No foolin’ — here’s your Wednesday
NCMS Morning Rounds
April 1, 2020
NC Medical Board Eases Some Requirements in Response to COVID-19
The North Carolina Medical Board (NCMB) held an emergency meeting last Friday during which they took several actions to support the state’s response to the COVID-19 pandemic.
Specific actions include:
- Adopted rules requested by NC Department of Health and Human Services (NCDHHS) Secretary Mandy Cohen, MD, MPH, to reduce the occurrence of reported stockpiling or inappropriate prescribing of chloroquine, azithromycin and other medications, and ensure that these drugs are available to patients who need them.
- Approved an order to postpone USMLE and COMLEX–USA Step/Level 2 testing requirements for medical students prior to beginning a residency program. This will allow medical students who have otherwise completed the requirements to graduate from medical school and been accepted into a North Carolina residency training program to start their residency, which will almost certainly include assisting in battling the COVID-19 pandemic.
- Approved an order to allow hospitals, health systems, or multi-specialty group practices to temporarily reassign a PA to a new practice area to meet a critical need without formally notifying the NCMB of the new supervisory arrangements. The supervising physician and facility administration should ensure the physician assistant:
o Is reassigned to perform only those medical tasks for which they are competent and qualified to do;
o Has reasonable and immediate access to a physician, either in person or electronically, should medical issues arise;
o Should comply with all applicable rules including the requirement to confer at least monthly with a physician to ensure meaningful supervision and quality assurance within the new practice setting. - Approved an order to allow Fellows with a Resident Training License (RTL) to apply for a Limited Emergency License, which provides a temporary unrestricted and full medical license during the declared state of emergency. This action will allow several hundred physicians with proven competence in a primary specialty to take care of patients and ease the potential strain on physicians currently in the health care system.
These actions seek to support Gov. Cooper’s call to increase the supply of qualified medical professionals available to help during this pandemic. In addition to the above, the NCMB offers two different emergency temporary license applications to facilitate quickly getting physicians and PAs to work. There are no fees and typically licenses are issued within 48 business hours. Learn more about those licenses and other steps NCMB has taken to address the COVID-19 crisis at www.ncmedboard.org/covid.
NCMS Hosts ‘Power Hours’ Starting Friday
As COVID-19 continues to spread, and we are all full of uncertainty and trying to adjust to a different reality, the NCMS wants to help you any way we can. We know that conversation, collaboration and community are crucial right now. To bolster those crucial values, the NCMS Foundation and its Kanof Institute for Physician Leadership (KIPL) will offer weekly ‘Power Hour’ forums starting this Friday. These virtual gatherings will allow you to hear from different experts, decision makers and influencers on a variety of topics that are likely top of mind for you right now.
Our aim is to provide a community conversation around a range of important issues. You will be able to hear from all participants and share your thoughts and ideas in addition to your questions. The format is informal, conversational and the sessions will be easy to access through Zoom. The sessions will be recorded and made available on the KIPL home page. The first Power Hour will be this Friday, April 3 at noon. Mark your calendar and find the topic and link to join this week’s conversation in tomorrow’s NCMS Morning Rounds.
As the health care leaders on the frontlines in this crisis, we are so grateful for all the work you are doing under very challenging circumstances. We hope our Power Hours will offer you a chance to step away for a moment, to learn and to reflect on the important role you play every day on behalf of your patients and the larger community.
The Medical Student Perspective on COVID-19
This perspective piece was written by Austin Lucke, Diana Dayal and Edward Diaz,
three medical students at the University of North Carolina School of Medicine, who are involved with the NCMS student council and sit on several of our committees. The essay gives some insight into what medical students are thinking about the upheaval wrought by COVID-19.
This spring, we and our classmates were set to begin our fourth and final year of medical school. This was supposed to be a glorious final year before starting our careers in our respective residency programs, but in a matter of weeks, our schedules have been completely turned upside down because of COVID-19. While changes for pre-clinical medical students have been analogous to most other graduate and undergraduate students, changes for medical students in the clinical phase have been quite disruptive. Lectures are easy to digitize. Learning assignments can be done on the couch next to your dog. However, clinical learning is difficult to do remotely. To learn to care for patients, we have to learn by being in the hospital. We must learn to face disease and death in person – not through a computer. So many of our most formative medical experiences occur when the situation is the most frantic, most tense and most dire.
Despite this, our clinical rotations are currently on hold. We have been told that we will return at the beginning of April, as are the majority of medical students around the country. UNC School of Medicine’s administration has worked tirelessly to ensure transparency and communication with students, as they too want medical students back in the hospital as soon as possible. We all know that medical students, even as trainees, can play a pivotal role in patient care. Yet, as of now, shortages of personal protective equipment (PPE) are currently limiting student access to clinical duties.
