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Montana Governor's Newsletter August 2018

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Pam Hiebert, MD, FACP, ACP Governor

Pam Hiebert, MD, FACP, ACP Governor


Billings Clinic Residency Graduation


I attended the second Billings Clinic internal Medicine Residency graduation June 1, 2018.

Six excellent physicians successfully completed the internal medicine training program.

Christopher Dietrich, DO Faculty Hospitalist at Billings Clinic
Danielle deMontigny Avila, MD Infectious Diseases University of Alabama
Kylie Ebner, DO, Faculty Hospitalist at Billings Clinic
Christopher Kerrigan, MD, Addiction Medicine Vanderbilt University
Kevin Mitchell MBBS, Nephrology and Critical Care Brown University
Matthew Niemeyer DO, Faculty Hospitalist at Billings Clinic

The Billings Clinic IM residency continues to thrive with top notch faculty and residents.



Montana Chapter Leadership Award


I also had the honor of presenting the MT ACP Leadership Award to Kylie Ebner DO, graduating IM Resident. Dr. Ebner served as president of the Billings Clinic IM Residency Association. She serves as resident representative on the GME Teaching Committee and Program Evaluation Committee. She has also been very active in the MT Chapter of ACP with poster presentations and lectures at the Scientific Sessions. She recently attended ACP Leadership Day in Washington DC. She visited legislators to advocate for priorities of ACP. These include importance of GME funding, lower prescription drug costs, and measures to reduce firearm injury and death. Dr Ebner will be a great addition to the Billings IM Residency faculty starting this July. (picture)



2018 Leadership Day


Dr. Kylie Ebner, one of our graduating Billings Clinic Internal Medicine Residency residents, and I attended the ACP Leadership Day in Washington DC 5/22-23. The first day was spent learning about the legislative process and the ACP priority policy issues. We heard from our ACP lobby experts as well as those involved directly with the legislative process. On the second day, we met with the offices of Senators Daines and Tester and with Representative Gianforte himself. During our meetings we discussed some of the ACP priority issues including GME funding, prescription drug costs, and reducing firearm injury and death. Of course, during free time we explored venues along the Washington Mall.

Through this opportunity we gained insight into how physicians can affect healthcare policy and learned much about the process. We believe that our message was well received by our legislators and appreciate very much their willingness to meet with us and listen to our perspective. We also strongly appreciate the Montana ACP Chapter for this opportunity to advocate on their behalf.

Kylie Ebner DO ACP member

Steve Gerstner MD FACP



2018 Montana Chapter Scientific Meeting


September 6-8, 2018

Double Tree Hotel, Billings

Don't forget to register for the Montana Chapter Scientific Meeting “Geriatric Women's Health”!

Highlights include:

  • It's Not Just Hot Flashes After Menopause, Here Come Osteoporosis, Joint Pain, and Gout!!′
  • Red Hats, Purple Shoes and Everything in Between′
  • Geriatric Screening and Preventative Care′
  • Medical Jeopardy′
  • Resident's Poster Presentations′
  • Earn 12.5 CME Credits and MOC Points′

Visit the chapter website to view the meeting brochure and to register.

Hotel reservations can be made by calling (406-252-7400) or by using the following link:

Post Meeting Workshop: Employment Contract Negotiations and Legal Pitfalls

September 8, 12:00 pm, Double Tree Hotel

Following the chapter meeting on Saturday, there will be a panel presentation on the following topics:

Negotiating a Contract – Katherine Dietrich, DO FACP
Contract Negotiations – Legal Pitfalls and Definitions – Rob Renjel, MBBS
Viewpoint from the C Suite – James Loeffelholz, MD, FACP
Well Being: Take Charge of Your Career, Clarify Your Goals, Achieving Gender Equity and Compensation and Advacement – Pam Hiebert, MD, FACP

Lunch provided with the $10.00 registration fee.

The WWAMI Internal Medicine interest group hosted the Osler club, June 11. We were honored to have Don Demetriades PHD, MSU philosophy professor. We had a lively discussion on the evolution of Hippocratic Oath. We read the ancient document and modern renditions of the oath. Consider reviewing the following:


NOVA - Official Website | The Hippocratic Oath Today
Modern Physician's Oath (The Lasagna Oath)
Declaration of Geneva - Wikipedia
Hippocratic Oath - Wikipedia



Healthy Montana – I 185

  1. Your organization's name can be added to the endorsement list for I-185. Please fill out this form:
  2. TOBACCO STORIES. Any tobacco story can be shared thru link to the ACS CAN story collection form:
  3. Donations. Physicians can contribute to this effort with a donation to the MTMedPAC on Your medical society and Clinics can make a contribution to the MMA and we will make, a donation through the incidental committee, formed for this purpose. Individual donations to MMA is fine too. The MMA has contributed $15,000 so far.
  4. Commitment. Commitment to donate money at a future date is also being accepted. Signatures are being certified over the next 30 days. It is anticipated the needed number will be achieved and they will now evaluate if there is enough cash to fund this campaign. So commitments can be sent to me. Heard today that big tobacco could spend close to 25 million.
  5. Local champions. As we move forward with the funded campaign, we will be looking for local champions. Dr. Cohen of Whitefish will be helping to lead this part of the effort. Any physician willing to do this can let me know of their interest at

ACP's 2016-17 Annual Report from the EVP and CEO and Town Hall Webinar

ACP's Plan to Offer a Comprehensive Response to CMS's Proposed Physician Payment Rules



ACP Well-being Champions Update June 2018

Thank you for sending your leaders to the Well-being Champions training at Internal Medicine. There were 73 Chapter Leaders trained as champions! They represented 46 domestic and 4 international chapters. As you know, the goal of the Well-being Champion program is to foster local communities of well-being by supporting chapter members, practices and organizations in addressing burnout and the conditions that create it. This training was an important first step; more great steps are coming.

