COLORADO MEDICINE
ADVOCATING EXCELLENCE IN THE PROFESSION OF MEDICINE
Practice viability is patient care:
Protecting Colorado physicians’ ability to practice
PRACTICE VIABILITY IS PATIENT CARE
Practice viability is the foundation that allows physicians to care for patients and sustain successful careers. From downcoding and prior authorization to insurer consolidation and regulatory overreach, pressures on Colorado practices are intensifying. Learn how we’re advocating for you — and access tools to help protect your practice.
8 LEGISLATIVE UPDATE: AFFORDABILITY TAKES CENTER STAGE
Affordability is the defining theme of Colorado’s 2026 legislative session, as budget pressures, election-year politics, and federal uncertainty shape debates under the Gold Dome. From Medicaid and insurance coverage to liability, licensure and AI, lawmakers are tackling issues with major implications for physicians, patient access and practice sustainability.
10 RECENT COLORADO SUPREME COURT DECISIONS AND THEIR IMPACTS ON PHYSICIANS
Two recent Colorado Supreme Court rulings are reshaping the state’s medical liability landscape, broadening financial exposure for physicians, insurers, and health systems. Learn how CMS and CPPA are responding with research, education and advocacy to protect patient access and support physicians amid a changing legal environment.
23 FINAL WORD: THE LIMITS OF RESILIENCE AND WELLNESS
Physician burnout isn’t a failure of resilience – it’s a symptom of systemic workplace pressures that have intensified over decades. Drawing on CPHP’s long experience, CPHP Medical Director Emeritus Michael Gendel, MD, explores why wellness efforts alone fall short and what physicians can do to reclaim agency, reduce stress, and protect their wellbeing in challenging practice environments.
In this column, CMS President Brigitta Robinson, MD, FACS, discusses the importance of protecting practice viability to preserve physicians’ ability to care for patients the way medicine is meant to be practiced — with thoughtful, independent clinical judgment at the center.
14 WHAT IS CENTRAL LINE AND HOW DOES IT BENEFIT YOU?
Central Line is one of CMS’s premier member benefits — an innovative platform that brings member voices directly into the boardroom and strengthens engagement in governance.
15 EXCLUSIVE CMS MEMBER BENEFIT: THE VALUE OF A MODEST LONG-TERM CARE PLAN
The Colorado Medical Society, Copic Financial and BuddyIns have teamed up to provide a great long-term care plus life insurance option, exclusive to CMS members. Even a minimal plan gives you immediate protection and peace of mind – enough to cover some essential care, preserve savings, and buy time to make decisions.
16 Partner in Medicine Spotlight: Less time doing data entry = more patients
17 Reflections: Hearing another’s voice
18 Letter to the editor: A lifetime dedicated to women’s health
19 Introspections: From loss to calling: What rural medicine gave me when I needed it most
20 Copic Comment : Recalls and warnings: Risk management considerations
COLORADO MEDICAL SOCIETY
OFFICERS, BOARD MEMBERS, AMA DELEGATES, and STAFF
2025-2026 OFFICERS
Brigitta Robinson, MD, FACS
President
Sean Pauzauskie, MD
President-elect
Kim Warner, MD
Immediate Past President
Hap Young, MD
Treasurer
Dean Holzkamp Chief Executive Officer
BOARD OF DIRECTORS
Matthew Belton, MD
Brittany Carver, DO
Elizabeth Cruse, MD, MBA
Kamran Dastoury, MD
Scott Dhupar, MD
Dakota Hitchcock, MD
Eleanor Jensen, DO
Rachelle M. Klammer, MD
Marc Labovich, MD
Justin McCoy, DO
Michael Moore, MD
Erik Odderson, MSC
Rhonda Parker, DO
Lynn Parry, MD
Darlene Tad-y, MD, MBA
Andrew Tannous, MD
COLORADO MEDICAL SOCIETY STAFF
Dean Holzkamp Chief Executive Officer
Dean_Holzkamp@cms.org
Kate Alfano Director of Member Engagement
Kate_Alfano@cms.org
Jen Atchison, BHA, MSDA
Director of Continuing Medical Education and Recognized Accreditor Programs
Jen_Atchison@cms.org
Virginia "Ginny" Castleberry Executive Director Denver Medical Society Virginia_Castleberry@cms.org
CO 80230-6902. 720-859-1001.
Cecilia Comerford-Ames
Executive Director, Colorado Society of Eye Physicians and Surgeons Communications and Marketing Manager
Cecilia_Comerford@cms.org
Dorcia Dunn
Membership Operations Manager Dorcia_Dunn@cms.org
Crystal Goodman
Executive Director, Northern Colorado Medical Society
Crystal_Goodman@cms.org
Blake Johnson
Member Engagement Specialist Blake_Johnson@cms.org
Dean Holzkamp, Executive Editor, and Kate Alfano, Managing Editor.
AMA DELEGATION
David Downs, MD, FACP
Amy Duckro, DO, MPH
Carolynn Francavilla, MD
Mark Johnson, MD, MPH
Jan Kief, MD
Rachelle Klammer, MD
A. “Lee” Morgan, MD
Tamaan Osbourne-Roberts, MD
Lynn Parry, MD
Brigitta J. Robinson, MD
Michael Volz, MD
Patricia Weber, MD
AMA PAST PRESIDENT
Jeremy A. Lazarus, MD
Mihal Sabar Director of Accounting
Mihal_Sabar@cms.org
Chet Seward
Chief Strategy Officer
Chet_Seward@cms.org
Debra Will Director of Business Development
Debra_Will@cms.org
Tim Yanetta
Membership and IT Manager
Tim_Yanetta@cms.org
Practice viability is essential to patient care
Brigitta Robinson, MD, FACS President, Colorado Medical Society
As physicians, we know that when we talk about practice viability, we are really talking about the ability to care for our patients the way medicine is meant to be practiced – thoughtfully, responsibly, and with professional judgment at the center. Practice viability is what allows us to spend meaningful time with patients, support the teams we work alongside, and keep our doors open, so care remains available in our communities.
Across Colorado, physicians practice in many different settings: independent offices, small groups, large groups, hospitals, and large health systems. While those environments vary, the foundation of practice viability is the same. It depends on stability, predictability, and systems that support – rather than complicate – the physician-patient relationship.
Over the past several years, the administrative side of medicine has grown increasingly complex. Prior authorization requirements, coverage verification, claim reviews, and coding adjustments are now routine parts of practice. While oversight and accountability have an important role, these processes often slow care delivery and consume time that would otherwise be spent with patients.
From a practice perspective, those delays matter. When claims are denied or downcoded, payment for care already delivered is postponed or reduced. Over time, uncertainty strains even well-managed practices – particularly as operating costs continue to rise. Staffing, rent, technology, and health insurance expenses increase year after year, while reimbursement often remains flat or declines.
