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BULLETIN Allegheny County Medical Society

December 2025 / Vol. 115 No. 12

BULLETIN Allegheny County Medical Society

December 2025 / Vol. 115 No. 12

Opinion

Society News

Articles

Editorial

ACMS News

Article

Editorial

Membership

Article

• Curtain Deval (Reshma) Paranjpe, MD, MBA, FACS • Gene Therapy for Huntington's Disease Anthony Kovatch, MD

• Reflections Keith T. Kanel, MD, MHCM, FACP -- ACMS President • Q&A with Deval (Reshma) Paranjpe, MD, MBA, FACS

ACMS News

• ACMS Member Acknowledgements

ACMS News

• ACMS in Action - Women in Healthcare Event

ACMS News

• Specialty Group Updates ACMS Staff: Nadine Popovich, Melanie Mayer and Haley Thon

• New Pitt Study on Adolescent Health Decisions Maggie Slavin • Health Department HIV Data Ejakuwa Abubakar, MPH and Jennifer Fiddner, MPH, Allegheny County Health Department

Article

• The Charlie Gard Case Timothy Lesaca, MD

Article

• A Brief Overview of Physician Unionization Trends James Latronica, DO, DFASAM

Moraine Lake, Banff National Park Cover photo by Robert Cicco, MD Dr. Cicco is a retired Neonatal-Perinatal Pediatrician 2

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Bulletin Managing Editor Sara C. Hussey, MBA, CAE ACMS Executive Director shussey@acms.org Medical Editor Deval (Reshma) Paranjpe, MD reshma_paranjpe@hotmail.com

2025 Executive Committee and Board of Directors President Keith T. Kanel, MD President-elect Kirsten D. Lin, MD

PAMED District Trustee James Latronica, DO, DFASAM

2025 Board Committees Bylaws Richard B. Hoffmaster, MD Finance William F. Coppula, MD

Secretary Richard B. Hoffmaster, MD

Nominating Kirsten D. Lin, MD

Treasurer William F. Coppula, MD

Bulletin Designer Victoria Gricks

victoria@thecorcorancollective.com

2025 Bulletin Editorial Board Richard Daffner, MD, FACR Robert Howland, MD Anthony Kovatch, MD Charles E. Mount, MD, FAAD Alexandra Johnston, DO John P. Williams, MD

Women’s Committee Prerna Mewawalla, MD & Meilin Young, MD

Board Chair Raymond E. Pontzer, MD

Board of Directors Term Expires 2025 Anuradha Anand, MD Amber Elway, DO Mark A. Goodman, MD Elizabeth Ungerman, MD, MS Alexander Yu, MD Term Expires 2026 Michael M. Aziz, MD, MPH, FACOG Michael W. Best, MD Micah A. Jacobs, MD, FIDSA Kevin G. Kotar, DO Jody Leonardo, MD

Administrative Staff Executive Director Sara Hussey shussey@acms.org Vice President - Member and Association Services Nadine M. Popovich npopovich@acms.org

Term Expires 2027: David J. Deitrick, DO Sharon L. Goldstein, MD Prerna Mewawalla, MD Raymond J. Pan, MD Nicole F. Velez, MD

Manager - Member and Association Services Haley Thon hthon@acms.org

Operations Coordinator ACMS & ACMS Foundation Melanie Mayer mmayer@acms.org Manager - Operations and Finance Elizabeth Yurkovich eyurkovich@acms.org Bulletin Designer Victoria Gricks victoria@thecorcorancollective.com

EDITORIAL/ADVERTISING OFFICES: Bulletin of the Allegheny County Medical Society, 850 Ridge Avenue, Pittsburgh, PA 15212; (412) 321-5030; fax (412) 321-5323. USPS #072920. PUBLISHER: Allegheny County Medical Society at above address. The Bulletin of the Allegheny County Medical Society is presented as a report in accordance with ACMS Bylaws. The Bulletin of the Allegheny County Medical Society welcomes contributions from readers, physicians, medical students, members of allied professions, spouses, etc. Items may be letters, informal clinical reports, editorials, or articles. Contributions are received with the understanding that they are not under simultaneous consideration by another publication. Issued the third Saturday of each month. Deadline for submission of copy is the SECOND Monday preceding publication date. Periodical postage paid at Pittsburgh, PA. Bulletin of the Allegheny County Medical Society reserves the right to edit all reader contributions for brevity, clarity and length as well as to reject any subject material submitted. The opinions expressed in the Editorials and other opinion pieces are those of the writer and do not necessarily reflect the official policy of the Allegheny County Medical Society, the institution with which the author is affiliated, or the opinion of the Editorial Board. Advertisements do not imply sponsorship by or endorsement of the ACMS, except where noted. Publisher reserves the right to exclude any advertisement which in its opinion does not conform to the standards of the publication. The acceptance of advertising in this publication in no way constitutes approval or endorsement of products or services by the Allegheny County Medical Society of any company or its products. Annual subscriptions: $60 Advertising rates and information available by calling (412) 321-5030 or online at www.acms.org.

Improving Healthcare through Education, Service, and Physician Well-Being ACMS Bulletin / December 2025

Editorial

Curtain By: Deval (Reshma) Paranjpe, MD, MBA, FACS As the year draws to a close, so does the old incarnation of the ACMS Bulletin, as well as the tenure of the current editorial board, myself included. This will be my last column as ACMS Bulletin Editor. Thank you for reading the Bulletin and for being friends with me through its pages for over a decade. Thank you for championing its very existence in previous years. Thank you for writing in with kind words, opinions and suggestions, for sharing your thoughts and for sharing your great writing with the ACMS community in the Bulletin. Thank you for stopping me over the years in the hallways of AGH and random places in Pittsburgh and telling me that the Bulletin matters to you and that you look forward to reading it each month after a long day at work. Thank you for having the Bulletin on your coffee table as a reminder of community, caring, and all the reasons we went into medicine in the first place. A huge thank you to current editorial board members Drs. William Daffner, Robert Howland, Anthony Kovatch,

Charles Mount, Alexandra Johnston and John Williams for their steadfastness, good energy, love, and excellent writing. And great thanks to Sara Hussey (ACMS Executive Director and Bulletin Managing Editor) as well as Victoria Gricks (Bulletin Designer) for keeping the publication running smoothly and looking beautiful. Many thanks to editorial boards past and to retired ACMS Executive Director Jack Krah and former Managing Editor Megan Sable who championed the Bulletin and steered it through choppy waters in prior years, and to my predecessor, Dr. Safdar Chaudhry, who showed me how his incredibly beautiful prose could uplift and inspire the readership each month. The Bulletin is the main outreach and marketing tool for the ACMS and reaches members, prospective members, non-members and the public at large. My hope is that the new incarnation of the Bulletin will continue to be a source of relaxation, information, and delight for physicians in our off-hours—a safe space for us. I

also trust that it will heartily publicize and promote all the good work that ACMS is doing for physicians, patients and our community—in new and modern ways that will have an even broader reach. Serving as your Bulletin Editor has been the greatest joy and privilege. I have learned so much personally and professionally in this role, and the experience has changed me for the better. Writing this column has been humbling, joyful, cathartic, corrective, therapeutic, and a wonderful way to get to know and connect colleagues I’d never have had the honor to meet otherwise. And I realized that I love to write. If you’d like to read more from me in days ahead delivered straight to your inbox (there will be restaurant reviews!), please sign up for my posts on Substack at https://substack. com/@devalinthedetails Take care of each other, my dear friends, and take care of yourselves. Thank you again.

