| Spring 2009 Newsletter |
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Check out the Spring 2009 newsletter from the NHSPA board of directors.
In this issue: Urgent Message from the NHSPA President New NHMS President 2009 Fall Conference A Message from the NHSPA Board Department of Transportation (DOT) Physicals 7th Annual Orthopedics in Primary Care Symposium Constituent Organization Resource Exchange (CORE) Report Urgent Message from the NHSPA President Are You A Physician Assistant practicing in NH? If so, you may be entitled to funds. Thursday 2/19/09, Governor Lynch announced that the State will be seeking acquisition of $110 million surplus funds from the NHJUA (NH Joint Underwriters Association) stabilization reserve fund, as part of the state budget proposal. At the NHMS monthly meeting, I learned of these events and that some PAs have paid into the JUA. I do not know the actual # of PAs so I need your help in gathering that data. Initial reaction from physicians who were at the meeting and have paid into the JUA is of shock and concern. The Medical Society is currently working with legal counsel and others to gather all the facts & review the options. Physicians, hospitals, nurses, nursing homes, dentists, PAs, etc., have all paid into the JUA. According to NH Administrative Rule 1703.07, if there is a surplus, the excess shall be distributed to the providers covered by the JUA -- not to the state. The AG has given the Governor a legal opinion that supports the argument that the state has the authority to take the money. NHMS distributed the document prepared by the AG's office 2/26/09 . They will keep the executive committee (as PAs we have a voting seat on this committee ) & physicians informed, once they get a better understanding of the options but this is moving fast. In the meantime, there are two things you can do:
Susan Finerty PA-C
2009 Fall Conference - SAVE THE DATE This is the first time we are using the Lake Opechee Inn and Spa but are looking forward to the venue. The Inn has lovely rooms, some with a lake view, and a full spa on the premises. In addition the Lakes Region offers many other attractions and plenty of shopping. Contact the Inn directly to make your reservations. A block of rooms has been reserved for us so mention that you are attending the NHSPA Fall Conference. Meet Your Board of Directors - A message from Susan Finerty, President I am your current President for 2009. I have been a past president of NHSPA in 2003 and 2004. I wanted to come back to this position to help mentor our “younger” PAs as NHSPA transitions it’s board of directors’ members. I am in clinical practice in Urology at The Urology Center of Southern New Hampshire in Nashua. I have been a PA for 25 years, 18 of those years spent in Urology. While I see all types of urological problems, my main area of interest is in urinary incontinence and interstitial cystitis. I established The Center for Bladder Health in 2006 which is located in our office and caters to adults and children with bladder control problems. I moved to NH in 2000 to join the practice where I am currently employed. Prior to that I resided in Massachusetts and was employed by Harvard Vanguard Medical Associates. I joined NHSPA in 2001 to meet other NH PAs (as I was the sole PA in our practice) and the experience I have had with NHSPA has been very rewarding. I reside in Bedford, am married and have 2 children, one in 6th and one in 7th grade which makes life challenging to say the least. I enjoy running which helps me maintain my sanity! My goals for this coming year as your president are to increase membership in NHSPA, to work closely with the NHMS on legislative initiatives, and to participate in what I am calling the NHSPA Health Initiative Project for 2009. NHSPA is planning to work with a national group called “Girls on the Run”. This group works with girls ages 8-13 and through a 10 week running/walking program, helps them build self esteem, confidence and hopefully helps to deter them from engaging in detrimental activities such as drug/alcohol abuse, eating disorders and pregnancy. NHSPA is hoping to participate with their fall program and helping Girls on the Run NH in achieving their goal as well as my goal for health initiative with young girls. If you are interested in working with NHSPA in this effort, I’d love to hear from you! I welcome phone calls or emails from you, our members. Thanks for your involvement. -Susan M Finerty, PA-C Department of Transportation (DOT) Physicals In this quarter's Clinical Corner, I would like to spend a little time going over something we all probably do everyday, the Commercial Driver Medical Clearance Exam, or the DOT (Department of Transportation) Physical. I am not here to tell you how to do a DOT physical, but to offer insight into some of the intricacies, and to some of