Practice viability is not solely a concern for independent physicians. Employed physi -
Practice viability is what allows us to spend meaningful time with patients, support the teams we work alongside, and keep our doors open, so care remains available in our communities.
cians experience these pressures as well. When organizations face financial strain, it can lead to a decrease in compensation, staffing changes, or service consolidation. Regardless of employment model, physicians rely on sustainable systems that recognize the value of their work and allow them to focus on patient care.
It is also important to address a misconception that this is about increasing our pay. Physicians are not asking for special treatment. We are asking for stability and fairness – being paid appropriately for the care we provide and minimizing unnecessary barriers that delay care for patients. Few other professions have their work routinely reassessed after it is completed, and reimbursed at a lower rate despite being performed appropriately and in good faith.
Policy decisions play a meaningful role in shaping practice viability. Reimbursement policies, particularly in public programs such as Medicaid, directly affect access to care. When reimbursement fails to cover the cost of providing services, practices are forced to make difficult decisions that can limit access for patients. Thoughtful policymaking can help ensure that cost-containment efforts do not unintentionally reduce access or destabilize physician practices.
There is also an opportunity for greater understanding of how physician practices operate. Many function as small businesses with narrow margins. Physicians invest deeply in their communities – employing staff, maintaining offices, and caring for patients with increasingly complex needs. Supporting physician practice viability helps ensure these community anchors remain strong and accessible.
HOW THE COLORADO MEDICAL SOCIETY SUPPORTS PRACTICE VIABILITY
The Colorado Medical Society plays a critical role in supporting physicians as they navigate these challenges. CMS provides practical resources, education, and advocacy focused on strengthening practice sustainability and preserving physician autonomy. This includes tools and guidance related to prior authorization, downcoding, and administrative burden, as well as educational opportunities that share best practices from physicians and practice experts.
CMS also serves as a connector – bringing physicians together to learn from one another, identify emerging challenges, and elevate shared concerns. In our Partners in Medicine supporter program, there are companies that provide resources for contract review and financial support. Importantly, these resources are designed to be accessible and efficient, recognizing that physicians’ time is limited and best spent caring for patients.
For physicians who feel overwhelmed, it is important to know that these challenges are not unique to you and that support exists. Organized medicine provides both a collective voice and practical tools to help practices adapt, respond, and remain viable in a changing health care environment.
At its core, physician practice viability is not about preserving a business model – it is about preserving access to care. When physician practices are stable, patients benefit. When physicians can focus on medicine rather than administrative hurdles, care improves. And when practices remain viable, communities across Colorado retain the access to high-quality care they depend on. ■
Practice viability is patient care:
Protecting Colorado physicians’ ability to practice
Cecilia Comerford-Ames CMS Communications and Marketing Manager
Practice viability is not an abstract policy concept – it is the foundation that allows physicians to care for patients, sustain their practices, and have successful and satisfying careers. From downcoding and prior authorization barriers to insurer consolidation and regulatory overreach, the pressures on physician practices continue to intensify. Ensuring that Colorado physicians can practice medicine without unnecessary interference is one of our highest priorities. We have information and tools for you.
COVER
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CMS members-only practice resources
RIGHT CODE, RIGHT CARE: STOPPING HEALTH PLAN DOWNCODING
Several health plans have implemented automatic downcoding programs that reduce physician reimbursement without reviewing medical records or providing meaningful notice. These practices directly violate Colorado Division of Insurance Regulation 4-2-17 and represent a fundamental breach of the physician-payer relationship. Any reduction in reimbursement – whether made before or after care is delivered – meets the regulation’s definition of an adverse determination and requires timely notice, a clear medical and contractual explanation, and a meaningful opportunity to appeal. Automatic downcoding fails on all counts, creating a “guilty until proven innocent” approach that undermines due process, threatens practice viability, and ultimately limits patient access to complex care.
Rebranding these reductions as “payment adjustments” or relying on algorithms does not change the legal standard. Under Colorado law, reduced payment is a reduced benefit, and health plans must follow established protections.
“As a small business, automatic downcoding creates a significant issue for us,” said Nicole Allison, practice manager for Dynamic Athlete in Boulder. “We have to divert resources to spend time appealing the unsubstantiated downcoded claims. If the claims are ultimately not reversed, it creates a loss of revenue, which will become problematic quickly and ultimately affects patient care and access.”
The Colorado Medical Society (CMS) has formally notified the Division of Insurance and sent letters to Aetna, Anthem, Cigna, and UnitedHealthcare. CMS has provided and will continue to develop tools to identify downcoding, template letters, guidance on regulatory violations, and instructions for submitting complaints –
because fair reimbursement is essential to sustaining physician-led care. Resources are available on the new CMS membersonly practice resource page, cms.org/info, linked from the QR code on this page.
PRIOR AUTHORIZATION REFORM: NEW PROTECTIONS NOW IN EFFECT
As of Jan. 1, 2026, major reforms to Colorado’s prior authorization laws are now in effect under HB24-1149, bringing meaningful improvements for physicians, care teams, and practice operations. These changes reduce administrative burden, improve transparency, and help protect timely access to medically necessary care – critical components of practice viability.
For medical services, prior authorization
approvals now last for one year or the full length of treatment. When a request is denied, insurers are required to identify covered alternatives, and carriers must conduct annual reviews to eliminate prior authorization requirements that are no longer clinically necessary. For prescription drugs, chronic medications now receive three-year approvals unless classified as high-cost, and insurers must publicly post searchable formularies and clinical criteria.
Surgical practices benefit from important new safeguards. When an approved surgery requires an additional or related covered procedure during the operation, insurers may not deny coverage if delaying care would place the patient at risk. Carriers are also prohibited from retroactively
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- Nicole Allison, practice manager for Dynamic Athlete in Boulder
Practice viability and the effects on patient care
Downcoding and payment reductions
• Automatic downcoding
• Violation of Regulation 4-2-17
• Due process + appeal rights
Prior authorization changes
• Reform through HB24-1149
• Longer approvals
• Fewer retroactive denials
Insurer consolidation and pricing
• MultiPlan
• Out-of-network repricing
• Alleged suppression of fair market rates
Administrative and regulatory pressures
• Resources diverted to appeals and compliance
• Practice operations under strain
• Reduced patient care and access
denying payment for approved surgeries insurers including UnitedHealth, Elevance (Anthem), Humana, Aetna, Cigna, and various Blue Cross Blue Shield entities. MultiPlan’s pricing tools – operating under names such as Data iSight, Viant, NCN, ProPricer, and MARS – are alleged to have played a central role in a coordinated effort to suppress out-of-network payments.
CMS is closely tracking a federal antitrust lawsuit that could have significant financial implications for Colorado physicians who have been paid out-of-network rates by large commercial insurers.
The lawsuit is against MultiPlan (recently rebranded as Claritev) and several major
According to the allegations, insurers relied on MultiPlan’s data to align out-of-network reimbursement at artificially low levels, rather than allowing prices to reflect independent market negotiations. If proven, this conduct may have systematically underpaid physicians and health care facilities for years – without their knowledge or ability to negotiate fairly.
