Physician with a following

A robust media approach has helped this physician share his expertise—and passion—outside of medicine.

By Marcia Travelstead | Career Move | Fall 2018


"I got sick of watching doctors make the same financial mistakes over and over again" said Jim Dahle, M.D.

“I got sick of watching doctors make the same financial mistakes over and over again” said Jim Dahle, M.D.

Name: James M. Dahle, M.D.

Employer: Utah Emergency Specialists, Salt Lake City, Utah


Undergraduate: Brigham Young University

Med school: University of Utah School of Medicine

Residency: University of Arizona, Tucson

In residency, James Dahle, M.D., developed an interest in personal finance and investing. In 2011, he started The White Coat Investor, now the most widely-read physician-specific personal finance and investing website in the world. In February 2014, he published a bestselling book, The White Coat Investor: A Doctor’s Guide to Personal Finance and Investing. He also runs a successful podcast, videocast, CME conference, newsletter, forum and scholarship program. Most recently, he launched the online course “Fire Your Financial Advisor: A Step by Step Guide to Developing Your Own Financial Plan.” He is a father of four and enjoys skiing, climbing, mountain biking, canyoneering, and wakesurfing.

Why did you become a blogger and start a podcast?

I got sick of watching doctors make the same financial mistakes over and over again and felt a bit of missionary zeal to try to get basic financial information into the hands of those who have dedicated their lives to the healing of the sick and injured. Second, I was interested in business and passive income and wanted to learn more about online entrepreneurism.

The blog was born in May 2011 and has grown by leaps and bounds ever since. Over the years, people have slowly trended from blogs to podcasts to videocasts, and we’ve tried to move along with them.

What do you like about blogging?

As a kid, I had three potential career interests: being a physician, being a writer, or operating heavy machinery like huge dump trucks and excavators. I’ve managed to do two of the three, and that’s not too bad.

Besides the writing, I love the interaction with the readers. If you write something wrong, readers will let you know in a hurry. I went into medicine because I like to help people. This blog is just another way to help some of the best people in the world. It’s a bit like practicing medicine in the military. You’re serving those who serve, which is particularly rewarding.

Podcasting is OK. I don’t enjoy it nearly as much as writing. I don’t particularly like hearing the sound of my own voice. I have an assistant that runs the most painful parts of running a podcast; otherwise, there wouldn’t be a WCI podcast at all. I do enjoy the back-and-forth with a guest on the show, and I enjoy answering reader questions on the podcast.

From a business aspect, I love the scalability and passiveness of some of the income sources. It’s a lot of fun to make money while I’m sleeping or skiing.

What are the most challenging aspects?

Blogging is fun; I’d do that for free. But blogging isn’t a business. The blog is just the front door to the business. The business might be selling ads, marketing other people’s products, selling your time, or selling your own products. Some aspects of running a business aren’t very fun, so I’ve been trying to hire and outsource what I can.

Was there anything about doing this that surprised you?

First, I didn’t think it would ever generate more money than my practice, but I think that’s pretty atypical for a blog. The vast majority of for-profit blogs make less than $10,000 a year; it is quite a remarkable one that generates a six-figure income.

Second, I didn’t think I would ever be able to help. That’s been very rewarding.

Third, I didn’t expect quite so much opposition from the people whose business I’m hurting, like whole-life insurance salesmen. You wouldn’t believe some of the hate mail and comments we see.

Do you have any advice for physicians who want to start a blog or a podcast?

Make sure it is something you feel passionately about because you probably won’t ever make a significant amount of money—and even if you do, you’ll basically be working for free for at least two years. But the barrier to entry is low. You could do it for $50 for your first year, so you’re really just wasting your time if it doesn’t work out. You won’t go broke.

Anything you’d like to add?

If I could only give five financial tips to doctors, they would be:

  1. Live like a resident for two to five years out of residency to pay off your student loans, save up a down payment on your dream home and catch up to your college roommates with a retirement nest egg.
  2. Maxing out retirement accounts reduces your taxes, boosts returns, facilitates estate planning and protects your assets.
  3. Whole life insurance is a product made to be sold, not bought. It’s frequently sold to physicians inappropriately, never necessary and almost never appropriate.
  4. Put 20 percent of your gross income toward retirement throughout your career, and you’ll retire wealthy.
  5. If you use a financial adviser, make sure you’re paying a fair price for good advice.



Physician adviser

Physician advisers serve as the links between providers, administrators and patients.

By Marcia Travelstead | Career Move | Summer 2018



Clinical experience and administrative interest uniquely position physician advisers to be a link between the two. · Photo by William Hendra

Clinical experience and administrative interest uniquely position physician advisers to be a link between the two. · Photo by William Hendra

Name: Howard Stein, D.O., MHA

Employer: Associate director of medical affairs, physician adviser for care management at CentraState Medical Center in Freehold, New Jersey


Undergraduate: Muhlenberg College, Allentown, Pennsylvania

Postgraduate: Nova Southeastern College (D.O.), Fort Lauderdale, FloridaUniversity of Maryland (MHA), Adelphi, Maryland

Residency: Union Hospital, Union, New Jersey

A physician adviser serves as a liaison between the medical team and hospital administrators. Stein is a national speaker advocating the physician adviser position and the importance of performing multidisciplinary rounds. He left clinical practice in 2003 as his role at CentraState Medical Center evolved into full-time administrative work. He obtained his MHA in 2014, which gave him insight into the administrative and economic aspects of medicine.

What does it take to become a physician adviser?

In general, preparation for the physician adviser position involves practicing medicine for at least five years and showing an interest in utilization, quality assurance, coding, billing or informatics.

What do you like about your role?

I like working on all of the hospital floors and interacting with all of the physicians as they come around to see patients. I also like multidisciplinary rounds; I do six sets of rounds per day. I interact with nursing staff, physical therapists, clinical pharmacologists, pastoral care workers, social workers and case managers. They’re all part of multidisciplinary rounds, so each day we efficiently discuss each patient.

We communicate on an interdisciplinary level so everyone knows what each discipline is working on. I find out what the physician issues are so that I can address them. And when an insurance company is not going to pay for a patient’s stay, I know about it while a patient is an inpatient instead of finding out about it a week later. So we can react to it by either appealing it or by helping the patient obtain an earlier discharge. There are multiple other good things that happen when you do multidisciplinary rounds from a quality and economic perspective.

What’s the most challenging part?

I don’t like how insurance companies take advantage of hospitals and patients by denying them care when it’s appropriate for them to have the care. The physician adviser’s role is to be an advocate for that patient. As denials are issued by an insurance company, the physician adviser reviews the case, talks with the doctors who were involved and makes the decision to appeal the decision or work toward a safe discharge plan if that’s an accurate decision.

Was there anything about becoming a physician adviser that surprised you?

In some hospitals, there’s a large divide between the administration and the medical staff. So, there’s some natural pushback by the medical staff on what the physician adviser does. In some organizations, the physician adviser is looked at as an outsider, not really a member of the medical staff.

I don’t have this problem. Those that do have to work hard to be credible and to gain the trust of the physicians on the medical staff, make them understand that the physician adviser is there to help them and their patients. Physician advisers are not just somebody from administration telling them what to do.

How can other physicians pursue physician adviser roles?

The optimal candidate is a primary care physician, although there are a lot of non-primary care physicians that do it. The primary care physician has a somewhat greater perspective on a wider variety of cases that come into a hospital.

Interested physicians should spend some time with a physician adviser in a hospital to get to see what they do on a day-to-day basis. I suggest joining the American College of Physician Advisors. The other organization that’s very helpful is the American Board of Quality Assurance and Utilization Review Physicians.

There are some conferences each year that I think are helpful. There is also a physician adviser boot camp held yearly. ABQAURP holds an annual conference as well.

It’s about combining the clinical knowledge from practicing medicine for a number of years and learning to understand the utilization rules given by insurance companies and Medicare. Then, the physician adviser needs to be able to teach the medical staff and finance department the ins and outs of the rules to maximize quality and the reimbursement received by using hospital services efficiently and billing correctly.

Anything else?

It’s definitely a field that’s expanding and growing. There are physician advisers now in different fields of administrative medicine. It’s not just utilization, but it’s also quality, informatics, coding and documentation.

Physician advisers are key to successful organizations. Physician advisers bridge the gap between hospital administration and clinical medicine.



Physician app cofounder

Jason Reminick, M.D., saw a need—and decided to fix it through technology.

By Marcia Travelstead | Career Move | Spring 2018


 Jason Reminick, M.D., cofounded a GME interview management platform after getting stuck in New York City during his own interview process.

Jason Reminick, M.D., cofounded a GME interview management platform after getting stuck in New York City during his own interview process.