the changes coming soon to a DOT physical near you. DOT physicals are regulated by the Federal Motor Carrier and Safety Administration (FMCSA), which is a separate administration under the US Department of Transportation. The DOT Medical Examination is designed to identify commercial vehicle drivers who could potentially become a safety hazard to themselves or to other drivers on the road, due to a medical condition that has or has not been identified. Who can perform a DOT physical? The FMSCA definition of a medical examiner is; a "Medical examiner means a person who is licensed, certified, and/or registered, in accordance with applicable State laws and regulations, to perform physical examinations. The term includes, but is not limited to, doctors of medicine, doctors of osteopathy, physician assistants, advanced practice nurses, and doctors of chiropractic." Medical examiners should be knowledgeable of the specific physical and mental demands that are associated with commercial driving. The medical examination for qualified driver without restriction is required to be renewed every 2 years. Who needs a DOT medical Certificate? In 1992, the FMCSA passed into law a set of standards. Creating one clear definition of what is Commercial Driving. A commercial vehicle is a vehicle used for business purposes. A Commercial Driving License (CDL) is required if: The vehicle weighs more than 26,001 lbs, or if the vehicle carries more than 16 passengers (including the driver), or if placarded for hazardous materials. There are different classifications within the CDL standard; including class A, which includes vehicles pulling trailers weighing more than 10,000 lbs, class B which are vehicles more than 26,001 lbs, but may tow or carry less than 10,000 lbs gross vehicle weight, and class C, which are passenger vehicles carrying 16 or more passengers (including driver), or small vehicles placarded for hazardous materials. If the driver drives any of these vehicles for a job, then he/she must have a DOT Medical Examination, and certification. Diseases/Conditions The DOT, and FMCSA have formulated a list of conditions which can limit commercial drivers to certification that is less than the standard two years; there are also some disease conditions, and their treatments, which could render a driver disqualified from commercial driving. The first diagnosis that would be disqualifying for commercial driving would be a diagnosis of diabetes mellitus, which requires insulin for control. Treating your diabetes with insulin can be a complicated and difficult medication to administer while operating a commercial vehicle, but due to its possible side effects including, but not limited to, acute hypoglycemia, and the potential resulting incapacitation, puts both the driver and the general public at risk. Non-insulin dependant diabetics who take oral hypoglycemic medications are able to be qualified, but are required to be evaluated annually for monitoring, and evaluation for some of the sequelae of diabetes. The State of New Hampshire does have a waiver program, which allows Type II diabetics who use insulin for treatment, to drive commercially, except for hazardous materials transport, and driving school children. A provider wishing to help a patient obtain such a waiver should contact the NH State Police DOT unit for further instructions. Under the criteria for cardiovascular conditions, the FMCSA identifies disqualifying conditions as conditions that may, "cause symptoms of syncope, dyspnea, collapse, or congestive cardiac failure." The FMCSA recommends that, patients who have had a diagnosis of myocardial infarction, or other condition which may have caused some form of cardiovascular insufficiency, should have a normal resting and stress echocardiogram, and not on any medications likely to interfere with safe driving. As a matter of fact, the DOT requires biannual stress testing for patients with a know history of CAD, MI, Angina, or stent placement, and annual clearance in writing, by the treating cardiologist, in order to pass the examination with a one year expiration. CABG surgery, and pacemaker placement is not in itself disqualifying, because they are remedial procedures; however the implantation of a cardiac defibrillator is disqualifying, in particular due to the underlying cause for the defibrillator (arrhythmia inducing syncope or cardiac arrest), and the distracting pain and potential syncope that would be incurred during the machine's discharge. The DOT standards for hypertension can be somewhat confusing. Blood pressures less than 140/90 qualify for the standard 2-year certificate. For patients receiving a new or first time DOT exam, with an untreated blood pressure >140/90, but <160/100, the commercial driver may be certified for 1 year; if at the end of 1 year, or for a patient that is re-certifying an