Many Colorado physicians may not realize their claims were repriced using MultiPlan’s systems. Clues can often be found in Explanations of Benefits or remittance advice, though the involvement of MultiPlan is not always transparent.
The case, consolidated in federal court in Illinois, has passed key legal hurdles. In March 2025, the U.S. Department of Justice filed a statement of interest underscoring the seriousness of the allegations. In June 2025, the court denied the defendants’ motion to dismiss, allowing the litigation to proceed into discovery.
For physicians, this progress signals a meaningful opportunity for scrutiny of insurer practices that have long raised concerns about fairness and transparency in payment.
How CMS advocacy is protecting your practice
• Downcoding must follow due process
• Prior auth approvals now last longer
• CMS provides tools, templates, and escalation paths
• Physicians may have recourse in MultiPlan-related cases
Practice viability advocacy is strongest when physicians share real-world experiences. Your feedback drives the tools, strategies, and protections CMS advances.
Physicians and health care providers who have been out-of-network with major insurers may be entitled to financial damages for claims dating back to 10 years. Those interested in learning more can contact one of the lawyers appointed by the court to lead non-class claims or access resources, including a free case evaluation, at napolilaw.com/en/%20 multiplan.
The court also has appointed attorneys to litigate a proposed antitrust class action on the same issues, but a ruling on any proposed class certification is not expected until 2027. Providers who believe they have been impacted by MultiPlan’s conduct can join the litigation individually on a non-class basis and do not need to wait for any ruling on a proposed class. Stay tuned.
THE LEGISLATIVE AND REGULATORY ARENA
The legislative and regulatory arena has a direct and lasting impact on practice viability. Many of the pressures physicians face – administrative burden, payment delays, and coverage restrictions – are shaped by laws and regulations far beyond the exam room. CMS works tirelessly in this space to protect physicians’ ability to care for patients and sustain their practices. As you’ll see in this issue of Colorado Medicine, advancing practice viability remains a central focus of our efforts.
Practice viability advocacy works best when it is informed by real-world experience. The tools, template letters, legal actions, and legislative strategies outlined
here exist because physicians told us where the system is breaking down. When you encounter inappropriate downcoding, unreasonable prior authorization demands, or insurer practices that interfere with patient care, we need to know. Use our template letters when insurers are out of line, and tell us when you engage so we can track patterns, escalate issues, and push for systemic fixes. Your feedback drives our work – and your engagement strengthens it. Please stay connected, reach out early, and interact with your Colorado Medical Society so we can continue to protect your ability to practice medicine in Colorado. ■
Legislative update: Affordability takes center stage
Cecilia Comerford-Ames CMS Communications and Marketing Manager
Colorado lawmakers convened in January for the 2026 legislative session, and affordability is the defining theme shaping debates under the Gold Dome. A persistent state budget deficit, election-year politics, and uncertainty around federal health policy are converging to influence nearly every major issue – from Medicaid and insurance coverage to liability protections, licensure, and artificial intelligence.
For physicians, the session brings a mix of familiar battles and emerging policy questions, with significant implications for patient access and practice sustainability.
FISCAL CONSTRAINTS WILL DRIVE THE AGENDA
Colorado entered the session facing a challenging fiscal outlook. Initial projections show an additional $850 million shortfall for FY 2026, with updated forecasts expected mid-session.
Options that helped balance prior budgets are largely exhausted, leaving limited flexibility. Program cuts and constrained spending growth are increasingly likely, and proposals for new investments will face steep scrutiny. Federal changes tied to HR-1, continued Medicaid cost growth, and declining federal support are expected to further strain the state’s budget.
MEDICAID AND COVERAGE STABILITY IN FOCUS
Medicaid is once again a central topic. Governor Polis has proposed a cap on Medicaid budget growth, acrossthe-board rate decreases, and other
cost-containment measures. At the same time, Colorado is building infrastructure to implement HR-1 work requirements, expected to be operational by the end of the year.
Recent experience underscores the stakes. During the public health emergency unwind, approximately 373,000 eligible Coloradans lost Medicaid coverage, contributing to a rise in the uninsured rate in 2023 and 2024. Additional eligibility hurdles could exacerbate access challenges for patients and increase uncompensated care pressures on physicians and hospitals.
The individual insurance market also faces uncertainty. Federal reauthorization of enhanced premium tax credits appears unlikely, putting exchange affordability at risk. While last year’s SB25-290 created stabilization payments for safety-net providers, those funds alone may not offset broader coverage losses.
MAINTAINING STABILITY IN LIABILITY AND PEER REVIEW
Following the passage of non-economic damages cap legislation in 2024, physician advocates will focus on preserving stability in Colorado’s liability environment. A key priority this session is opposing renewed efforts to expand liability by altering the deceptive trade practices impact standard – a proposal that has surfaced for the third consecutive year.
Protecting peer review confidentiality remains equally important. CMS continues its work with Coloradans Protecting Patient
Access, legislators, and allied stakeholders to defend peer review processes that are essential to quality improvement and patient safety. Physician engagement will be critical as these protections face ongoing scrutiny.
SUNSET REVIEWS
The reauthorization of the Medical Practice Act is required this session as part of the state mandated sunset review process. As with any sunset review, the process presents both opportunities and risks. Issues to watch include questions about the balance of representation (physician, non-physician) on the Colorado Medical Board and the critical importance of continuing the confidentiality of peer assistance services for physicians that need help. Other sunset reviews will also see action, including the state recommendation to sunset the podiatry board and integrate it into the medical board and expanding licensure portability for internationally trained professionals.
ARTIFICIAL INTELLIGENCE POLICY CONTINUES TO EVOLVE
Colorado’s first-in-the-nation artificial intelligence (AI) law, SB24-205, continues to shape national and state-level debates. Designed to address bias in AI systems, the law imposed broad regulatory requirements that have prompted significant concern from stakeholders across industries, including health care.
Efforts to revise or clarify the law stalled last year, even during a special session. A governor-appointed AI task force is now
2026 session: Key issues to watch
• State budget deficit and constrained spending
• Medicaid growth and coverage stability
• Liability and peer review protections
• Medical Practice Act sunset review
• Artificial intelligence regulation
• Scope of practice proposals
exploring alternative approaches, though it remains uncertain whether consensus legislation will advance this year. Additional AI-related bills are expected, including proposals addressing AI use in health care and a ban on psychotherapy chatbots.
VACCINATION POLICY AND SCOPE OF PRACTICE
Federal vaccination policy changes are driving renewed state-level discussions. In response to the new Advisory Committee on Immunization Practices (ACIP) recommendations, a bill has been introduced that will allow Colorado providers to consider either the ACIP or the vaccine guidelines from national primary care societies like American Academy of Pediatrics (AAP). CMS continues to partner with Colorado Chooses Vaccines and others to promote science-based information and support
access to vaccines that protect community health.
Scope of practice debates will also continue. Safeguarding physician-led, team-based care remains a priority, with the potential for renewed efforts to expand prescription authority for naturopathic providers and other scope changes.