A Note of Thanks On behalf of the Allegheny County Medical Society, we extend our deepest gratitude to Dr. Deval Paranjpe for her extraordinary leadership, voice, and stewardship of the ACMS Bulletin for more than a decade. Dr. Paranjpe has shaped this publication with uncommon heart. Lifting up the stories of physicians, creating a place of reflection and respite, and sustaining a sense of community through times of profound change. Her columns have been a source of comfort, honesty, and connection, and her vision has ensured that the Bulletin remained not just a publication, but a gathering place for the ACMS family. Dr. Paranjpe, thank you for your years of service, your beautiful writing, your steady leadership, and the countless hours you’ve given to ACMS and its members. While this is her final editorial as Editor-in-Chief, we are thrilled that Dr. Paranjpe will continue to serve ACMS as Editor Emeritus, offering her wisdom, perspective, and occasional contributions in the years ahead. Her voice will continue to be a touchstone for our community as we evolve the Bulletin’s next chapter. Warmest congratulations on this milestone, and with admiration, The Allegheny County Medical Society

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Article

New Pitt Study on Adolescent Health Decisions Seeking Community Partners in Allegheny County By: Maggie Slavin Across Allegheny County and beyond, researchers and clinicians are working to close the gap between public health evidence and the realities of clinical practice. A new project led by Dr. Kar-Hai Chu at the University of Pittsburgh School of Public Health aims to do just that—by examining how laws surrounding medical decision-making for adolescents shape population health outcomes. Understanding the Law’s Role in Adolescent Health In the United States, laws governing how medical decision-making for minors vary significantly across states and even at the local level. These variations can influence whether young people receive timely and appropriate care. This research team seeks to build an evidence base that helps explain how these policy differences affect adolescent health and public health. Using a combination of legal epidemiology, community engagement, and computational modeling, the project aims to make complex relationships between law and health more transparent, data-driven, and actionable. About the Study This interdisciplinary project brings together experts in public health, law, behavioral science, and informatics. The goal is to create a dynamic model that captures how different laws for adolescent healthcare influence realworld health outcomes and to identify pathways for policy and practice improvement. To accomplish this, the team will employ agent-based simulation

ACMS Bulletin / December 2025

modeling—a method that allows researchers to replicate real-world conditions and test how changes in policy might affect health behaviors and outcomes over time. By simulating these “what-if” scenarios, the project will provide evidence to inform more effective health policies. Specific Aims 1. Policy Surveillance: Apply policy surveillance methods to develop a publicly available, regularly updated dataset of state and local laws related to adolescent medical decision-making. 2. Community-Informed Modeling: Build a community-informed model to capture how these laws affect key public health measures. 3. Simulation and Scenario Testing: Use FRED (Framework for Reconstructing Epidemiological Dynamics), an agent-based modeling platform developed by the Pitt Public Health Dynamics Laboratory, to simulate multiple scenarios exploring how laws for adolescent medical decisionmaking and potential interventions may influence population health. This research reflects the growing need for cross-sector collaboration: linking legal frameworks, community voices, and health data to address complex issues. Why It Matters For clinicians, this work can demonstrate how legal and social environments shape adolescents’ willingness and ability to seek care, ultimately influencing adherence, outcomes, and trust. For public health professionals and

policymakers, the project offers a foundation for designing interventions and policies that reflect both scientific evidence and the lived realities of adolescents, families and communities. Ultimately, the project seeks to strengthen the evidence base on how adolescent healthcare laws relate to population health thereby empowering communities and policymakers to promote prevention, early detection, and access to care. Call for Community Collaboration The research team is currently inviting community partners and key stakeholders to participate in upcoming collaborative model-building sessions. The team is especially interested in engaging: • Adolescents (ages 12–17) • Parents of adolescents • School representatives (administrators, teachers, coaches) • Pediatricians and adolescent medicine specialists • Local public health and health department officials These sessions will ensure that the model reflects the perspectives and experiences of those affected by adolescent healthcare policies, creating a stronger link between research and the communities it aims to serve. If you or your organization would like to get involved or learn more about this study, please contact Maggie Slavin at slavinm@pitt.edu. Together, we can strengthen the bridge between research, policy, and community health practice across Allegheny County and beyond.

Society News

What a Year!

Reflections on an Astonishing 2025 By: Keith T. Kanel, MD, MHCM, FACP -- ACMS President On a summer’s day earlier this year, I spent an afternoon with the history of the Allegheny County Medical Society. I wanted to learn about why we do what we do. Settling into the expansive reading room of the Heinz History Center in Pittsburgh’s Strip District, archivist librarians brought me some of the 41 musty boxes containing the assembled Bulletins of ACMS dating back to 1866. It was remarkable reading. It told the story of how the physicians of Pittsburgh built a medical community and public health system, responding to epidemics, two world wars, the birth of our first (and second!) medical school, the advent of health insurance, the big local health corporations, transplantation, managed care, underserved populations, and the digital revolution. A common thread was that ACMS was always the bedrock center of physician life and unfailingly rose to meet the moment. Our legacy is to be in a constant state of reinvention, guided by generations of volunteer physician leaders. When I began my term as ACMS president in January 2025, we had familiar challenges. Rising rates of physician burnout. Unenlightened oversight by state and local government. A health care industry occasionally placing profits over patients and threatening the doctorpatient relationship. A digital communication revolution that misinforms as often as it includes, potentially eroding the core humanness that defines our everyday work. Led by its phenomenal 2025 Board

of Directors and chairman Raymond Pontzer MD, ACMS once again stepped up, listened to membership, and took action. During this incredibly busy (and occasionally exhausting) year our portfolio of accomplishments is truly amazing, including: Membership remained robust, and in 2025 ACMS officially became the largest of the 63 county medical societies in Pennsylvania. In April 2024, ACMS launched its new Physician Wellness Program to combat burnout and stress, offering completely discrete, immediate, and anonymous behavioral health support to any regional physician or medical student in need. Dozens of practitioners have received up to four one-on-one sessions with licensed therapists at no charge. The program was funded entirely with ACMS dollars and has already become a model for other medical societies. In 2025, that program grew and expanded. Partnerships were created with the major hospital systems to help support Physician Wellness in the County. To help ACMS truly serve as the voice of the physician, a new Advocacy Task Force was created in 2025 to monitor and communicate to membership breaking legislative developments. Working with our colleagues at the Pennsylvania Medical Society (PAMED), we proactively track issues important to our membership, such as supporting efforts to ban non-compete clauses in physician contracting and preserving sensible patient safety parameters on non-physician scope-of-practice. To fight misinformation on vaccine policy, ACMS forged a new

relationship with the Allegheny County Immunization Coalition as their 2025 fiscal sponsor. This legacy grassroots organization, previously funded by the Center for Disease Control, literally takes preventive health to the streets and into the schools. Our physicians are excited to begin working with a great new community partner. For the first time, the Allegheny County contingent to the October 2025 PAMED House of Delegates in Hershey was the biggest at the convention, surpassing Philadelphia County. Our 20 elected representatives spoke passionately of changes they would like to see in health policy To help our Allegheny County physician-trainees succeed in launching their professional careers, our board voted to pay the 2025 PAMED portion of membership dues for 741 medical students, residents, and fellows (ACMS membership remains free for student and resident members). The ACMS Women in Healthcare affinity group grew in 2025, with a vibrant presence and sold-out social events. ACMS was honored to be the only county medical society invited to present at the October 2025 meeting of the Federation of State Medical Boards in Washington, DC. ACMS joined the Massachusetts Medical Society and Oregon Board of Medicine in offering perspectives on looming trends in physician unionization. Upgrading our communications for a new age, ACMS overhauled the ACMS Bulletin, published regularly since 1911, to a new quarterly journal debuting in early 2026, to be accompanied by an

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Society News expanded digital platform. ACMS again hosted the physicians of Allegheny County at the 2025 Distinguished Awards celebration at Acrisure Stadium in November. The fundraiser netted a record $43,000 for future programming. Through our ACMS Foundation, we awarded $245,000 to 15 exceptional community-based organizations which join us in addressing social determinants of health within Allegheny County. Among grantees identified at our October 2025 meeting were Global Links, Jeremiah’s Place, Sojourner

House, Light of Life Mission, The Neighborhood Resilience Project, and others. And it feels like we are just getting started! My personal thanks go to our amazing Boards of Directors for both ACMS and the ACMS Foundation, who gave selflessly of their time throughout the year. Special thanks go to the 2025 ACMS Executive Committee, including board chair Raymond Pontzer MD, president-elect Kirsten Lin MD, treasurer William Coppola MD, and secretary Richard Hoffmaster MD.