exam, the blood pressure is still >140/90, but <160/100, they may be certified with a 3 month certificate, with the encouragement to seek treatment with Primary Care. When the patient returns at the end of three months, and their blood pressure is qualifying (<140/90), then the provider should complete the certification for the remainder of the year from the initial date of exam. Patients on anti-hypertensive medication to control their blood pressure may only be certified for one year. Patients in for initial exam and evaluation, with an initial B/P >160/100, but < 180/110, may only be certified for 3 months. If after 3 months, the treated B/P is under 140/90, then they may be certified for 1 year from the date of the initial exam. A blood pressure greater than 180/110 is disqualified from commercial driving, at least temporarily, until they can undergo treatment, and have a blood pressure that is under 140/90. Commercial drivers can be qualified if they do not use controlled substances. There is an exception, though. If the substance is prescribed by licensed medical provider who is familiar with the driver's medical history, knowledgeable of the required duties of a commercial driver, and has advised the driver that the prescribed medication will not adversely affect the driver's ability to safely operate a motor vehicle; then they may qualified. However, the exception does not apply to Methadone, which is disqualifying. Also the patient may not be qualified if they have a current clinical diagnosis of alcoholism (not being treated or not in recovery). Patients who are under the care of a primary care provider or behavioral specialist, and are taking psychiatric medications (i.e. SSRI, Antipsychotics, SNRI, etc), should have a letter from the prescribing provider that states there are currently no complaints of side effects that would affect their driving, or are responding well to treatment, and are cleared to drive commercially. Recent changes of note:
Hopefully this clinical corner will help clarify some of the confusing parts of the US DOT commercial driver medical examination. Maurice Paquette MPAS, PA-C, NREMT-P is a PA working in Occupational Health in Londonderry NH, and Emergency Medicine in Manchester, NH Definitions, and information for this article was taken from the US Federal Motor Carrier Safety Administration website at http://www.fmcsa.dot.gov/, and was accessed 02/09/2009 7th Annual Orthopedics in Primary Care Symposium The 7th Annual Orthopedics in Primary Care Symposium will be held April 18, 2009 from 7:30 a.m. -12:30 p.m. at Catholic Medical Center in Manchester, NH. This educational opportunity is FREE to NH providers and allows you to earn up to 5 category 1 CME credits. Lecture topics will include: Shoulder exam and treatment of rotator cuff pathology; treatment of plantar fasciitis; treatment of hip pain; return to play after sustaining a head injury; diagnosing ACL injury and knee pain; the benefits of computer assisted total knee arthroplasty and MRSA. The lectures will be held on Level C in the Roy Auditorium. Space is limited to the first 50 registrants so be sure to register early. Constituent Organization Resource Exchange (CORE) Report Two of our BOD members (Monica Ball and Mark Rescino) attended this meeting along with members from 37 other state organizations to discuss a variety of topics to help lead our profession into the future. Our national organization is primed to move forward and is already working hard with the Obama administration to solidify a place for Physician Assistant’s in the nation’s healthcare picture. This meeting was also a chance to meet and discuss issues affecting PA’s specifically in the northeast region (Maine, New York, New Jersey, Connecticut, Pennsylvania, Delaware, New Hampshire, Rhode Island, Massachusetts and Vermont) at a special regional meeting. NHSPA will focus on the following information that was shared at the meeting: Membership Marketing and Electronic Social Networking (i.e., Facebook, etc.), Reimbursement Monitoring (including updates to our website), and focusing on prioritizing legislative initiatives at both the National and State level that affect PA practice. Other information presented at the meeting included the AAPA 2010-2012 Strategic Plan, Volunteer Management and Utilization, and the new Environment of Industry Support (i.e., how the PhRMA Code and other legislation will affect vendor financial backing of PA education and CME presentations). It was an extremely important meeting and was very informative about how essential it is to be active as individual PAs and also as a constituent organization. Perhaps it is best summed but by the quote, “If you are not at the table, you are on the menu”. Our future as PAs is very bright and now is the time to push forward and make an impact on the medical profession. |