LOOKING AHEAD
With affordability dominating the legislative landscape, this session will test Colorado’s ability to balance fiscal discipline with patient access, physician practice sustainability, and high-quality care. As debates unfold, physician engagement will be essential to ensuring that cost-containment strategies do not undermine either coverage and access, or the long-term viability of medical practice in Colorado. ■
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Navigating a complex legal landscape in health care
RECENT COLORADO SUPREME COURT DECISIONS AND THEIR IMPACTS ON PHYSICIANS
Coloradans Protecting Patient Access
Two recent Colorado Supreme Court rulings, Bianco v. Rudnicki and Gresser v. Banner Health, bring significant changes to the state’s medical liability environment. These decisions clarify language in Colorado’s Health Care Availability Act (HCAA). In doing so, they broaden financial liability for physicians, insurers and health systems. As health care professionals adapt to the consequences of these cases, organizations like the Colorado Medical Society (CMS) and Coloradans Protecting Patient Access (CPPA) are stepping up to lead research, education and advocacy efforts to address growing challenges in medical liability law.
Higher awards and insurance costs may affect where and how care is delivered – especially in high-risk specialties.
Here’s a breakdown of what these cases mean and how Colorado’s health care community can respond moving forward.
THE CASES: BIANCO V. RUDNICKI AND GRESSER V. BANNER HEALTH
Bianco v. Rudnicki
This is the follow-along case to the 2021 decision in Rudnicki v. Bianco, in which the Colorado Supreme Court concluded minors and their parents have a joint right to pursue an injured minor’s pre-majority medical expenses.
In this case, the Colorado Supreme Court addressed whether Alexander was entitled to prefiling, prejudgment interest in excess of the HCAA’s then-$1 million damages cap on his pre-majority medical expenses. In concluding he is, the Court determined that pre-filing, prejudgment interest is part of the “past and future economic damages” the HCAA allows to exceed the damages cap.
The practical effect of this ruling is that it increases damages awards. Pre-filing, prejudgment interest is the interest that accrues from the time of the alleged injury to the time the plaintiff files the lawsuit. While the statute of limitations for bringing a claim for medical negligence is typically two years, the statute of limitations may be as much as 20 years in cases, like this one, concerning obstetric negligence. In this case, Alexander did not file his claim until he was nine years old. This resulted in an award of approximately $319,000 in pre-filing, prejudgment (which accrues at 9 percent simple interest) on Alexander’s $391,000 pre-majority medical expenses damages award. Physicians and insurers should therefore be aware of these additional damages when evaluating medical negligence claims.
Gresser v. Banner Health
This case also involved obstetrics negligence. The Colorado Supreme Court addressed the question of whether, in those cases where the plaintiff is allowed to exceed the damages cap in the HCAA,
the plaintiff is allowed to recover the full amount the jury originally awarded.
As background, in HCAA cases, the trial court judge will typically reduce a jury’s award in compliance with the HCAA, awarding the plaintiff no more than $300,000 in noneconomic damages [pre-House Bill 24-1472] and no more overall than the damages cap that applies. The plaintiff then has an opportunity to ask the trial court judge to exceed the damages cap for “good cause shown” to receive additional “past and future economic damages.”
In this case, the Colorado Supreme Court determined that when a plaintiff successfully shows good cause, the trial court judge is required to reinstate the jury’s verdict as to the past and future economic damages (plus interest). The only way to reduce this award is for the defendant to argue that there is no evidence in the record to support the jury’s award (a hard argument to win).
The practical effect of this ruling is that damages awards in medical negligence cases will be allowed to the full amount of economic damages a jury awards, with little ability to reduce them once the jury awards them.
WHAT THESE CASES MEAN FOR PHYSICIANS
Together, these rulings create ripple effects that alter Colorado’s medical liability landscape, with potential consequences for both physicians and patients.
Balancing compassionate care and a sustainable liability system
Physicians, health care organizations and members of CPPA share a core belief: every individual injured by medical negligence should have access to the resources they need to receive care and support, within the framework of the law. At the heart of CPPA’s mission is the principle of ensuring injured patients are fairly compensated and receive the help they need while preserving a liability
system that remains stable, predictable and sustainable for everyone in the health care ecosystem.
However, these court rulings significantly raise the stakes for defendants in medical malpractice cases. By allowing judgments to exceed the $1 million economic cap –with substantial amounts of prejudgment interest layered on top – these rulings make it increasingly expensive to resolve claims. The costs are especially burdensome for physicians and insurers already facing pressures in the current health care environment.
Incentivizing delayed claims
Another growing concern is the unintended incentive for plaintiffs to delay filing claims. In birth injury cases, for example, families can wait until the injured child reaches adulthood (due to Colorado’s statute of limitations for minors) to initiate legal action. If a claim is delayed 18-20 years, pre-filing, significant amounts of prejudgment interest – which accrues at 9 percent simple interest – will accumulate. This means the eventual final award is exponentially larger than the actual damages.
Take the Bianco matter, for example. Colorado law further provides for 9 percent interest compounding annually from the date a lawsuit is filed until the date a judgment enters. And this post-filing interest runs on the damages the jury awards plus the pre-filing, prejudgment interest. This means that Alexander was entitled to $391,000 in pre-majority medical expenses, plus $319,000 in pre-filing, prejudgment interest – but that post-filing, prejudgment interest accrued at 9 percent compounding annually on $710,000 from the case’s inception to judgment. This results in a judgment of approximately $1.3 million.
Impacts on physician workforce and patient access
One of the greatest risks of larger judgments is the potential impact on access to care. Rising judgments often result in higher malpractice insurance premiums
How liability exposure changed Area
What changed Damage limits Certain economic damages can exceed caps
Jury verdicts Judges have less discretion to reduce awards
for physicians, especially those in highrisk specialties such as obstetrics. As insurance costs increase, some providers may limit the types of care they offer, avoid higher-liability cases or even leave the specialty altogether. These shifts could lead to reduced access to critical care services for Coloradans, creating challenges for patients who require these specialized services.
WHAT’S NEXT: RESEARCH, EDUCATION AND ADVOCACY
In the wake of these decisions, it’s critical for Colorado’s health care community to collaborate on solutions that strike a balance between fair compensation for injured patients and protecting access to care. Here’s what’s ahead:
• Research: We’re committed to studying the broader implications of these court rulings, including their impact on physician liability, insurance premiums and
patient care costs. This research will serve as the foundation for evidencebased policy recommendations.
• Education: Communicating the impact of these rulings is vital. We are focused on educating not only our physician members, but also others within the defense and insurance communities. Physicians need to understand how these changes may affect their practice and what they can do to reduce potential risks.
• Advocacy: Future focused advocacy efforts will emphasize the importance of maintaining balanced medical liability laws to protect care access across Colorado.
WHAT PHYSICIANS CAN DO
While these legal changes may feel daunting, physicians in Colorado play a critical role in shaping the future:
1. Stay informed – Educate yourself on these rulings, their implications and existing liability protections.
2. Engage with advocacy efforts –When asked, join CPPA and CMS’s push for legislative reform to ensure a balanced liability environment. Your voice and experiences as a provider matter.
3. Focus on risk mitigation – Continue prioritizing patient safety, strong communication and thorough documentation to help minimize liability risks and improve outcomes.
MOVING FORWARD TOGETHER
The Bianco and Gresser decisions underscore the complexity and sensitivity of Colorado’s medical liability system. Physicians want injured patients to receive the care and resources they need, yet these rulings raise questions of sustainability and fairness in how liability awards are determined.
With the leadership of CMS and CPPA, Colorado’s health care community can confront these challenges both thoughtfully and with purpose. Through research, education and advocacy, we will work together toward a fairer system – one that supports both patients and the physicians who care for them. ■
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What is Central Line and how does it benefit you?
CENTRAL LINE: A COMMUNICATIONS PLATFORM FOR COLORADO MEDICAL SOCIETY MEMBERS
Central Line is one of CMS’s premier member benefits, a communications platform designed to lead to member engagement and governance. This innovative platform, the first of its kind among state medical societies, brings member voices directly into the CMS boardroom, ensuring a more inclusive and participatory decision-making process. Since its launch in 2017, 78 Central Line proposals have moved through the process.
HOW IT WORKS:
24/7 ACCESS TO SUBMIT POLICY PROPOSALS
Central Line allows members to submit policy proposals around the clock, 365 days a year. This continuous access enhances the society’s responsiveness and adaptability, making CMS a more dynamic and member-driven organization. Members wishing to submit a proposal must log in using their CMS.org credentials. Once submitted, proposals are reviewed by the CMS policy office to ensure fiduciary responsibilities and policy review are met and to assign the proposal to an Interest Area.
VOTING
After a policy is submitted, reviewed by staff and assigned to an Interest Area, it is eligible to start the voting process. Four weeks before the board meeting, members within the relevant Interest Area receive an email invitation to review the policy proposal. They can vote “yes,” “no” or “maybe,” and leave a comment. Two weeks before the board meeting, all members receive a Central Line email
inviting them to review the proposal and vote. Although the member vote on the proposal is non-binding, the board representatives review the vote and member comments before taking action on the policy proposal.
CHECKS AND BALANCES
After the CMS Board of Directors takes action at the board meeting, all members receive an email asking them to review the board's decision and provide feedback on whether the board made the right decision. If a majority of respondents disagree with the board’s decision, the proposal will be reconsidered at the next meeting.
EMPOWERING MEMBERS WITH DIRECT INPUT
Central Line empowers CMS members to provide their board representatives with input before and after votes on policy matters at board meetings. Your board representative will personally review and consider your feedback, ensuring your voice is heard.
A STRONGER, MORE CONNECTED CMS
Central Line ensures real-time interaction between members and the board of directors, serving as a crucial check and balance. This enhanced connection
makes CMS stronger, better connected, and more responsive to member needs. With just a few clicks from your desktop, laptop or mobile device, you can actively participate in shaping the future of CMS.
ARE YOU ENGAGED WITH CENTRAL LINE?
Log in: Visit www.cms.org/central-line and enter your login credentials. If you need to activate your account or reset your password, contact membership@cms.org
1. Complete your profile: On your first login, update your profile by selecting your Interest Areas and preferred email. You can access your profile by clicking “My Profile” at the top of any Central Line page.
2. Engage and participate: Select Interest Areas that align with your passions, and save your settings.
Central Line provides a seamless and efficient way to influence policy and governance. Watch your inbox for Central Line notifications and make your voice heard in the Colorado Medical Society.
For any assistance or questions, please contact membership@cms.org or call (720) 859-1001 ■
HOW DO I CHOOSE MY INTEREST AREAS?
Be sure you have selected your Interest Areas so you have priority voting on proposals that align with your passions. To designate your Interest Areas:
1. Login to cms.org/central-line
2. Select “My Profile” from the top navigation bar
3. Review the list of Interest Areas
4. Press the square to select that topic area (then indicated with a check mark)
Exclusive CMS member benefit: The value of a modest long-term care plan
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and Extension of Benefits help preserve death benefits and extend care payments when needed. Affordable, entry level coverage locks in lower rates now and keeps future options open.
Begin with something – any coverage is better than none. Even a basic monthly benefit can reduce stress, protect family resources, and let you focus on care instead of cost. Start small, stay flexible, and build your plan as life changes. For more information and to enroll, go to enroll.buddyins.com/cms. ■
Less time doing data entry = more patients
Ben Walker, CEO
Ditto Transcripts
Physicians and health care professionals at every level face an increasing number of required tasks. Unfortunately, many of these tasks take time away from direct patient care.
Medical professionals work diligently on behalf of their patients, using every available procedure, drug, or technique to achieve the best possible outcome. Why should medical transcription be any different?
Aren’t all transcription services the same? No, and for the same reason that not all treatment protocols or providers are the same. Sure, you can always find a company that offers low prices. Yet, how do they stack up when experience, speed, and accuracy are paramount?
ISN’T AI REPLACING HUMAN TRANSCRIPTION?
No, not hardly. Artificial Intelligence models, especially in health care, are rapidly advancing. However, would you use a service with a 61.92 percent or a 99 percent guaranteed accuracy rate? Ditto Transcripts offers a money-back guarantee, and we stand behind our work.
Would it surprise you to know that the medical transcription field is expected to grow about 4 percent over the next several years? That’s certainly not the case for many technology fields.
Our experienced, qualified, and U.S.based human transcriptionists are trained to listen for common and complex medical terminology. Abbreviations and scientific terms are commonly used in patient charts. Given that about 90 percent of adverse medical errors involve miscommunication at some level, misunderstanding one word, phrase, or sentence can have disastrous consequences.
IS YOUR TRANSCRIPTION PROVIDER HIPAA COMPLIANT?
Nearly 90% of adverse medical errors involve miscommunication – one word can matter.
Accountability Act (HIPAA) mandates strict compliance guidelines regarding patient privacy. Yes, we know all too well the importance of following HIPAA and why protecting patient privacy is so critical.
Physicians and medical professionals know that violating any part of the act can result in severe penalties.
Are you 100 percent certain that your transcription service is HIPAA compliant? If not, then I recommend inquiring.
Reputable, HIPAA-compliant transcription companies should proudly promote this achievement on their websites. However, I recommend confirming a company's HIPAA compliance by calling their home office and asking to speak with someone in senior management. If reaching a senior executive isn’t possible, then you could definitely be concerned.
Maintaining strict compliance and confidentiality standards is paramount when transcribing medical files. Why rely on any provider who doesn’t maintain the same standards that you and your staff do?
WHY CHOOSE A QUALITY TRANSCRIPTION SERVICE?
Medical professionals spend about 15 hours per week on administrative tasks. In practical terms, that equates to almost two days of seeing patients or performing procedures. That’s precisely why a quality transcription provider should help reduce time spent on non-medical tasks.