Name: Jason Reminick, M.D., MBA, MS

Employer: CEO and cofounder, Thalamus


Undergraduate: University of Pennsylvania

Postgraduate: University of Rochester (NY) School of Medicine & Dentistry, Simon Graduate School of Business Administration (MBA)

Internship/Residency: Combined Pediatrics and Anesthesiology Residency Program, Stanford University Medical Center; Stanford Children’s Health-Lucile Packard Children’s Hospital

Reminick developed the idea for Thalamus after getting stuck in New York City during Hurricane Sandy. After several of his residency interviews got cancelled, he returned to his medical school and brainstormed with his mentor, now Thalamus cofounder, Suzanne Karan, M.D. Thalamus is the premiere cloud-based interview management platform designed specifically for application to graduate medical education training programs. The software was established by a grassroots collaboration of medical students, residents, fellows, program administrators and GME leadership to provide comprehensive online interview reservation and travel experience via a real-time scheduling system. Thalamus assists over 25,000 applicants and schedules more than 50,000 interviews at over 100 institutions nationally for all medical specialties.

What do you enjoy most about your role? To be clear, I’m not an engineer or coder, but lead our app and product development. What I most enjoy is the fact that we experienced a problem firsthand and then, along with my cofounder, built the solution into our product to best manage and streamline the residency and fellowship interview scheduling process.

It went from an idea to a successful app solving problems for both medical students and administrators. We’re really proud of that, and hopefully it’s making the process easier for all involved.

What’s the most challenging part? I enjoy this a great deal, but remain frustrated by the amount of anxiety that exists on both sides of the interview scheduling process. We are trying to figure out ways to allay that because applicants are applying to more programs than needed, further increasing their application costs. Similarly, programs continue to over recruit the amount of applicants, inviting more applicants than they have available interview positions. All are trying to protect themselves, and yet it’s adding even more anxiety and noise to the process. We are continuing to explore analytic solutions to allay these concerns.

What’s your advice to other physicians with an idea? I think the most important thing is to keep an open mind and be creative. Continue to learn by reading blogs and online publications. Also, connect with people and network.

There’s no unique formula, but seek out physicians in entrepreneurship, be that through Google or other search. It is a matter of networking with them. People are usually pretty forthcoming.

I believe it is important for physicians to be involved with innovation because we have firsthand and front-line knowledge of health care processes and can implement our experience to innovate health care, improve patient care, and benefit the medical profession as a whole.

Medicine is very structured in a lot of ways and often establishes a set path with limited flexibility. If you want to be an internist, an anesthesiologist, a surgeon or otherwise, you have a very set and distinct training path. Conversely, entrepreneurship is in many ways the opposite. It allows you to be creative and often face great uncertainty. It’s a different type of expertise, which at times can be challenging to fit into the paternalistic structure of medicine. It’s a matter of finding your passion and seeing it through. Surround yourself with the people who can help you get there.



Serving the military, civilian style

A move to a military base community could mean a higher quality of life—even for civilian physicians.

By Marcia Travelstead | Career Move | Winter 2018


Frank Roam, D.O.

Frank Roam, D.O., is a civilian physician at a military hospital—a career move that allowed him to move back to his hometown and achieve a favorable work – life balance.

Fort Leonard Wood, Missouri, is home to a military base. The community is nestled in the heart of the Ozarks about 134 miles southwest of St. Louis on Interstate 44. There’s boating, fishing, hunting, hiking and camping for those who wish to pursue outdoor sports. The low cost of living makes it a great place to retire or raise a family—and there are practice opportunities for civilian physicians.

What do you like about being a civilian physician at a military hospital? I was able to move back to my hometown, and my family is here. Previously, I was part of a large conglomerate for several years, and there was a lot of micromanagement and inconsistency. It was somewhat of a bureaucracy, so I was ready to leave when I discovered there was an opportunity to come here. There isn’t as much pressure here.

What’s the most challenging part of your role? The practice I have here is a two-edged sword. I’m still busy, but it’s a different type of busy. It’s more focused on patient-related issues such as surgery, clinical follow-ups, etc. I no longer have the time-consuming collateral duties that a civilian hospital can overwhelm an experienced physician with.

I perform a lot of the same types of surgeries, such as hernias, endoscopies, gall bladder, etc. So, there’s a trade-off, as there is not as much pathology.