This puts us in a precarious position. Our medical system—already chronically underfunded, understaffed and stretched thin—is about to be pressured in a historic way by COVID-19. Every hand will be needed in the coming weeks. We’re witnessing this grim reality play out in countries across the globe that are in the throes of this pandemic. Italy has fast-tracked many of its senior medical students to become practicing doctors to respond to the urgent need for health care workers. It’s not unreasonable to predict the United States may soon be in a similar situation. All health care providers, not just doctors, will be working at maximum capacity. We know that we are needed in this unprecedented moment in history.
As formal clinical rotations have been suspended due to the PPE shortage, we have been seeking opportunities to be a part of the COVID-19 response. We have been absolutely amazed by the creativity and passion of our colleagues and friends in the UNC medical student community. Over the course of two days, a team of over 100 students across the state have launched projects to support frontline healthcare workers in the weeks to come. Our student-led task force has developed countless initiatives and has compiled a database of local volunteer opportunities.
We are preparing to reinforce the emergency department’s COVID-19 protective equipment protocols to keep doctors, nurses and other patients safe from exposure. In the face of dangerous shortages, we are literally making protective face shields from scratch. We have a long list of volunteers who are ready to provide free childcare services for all the healthcare workers who desperately need it. We are incredibly proud to go to a school surrounded by peers who choose to run towards a crisis instead of away from it. Moreover, we are inspired by medical schools around the country putting forth similar efforts. Now more than ever, we are proud to be in the field of medicine, and remain hopeful in this strange time.
If you’re a medical student and would like to get involved, please contact Austin Lucke at [email protected].
In the News
As Coronavirus Impact Grows, Volunteer Network Tries to Help Health Care Workers Who Have ‘Helped Us,’ STAT, 3-31-20
Learning Opportunity
Here is a question arising out of the COVID-19 situation with an answer from the NC Medical Board’s Chief Medical Officer Karen Burke-Haynes, MD.
Q: My student patients have returned to their home states. Is it legal for me to conduct assessments via telemedicine and prescribe to them?
A: Most medical boards require a physician or PA to be licensed in the state in which the patient care is given. Each state has different laws and rules regarding licensure, telemedicine and prescribing. Some of these restrictions may be lifted during a state of emergency, but you would need to contact the corresponding medical licensing authority of that state to determine its individual requirements.
In North Carolina, patients who are currently in the state but have an established relationship with a physician or PA in another state may receive care, including prescriptions, from the out-of-state clinician via telemedicine.
This Federation of State Medical Boards (FSMB) resource summarizes each states’ emergency policy.
Thank you all for your tireless efforts to keep us all safe!
Re: the Medical Student letter, just a reminder: face shields have NOT proven to be effective in airborne droplet transmitted diseases because we still pull-in air around the shield. Face shields are useful in preventing liquids from contacting our faces. For true protection, our eyes, noses and mouths need to be covered. Covering our noses and mouths along with the face shield is necessary.
Please encourage our leaders and members seeing patients to recommend the public wear masks, even home-made ones, when in public. Reducing person-to-person transmission of airborne droplets can prevent people from getting infected and thus lower the volume of sick people overwhelming the healthcare system. By not also recommending wearing masks as part of mitigation, we’re putting ‘the cart before the horse’. Japan and S. Korea have low rates of infection partly due to the public wearing masks. Look at the numbers: www. worldometers.info. Tokyo has nearly 36M people compared to 8M in NYC. The infected number of people in Japan is only just over 2,000. Infected number in NYC is now over 80,000. Testing and isolation/quarantine played a big role, but reducing person-to-person transmission is likely the largest reason for the low numbers. Let’s follow what’s working elsewhere.
The ‘experts’ are now admitting covering our noses and mouths can reduce transmission and the reason they haven’t recommended wearing masks was for fear there’d be a shortage of masks for healthcare workers. Well, there was already a shortage! Hoarders couldn’t get them either. What they should have done is at least recommend making home-made ones per the CDC guidelines. The underlying ‘agenda’ to protect themselves has obviously backfired and borders on being unethical. The numbers are still growing nearly exponentially. We must add wearing masks to the other mitigation protocols. What can it hurt, we’d look ‘silly’? I’d rather look silly alive than be on a ventilator or dead.
Let’s help ‘Slow or Stop the Spread’ by adding masks and even eye covering to the mitigation recommendations.
If there’s a way to pass this opinion to our members, like you did with the Medical Student letter, it would be very much appreciated. Who knows, it may save a life.
Thank you,
Greg Temas, MD
Winston-Salem, NC