgical groups are tackling these issues regarding procedures, while groups like PRS are interested in prior authorizations for medication.

The Medical Society is also supporting new legislation which was introduced to modify Act 112 (2018) which requires reporting of test results to the patient. There is hope that this new legislation will modify the language of the previous bill to make it easier for physicians and medical institutions to comply with the previous past act.

It is also significant to note that Telemedicine legislation has hit a roadblock over abortion issues.

There is still a lot of activity although no final legislation related to House Bill 1862, which is designed to try to correct problems with out of network balanced billing which often inflate patient’s out-of-pocket expenses related to ER visits or surgery from physicians who do not participate in the patient’s health care plan. The Pennsylvania College of Emergency Physicians are trying to make sure that any final legislation does not mandate specific payment levels that are not fair for them.

The Pennsylvania Medical Society is also working with legislative representatives on new bills that would help prevent institutions from forcing restrictive covenants on physician contracting, and also to create a bill that will prevent separate regional PDMPs that would end up competing with the state-wide PDMP and could end up requiring physicians to check multiple PDMP’s before prescribing a narcotic.

Alan D Roumm MD
PRS Specialty Leadership Cabinet representative
ANNUAL MEETING
Planning is well underway for the 2020 Annual Scientific Meeting! The planning committee is excited to welcome our membership back to the Hershey Lodge this September. We have several speakers lined up to talk on IGG4 and Related Disease, Gout & Comorbidities, Myositis, and more. PRS Staff is preparing to launch exhibitor registration in the coming weeks. Be sure to sign up for the 2020 Annual Scientific Meeting and reserve your Hershey Lodge room when registration opens this spring.
MY JOB SEARCH EXPERIENCE
According to the National Resident Matching Program (NRMP), twenty-five percent of the matching rheumatology fellows from 2019 are non-US international graduates. As an international medical graduate (IMG) myself, I wanted to share what I have learned while looking for a J1 waiver rheumatology position.
 
1- Plan ahead. Easier said than done for a variety of reasons, but if you are looking for a J1 waiver position, time is of essence because of application deadlines and spots filling up quickly (except if you are applying through the Delta Regional Authority or the Appalachian Regional Commission). In my opinion, the latest you can start your job search is at the beginning of your last year of fellowship, but the sooner the better. Ask yourself the following questions to begin with: do you want to work in a private practice or in academic medicine and what are your preferred geographic areas? If you want to work in academic medicine, you need time to build up your curriculum vitae during your fellowship (with scholarly activities, publications, etc.)

2- Where do you search for jobs. Aside from asking colleagues or mentors if they are hiring, I became aware of a few job posting websites (but there are many more) that people were using: ACR Career Connection , NEJM Career Center , JAMA Career Center , PracticeLink, PracticeMatch, 3RNet.org. The American College of Rheumatology also hosts a career fair at their Annual Meetings. You can seek help from physician recruiters too, at no cost to you. If you are interested in academic medicine and in obtaining a faculty position at a University Hospital, the best thing to do is to send a direct email to the Chief of the Division of the Institution(s) that you are interested in and send them your curriculum vitae and a cover letter. You can find a list of these Academic Institutions in FREIDA by typing “Rheumatology (IM)” in the search box.

3- Preparing for the interview. The following are some questions or topics that you may want to ask or discuss:
  • How big is the practice; how many rheumatologists, nurse practitioners, medical assistants and/or registered nurses do they have?
  • Clinic locations, infusion center (and number of chairs), satellite clinics
  • Electronic Medical Record
  • Telemedicine
  • Inpatient vs Outpatient
  • Access to other specialties or services: dermatology, radiology, musculoskeletal ultrasound service, pathology, immunology lab, ophthalmology, nephrology, hematology, physical medicine and rehabilitation, orthopedic surgery, pain management, physical therapy, aquatherapy, etc…
  • Work schedule, phone schedule and call schedule
  • How many patients per day and how much time allotted per patient (new or follow up)
  • Teaching opportunities
  • Research opportunities
  • City and population characteristics, schools, nearby airports
  • Malpractice insurance, tail coverage

4- Visa Waiver Process: After you sign the 3 year-job contract with an employer in an underserved area, the waiver recommendation is made on your behalf by the State Department of Health (if you are applying through the Conrad 30 Program), the Delta Regional Authority (DRA) or the Appalachian Regional Commission (ARC). For the Conrad 30 Program, you need to have your paperwork ready for submission by October 1 st of any given year (to start the job the following year). The DRA and ARC have no deadlines for submission (but these waiver agencies are present in only certain US states). After the initial waiver recommendation is made, your information is submitted to the US Department of State Waiver Review Division and then to the United States Citizenship and Immigration Service (USCIS), where it can get finally approved or not. After it is approved, your status will change from J1 to H1B.

Another recommendation usually made, specially if you are going into private practice, is that you consult a lawyer to review your job contract before you sign it. 

Cathy Lee Ching, MD, Fellow-In-Training Representative
MEET YOUR LEADERSHIP
Alfred Denio, MD
President
10/1/19 – 9/30/21

Current Title: Rheumatology Fellowship Program Director, Geisinger Health System past 7 years.

Previously in Private Practice Norfolk, Va in single specialty Rheumatology Practice 23 years but did considerable work as Community Faculty Leader Eastern Va School of Medicine.

Very active in American College of Rheumatology serving variety of committees as well as Board of Directors.

Helped sustain Virginia Society of Rheumatologists as Secretary/Treasurer for 10 years.

Pa Rheumatology Society service helps me fulfill desire to improve the care of rheumatic disease patients on a scale larger than I can accomplish on my own and incorporate perspectives learned from others in my own personal growth. 
Irene J. Tan, MD
Vice President
10/1/19 – 9/30/21

Current Title: Rheumatology Division Chief and Fellowship Program Director, Einstein Medical Center Philadelphia. 1/21/2020-present

Previous Titles: Rheumatology Fellowship Associated PD then Program Director, Temple University Hospital past 7.5 years.

I am active in the American College of Rheumatology serving a variety of committees and subcommittees.

Pennsylvania Rheumatology Society (PRS) service helps me effects changes in the education of rheumatologists and fellows on a state level. It’s rewarding to learn the organizational process and be part of the team to launch the inaugural PRS scientific meeting in 2014, then refining the subsequent ones. It is most satisfying to see the implementation of the PRS Fellows-in-Training (FIT) travel scholarship to help offset expenses for Fellows to attend the national ACR meeting. I have a deeper appreciation of the dedication and the stewardship of all my colleagues and the staff of PRS from volunteering.  
Rebecca Doctrow
Executive Director

I started with PAMED’s Total Excellence in Association Management (formerly Specialty Society Management Services) department in January of 2018 as an Assistant Association Executive, charged with managing marketing and communications for my clients. After some department restructuring, I started working with PRS early 2019 as an assistant before becoming Executive Director in September.

A Harrisburg, PA native, I hold a bachelor’s degree from the University of Pittsburgh and a master’s degree from New York University. Prior to coming to PAMED, I was the Office Manager & Marketing Director for a Personal Injury Law Firm in Harrisburg.  

In my free time, I teach spin classes, enjoy reading, traveling, and spending time with my fiancé, Sowah, and dog, Boris. 
If you are interested in posting a job, please contact us at (717) 558-7750, extension 1599 or  [email protected] ​ . Postings are complimentary.
Ideas or suggestions for newsletter articles can be submitted to the PRS staff office,  [email protected]  or by telephone, (717) 558-7750, ext. 1599.