The environment is a little more relaxed. Earlier in my career, I would have wanted to be busier and have the variety. Today, my days tend to be over by 4 or 5 p.m. as opposed to 7 or 8 p.m. in my private civilian practice. Depending on the call schedule, it might be much later. If someone wanted to do 60 to 70 major cases a month, the practice I have now might not be what they are looking for. However, I find it very gratifying—especially at this point in my career.

Was there anything about practicing as a civilian physician at a military hospital that surprised you? Not really. The physician recruiter was open and honest about what to expect. I was able to speak with some of the other physicians before I actually signed up, so I knew what I was getting into and what the practice was like in the hospital.

Where I was previously, I wore a lot of hats. I had to be on a lot of different committees, such as credentialing, infectious diseases, etc. As far as my time was concerned, I had to split it with these meetings and my practice. They have the same meetings here, but the physicians on the committees are military. In a way, I gave up a little bit of control from where I was before. I had input as to the rules and the way things were going to be done. For me personally, it is refreshing to no longer have to deal with that.

What advice would you give to physicians who want to pursue a similar career move? I can only speak to Fort Leonard Wood. Even though it’s a fairly large military base and hospital, the area is rural. It isn’t for everyone. However, if the physician is willing to drive a few hours, they would be in St. Louis.

Although a physician can read about the area they are interested in, the number of surgeries being conducted here and other statistics, that’s not the same as coming and actually seeing what is available.

Also, I would tell physicians not to be afraid to ask questions specific to their military hospital of interest.

Anything else? I have found this to be a much more relaxed schedule for me. I realize that might not be what a young physician is looking for. I can only speak for here, as there might be other military institutions that are busier and have a larger surgical practice.

One thing I would like to mention: There aren’t really malpractice issues in the military. Although patients do have recourse and may file claims in the event they think something is wrong, in the military, the physician is somewhat protected. The physician doesn’t have to pay any malpractice insurance. I was previously paying between $75,000 to $80,000. That’s one of the other enhancements here and can have some bearing on where a physician practices and the money they can make. That’s a real benefit.



Medical Expert Witness

By Marcia Travelstead | Career Move | Fall 2017


Name: Jennifer L’Hommedieu Stankus, M.D., J.D. Emergency medicine physician at Madigan Army Medical Center in Tacoma, Washington

Undergraduate: Chaminade University, Honolulu; University of Colorado, Boulder

Medical school: University of Washington School of Medicine

Law school: University of Denver Sturm College of Law

Internship/Residency: University of New Mexico, Albuquerque

L’Hommedieu Stankus was a captain in the United States Army JAG Corps and Assistant Center Judge Advocate at the Eisenhower Army Medical Center. She was a police officer for the Englewood, Colorado, and University of Colorado police departments. She has worked in a number of leadership positions and has written several publications. Now, she also provides expert witness services.

What do you like about being a medical expert witness? I love being able to work from home on my own schedule because my emergency department schedule is so chaotic. I like having a 9-to-5 schedule with my husband. It’s really nice to be able to have that flexibility and be able to decrease the number of shifts that I work.

What’s the most challenging part of the role? You need to be credible to do plaintiff and defense work. Testifying against another physician is always difficult because your heart goes out to them. You know that if you go to court, you have to look them in the face and do your job knowing what an impact you could have on their life. On the other hand, when there is negligence and injury results, the injured person deserves to be compensated.

When you do your job objectively and you’re testifying against another physician, there can be backlash against you. You have to be objective and careful in your answers but you have to know that may happen. Your testimony will be scrutinized much more heavily than if you are defending a doctor. You have to be absolutely certain of your opinion.

Did you go into law before you went into medicine? I was a medical malpractice attorney prior to becoming an emergency physician, so this is right up my alley. …Most physicians who are expert witnesses do not have that background.

Jennifer L'Hommedieu Stankus, M.D., J.D.

Jennifer L’Hommedieu Stankus, M.D., J.D., combines her previous work as an attorney with her current experience as an emergency medicine physician as a medical expert witness.

What does a medical expert witness do? It could be insurance fraud or forensic-type work. Most of the time, it’s a medical malpractice case either for the plaintiff or for the defending doctor. What that entails is the medical chart review and then rendering an opinion—sometimes written, often just verbal. Some experts also do independent medical examinations. You also need to provide your own supplemental malpractice insurance.

What surprised you about the expert witness role? I’m very logical, matter-of-fact and practical. When I see negligence, it deserves to be compensated. I didn’t realize how much heartburn I would have in testifying against my own. I was also surprised that even as a former medical malpractice defense attorney, how long it takes to get the business going to the level I would want. I’ve been doing this for years, and I am still not where I want to be in terms of volume of cases.

What advice would you give to physicians who want to do this? They have to know that this is and always will be a side job. It can’t really be full time. The reason is that, in most states, the experts still have to be practicing in their profession at least half the time. That makes sense because they can’t be a subject-matter expert if they are not practicing. However, some retired doctors act as expert witnesses in the states where it is allowed.

Expect that they are going to have to build a website, spend a lot of money on advertising, spend time on sites such as LinkedIn if they are very serious about it. If they have no legal experience, they need to know the courtroom is a totally different setting with different language other than what they are used to in medicine.

The other thing I would say for new physicians is that there are rules about when they can testify as an expert. States may vary, but typically they have to have been practicing in their specialty for a certain number of years.

How does a physician become an expert witness? Research and understand what the expectations and requirements are, and look at expert witness directories.

Lawyers will pull everything out of their hat to make the experts look bad. If that is something that makes them uncomfortable, this is not the job for them.

Anything else you’d like to add? This can be very exciting. However, they need to always remember that they are NOT the advocate for one side or the other.

As an expert, they are there to objectively review materials and render an opinion. This will, if they are doing their job correctly, go against what the attorney wants on a regular basis. That is normal. They need to be aware that they can be held liable for reports and testimony that are not neutral.

They need to always, always, always be objective and never change or tweak their opinion for the buck, or they will have a bad outcome.



Medical Missions Physician

Career Move | Summer 2017


Wael Hakmeh, D.O., FACEP, has served on multiple mission trips with the Syrian American Medical Society (SAMS), a nonpolitical organization that does medical relief work in Syria and around the world. He has arranged his schedule as a locum tenens physician in a way that enables him to make trips several times a year. Prior to arriving in Syria, he taught an emergency medicine/critical care course to Syrian health care workers in Turkey, preparing them to treat the traumatic injuries commonly seen there. Hakmeh was honored for his volunteer work with the 2016 Physician of the Year Award.

What do you like best about being a medical missions physician? Medical mission work gives me a chance to practice medicine for the reasons that many of us went into medicine: to help those who need it the most. In Syria, over 95 percent of the physicians who were once there have been imprisoned, fled the country or were killed. A lot of health care providers get killed from indiscriminate government bombings. The Syrian patients I met are some of the warmest and kindest people I’ve ever met, so to be able to practice medicine there is the most rewarding thing I’ve ever done professionally.

Did you specifically request to go to Syria? Yes, a couple of my colleagues shared with me their experiences from working there—I’m very grateful to them. Several times I planned on going into Syria, but for different reasons, of the five times I planned to go, I was only able to twice. While I’m confident working there helped patients, I always left there feeling I benefit the most personally. The strength and perseverance of the people there is uplifting and difficult to put into words without doing injustice. The presence of volunteers lets them know they are not there alone and that the world has not forgotten them even though in reality, it has. So I think what I and the other physicians provided was as much of a psychological boost as any life-saving procedure we could perform.

Wael Hakmeh, D.O.

Medical mission work gives Wael Hakmeh, D.O., a chance to help those who need it most.

How long do you spend there? It was a short time, usually about a week. You have to factor in that you can get stuck at the border, and there’s a lot of uncertainty with the bombing. The roads can be closed. At the time I was last there, there was only one road in and out of Aleppo, dubbed ‘the road of death,’ and now that road is cut off [before the siege against the entire city ended]. There’s a lot that has to be taken into account. If I could have stayed longer, I would have. We spent the greater part of a week training Syrian physicians and medics in emergency medicine and ICU training courses in Turkey prior to my work in Syria. My whole trip is usually 2 1/2 weeks.

How many trips have you made? I’ve been to southern Turkey seven times, where we had the training courses. I was able to go into Syria twice. For a number of different reasons, I wasn’t able to go into Syria. One time, the border was closed and they would not let any health care professionals cross. … Another time, I tore my ACL a few days before playing basketball.

What don’t you like about medical missions? There wasn’t much that I didn’t like about it. The biggest thing that bothered me was the amount of preventable deaths and injuries that didn’t have to happen. For example, my first day there, a barrel bomb was dropped on an open market as people were shopping with their kids. Fifty people were killed that day for no reason. These aren’t people on battlefields, just people shopping for fruits and vegetables trying to figure out what to cook for dinner. This part of it was frustrating. The lack of news coverage about the deaths and injuries was, too. One night, 40 people were killed and the bodies were lined up … a lot of horrific scenes. I went online that night to different news outlets, and there was no mention of the incident. That’s why the people feel that the world has turned their backs on them. Medical missions expose its participants to uncomfortable truths of grave injustices.