Lastly, nothing happens without the diligent and enormously professional ACMS staff team: executive director Sara Hussey, vice-president Nadine Popovich, operations coordinator Melanie Mayer, finance manager Elizabeth Yurkovich, and membership manager Haley Thon. I personally look forward to the 2026 presidency of Dr. Kirsten Lin, who will, as it has been for 160 years, lead us forward in meeting the challenges ahead for ACMS physicians and our patients. No doubt it will be another exciting year.

ACMS Responds to ACIP Hepatitis B Vaccine Recommendation Change Through the work of the newly formed ACMS Advocacy Task Force and at the direction of the Board of Directors, the Allegheny County Medical Society (ACMS) joined other leading health organizations in publicly expressing concern regarding the Advisory Committee on Immunization Practices’ (ACIP) recent decision to change its long-standing, evidence-based recommendation that all newborns receive the hepatitis B vaccine at birth. ACMS believes this action is not supported by scientific evidence and risks increasing vaccine confusion while undermining public trust in proven public health protections. ACMS notes that leading medical organizations, including the American Academy of Pediatrics, continue to strongly recommend administering the hepatitis B vaccine within 24 hours of birth, followed by additional doses during infancy. The Society reaffirms its commitment to working collaboratively with local public health partners to ensure physicians and patients across Allegheny County have access to vaccines, as well as accurate, reliable information about their safety and benefits—central to ACMS’s mission to protect and strengthen community health. This statement has been shared across ACMS social media channels. Members are encouraged to view the posts and engage in the conversation. As ACMS continues to navigate the increasingly complex intersection of science and public policy, the Society remains committed to representing the voices and values of its physician membership. Member feedback on ACMS’s ongoing and future advocacy efforts is welcome, and ACMS looks forward to hosting a member advocacy forum in early 2026 to further foster dialogue and collaboration around these important issues. Comments may be directed to shussey@acms.org.

ACMS Bulletin / December 2025

Editorial

Gene Therapy for Huntington’s Disease “A Many-Splendored Thing” By: Anthony Kovatch, MD “He would be lonely all his life. But a man took it for his share and went on.” --closing lines of "The Yearling" by Marjorie Kinnan Rawlings My mother Virginia, the 9th of 13 children in a well-to-do Italian immigrant family in the small village of Tresckow, PA loved to dance. Now, 6070 years later, I still vividly remember her and my father dancing to the music (that still echoed in their minds from the glorious days of their courtship) in the living room of our humble singlefamily dwelling in Clifton, NJ when my younger brother and I were busy doing our homework. It was the same living room where my father in desperation gave her a mink coat as a bribe to earn her cooperation with seeking a consultation with a super-specialist in neurological diseases in New York City; this Christmas Eve memory was highlighted in the Bulletin in December of 2023 (1).

Our little family dressed up for Christmas in 1955: Although I did not know it at the time, our happiness was a “many splendored thing”.

Fortunately, or unfortunately, the constellation of symptoms which had commenced in her early 40’s with memory loss, cognitive decline, and emotional instability—and was medically diagnosed as mere “change of life” --progressed on a rapid course of deterioration to diffuse choreiform movements and complete intellectual impairment where she recognized none of us. Only when the grim diagnosis (spoken of only in a whisper) of Huntington’s Chorea was clinched by the superspecialist did the “skeletons” of previously affected family members come out of the closet. It was not to be the self-limited “St Vitus dance” characteristic of outbreaks of acute rheumatic fever. Although everybody tried to reassure my brother and me that the “disease skips a generation,” this confused, lonely, adolescent bookworm had learned enough of basic genetics to know that they all were liars. As I look back 60 years from the present day, only now do I understand the words of author Mitch Albom in “The Little Liar”: “To keep harmony, there are things you might not say, even if you know them to be accurate. It IS, technically, an act of deceit. It is also an act of love.” My long-suffering father joined Virginia in the grave only 4 months after she died following long-term institutional care. I, the self-important, all-judgmental medical student accused the man who had salvaged my childhood to be a non-compliant patient, neglecting his own health by smoking, drinking, and worrying about his sons to the point of depression. Again, years later, I make a more

accurate diagnosis: Takotsubo cardiomyopathy (previously referred to as "broken heart syndrome.") I argued to my wounded psyche that ironically they had selfishly "danced themselves to death;" the love affair that had for 3 decades been nourished by dancing became fatal in the bitter end! Convinced that I was condemned to be lonely all my life like the boy in “The Yearling,” I became a pathological liar-only to myself--denying that I had a 50% risk of likewise developing the “family curse” and refusing to modify the trajectory of my life, even to determine if I carried the huntingtin gene when testing became available in 1993 after my youngest child was born. And then an almost miraculous event of synchronicity occurred! In early November, the death of molecular biologist Doctor James Watson at 97 years of age rekindled in our collective memory his landmark discovery with Francis Crick over 70 years ago in 1953 of the decoding of the double-helix structure of DNA. This discovery-which will forever be associated with “Watson and Crick”, the joint deities of DNA--showed how genetic information is stored and replicated and ushered in a new era of molecular genetics and biotechnology, leading to the current advances in gene therapy. Almost simultaneously, investigators at the Division for Movement Disorders at the University of Alabama at Birmingham (UAB) announced the results of a preliminary study showing that a novel form of gene therapy, called AMT-130, significantly slowed the progression of HD so that it could be considered for the first time a potential

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Editorial cure for the devastating genetic disorder (2). This novel therapy “corrects” the mutation in the huntingtin gene which is inherited 90% of the time from the affected parent at the time of conception; this abnormal gene provides the genetic information for the so-called huntingtin protein. The biochemistry of the aberration involves expansion of CAG repeats of cytosine-adenosine-guanine (known as a trinucleotide repeat expansion) in the gene coding for the abnormal mutant protein, which gradually damages the victim’s brain cells, leading to a vegetative existence and death within 10 to 20 years. In contrast to the daily oral medications which afford marginal relief of symptoms only and are fraught with troublesome adverse side effects, the procedure which was performed on 29 participants involved direct delivery of AMT-130 to the brain during an 8- to 10-hour surgery. After three years of intense follow-up, those who received the higher dose showed a 75 percent slower disease progression compared to those who did not receive the treatment. The treatment helped trial participants maintain more of their movement, thinking and daily functioning abilities without causing significant side effects. While invasive, this single-dose treatment is designed to last an entire lifetime, reducing the need for daily medication and having the possibility of a “one and done” treatment. Moreover, because the treatment does not permanently alter DNA, it avoids many of the risks associated with gene editing—-the modality employed for Sickle Cell Anemia, Beta-thalassemia, and early this very month for X-linked Chronic Granulomatous Disease; this gene-editing tool called CRISPER (Clustered Regularly Interposed Short Palindrome Repeats) was described to me by a ChatGPT Copilot as a pair of “molecular scissors” guided by a GPSlike system called Cas protein that can cut DNA at a precise point.