A quality, experienced transcription company should meet all your needs at a competitive rate. In fact, a reputable company should offer a trial period so you can evaluate transcription accuracy and
turnaround time, and workflow compatibility, among other factors.
Unlike other service providers, choosing the wrong transcription service can endanger a patient’s life or compromise the quality of care. That’s why all of our medical transcriptionists are U.S.-based, undergo a thorough pre-employment background check, and have experience transcribing medical files.
LET US HELP YOU
At Ditto Transcripts, we understand that transcribing charts and records is about as fun as some medical procedures. That’s why we are committed to providing quality transcription at an affordable rate with quick turnarounds.
These are the issues I would recommend you consider for your next transcriptions:
• We offer a 99 percent accuracy guarantee
• Only U.S.-based, human transcriptionists handle medical audio files
• Every applicant or employee undergoes an extensive background check
• Rigorous quality control helps ensure the accuracy of every transcript
• Stat delivery, sometimes in four hours or less is available
• Competitive pricing and based in Denver, Colo.
Feel free to contact me, our company founder and CEO, for any questions or inquiries by calling (720) 287-3710. Like you, I am committed to providing the highest-quality care possible. ■
Hearing another’s voice
Jamie Cronin
Jamie Cronin is a third-year medical student at the University of Colorado School of Medicine. Originally from Alabama, her path to medicine began as a professional rider in three-day eventing, where working on rural farms across the country exposed her to education and health care disparities that sparked a lifelong commitment to advocacy. After trading her helmet for a stethoscope, she earned a Master’s in Modern Human Anatomy at CU, focusing on the development of accessible health literacy resources. Drawn to the high stakes worlds of surgical and critical care, Jamie finds purpose in helping families navigate the decisions that define our most human moments and hopes to build a career at the intersection of health care policy, education, and rapid, lifesaving care.
Beginning my inpatient psychiatry rotation at the VA brought a mix of anticipation and doubt. The emotional complexity of the work felt heavy, and I struggled to enter conversations shaped by trauma, isolation, and long-standing illness. Finding the right words, or even the right presence, felt out of reach. That changed when I met Dr. H. He moved through the psychiatry unit with a quiet steadiness. His presence was calm, his words deliberate. In each patient encounter, he created space for dignity and never rushed. He listened as though every story mattered. And it became clear that they did. He modeled a kind of medicine rooted not only in knowledge, but in respect.
One day, I met “Mr. Jones.” An older Black veteran, he recently survived a stroke that left him paralyzed from the waist down. He also lived with schizophrenia, a diagnosis he had carried for most of his life. Until his stroke, he had lived independently. Afterward, he was transferred to a rehabilitation center that failed him immensely. He was denied access to his psychiatric medications, missed appointments for both mental health and physical therapy, and was left alone, often in the dark for days. He and his family tried to speak up but were quickly dismissed. They felt
his diagnosis made it easier for others to overlook his suffering.
When he shared his story, I felt the weight of it settle in my chest. I didn’t know what to do, but I knew it mattered. I brought it to Dr. H, expecting perhaps a plan. Instead, he said, “If it moves you, follow it.”
That simple guidance reshaped my understanding of what it means to care. With his encouragement, I spoke with Mr. Jones’s family and friends, contacted the facility, and confirmed the details of his story. Dr. H responded by organizing a team meeting, bringing together physicians, social workers, and therapists. He invited me to share what I had learned. In that room, I felt not like a student reporting a case, but a team member speaking on behalf of someone who had been silenced.
We contacted the state ombudsman and adult protective services. An investigation was opened, and other residents of the facility began sharing similar stories. But the most meaningful moment came when I returned to Mr. Jones. I knelt beside his wheelchair and shared what we had accomplished because of his bravery. He reached for my hand and said, with tears in his eyes, “You believed me.”
Under Dr. H’s mentorship, I began to feel the weight of responsibility not as pressure, but as purpose. His quiet consistency made space for patients who had been ignored, and for students still learning how to carry that responsibility. He helped me understand that humanism is not a skill to master, but a way of approaching others with care and conviction. That lesson shaped how I showed up for Mr. Jones, and it will continue to shape how I care for every patient I serve. ■
Reflective writing is an important component of the University of Colorado School of Medicine curriculum. Beginning in the first year, medical students have the opportunity to write essays, stories or poetry, or create works of art, that reflect what they have seen, heard and felt. The Reflections column was co-founded by Steven Lowenstein, MD, MPH, and Tess Jones, PhD. It is edited by Dr. Lowenstein. It is dedicated to the memory of Henry Claman, MD, Distinguished Immunologist, Professor, and founder of the Arts and Humanities in Healthcare Program.
A lifetime dedicated to women’s health
Warren M. Hern, MD, MPH, PhD
Sharon was the first patient I was assigned to help on my first clinical rotation of obstetrics as a junior CU medical student in 1963. It was my first week on the labor deck. Suddenly, Sharon began to bleed heavily. Within a few minutes, she was going into shock. The residents did a cesarean delivery of her blue baby with an Apgar of 2. It was my first experience with the dangers of pregnancy.
My next rotation was on gynecology where we spent all night helping women who were desperately sick from illegal, unsafe abortions. In 1964, I worked at a small hospital in the Peruvian Amazon, where I saw more women dying from unsafe abortions. As a Peace Corps physician in Brazil from 1966-1968, a Brazilian colleague took me through the maternity hospital. There was one ward of women recovering from childbirth and two wards full of women gravely ill from unsafe abortions. Fifty percent of them died.
After receiving my Master of Public Health degree, I helped administer a federal family planning program which helped 300,000 poor women have access to contraceptives.
After returning to Colorado in 1972, and right after the 1973 Roe v. Wade decision, I was asked to be the founding medical
➊
director of the first private, nonprofit abortion clinic in Colorado. This experience taught me that helping women have safe abortions was the most important thing I could do in medicine.
On Jan. 22, 1975, I opened my private practice in Boulder specializing in outpatient abortion services. Each patient represented not a controversy, but a human being deserving of dignity, safety, and thoughtful medical care. In early 2025, after 50 years, I closed my practice, Boulder Abortion Clinic. We had helped over 43,000 women.
From November 1973 on, we had the support and help of hundreds of Colorado physicians and other health care workers who agreed with us that safe abortion is an essential component of women’s health care. We could not have done this without their help. They helped us have a unique record of safety that preserved the lives, health, and future fertility of our patients. I am deeply grateful for the privilege of doing this work in Boulder and grateful to my medical colleagues throughout Colorado. ■
Warren M. Hern, a 1965 graduate of the University of Colorado School of Medicine, is Director of the Boulder Abortion
Clinic, P.C. and Associate Clinical Professor, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus. He is the author of Abortion Practice (J.B. Lippincott, 1984; Alpenglo Grahics, 1990) and Abortion in the Age of Unreason: A Doctor’s Account of Caring for Women Before & After Roe vs. Wade (Routledge Press, 2024).