What surprised you most? The limitation of resources. The destruction is beyond anything that Hollywood could produce—the oldest civilized city in the world with a population of 3 million, reduced to rubble. It’s an unbelievable level of deprivation. It surprised me that the surgical room had a bug zapper in it, particularly in a country that had an excellent health care system 10 years ago. What appeared to be a soda machine was actually a blood bank. There are shortages of all medicines. Bringing narcotics across the border is not possible. I had to put a chest tube in a man with no analgesics at all. He begged me to let him die. Pain medication has to be rationed. This should never have to happen.

Do you have any advice for physicians considering medical missions? The first thing to do is to find something you feel passionate about. Look for a credible and trustworthy organization to work with. Preferably, find something you can benefit from in whatever field you are in. Working as an emergency physician meant working in Aleppo made more sense than on the periphery where people by definition are stable. Talk to other physicians and learn from their experiences. Insight into which medical missions are good is generally [gathered] through word of mouth. If you decide to go somewhere where you could be in danger, you really need to give it a lot of thought. Pray and make sure you are 100 percent mentally and psychologically onboard.

Is there anything else you’d like to add? As I just mentioned, pray about it. Make sure it’s what you want to do, particularly if it’s a dangerous venue. Once you are there, fear should not drive or dictate anything you do. Take a lot of stuffed animals as kids really love that. A lot of times, it’s not the medical work that we do; it’s your actions and genuine caring that people notice. It’s very meaningful and uplifting that somebody came thousands of miles across the ocean to care for them. That will do more good a lot of times than any application of medical knowledge will. Do your homework. Learn about the culture of those you will be serving as provision—culturally sensitive care maximizes your effectiveness as a physician.



Physician Astronaut

By Marcia Travelstead | Career Move | Spring 2017


David Wolf, M.D

David Wolf, M.D., has been a pioneer in three-dimensional tissue engineering and in using digital ultrasound for medical purposes. He is co-founder of a pharmaceutical company—and an astronaut who has spent 168 days in space. · Photo by Pixel Studio Productions

Name: David Wolf, M.D.

Work: Astronaut, cosmonaut

  • Co-founder, president and chief medical officer of Spektron Systems
  • Consultant in biotechnology, aerospace, medical delivery and bioinstrumentation

Undergraduate: B.S. in electrical engineering, Purdue University, Lafayette, Indiana

Medical School: Indiana University School of Medicine, Indianapolis

Internship: Methodist Hospital, Indianapolis

David Wolf, M.D., co-founder, president and chief medical officer of Spektron Systems, is passionate when he says he wants to make having been an astronaut a footnote in his file. Spektron is a pharmaceutical company disruptively improving the methods for medicinal molecule design. It combines the methods of aerospace, physics and biology in a way never before conceived. Through it, Wolf is striving to make medicines that are developed more quickly with less expense and fewer side effects.

With 17 patents in the area, Wolf is considered by many to be the father of three-dimensional tissue engineering. There are now more than 3,000 publications worldwide on the methods for growing human tissue, both cancerous and normal, outside the body for regenerative medicine and cancer management. Wolf is also one of the pioneers of using digital ultrasound for medical imaging, bringing it into the modern era. He is an expert in medical ultrasonics and greatly improved the ultrasonic wave. Wolf was brought to the medical science division of NASA to design a custom ultrasonic machine for the space shuttle.

What did you like best about being a physician in space? All of the astronauts [and] space flight crews have a mix of talents that, when combined, produce a crew that is far more than any one of us. For me, it was very satisfying [to bring] the combination of engineering and medicine, which cut across a large amount of activities that astronauts do, whether it be managing the spaceship systems or taking care of crews as they get injured or sick in space, which happens fairly frequently.

I came into NASA as a contractor to build the American Flight Echocardiograph. It was custom built for the space shuttle so we could investigate cardiovascular physiology in zero gravity. Ten years later, I ended up flying that same machine on my first space shuttle mission. What’s important here is that this laid the foundation for today’s modern telemedicine. This is what I’m doing now in Spektron Systems.