ACMS Bulletin / December 2025

Despite the groundbreaking results with HD, Victor Sung, MD, Director of the UAB HD Clinic, was sober in directing his praises:

year 2030, 100,000 patients will have benefitted from this scientific miracle that was previously regarded as science fiction! There is still tremendous progress to be made, as approval of the drug would require the medical and scientific communities to address how to provide the treatment to patients, both surgically and financially. The implications for the remediation of Parkinson’s Disease and Alzheimer’s Disease are mind-staggering! But as American philosopher-writer Ralph Waldo Emerson (1803-1882), leader of the Transcendentalist movement of the mid-19th century, enlightened all of us: “All I have seen teaches me to trust the creator for all I have not seen.”

Victor Sung, MD

“We certainly remain cautious about interpretation of these results since they are only in a small number of patients, but the 75 percent diseaseslowing is a big number and still very much a reason to be excited. I also think it is important to highlight the bravery of these 29 patients...who underwent surgery to have a drug with permanent effects injected into the brain before we even knew if it was safe. But if their courage leads to the first FDA-approved disease-modifying therapy in HD, what a legacy that will be!” (Especially for those like this author who had been convinced that they would be lonely all their life.) The list of chronic conditions which have been remediated, if not cured, in children includes Spinal Muscular Atrophy (the genetic equivalent of “Lou Gehrig’s Disease”), Duchenne Muscular Dystrophy, and Severe Combined Immunodeficiency (SCID)-and is expanding daily. The next frontier is personalized therapy, where a treatment is designed for a single child’s unique mutation, opening the “door to cure” for thousands of rare childhood diseases. Analysts project that by the

Norman Rockwell's iconic "Freedom from Fear": a many splendored thing!

References: 1. Kovatch, AL. Yes, Virginia, There Is a Santa Claus…Yes, Miles, There Was a Virginia. ACMS Bulletin. Vol.113 No.12. December 2023 2. https://www.uab.edu/news/ research-innovation/breakthrough-inhuntingtons-disease-treatment-showsunprecedented-results-for-patients

QA Membership

For more than a decade, Dr. Deval (Reshma) Paranjpe has shaped the voice and vision of the ACMS Bulletin as its long-standing Medical Editor, stewarding its growth, strengthening its storytelling, and elevating the perspectives of physicians across Allegheny County. As she transitions into the role of Editor Emeritus in 2026, we are honored to recognize her remarkable service, her thoughtful leadership, and her unwavering support of the Allegheny County Medical Society. Dr. Paranjpe’s dedication to organized medicine—and to the ACMS mission of connection, advocacy, and physician well-being—has left a lasting and deeply valued imprint on our community. Deval Paranjpe, MD MBA FACS is a cornea specialist and serves

Dr. Deval Reshma Paranjpe

WITH DEVAL (RESHMA) PARANJPE, MD, MBA, FACS

as the Chair of Ophthalmology for Allegheny Health Network. She is a native Pittsburgher and returned to Pittsburgh after medical school at Brown University Medical School, internship at Mt. Auburn Hospital, ophthalmology residency at UPMC/Eye and Ear Institute and cornea fellowship at the University of Minnesota. She is actively involved in the Pittsburgh community and serves on the boards of Phipps Conservatory and the Pittsburgh Symphony. Q: CAN YOU SHARE A LITTLE ABOUT YOUR BACKGROUND AND WHAT LED YOU TO A CAREER IN MEDICINE? A: As the child of two physicians, choosing a career in medicine seemed a very natural thing to do. My parents always talked about their workdays at the dinner table, so I grew up listening and asking questions and found it fascinating. It was a given that I would work towards a career in medicine; the only question was which specialty. . Q: WHAT INSPIRED YOU TO PURSUE YOUR CURRENT SPECIALTY? A: During my surgery rotation, I was lucky enough to land a week's elective in Ophthalmology on a week when half the residents were either sick or presenting at meetings. So, I was put to work in clinic like a first-year resident and first-assisted in surgery. Being thrown into a hands-on situation made

me realize I really liked the work. It's a perfect blend of medicine and surgery, and the work is elegant, precise and delicate. And nearly bloodless- the EBL is usually under one drop if all goes well. The instruments are spring-loaded unlike those in general surgery and fit my hands perfectly; it was like the story of Goldilocks and the Three Bears. Also, I'm not necessarily wired for a highadrenalin specialty, Ophthalmology is intellectually and technically challenging but at a generally slower heart rate than my colleagues in other surgical specialties. Q: CAN YOU TELL US ABOUT YOUR CURRENT ROLE AND WHAT A TYPICAL WORK DAY OR WEEK LOOKS LIKE FOR YOU? A: I split my days evenly between clinic, surgery and the remaining time is dedicated to administrative tasks/ meetings. I like the mix because it's fulfilling and I'm never bored. As I'm based at AGH, there are also hospital consults and emergency department consults. There's always something interesting and challenging every day. Q: HOW DID YOU FIRST GET INVOLVED WITH THE ALLEGHENY COUNTY MEDICAL SOCIETY OR WHAT HAS YOUR OVERALL ENGAGEMENT BEEN WITH THE ACMS? A: I had been President of my medical school AMA-MSS Chapter

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Membership and didn't have the time to stay involved in organized medicine during ophthalmology training but knew how important it was to do so as an attending. So as soon as I moved back to Pittsburgh, I joined the ACMS. My parents were members, and I grew up with the Bulletin on our coffee table. Over the years, in addition to serving as Bulletin Editor for over a decade, I've served as an ACMS Board member, PAMED delegate and alternate delegate, and on various committees. Q: WHAT HAS BEEN THE MOST REWARDING ASPECT OF BEING AN ACMS MEMBER? A: There are almost too many to list. The friendships I've made and the colleagues I've met have been incredible. Serving with fellow physicians who are dedicated and passionate about medicine and community service is invaluable. It keeps you connected to all the reasons why you went into medicine in the first place. Watching the ACMS evolve and grow over the years has been rewarding as well. It is good to see so many younger physicians getting involved and making the organization thrive. Q: ARE THERE ANY ACMS INITIATIVES (OR PAMED INITIATIVES) OR EVENTS THAT YOU ARE PARTICULARLY PASSIONATE ABOUT? A: Well of course my first love is the ACMS Bulletin! Apart from that, I am a huge fan of all the initiatives that ACMS has put in place to care for physicians, from holding social events to foster connections to more personal help like opening doors to ways to get confidential therapy and counseling without risk or stigma. Physicians care for everyone around them; it's good to have an organization like ACMS that cares about and for physicians. Q: WHAT DO YOU THINK IS THE BIGGEST CHALLENGE FACING HEALTHCARE TODAY?

ACMS Bulletin / December 2025

with and places you look forward to visiting is great. I love to visit Phipps; the tropical forest is so refreshing and beautiful. And I lose myself in music at the Symphony. I love travel but even a small change of scenery like going to a conference can help reset things. Q: DO YOU HAVE A FAVORITE BOOK, PODCAST, OR RESOURCE THAT YOU WANT TO SHARE WITH OUR MEMBERS (OR THAT HAS INFLUENCED YOUR CAREER!)? A: Dale Carnegie's How to Win Friends and Influence People. Marty Raniowski, Dr. Paranjpe, and Dr. Kanel

A: Maintaining and increasing quality and innovation in the face of high costs. Reducing those costs so that no one suffers due to lack of access to high quality care. Reducing the cost of prescription drugs and ensuring domestic production of generic medications to ensure quality and avoid supply chain disruptions. Encouraging bright compassionate young people to pursue a career in medicine, and ensuring that they don't break their wallets or hearts doing it. Q: WHAT ADVICE WOULD YOU GIVE TO MEDICAL STUDENTS OR EARLYCAREER PHYSICIANS? A: Do it because you love it. You will always be needed as a physician. Remember to take care of yourself along the way. Q: OUTSIDE OF MEDICINE, WHAT ARE YOUR HOBBIES OR INTERESTS? A: Writing, art, music, cooking, gardening, travel, and most of all meaningful quality time with family and friends.