Contact:
Warren M. Hern, MD, MPH, PhD PO Box 1620 Boulder, CO 80306-1620 (303) 517-7215 bachern@msn.com www.drhern.com
Publication of guest editorials and letters to the editor does not imply endorsement by the Colorado Medical Society. They are published at the sole discretion of the Colorado Medical Society and are subject to editorial review, revision, and space availability. The views and opinions expressed are solely those of the individual author(s) and do not necessarily reflect the views, positions, or policies of Colorado Medicine, its editors, staff, management, or affiliates. We welcome member perspectives and encourage you to share your thoughts by submitting a letter to membership@cms.org.
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From
loss to calling: What rural medicine gave me when I needed it most
Annie Boesiger
Annie Boesiger is a third-year medical student dedicated to advancing care for rural and underserved communities. Influenced by her upbringing on a Hereford cattle ranch in southeast Nebraska, she brings a communitycentered perspective to her medical training. As a former high school English teacher, her interests include behavioral health, health equity, and patient-centered care.
The summer my dad passed away, I was scheduled to shadow Dr. Wong in Ogallala, Neb., for two weeks as part of an assignment for the rural and wilderness track at Rocky Vista University. However, instead of following Dr. Wong that summer, I would send him an email explaining that my dad had been tragically killed in a farming accident and that I’d need my last two weeks of summer to be with my family, our cows, and my little rural Nebraska community. I asked him to consider taking me on in my third year instead to fulfill my family medicine clerkship rotation requirement.
My second year of med school was marked by so much doubt and sorrow mixed with support that carried me through it. What words did I have for a grief so profound next to a call on my heart to push through and see it to completion? At the end of second year, my thoughts of belonging in medicine had significantly diminished. But I stayed in hopes of getting to clinical rotations, connecting with people, and seeing my purpose in the field again. I experienced an incredible amount of happiness and purpose in my first rotation, child and adolescent psychiatry, connecting deeply with hope-filled young people and again in pediatrics, where I
cooed at chunky babies and clicked with witty teenagers. And then it was time to complete family med. So, I packed up and planted my life in Ogallala, Neb., centered in the Nebraska sandhills, for two months.
My dad was a cattle man. Gentle, steady, and devoted to his native grass preservation and easy moving horned Hereford cows. Many of my family “vacations” were spent in bull sale barns, shoulder to shoulder with producers. His favorite place to visit were the Nebraska Sandhills; “pretty country” he called it and joked that someday he’d sell our livelihood in southeast Nebraska to move west. The last time I visited the sandhills had been on a Nebraska Hereford tour, traveling from ranch to ranch with my family to meet and visit with fellow Hereford breeders. It was a fond memory I held of time spent with my dad in the sandhills, roaming amidst white faced cows. When I got to Ogallala on a Sunday afternoon, I wondered how it would feel being in a place that meant so much to my dad, one of the last places he knew I’d be experiencing in my pursuit of becoming a doctor.
On my first day in clinic, I talked to an 82-year-old rancher about his purebred Angus herd. We talked about the weather,
calf prices, his hay crop. I thought all day about how my dad had showed up so clearly in the face of my patient. He would show up in many more “winks” over the course of my rotation. On the day of my mom and dad’s wedding anniversary, I delivered my first baby. And a week later, I would sit with a 97-year-old and her room full of family as she transitioned from one form of life to another, comfortable in the grief and complexity of goodbye and celebration of a good life. It felt like home to talk to patients about my own cow herd, my horse, my upbringing. I felt seen by nurses and doctors and patients alike. I was asked to come back, told that the community needed “people like me” to come care for them. What an honor. What a sense of belonging in a time of question and doubt and hanging on tight.
I hope that today, wherever my dad is, he knows how thankful I am for the grit, the gentleness, the sunsets, the glimpse of new life, the lessons in goodbye. And in the meantime of seeing him again, I’ll carry Ogallala, this “pretty country,” with me for a long, long time. ■
COMMENT
Recalls and warnings: Risk management considerations
Gerald Zarlengo, MD Chairman & CEO Copic Insurance Company
From time to time, the FDA, manufacturers, and other agencies issue recalls or serious warnings about devices, drugs, instruments and other health-carerelated products. When one of these notices impacts your medical practice, it is important to follow a comprehensive process and document all the steps you have undertaken to avoid potential liability and to maintain care for patients. Facilities, physicians, advanced practice providers, pharmacists and other health care professionals may all become involved in such warnings and recalls.
Depending upon the situation, medical providers may want to seek legal counsel to clarify their duties and responsibilities. The following are some general guidelines and key considerations:
• Always start with the most recent and accurate information from the agency and/or manufacturer. In general, the warnings and recalls describe the risks, benefits, and potential actions.
• Recall and warning notices frequently contain the following types of actions, and you should be aware of these specifics for a given patient and a given biologic, drug, device, or other health-care-related product:
Recalls are not just clinical events –they are documentation events.
• The recommended treatment or action for users to minimize risks or impact of the affected product to their patients.
• Actions to be taken such as correction or removal of the device.
• Necessary monitoring or additional steps for follow up with patients.
• Any available alternatives.
• Follow the manufacturer’s recommended action steps exactly, document those steps, and in the event that you cannot, document why you can’t. For individual patient encounters, your actions should also be documented in their personal medical record. In the case of patient noncompliance with your recommendations, document their informed refusal.
• Be aware that the manufacturers and pharmaceutical companies often put the responsibility for patient notification and counseling on the licensed health care providers. For example, typical language in recalls or warnings may read as follows: “[Manufacturer’s name] will not communicate with patients directly
about this issue. If patients have been impacted as part of this issue, health care providers have the responsibility to inform patients and/or update a patient’s care pathway.”
• Use your patient lists, EHR, and other resources to try to identify all of your affected patients. This applies most importantly to when you were the prescriber, used the device, or implanted the materials into your patient. If the recall is a general overthe-counter medication or one that you did not prescribe, the extent to which you identify, notify, and counsel is likely reduced.
• If you are unable to reach affected patients, try at least two attempts, and ideally use multiple modes such as phone, emails, etc. In serious recalls, it may be necessary to send a “return receipt requested” letter and keep a copy.
• Some warnings and recalls may result in high volumes of patient calls, therefore, you should direct inquiries (as best as possible) to an informed respondent in your office or facility who can provide the guidance and who understands when scheduling appointments with the providers is
necessary. It might be advisable for your “designated informed respondent” to have a script available. While the recalls and warnings are generally written at the provider level of understanding, many consider sending the patients the exact verbiage from the manufacturer. Document each and every phone call with patients.
One of the most complicated issues is the financial responsibility for all the above actions. In some instances, the necessary follow-up visits, procedures, and therapy are paid by the patient or their insurer, and patients may need to make claims against the manufacturer for reimbursement. In other instances, the manufacturer will describe the process by which they will assist patients and their insurance payers to reduce costs and any financial burden from the recalls or serious warnings.