What are the challenges? There are lots of things about being an astronaut that all astronauts don’t like. It’s like any other job, which leads me to a concept: Astronauts are not exceptional people. They are reasonably good people placed in extremely exceptional circumstances.

I have 168 days in space in four missions. As I became a more senior astronaut, I became a spacewalk specialist. … I became the coach of the astronauts’ spacewalk team that built the space station. NASA performed over 80 space shuttle missions and 135 spacewalks to build the International Space Station. This was an exceptionally exciting period because spacewalks are extremely demanding on the human physiology. For example, the spacesuit operates at a total pressure of 4.3 pounds per square inch. At that low pressure, a person would immediately get life-threatening bends. So we spend days preparing our bodies by desaturating them from nitrogen before we can go. My background allowed me to walk all those boundaries from medicine to engineering, which was very satisfying.

When did you know you wanted to be an astronaut? Our housekeeper [from when I was a child] still tells the story about when I got mad at her and told her I wasn’t going to take her to space with me. My earliest memory [is of] sitting on my uncle’s lap in an open cockpit biplane doing aerobatics. My family’s tradition was to fly competition aerobatics on the national circuit. My father’s interest was in electronics. He became a doctor while I was in high school. When I was in high school, I got interested in medicine, and I liked electronics from building stereos with my dad. My mom was athletic, and that’s how I got interested in sports, so everything fell together. Luckily, I could use all of that as an astronaut. However, my real interests were in biomedical engineering, which was a field that hadn’t been defined yet.

What was most surprising about working in space? Living and working in space is so completely unfamiliar to us on earth that it seems like Alice in Wonderland. All of the rules are broken that we have come accustomed to on earth. For example, in space, you feel like a superhuman. You can fly or lift a refrigerator with your baby finger. All the while, your body is literally melting. I lost 40 pounds and 15 percent of bone mineral in typically gravity loaded bones. The balance system readapts to space with both afferent and efferent neural reconnections. Your actual nerve connections change. You adapt to space in your balance system. When you return to earth, there’s a whole area at NASA that’s essentially a rehabilitation program for astronauts returning.

What advice would you give a physician who wants to become an astronaut? An early astronaut brochure … had declared that the most important characteristic they were looking for is perspicacity. It means, in this context—and is applicable to medicine as well—[that] when faced with an overwhelming amount of information, some people have a natural capacity to select the correct bits of information and act on them correctly. Doctors have this capacity. It’s just that getting things wrong unravels a lot quicker and more dramatically in a public way in space.

Being persistent and being a self-starter are obviously important. I knocked on NASA’s door, and they didn’t hire me, so I went to medical school. I went back, and they did not hire me. Then I did my internship at Methodist Hospital. It took me several years before I was hired as a contractor. I was rejected from four astronaut selections while working at NASA.

All astronauts became something else first, which they did very well. Follow your passion, and if that’s compatible with NASA’s needs, apply to be an astronaut. …Keep an eye on the astronaut business, and if you are really interested, you’ll naturally do the thing that will make you an astronaut.

For more information on Wolf, visit or check out #WeBelieveInAstronauts.



What it’s like to work at an FQHC

By Marcia Travelstead | Career Move | Fall 2016


Daniel Bow, D.O.

“Most of us go into medicine to help others, and this is a great opportunity to do just that,” says Daniel Bow, D.O. · Photo by Nicole Haley

Name: Daniel Bow, D.O.

Work: Internal Medicine physician, Baldwin Family Health Care, Baldwin, Michigan

Undergraduate: Eastern Michigan University, Ypsilanti, Michigan

Med School: Michigan State University, East Lansing, Michigan

Residency: Botsford General Hospital, Farmington Hills, Michigan

Federally Qualified Health Centers (FQHCs) like Family Health Care (FHC) in Baldwin, Michigan, are vital to rural areas. Health centers must meet specific criteria to qualify as FQHCs, including serving underserved populations, offering sliding fee scales, providing comprehensive services, having ongoing quality assurance programs and having governing boards of directors. Physicians who have federal loans may be particularly interested because FQHCs are able to help with the loan repayment of their employed physicians. Baldwin FHC, where Bow practices, is the third-oldest FQHC in the country. The National Health Service Corps, which connected Bow with Baldwin FHC, offers tax-free loan repayment to health care providers who choose to go where they are most needed including NHSC-approved FQHCs.