Q: WHAT IS ONE SENTIMENT YOU'D LIKE TO SHARE WITH YOUR FELLOW ACMS MEMBERS? A: Support each other. It's so easy to become disconnected from fellow physicians in the current mode of practice. Get to know each other and form meaningful personal and professional connections. It makes practicing medicine so much better. Q: HOW CAN FELLOW ACMS MEMBERS CONNECT WITH YOU OR SUPPORT YOUR WORK? A: Wear eye protection even if you think you don't need it-- including when gardening indoors. Don't sleep or swim in your contact lenses. Come to Phipps Conservatory and come to the Pittsburgh Symphony…two wonderful places to relax, reset and restore your soul. Look for me on LinkedIn and if you would like local restaurant reviews and musings in your inbox, please subscribe to my Substack at https://substack. com/@devalinthedetails

Q: HOW DO YOU MAINTAIN WORKLIFE BALANCE? A: It's always a struggle. I have to remember to have fun and scheduling it sometimes helps. Having people you look forward to spending time

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Human Immunodeficiency Virus in Allegheny County Ejakuwa Abubakar, MPH and Jennifer Fiddner, MPH, Allegheny County Health Department The HIV Virus HIV, transmitted via contact with infected blood and other bodily fluids, is a virus that attacks the body’s immune system. Left untreated, the infection can lead to acquired immunodeficiency syndrome (AIDS), damaging the body’s immune system, and leaving individuals at risk for serious, life-threatening infections. HIV can spread by having sex or sharing equipment used to prepare and inject drugs with an infected individual. Individuals generally experience flu-like symptoms including fever, muscle aches, and fatigue approximately 2 to 4 weeks after infection, although some individuals may not experience any symptoms. The infection develops into a chronic illness when individuals may or may not feel sick as the amount of HIV increases in their blood. Appropriate treatment can help prevent disease progression and the development of AIDS. HIV Testing, Treatment, and Prevention Every person between the ages of 13 and 64 should get tested for HIV at least once. People with certain risk factors should get tested more often. This includes men who have sex with men, people who have had sex with someone who was infected with HIV or whose sexual history was unknown, people who have had more than one sex partner since their last HIV test, people who have exchanges sex for money, people that have been diagnosed with or treated for another sexually transmitted infection, hepatitis, or tuberculosis, or people who have shared needles, syringes, or other drug injection equipment.

People who are infected with HIV can be treated with antiretroviral therapy, or ART. HIV treatment can reduce a person’s viral load, helping people stay healthy and reducing the risk of transmitting the virus to others. Treatment options include oral medication and long-acting injections. HIV infections can be prevented. Prevention measures include harm reduction practices like using condoms and not sharing needles, syringes, or other drug injection equipment. Healthcare providers can also prescribe PrEP to help patients prevent becoming infected with HIV. HIV Trends Between 2015 and 2024, Allegheny County identified 891 new HIV infections, 733 of which (82.3%) were among men. Most new cases occurred in people aged 15–24, 25–34, and 35–44. Over the past 10 years, the largest shares of new infections were in the 25–34 age group (34%) and the 15–24 age group (25%). Throughout this period, Black residents consistently had higher rates of new HIV diagnoses compared to White residents. An examination of new HIV cases by risk factors showed that men who have sex with men accounted for the largest proportion of new cases, followed by heterosexual contact. Injection drug use accounted for between 3% of new cases at its lowest point in 2016 and 11% at its highest point in 2017. About one-quarter of people newly diagnosed with HIV were diagnosed late, that is, they received a diagnosis of AIDS within 90 days of HIV diagnosis.

Figure 1: Rate of New HIV Diagnoses by Sex at Birth, Allegheny County, 2015 – 2024 *Additional information can be accessed on ACHD’s STI/HIV dashboard

HIV Elimination World AIDS Day occurs annually on December 1st. This day of recognition serves as a call to action. Achieving HIV elimination requires a collective effort to reduce risks associated with infection and provide timely, consistent, and low-barrier access to testing, treatment, and prevention services. Healthcare providers, especially those serving people at high risk of HIV infection, should ensure that their clients are familiar with harm reduction practices and ensure that they have timely access to HIV testing, treatment, and prevention services as a part of routine healthcare. The Allegheny County Health Department offers PrEP, HIV testing, and HIV treatment services, including free at-home testing kits. Healthcare providers are encouraged to visit the AIDS Free Pittsburgh webpage to learn more about patient and provider resources in Allegheny County.

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*This handout is informational only and not legal advice. Contact Quatrini Law Group for a consultation.

WHAT PHYSICIANS SHOULD DO IF THEIR LONG-TERM DISABILITY CLAIM IS DENIED BRIAN PATRICK BRONSON, ESQ. A denial of long-term disability (LTD) benefits is one of the most stressful moments a physician can face. You’ve spent years taking care of patients; now, when you need support, the insurance carrier says “no.” Take a breath. A denial is not the end of the road—but what you do next can make or break your case. 1. Don’t Panic — and Don’t Assume the Insurer Is Right A denial letter is meant to discourage you with technical language, selective reading of your records, and policy interpretations that favor the insurer – not you. Stay calm. A denial can often be overturned with the right evidence and strategy. 2. Find a Lawyer Who Specializes in Disability Claims — Not Just Any Lawyer Physicians often reach out first to colleagues, hospital counsel, or attorneys they know from the community. Those lawyers may be excellent in their fields, but LTD work is highly specialized. These cases are dense, technical, and adversarial. You want someone who handles this work every day. 3. See the Lawyer Before You Contact the Carrier Again This is one of the most important steps physicians overlook. Before responding to the denial, filling out forms, and speaking with an adjuster, bring your complete claims file and denial letter to a lawyer and orchestrate your appeal strategy together. 4. Meet With Your Treating Doctors (After the Attorney Consultation) Your treating physicians need to understand why the insurer denied your claim, what functional limitations matter for legal purposes, and exactly what evidence will help your appeal. Structure your doctor visits after meeting with your attorney so they align with the appeal plan. Most denials are overturned not with “more records,” but with targeted, strategic medical opinions. 5. Do Not Talk to the Insurance Company on Your Own Adjusters are not “checking in” for your benefit. Their goal is to secure statements and information that can be used against you. A single poorly-worded phone call or email can damage your case. Your attorney can protect your rights in this process.

ACMS Bulletin / December 2025

6. Strictly Track All Deadlines ERISA appeal deadlines are unforgiving. You typically have 180 days to appeal. If you miss it, your rights may be lost permanently. Do not delay in retaining an attorney. 7. Be Aware of Surveillance and IMEs After a denial or during ongoing review, insurers may conduct video surveillance, track your online presence and professional activity, and schedule an “Independent” Medical Exam (IME). For IMEs, consider bringing a nurse observer, a neutral witness, and written instructions from your attorney. Conclusion Physicians—especially specialists with high incomes, complex duties, and medical conditions that are not visible on imaging—face an uphill battle without knowledgeable representation. An experienced disability attorney provides far more than help with paperwork. • They level the playing field. • They understand how to interpret and counter policy loopholes. • They build the right medical case. • They prevent irreversible mistakes. • They take over the stress so you can focus on your health. • They significantly increase the likelihood of overturning a denial. For physicians, disability insurance is not just a benefit— it is a financial safeguard that protects your training, your career, and your family. When that protection is threatened, having the right advocate makes all the difference.

Brian Patrick Bronson is an attorney with Quatrini Law Group. He concentrates his practice in the areas of Disability Insurance, ERISA, and Social Security Disability. Brian understands how long and short term disabilities insurances are governed by ERISA (the Employee Retirement Income Security Act of 1974), as well as how they can interact with and affect other benefits. Brian can be reached at (724) 552-2755 or bbronson@qrlegal.com.

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The Charlie Gard Case A Tragedy Without Villains By: Timothy Lesaca, MD Some cases linger in our memory because of the humanity at their center. The case of Charlie Gard, which unfolded in England in 2017, is one of those. It took place within the National Health Service and under a legal framework in which courts decide a child’s treatment when parents and clinicians cannot agree. Before it became a global controversy, before it drew international headlines, it began as something far more familiar: a young couple, their infant son, and an unbearable collision between hope, harm, and uncertainty. Charlie was born healthy in August 2016. Within weeks, his parents noticed he was weak and unable to lift his head. Two months later, he was admitted to Great Ormond Street Hospital with profound muscle weakness, respiratory failure, and failure to thrive. Genetic testing identified an extremely rare mitochondrial DNA depletion syndrome (RRM2B), a condition associated with rapid deterioration in infancy, seizures, multisystem involvement, and early death. There was no established treatment. As Charlie’s condition worsened, his parents learned of an experimental therapy—nucleoside bypass treatment— that had shown promise in a different mitochondrial disorder. They pursued it with extraordinary determination. Although the treatment had never been tested in Charlie’s disease, it had a theoretical scientific basis, and a U.S. neurologist was willing to attempt it. His parents raised more than a million pounds through an international crowdfunding effort, organized medical records, contacted experts across

continents, and worked tirelessly to create a path for their son to receive the therapy abroad. In parallel, Great Ormond Street Hospital sought multiple external consultations: mitochondrial specialists from elsewhere in the United Kingdom, neurologists from academic centers in Europe, and a research group in Barcelona with expertise in related disorders. These consultations supported the hospital’s belief that Charlie’s illness, particularly the extent of his brain involvement, was too advanced for meaningful benefit. When consensus could not be reached between the family and the clinical team, Great Ormond Street Hospital asked the High Court in early 2017 for permission to withdraw life support. The court’s ruling in favor of withdrawal was followed by a sequence of appeals. His parents appealed to the Court of Appeal, sought review by the Supreme Court, and ultimately applied to the European Court of Human Rights. Each tribunal upheld the original decision, reinforcing the belief that further treatment would not change the outcome and might increase suffering. Even so, the appeals process extended the period in which outside experts were consulted, including a final invitation for the U.S. neurologist to evaluate Charlie in person. After that assessment, and further imaging demonstrating the severity of Charlie’s disease, the family accepted that treatment could no longer alter the course of his illness. Life support was withdrawn on July 28, 2017. What follows is not a legal analysis or a policy discussion. It is simply an

attempt to understand the humans caught in the middle of this tragedy. For Charlie’s parents, this began as the ordinary joy of new parenthood. By every account, they were loving, attentive, and devoted—the kind of parents who photographed each milestone and delighted in the everyday presence of their son. When he became ill, they did not retreat from the enormity of what lay ahead. They learned unfamiliar terminology, read medical papers late into the night, contacted specialists around the world, and sat at Charlie’s bedside for months. They raised unprecedented funds from strangers moved by their determination. Their hope was not naïve; it was the instinct of parents confronting a future they could not bear to accept without exhausting every possibility. Their suffering was profound. They watched their child deteriorate and found themselves navigating a complex medical system they had never imagined entering. They were thrust into international attention they neither sought nor were prepared for. Their motives were questioned publicly. Their identity as parents felt, at times, under examination. And in the end, they lost the opportunity to try the one intervention they believed might help their son before having to let him go. For the clinicians at Great Ormond Street Hospital, this case carried a different but equally heavy burden. These were physicians and nurses caring for a child with a catastrophic illness at the limits of medical capability. They believed, with compassion and conviction, that

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Article further treatment would not improve Charlie’s condition and would increase his suffering. Many faced harassment and threats during the course of the case. Yet they remained responsible for decisions they felt ethically bound to uphold. They were not indifferent; they were human beings trying to protect a child from what they believed would be harm, even as they empathized deeply with the grief and hope of his parents. The courts faced a burden of their own. Judges are often portrayed as detached arbiters, but cases like this demand an emotional resilience few would welcome. They were not choosing between life and death, but between a short life with suffering and no realistic prospect of improvement versus a longer life with continued suffering and no improvement at all. They acted within the constraints of

ACMS Bulletin / December 2025

English law—not because it is perfect, but because it is the framework available. They saw the parents cry in court. They understood the magnitude of the decision. They knew their ruling would be devastating. The broader public reaction reflected the intensity of the story once it entered the media. People saw a baby who might be saved, doctors who said “no,” and parents who refused to give up hope. The case quickly evolved into a symbol—invoked in political debates, ethical arguments, religious commentary, and socialmedia campaigns. The complexity of the medical facts and the nuance of the disagreements were often lost. Meanwhile, both the parents and the clinicians bore pressures few outside the situation fully appreciated. Step back from all of this, and the

essential lesson becomes clearer: this was a tragedy without villains. It was a conflict created not by malice or neglect but by the weight of love, the limits of medicine, and the fragility of decision-making under profound uncertainty. What remains are the human lessons. Love can clash with medical judgment, and both can still be rooted in compassion. Uncertainty requires structures more supportive than courtrooms and media frenzies. Disagreement does not imply cruelty or incompetence, and no parent or clinician should be left feeling powerless or attacked. These experiences stay with all who encounter them, even from a distance, because they touch something fundamental about what it means to care, to hope, and to let go.

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ACMS Member Acknowledgements December 2025

Dr. Donald Whiting, MD

Dr. Donald Whiting Honored The Chuck Noll Foundation for Brain Injury Research recently held its 2nd Annual Legends Event — an inspiring evening celebrating leadership, innovation, and the future of brain health. At the event, the Foundation honored ACMS member Dr. Donald Whiting, MD for his years of dedication to neurosurgery and brain-injury care, and for strengthening the Foundation’s mission. The gathering brought together supporters, partners, board members and guests — united by a shared commitment to advance research, protect the brain, and push science forward. ACMS Celebrates Gateway Medical Society at the 2025 “Black Excellence in White Coats” Gala ACMS was delighted to celebrate a year of transformative community service by the Gateway Medical Society at its annual fundraiser, The Black Excellence in White Coats Awards & Scholarship Gala, at the Pittsburgh Marriott on October 25, 2025. Gateway Medical Society is a not-forprofit physicians’ organization with a seven-decade history as a health care

Reverend Christopher Conti MD, President, Gateway Medical Society; Keith Kanel MD, President, Allegheny County Medical Society; Jan Madison MD, GMS Fundraising Chair and former ACMS Board Member; Rachel Toney MD, President-Elect, Gateway Medical Society

advocate and health policy champion for the socio-economically challenged and underserved communities of greater Pittsburgh. It is the local chapter of the National Medical Association, the largest and oldest organization representing African American physicians and their patients in the United States. ACMS Members Complete PAMED Leadership Training Congratulations to the 2025 YearRound Leadership Academy graduates! We’re thrilled to share that several ACMS members participated in this year’s cohort, with a goal of learning leadership skills to help them grow and

lead across Pennsylvania. Congratulations to ACMS members: Emily Cottrell, MD; James Latronica, DO; Richard Hoffmaster, MD; Prerna Mewawalla, MD; Alexandra Johnston, DO Thank you to PAMED for the facilitation of the program and the faculty for their outstanding instruction, including Catherine Baumgardner, PhD, MHA, FACHE and Douglas Spotts, MD, FAAFP, FCPP. If any ACMS members are interested in this program, enrollment is now open for the 2026 Year-Round Leadership Academy, and scholarships are available. Visit pamedsoc.org/YRA

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ACMS Bulletin / December 2025

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ACMS in Action December 2025 1.

The ACMS Women in Healthcare Committee kicked off the holiday season with an evening of connection and community. Guests enjoyed a cozy atmosphere, great food and wine, and plenty of moments to unwind, network, and share laughter. A highlight of the night was the Bloom Bar by Poppin’ Daisies, where attendees created beautiful floral arrangements to take home. Thank you to everyone who joined us and made the event a success. Here’s to another year of collaboration and support within the ACMS community!

1. Casey Martin, MD; Sukhmani Sandhu, MD; Rebecca Davis, DO 2. Amber Elway, DO; Stacie McKnight, DO; Marissa Tremoglie-Barkowski, MS4; Ann McGaffey, MD; Kirsten Lin, MD 3. Janine Boehmer; Jill White, MD 4. Anu Anand, MD; Mrunali Luke, MD 5. Women in Healthcare Committee Co-Chair, Meilin Young, MD 6. Women in Healthcare Committee Co-Chairs Prerna Mewawalla, MD and Meilin Young, MD 7. Direct Care Physicians of Pittsburgh, Kirsten Lin, MD; Emily Scott, DO; Marielle WilliamsonRea, DO

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ACMS Bulletin / December 2025

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A Brief Overview of Physician Unionization Trends By: James Latronica, DO, DFASAM For those who have been following PAMED’s efforts or who have heard me speak, this is likely not new information, but it’s still worth leading discussions about this topic with one piece of information: yes, it is legal for physicians to collectively bargain/ unionize! A quick “test” of a physician’s ability to unionize is to determine whether they are in a supervisory role with the direct ability to hire or fire staff. If this is not the case, then that physician can likely unionize. Physicians still have mixed opinions on unionization for many different reasons, and in the case of this piece, I’m not whipping votes or trying to do any convincing. I want to provide a brief overview of the history of physician unions, mainly focusing on the recent past, so we have an idea of what has transpired and what we may be looking ahead to. A Brief History The first physician union in the United States was the Intern Council of Greater New York, founded in 1934. The most populous physician union, the Committee of Interns and Residents (CIR) was founded in 1957, though large scale concerted efforts at unionization really started in the 1970s-1990s. In a landmark decision in 1999, the National Labor Relations Board (NLRB) ruled that residents and fellows are employees under federal labor law, greatly expanding their potential for collective bargaining power. Prior to this, it was held that resident and fellow physicians were learners, akin to medical students. Potential challenges to this ruling have popped up under certain administrations and, on the other side

of the coin, as experiential learning has evolved over the years, medical students have begun to challenge their role being strictly defined as “learners” given the increasing responsibilities placed on them throughout their clinical years. A frame of reference here may help. According to the Bureau of Labor Statistics, about 4.3 million wage and salaried workers (9.9% of total workers) in the US were unionized as of 2024. This is significantly lower than 20.1% of total workers who were unionized in 1983, the first year comparable BLS data was available, and is an all-time low when considering other data sets which reach further back. Data from the Organization for Economic Cooperation and Development (OECD) suggests a peak level of ~34% of Americans workers being unionized in the postWorld War II period through the early 1960s. Modern Physician Unions Between 2014 and 2019, the total number of physicians who were unionized rose from 46,689 to 67,673 which, based on the total number of physicians in practice in each of those years, accounted for 5.7% and 7.2% of the total physician population, respectively. Strictly in terms of raw numbers, this represented a 51% increase in the total number of physicians who were unionized in 2019 versus 2014, which is a remarkable rate over a given period of time, across industries. The COVID-19 pandemic and attendant workplace-related issues spurred even further interest in unionization, but the makeup of the NLRB had changed to be hostile to

unionization generally, and from 2019 to 2021, there were no elections held for physician unions. Part of this stemmed from a fear that the NLRB could use a given election as a wedge to challenge the 1999 ruling which permitted residents to fully be considered employees. Starting in 2022, after another shift in the NLRB, unionization efforts began again in earnest, with many large residency programs around the country organizing and holding elections. In May 2023, nearly 90% of residents that the University of Pennsylvania voted to unionize, becoming the first unionized residency program in Pennsylvania. The Training Gap (That Wasn’t) You’ll note that a lot of this data concerns resident unions. CIR estimates they represent 40,000 resident union members, and at the end of 2024 there were estimated to be about 72,000 total unionized physicians, so unionized residents account for over half the population of total unionized physicians. Considering that the ACGME reported 162,644 active residents and fellows at the end of 2024, and the AAMC estimated that there were about 1.1 million total active physicians in the country at that time, we see that unionized residents lead the pack on both a gross and per capita basis when it comes to unionization status. Part of the reason for that is that the CIR is part of the SEUI, and basically all residency programs that unionize do so through CIR, making both application and data collection uniform. A collective bargaining unit, the core aspect of unionization, is usually defined by

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Article who employs you (or, sometimes more specifically, where your paycheck comes from), and the provenance of resident pay is usually very easy to track. Even across specialties, the vast majority of residents in a given program receive their paychecks from the same source, making the establishment of a bargaining unit rather straight-forward, or so you might think. Some hospitals have argued that since residency spots are mostly funded by CMS that the hospital should not be considered the employer. Others have argued that attending physicians and APP’s should have to be in the same bargaining unit as the residents. Both of these arguments have been rejected, but you can see the…creative ways…in which employers deter the formation of unions. “There’s Got To Be A Better Way” Most people are likely vaguely aware of how a union is formed. Some troublemaker (like this author, in a previous life) gets on a soapbox in the break room, some percentage of their colleagues agree with them that they should form a union, and they get in contact with the NLRB to hold an election. It should be noted that once employees embark upon this process, there are two other things that could happen. Employees can bypass the election process if more than 50% of them sign their initial cards which demonstrate intent to unionize. This is called “card check” and while it is legal, court decisions have provided employes with the ability to demand a secret ballot election. Various efforts to strengthen “card check” have been initiated since the early 2000s, but at present it is not a valid tool. Remember, though, that a company could simply say “yes, we recognize you, and we will collectively bargain with you.” They don’t have to demand a secret ballot election or even oppose the union at all. This never happens, but it’s worth noting that this is a distinct possibility. Most health care employers have a mission and vision statement which supports employees, and likely have some sort of employee health and

ACMS Bulletin / December 2025

wellness program, ideally one that’s evidence-based. The Evidence Is In, Actually And from an evidence-based standpoint, unions improve working conditions, increase diversity, and decrease financial precarity. They have also, systematically, been shown to increase “…many of the social determinants of health, including income, security, time off, access to health care, workplace safety culture, training and mentorship, predictable scheduling to ensure time with friends and family, democratic participation, and engagement with management.” Admittedly, data like this specific to physician unions is scarce, since they are relatively new. But we can reasonably infer from decades of research across industries what the benefits might be. Assuming that physician unions would be a unique outlier—especially assuming that they would be a net negative to these wellresearched outcomes—would not be the most reasonable hypothesis at this moment in time. Labor unions are often seen as a “political” topic but they show testable and repeatable benefits to individual and public health, and so I don’t think it’s unreasonable to consider them more categorically similar to the health insurance your employer provides, as opposed to the political party you may be affiliated with. I said I wouldn’t convince or whip votes in this piece, and that’s really not what I’m doing here (though I understand how it may seem that way). I’m simply refusing to adhere to the narrow window through which unionization is traditionally discussed— as a political instrument, reactionary in nature, detached from the health or material conditions of individuals. In the midst of attacks on evidencebased public health, we should be brave enough to describe social constructs which make peoples’ lives better, even if historically discussing them has seemed gauche.