Lastly, in the event of legal action against the manufacturer or entity responsible for the harm, it is important that the facilities, licensed providers, pharmacists and other health care professionals follow all of the above steps to avoid also being named. In general, the legal actions are against the manufacturer and not the health care professionals and facilities; however, each case (individual or class action) is very fact-based.
If you aren’t signed up for FDA alerts, you can do so by going to: www.fda.gov/safety/ medwatch-fda-safety-information-andadverse-event-reporting-program/ subscribe-medwatch-safety-alerts
The information provided herein does not, and is not intended to constitute legal, medical, or other professional advice; instead, this information is for general informational purposes only. The specifics of each state’s laws and the specifics of each circumstance may impact its accuracy and applicability; therefore, the information should not be relied upon for medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation.
Eligible Colorado Medical Society (CMS) members can receive up to a 10% premium discount on Copic policies. Get more information on CMS membership by contacting membership@cms.org. ■
The limits of resilience and wellness
Michael H. Gendel, MD Medical Director Emeritus, Colorado Physician Health Program (CPHP)
I’m sure you’ll be shocked to hear that the wellbeing of physicians is not at the top of the list of the priorities of your workplace. Sure, you thought when you were medical students and trainees that once you were out in the world, the world would welcome you and be oh-so-supportive. Yes, personal and professional life is stressful (as well as gratifying), but you knew that your commitment to patients, your knowledge and skill, could not go unappreciated by your work environment, and that appreciation would certainly take the form of good administrative and clinical support, realistic expectations, and a palpable feeling that you were valued.
CPHP became aware and began to address work stress and burnout complaints among our participants in 1995. In 1999-2000 we conducted a study that demonstrated that the majority of those we worked with suffered from serious work stress. At the time, none of the institutions we worked with seemed aware of this problem, and none queried their physician community about it. The academic community was not interested. Years later, when Tait Shanafelt and his team at the Mayo Clinic began publishing their work on burnout – especially their finding that work stress was linked to suicidal ideation among doctors and medical errors – did workplaces begin to wake up, sort of. Now, all studies show that work stress and burnout symptoms are endemic among almost all specialties. I know, you’ve heard this before.
What ensued, as we know, was an effort on the part of hospitals, health maintenance organizations (HMOs), workplaces,
One of the most important things we’ve learned is how little is accomplished when we only address resilience and wellness.
and some malpractice carriers to encourage physicians to be more resilient. (Right. Health insurance companies didn’t notice). At CPHP, we knew that physicians were already among the most resilient groups of people anywhere, and did not suffer from a resilience deficit. Far from it, our resilience contributed to our organizations believing that we were not suffering. Initially. Because we could take it. Still, CPHP studied the literature on work stress, developed interventions aimed at strengthening our ability to manage it, and we continue to utilize these in our work with our participants.
Along the way arose the principles of wellness and work-life balance, and we wholeheartedly subscribe to evaluating and strengthening among our participants the areas of wellness: emotional, physical, occupational, intellectual, social, spiritual, and financial. I don’t mean to minimize the importance of this work. Most of our participants report they are helped by this help. But paraphrasing Wittgenstein in the introduction to his “Tractatus,” one of the most important things we’ve learned is how little is accomplished when we only address resilience and wellness. (I note that work stress, depression, and anxiety problems are often intertwined; CPHP
is extremely helpful in these situations). That’s because our internal resources, strengthened though they can be, are insufficient to combat the problems posed by our work environments. This was finally recognized by the Shanafelt group, noting that the problem is systemic, not a problem of individuals and their resilience, and offering nine recommendations for workplaces. These are not often implemented.
The fact is that the ownership of health care institutions is concentrated in fewer and fewer hands, the larger corporate world. Profit and wealth are the goal. “Efficiency” is the operational imperative, though it does not refer to actual efficiency, but to bare bones. Do more with less. Even among the nonprofits, the bottom line is sacrosanct. Before the 1980s, which (unfortunately) is a period I remember well, health care was a loss leader, expected to cost the institutions of medicine but out of a humane mindset. Granted, there was little gerontology before Medicare benefits. But coverage should not be conflated with profit motive.
Now, the fewer and larger the health care companies, the further down the list of priorities is the welfare of doctors. There is no sign that the pendulum is swinging
the other way. And venture capital –well. Studies show diminished quality of patient care, but experience tells us that we sell our souls, much of the time, often motivated by too much leveraged debt, sometimes by exhaustion. Yes, certain health care companies and HMOs, certain hospital systems, certain venture capital groups, certain clinics, are oases. But not many. And this is not a burgeoning group.
And yes, there are now wellness committees, chief wellness officers, ongoing research into burnout prevention and management. All are well-intended. At CPHP we work with all these groups and do research as well. But the data on the effectiveness of wellness interventions in industry (in general) is depressing.
Improvements in physician wellbeing brought about by these initiatives are for the most part on the margins of workplace challenges. What is often characterized as a struggle between the clinicians and administrators is oversimplified; it is really a struggle between ownership and everyone else, and rarely addressed.
And of course, in real life, work is not the only source of stress. Although the World Health Organization defines burnout as a work-stress syndrome, in real life we know that chronic, sustained stress in any venue of our life can induce symptoms of burnout: emotional exhaustion, detachment from those we care about, and a diminished sense of personal accomplishment and value. So, it’s complicated.
What to do? At CPHP, we will continue to apply what we’ve learned and continue to help. We know that a small improvement will feel big; a 15 percent reduction in stress will feel like a great relief. Burnout can and does resolve. But the forces opposed to our feeling better are granitic. Studies of physicians’ personalities show that we are a passive lot, though we don’t see ourselves that way. We gave up autonomy in our workplaces to organizations. We sat by while accountants and billing departments designed EHRs. To the extent we can assert ourselves and tackle workplace problems, let’s do so. Then, buckle up. Try to have fun at work. Look forward to seeing the patients you want to see and the staff you enjoy. Engage your colleagues. Talk and listen to your loved ones, family and friends. It’s up to us to manage it. ■
COLORADO PHYSICIAN OR MEDICAL STUDENT CALLS 720-810-9131.
24/7 line answered by a Masters-Level Licensed Clinician (LCSW, LPC) to assess the clinical need of the caller, including life-threatening situations.
CONFIDENTIALITY IS REVIEWED AND PEER SUPPORT SERVICES ARE INITIATED.
Only in circumstances where an individual is a threat to self or others or as outlined in the Medical Practice Act would confidentiality be breached. Doc2Doc Wellbeing Consulting has the same reporting obligation as all licensed Colorado physicians.
PHYSICIAN CALLER RECEIVES WELLBEING SUPPORT FROM A PEER PHYSICIAN.
If Doc2Doc Wellbeing Consulting is the best fit based upon the caller’s presentation, a physician will return the physician’s call for the first of three free peer consultations.
If CPHP traditional comprehensive evaluation services are a best fit based upon caller’s presentation OR if more help is needed at the end of three free Doc2Doc Wellbeing Consulting sessions, CPHP’s process will commence to ensure client has appropriate treatment supports in place.