We received survey evaluations from 78% of trainees. Overall, they were overall extremely pleased with the training and expressed gratitude that ACP is addressing this issue and that they were chosen (by you) to participate. Several key take-a ways were:

  • While most of the champions felt prepared to go forward, many mentioned that they would have liked more time to complete their action plans, more coaching on the action plans, more examples of what others have done, and similar. We will address this in next year's training and have also made this topic the kick-off for the follow-up virtual training sessions to begin later this summer.
  • Some of the champions mentioned wanting more time for the session and more role-playing; we are exploring the feasibility of extending the training time next year.
  • The three most requested additional training topics were coaching, how to “sell” this topic to the unconvinced, and what other chapters have done. They will be the first 3 of 5-6 sessions this year.

ACP is working on a number of next steps, including:

  • Mini Z links for every chapter′. Just this week, we sent chapter-specific URLs to all the 2018 Champions for both the mini z and mini z resident surveys. Many of the Champions indicated that they would like to survey chapter members on a regular basis regarding burnout/well-being.
  • Additional Champion training. We are planning to offer 5-6 virtual training sessions to the Champions over the course of this year. The sessions will be recorded and made available to those unable to attend.
  • Ongoing Communication
  • For Champions: We are developing a communication plan to assure regular interaction with the Champions. They also have a private web site and private forum to communicate with each other. Governors have access to the private site.
  • For Governors: We are also working on how to communicate with the Governors. Shortly, you will receive some template language to use in your chapter email or newsletter that you can also customize, with the help of your Champion, for your specific chapter events.
  • 2019 Champion Training. Only 20 chapters of 85 have two newly-trained Champions. Some of you already have one nominee on the list for 2019, but most of the 65 chapters that don't have 2 trained folks will have the opportunity to nominate one or two people for 2019. We will be reaching out to you later this summer to confirm any nominees on the list and to solicit any outstanding nominees. Please start thinking now about good candidates.

Professional Wellbeing

Sharon Hecker MD FACC, Montana ACP Wellness Champion

Physician burnout is a hot topic these days and it is easy to see why. What is “burnout”? Christina Maslach1 defines it: “Burnout is a psychological syndrome emerging as a prolonged response to chronic interpersonal stressors on the job. The three key dimensions of this response are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment.”

Six main factors seem to drive burnout: high workloads, workflow inefficiencies, increased time spent in documentation, loss of meaning in work, social isolation at work, and a cultural shift from health values to corporate values2.

Over 50% of physicians are considered at risk for burnout and this number is rising yearly3. While the personal costs of burnout are high (depression, divorce, substance abuse) health professional burnout can pose a significant threat to the clinical, financial and reputational success of an institution. For example, the national mean cost of a single physician turnover is $500,000. In other words, if an organization loses 4 doctors, the estimated cost of replacement is $2M.

In psychological research, the opposite of burnout is “engagement”. Engagement is considered a positive state and consists of high energy (vigor), dedication, and a sense of efficacy (absorption). There has been a concerted effort to collect data4 about what contributes to burnout and how we can change burnout to engagement, not just in individuals but in entire organizations.

The AMA “Steps Forward” program recommends the following nine steps2:

  • 1. Engage senior leadership
  • 2. Track the business case of well-being
  • 3. Resource a wellness infrastructure
  • 4. Measure burnout and the predictors of burnout longitudinally
  • 5. Strengthen local leadership
  • 6. Develop interventions and evaluate their impact
  • 7. Improve workflow efficiency and maximize power of team-based care
  • 8. Reduce clerical burden and tame the EHR
  • 9. Support the physical and psychosocial health of the workforce

Something we can do ourselves, without the help of administration, is to support a “Community of Wellbeing”5.

Recognize well-being as a professional competency
Recognize burnout as a national epidemic and not a personal failure
Support peers' healthy behavior and help-seeking behavior

It is important that healthcare providers do not take on the entire burden of fixing this problem. Although there is much we can do around selfcare and advocacy, it is estimated that 80% of the factors contributing to burnout are organizational factors and outside of the direct control of healthcare providers3.

Figure 2: Key drivers of burnout and engagement in physicians6

A more engaged, satisfied workforce will provide better, safer, more compassionate care to patients, which will, in turn, reduce the total costs of care.

In fact, The Triple Aim of better care for individuals, better health for populations and at lower costs has been updated to the Quadruple Aim, with the fourth aim of clinician well-being7.

Most medical professional societies have taken up the cause of Professional Wellbeing and offer a number of resources which I will continue to share in this column. I will also spend some space focusing on solutions, some for the individual provider and some to help us advocate with our administrators and legislative representatives for change. If you have comments or suggestions, please feel free to stop me in the hall, email me at or give me a call at 406-471-7429.


  • Maslach and Leiter, World Psychiatry. 2016 June: 15(2):103-111 “Understanding the burnout experience: recent research and its implications for psychiatry”
  • Sinsky et al. “Creating the Organizational Foundation for Joy in Medicine™”
  • Shanafelt, Tait D. et al. Mayo Clinic Proceedings, Volume 90, Issue 12, 1600-1613: Changes is Burnout and Satisfaction with Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014
  • Shanafelt, Goh and Sinsky, JAMA Intern Med. 2017, 177(12):1826-1832: The Business Case for Investing in Physician Well-being
  • American College of Physicians “Well-being and Professional Satisfaction Initiative” recommendations
  • Shanafelt, T.Noseworthy, J.H., Mayo Clinic Proceedings, Vol. 92 Issue 1: Executive Leadership and Physician Well-being
  • Bodenheimer and Sinsky, Ann Fam Med. 2014 Nov: 12(6): 573-576: From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider