The U.S. Food and Drug Administration has approved the first generic of Symbicort (budesonide and formoterol fumarate dihydrate) Inhalation Aerosol for the treatment of two common pulmonary health conditions: asthma in patients six years of age and older and the maintenance treatment of airflow obstruction and reducing exacerbations for patients with chronic obstructive pulmonary disease (COPD).
“Today’s approval of the first generic for one of the most commonly prescribed complex drug-device combination products to treat asthma and COPD is another step forward in our commitment to bring generic copies of complex drugs to the market, which can improve quality of life and help reduce the cost of treatment,” said Sally Choe, Ph.D., director of the Office of Generic Drugs in the FDA Center for Drug Evaluation and Research.
Much of the federal government’s solution to resolve certain out-of-network billing disputes without balance billing or otherwise involving patients – known as the No Surprises Act – took effect at the start of 2022.
Among other pieces physicians must familiarize themselves with, the new federal law features an independent dispute resolution (IDR) process that was intended to let physicians and insurers both make their case for fair payment. Naturally, plenty of minutiae and arcana exists within the law, and a portion of the rules for the IDR process is under a legal challenge from the Texas Medical Association and others in organized medicine.
To help physician practices understand and navigate the new law, the American Medical Association has created a toolkit, Preparing for Implementation of the No Surprises Act. The 20-page toolkit includes information on:
Operational challenges physicians “will need to address immediately” to be compliant with the law’s new requirements, such as when uninsured and self-pay patients must receive a good-faith estimate of charges before they receive services;
What services and care fall under the rules of the No Surprises Act;
Timetables and requirements for the IDR process; and
When and how facilities and physician practices can obtain a patient’s consent to balance bill for out-of-network care at an in-network facility.
AMA says it will update the toolkit “as additional guidance is available” and will develop new resources on parts of the law not already included in the toolkit.
Meanwhile, TMA and others are still pushing to ensure the implementation of the law is fair for physicians seeking to get paid. In late October 2021, TMA filed suit to challenge what physicians and hospitals say is an unfair piece of the IDR process outlined in federal rules. Check future editions of Texas Medicine Today for updates on that lawsuit.
During a short break from medical school during Summer 2021, Sereena Jivraj, a second-year medical student at the TCU School of Medicine, had a burning desire to create something.
“I’ve had these ideas in the back of my mind for some time,” Jivraj said. “I’ve spent so much time around children whether that was tutoring or babysitting and I’ve always been reading children’s books for years and it just felt like I’ve been so involved with kids in the past that it would be cool to keep it going in the future.”
Sereena Jivraj, a second-year medical student at the TCU School of Medicine, holds her newly published children’s books entitled “Connor and His Composting Adventures” and “Ella and Her Vaccine Soldiers.”
In “Connor and His Composting Adventures,” Connor learns what the difference is between compost and regular trash. Throughout the course of the story Connor learns what everyday items can be composted and how to prevent trash from ending up in a landfill.
“The point is just to educate kids and even parents on what composting is,” Jivraj said. “A lot of people when you speak to them about it they’ve never heard of it. What I really wanted to do is be able to instill that knowledge from a young age. Hopefully that will make it easier to make changes in our society one day in the future.”
Her second children’s book called “Ella and Her Vaccine Soldiers” is about young Ella’s visit to her doctor. Ella learns how important vaccines are and how they can turn into “mini soldiers” to help her body fight viruses and diseases.
“With COVID-19 around last few years and previously with flu shots, I can remember everyone being afraid to go to the doctor just because they knew a shot was coming,” Jivraj said. “I want kids’ fears to be diminished so they can have a healthy relationship with their doctors and not fear them because you’re really brave when you get these vaccinations. I don’t want this fear of vaccines to prevent you getting the help that you need.”
Writing the books was a process that helped Jivraj tackle some of her own issues with long form writing. She reached out to the medical school’s Compassionate Practice® team after she did some volunteer work gathering donations for homeless individuals in Fort Worth and felt compelled to pen a poem about her experience.
“I used it as a way to get out my emotions and help me decompress,” Jivraj said. “I went to the Compassionate Practice® team and that kind of gave me the confidence to do this because I always felt like writing was my weakness.”
She also talked to Samir Nangia, M.D., a Physician Development Coach at the medical school, about the idea of penning the children’s books. During their chats, Dr. Naniga said that her urged Jivraj not to put her ideas off and take some time during her break to pursue them.
“In some instances, through coaching we can help students become more efficient with their time management and help them discover what resources they need to make their dreams a reality,” Dr. Nangia said. “However, in some instances all it takes is that motivation and emotional support. Both of which were true in Sereena’s case.”
In addition to embracing her creativity, Jivraj said that she chose to author children’s books so the information would be easy to understand and accessible to all people.
“This is a book that you can read to your child in your belly or read to your newborn,” Jivraj said. “Because just exposing them to the vocabulary and to the words it helps create those processes in their brains so when they are exposed to it later on, they are not completely confused about it.”
Physicians, nominations are now open for the 2022 Gold-Headed Cane Award, which is given annually to an outstanding TCMS member who has made a significant impact on our medical community.
To be eligible for the award, a nominee must be a current member of TCMS and have been a TCMS member for at least 15 years. You can find the list of members who are eligible here.
All current TCMS members have the opportunity to nominate one candidate for this award. You can make your nomination or learn more here.
All nominations must be received by April 22, 2022.
Fort Worth internist Mo Rezaie, DO, talks with Lili Zheng of NBC5 about the current state of the coronavirus pandemic two years after the first case was discovered in Texas.
Join our local chapter of Walk with a Doc on Saturday, March 12, for a fun morning walking, talking about health, and meeting people in our community. You can find information about the spring dates here.
Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County updated Wednesday, March 2, 2o22.Find more COVID-19 information from TCPH here.
*These data are provisional and are subject to change at any time.
Deaths and recovered cases are included in total COVID-19 positive cases.
The AMA-MSS Region 3 includes medical schools in Arkansas, Kansas, Louisiana, Mississippi, Oklahoma and Texas.
“My job is to learn about what different health care policies are being passed in these different states,” Singh said. “And spread that news and raise awareness among medical students because as we all know these policies impact everyone from students to physicians and patients.”
Singh will oversee the Region 3 advocacy committee and lead advocacy initiatives to engage region chapters.
He will also work with the Advocacy Subcommittee of the Committee on Legislation and Advocacy (COLA) to help our region engage with events like National Advocacy Week (NAW) and the Medical Student Advocacy Conference (MAC). He will also support the Membership Chair and Secretary in reaching out to local chapters to highlight advocacy endeavors and provide advocacy updates in AMA-MSS Region 3 monthly newsletters.
“Policy writing is very niche and not every physician has to do that but the way this connects with the medical school is how they teach us to be an advocate for your patients,” Singh said. “And growing that idea on a larger scale its advocating for your population. Not only talking to physicians you’re talking to legislative members, congress members and kind of impact a larger audience that’s a really great opportunity as future physicians.”
The Medical Student Section (MSS) aims to be a voice for medical students’ across the AMA to help improve medical education and advocating for the future of medicine.
Statement by Diana L. Fite, MD, Texas Medical Association (TMA) immediate past president, in response to the U.S. District Court for the Eastern District of Texas’ ruling on TMA’s motion for summary judgment in its lawsuit opposing federal regulatory agencies’ unlawful approach to dispute resolution under the No Surprises Act.
“TMA is pleased that the court granted its motion for summary judgment in its lawsuit challenging the federal agencies’ unlawful approach to resolving disputes under the No Surprises Act. This decision is a major victory for patients and physicians. It also is a reminder that federal agencies must adopt regulations in accordance with the law.
“This decision is an important step toward restoring the fair and balanced process that Congress enacted to resolve disputes between health insurers and physicians over appropriate out-of-network payment rates. The decision will promote patient access to quality care when they need it most and will guard against health insurer business practices that give patients fewer choices of affordable in-network physicians and threaten the sustainability of physician practices.”
TMA is the largest state medical society in the nation, representing more than 56,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
Deciding to become a doctor meant comparing myself to numbers my whole academic career. In high school, I put my self-worth in my class rank and SAT score. In college, my sense of self relied heavily on my GPA, MCAT score, and volunteer hours. Getting anything less than an A (which happened more often than I would like to admit) sent me into a spiral of anxiety. I found myself scouring through online forums such as Reddit and Student Doctor Network to see where I stacked up to my peers. I would compare my GPA and MCAT score to the acceptance data provided by schools to determine if I was truly worthy of applying to that school. The uncertainty and stress of being a pre-medical student caused me to value numbers over relationships, but I told myself that one day, it would be worth it.
The sad reality was that in an effort to succeed, I had isolated myself emotionally and physically. These numbers I was chasing had come at a cost – I had become so single-minded that I had conditioned myself to study alone. I found class, study groups, and review sessions pointless because, in my mind, I was counting the hours down to when I could be alone at my desk, studying how I thought was best.
I started medical school in 2020 during the height of the pandemic. I had a positive mindset going in, but the first semester was one of the hardest times of my medical career. The forced social isolation stripped me of any sense of drive. I started missing class, my mental health declined, and my grades reflected my inner turmoil. The propensity for self-imposed seclusion that I had developed came back with a vengeance and worsened my cycle of apathy and misery. I struggled silently.
Things did not get much better during my second semester, so when I saw a classmate post about forming a study group called “Booked Up Together” over Zoom, I figured it was at least worth trying. As dramatic as this sounds, there was a little voice in my head telling me that I needed to admit that my way was not working, and I had to try something different. Let me tell you – I am so glad that I listened to that side of myself. Time that would have normally been spent alone in my room was now filled with friends quizzing each other and breaking down lecture material in a way that was easier to understand. Joining Booked Up Together was hands-down the best decision I have made since starting medical school. I started going to class, my mental health improved, and my grades got better. I became friends with warm and genuine people who helped me see the importance of not going through school alone. Study group became a safe space – I knew even on my bad days, there were people who understood and related to the pressure and stress.
Healthcare is multifaceted. As physicians, we will work together with different specialties and healthcare workers to ensure our patients receive the best care possible. While we are told that medicine is collaborative, the journey through medicine often feels solitary. I suppose it seems obvious now, but it is vital to protect our humanity while going through medical education not only for ourselves but for our future patients. For me, studying with my classmates reminded me that medicine at its root is a collective field, and while it is easy to get swayed by numbers and resume building, it is also important to remember why we decided to become physicians in the first place. What worked for me might not necessarily work for someone else, but I believe finding an avenue to collaborate is a beneficial way to stay connected with that part of yourself. Medical school is hard but going about it alone is even harder.
Tarrant County Physician Online 