In Closing As more residents unionize, I expect to see a “trickle-up effect” wherein graduating residents are going to seek out or create workplaces which can collectively bargain. When CIR was founded about 80% of physicians were independent, and now about 80% of physicians are employed. This trend toward consolidation and homogenization has surely been a factor in the inflection point in unionization created at the start of the COVID-19 pandemic. Resident attitudes toward unionization are largely positive, even among non-unionized residents, and survey data, while still relatively scant in the literature, tends to show positive physician attitudes toward unionization overall. Whether it is PAMED, a county medical society, your own workplace, or whether or not you support the idea of physician unionization, the trend toward an increase in physician unionization is undeniable, and it would behoove physicians to remain informed about the rights you, your colleagues, and your trainees have under the National Labor Relations Act (even in the absence of a formal union vote!) Dr. Latronica serves as the 13th District Trustee on the Pennsylvania Medical Society (PAMED) Board of Trustees, representing physicians from Allegheny County and the surrounding region at the state level. If you wish to connect with Dr. Latronica regarding state-level issues or policy, please contact Sara Hussey at shussey@acms. org and she will be happy to put you in touch with him.

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Specialty Group Updates December 2025

By: Nadine Popovich, Melanie Mayer, and Haley Thon Allegheny County Immunization Coalition (ACIC) — 2025-2026 Chair Jenny Bender, MPH, BSN, RN, CIC: Allegheny County Immunization Coalition is a nonprofit network of physicians, public health professionals, and community partners promoting immunizations and disease prevention across all stages of life in Allegheny County, Pennsylvania. You have access to free membership, seasonal outreach projects, and ready to use vaccine education tools through www.immunizeallegheny.org and acic10.wildapricot.org. Visit www.immunizeallegheny.org to access vaccine schedule resources, and stay informed about future meetings, volunteer events, and the 2025 ACIC Conference Recap. Our leadership team is building the 2026 calendar now. Member engagement in meetings and community outreach will shape priorities for the year ahead. American College of Surgeons Southwestern Pennsylvania Chapter (ACS-SWPA) — 2025 President – Richard Fortunato, DO, FACS: The ACS Leadership & Advocacy Summit will take place February 28–March 3, 2026, at the Grand Hyatt Washington, DC. This in-person event offers ACS members the opportunity to enhance their leadership and advocacy skills through workshops, expert-led sessions, and congressional visits. The Leadership Summit emphasizes communication and leadership development, while the Advocacy Summit focuses on healthcare policy and surgeon advocacy. For more details, please visit https://www.

facs.org/for-medical-professionals/ conferences-and-meetings/leadershipand-advocacy-summit/. For questions or membership assistance, contact Haley Thon, Chapter Administrator, at 412-321-5030 x105 or hthon@acms.org. Pennsylvania Geriatric Society Western Division (PAGS-WD) — 2025 President - Heather Sakely, PharmD, BCPS, BCGP: 2025 Geriatrics Teacher of the Year Award – Nominations Submission Deadline is December 31st The Society is proud to announce that nominations are now being accepted for the 2025 Geriatrics Teacher of the Year Award. This prestigious annual honor recognizes two outstanding educators, one physician and one healthcare professional, who have shown exceptional commitment to advancing geriatrics education. Award recipients are individuals who have made a lasting impact on the training and development of future geriatric professionals and have significantly contributed to the growth of geriatrics education across the healthcare continuum. Full details, including eligibility requirements, selection criteria, and the nomination form, are available on the Society’s website at https://pagswd.org/ Geriatrics-Teacher-of-the-Year-Award. Clinical Update 2026 Mark your calendars! The 2026 Annual Conference: Clinical Update in Geriatric Medicine will be held April 16–17 at the Sheraton Pittsburgh Hotel at Station Square. The program agenda is being finalized, and registration will open early 2026. For any questions or to join the

society, please contact Haley Thon, Chapter Administrator, at 412-321-5030 x105 or hthon@acms.org . The Pittsburgh Ophthalmology Society (POS) — 2025 President - Laurie A. Roba, MD: Pittsburgh Ophthalmology Society: Mark Your Calendar – 2026 Monthly and Annual Meeting Dates The Pittsburgh Ophthalmology Society will host their final monthly meeting on January 22, 2026 and welcome Raymond Cho, MD, FACS, Director of Ophthalmic Plastic and Reconstructive Surgery at The Ohio State University Wexner Medical Center, Columbus, Ohio. The Society extends special thanks to Lance Bodily, MD, for inviting Dr. Cho to present, and to our meeting sponsors — Amgen, Biotissue, and Zeiss — for their generous support. Dr. Cho served as chief of ophthalmology at Ireland Army Community Hospital, Fort Knox, and Keller Army Community Hospital, West

Raymond Cho, MD, FACS

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Society News Point, and was the ophthalmology consultant for the Iraqi theater during his 2005–2006 deployment to Balad Air Base. Since 2015, he has been Director of Ophthalmic Plastic and Reconstructive Surgery at The Ohio State University Wexner Medical Center and a Clinical Professor at the OSU College of Medicine. A Fellow of ASOPRS and the ACS, he has held committee roles with ASOPRS and the AAO and received the AAO Achievement Award. He is President of the North American Society of Academic Orbital Surgeons and serves on the editorial board of Ophthalmic Plastic and Reconstructive Surgery. Since 2023, he has completed three humanitarian surgical missions to Ukraine and is widely sought after for his expertise in orbital surgery. 61st Annual Meeting and 46th Ophthalmic Personnel Meeting Date Announced The Society is proud to announce the 61st Annual Meeting and 46th Annual Meeting for Ophthalmic Personnel is scheduled for Friday, March 20, 2026, at the Omni William Penn Hotel in Pittsburgh, PA. These events provide a premier platform for education and networking, fostering professional growth in a collegial setting. Laurie

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Joel Schuman, MD, FACS

A. Roba, MD, president is honored to announce the 45th Annual Harvey E. Thorpe Lecturer, Joel S. Schuman, MD, FACS. Dr. Schuman is an internationally renowned clinician-scientist, inventor of optical coherence tomography (OCT), and one of the most influential figures in modern glaucoma research. He serves as the Kenneth L. Roper Endowed Chair and Vice Chair for Research Innovation at Wills Eye Hospital, Co-Director of the Glaucoma Service, and Professor of Ophthalmology at Wills Eye Hospital and

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Sidney Kimmel Medical College, as well as Professor of Biomedical Engineering at Drexel University. A pioneering researcher continuously funded by the National Eye Institute since 1995, Dr. Schuman was the first to identify a molecular marker for human glaucoma and has authored more than 450 peerreviewed publications. Esteemed guest faculty members, including Debra A. Goldstein, MD, FRCSC, H. George Tanaka, MD, and Steven G. Safran, MD, PA will share cutting-edge insights on various ophthalmic topics. The 45th Annual Meeting for Ophthalmic Personnel will run concurrently, offering participants the opportunity to earn up to 7 IJCAHPO credit hours, pending approval. Course directors Avni Vyas, MD; Cari Lyle, MD; Jeffrey Wincko, MD; and Ryan Zukerman, MD have prepared a dynamic program. Sessions featuring respected local faculty include critical topics on Glaucoma, Retina, Systemic Disease, Oculoplastic, and Ocular Trauma. In addition, the 2026 program will see the return of Ophthalmic Jeopardy! Registration begins January 18 with members and past attendees receiving notification by email.

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