How did you become an FQHC physician? There are different routes to be taken. For me, I found Baldwin Family Health Care while I was a student at Michigan State. I joined the National Health Service Corps, and they connected me with Baldwin. So the National Health Service Corps paid for some of my schooling. At Baldwin, money has been provided to pay back my student loans while I am working. I believe the state of Michigan has a similar program.

What is your workweek like? I work [a] set workweek, [and] there’s a call schedule to be available to patients after hours to answer questions. There are two other physicians at the center in addition to a physician assistant and a nurse practitioner. [Among] all of us, we handle the call schedule. We rotate for a full week [among] the five of us.

What do you like best about working for an FQHC? That’s easy to answer: mainly the patients. They’re basically hardworking people who live in underserved areas. A lot of them don’t even have the resources that would possibly be available to them elsewhere. I feel like I’m making more of a difference to the people living in an underserved area.

Is there anything you don’t like? The commute. … I don’t live in the same area due to family constraints. That, in a way, can be a challenge, but it can also be mind-cleansing. The commute is the biggest thing—just getting there. However, that’s the whole point of the health center. It’s sometimes a difficult area to get to. That’s why there can be difficulty recruiting. Yet that shouldn’t sway anybody because I think the benefits far outweigh the bad.

What advice do you have for physicians interested in FQHCs? Regarding this or any other job, I would say to visit and do your footwork, investigate and make sure that where you are going is where you want to be. When I teamed up with NHSC, Baldwin FHC was not the only FQHC that I was able to visit. There are other places that are HPSA-qualified [Health Professional Shortage Areas]. I visited all of the places and went to the Upper Peninsula of Michigan, which is pretty remote. I decided on Baldwin FHC because of the benefits the practice offers.

Would any specialty be able to work for an FQHC? It’s mostly primary care. When I say primary care, I’m talking about family practice. I believe pediatrics, internal medicine, gynecology and psychiatry are applicable. I don’t think it applies to orthopedics or surgeons.

What surprised you? Being in an area where I thought there wouldn’t be resources, I was surprised at the number of resources that were actually available. For instance, we actually have a dental center in the same building. So if a patient has a dental need, it’s just down the hall. The resources are a little more than if I were in a private practice. In the U.S., the funding for mental health has really been cut back over the years. In our clinic, because of a grant and the work of the CEO and CMO, we have a behavioral health specialist on site. They’ve been working very hard to foster this because there are a lot of mental health issues out there. It’s a nice bonus to have those specialties readily available for patients. We also provide pharmacy, radiology and laboratory services on-site—kind of one-stop shopping for our patients’ health care needs.

Anything else? If a physician is looking to make a difference, this is the type of facility he or she would want to work in. Most of us go into medicine to help others, and this is a great opportunity to do just that.



Integrative medicine evaluates a person’s many facets

By Marcia TravelsteadMarcia Travelstead | Career Move | Winter 2017


Practicelink molly roberts sf 037

Through probing questions and integrative medicine, Molly Roberts, M.D., aims to get to the root of patients’ issues. “If more attention was placed on dealing with the underlying problem, then we’d have fewer people dealing with the serious health issues they have now,” she says. · Photo by Drew Bird Photography, LLC

Name: Molly Roberts, M.D., MS

Work: CEO and president of LightHearted Medicine, San Francisco

Undergraduate: St. John Fisher College, Rochester, N.Y.

Med School: University of Arizona, Tucson

Residency: University of Arizona

Molly Roberts, M.D., known as “Dr. Molly,” is on the board of directors for the Academy of Integrative Health and Medicine and is chairman of the Academy’s Association Leadership Counsel. She is past president of the American Holistic Medical Association and the past chairman of the Board for the Integrative Medicine Consortium. She is a psychotherapist with a master’s in rehabilitation counseling and vocational evaluation with Ph.D. work in rehabilitation psychology. Dr. Molly has published a number of books and has contributed to numerous articles and publications. She has been a volunteer faculty member at the University of Arizona College of Medicine and continues to serve as a mentor. Her business partner and husband Bruce Roberts, M.D., brings his vast experience and expertise to LightHearted Medicine as well.

What do you like best about practicing integrative medicine? I get to spend time with my patients. I think it’s important to get to the root cause of their symptoms. Instead of treating one symptom after another, you can delve into all of the clues of what’s going on physically, emotionally and spiritually. We can look at it together to figure out what is the next step in their life journey.

I tell my patients that “I follow the energy.” So, if they’re talking about their physical symptoms, we head in that direction. If they’re talking about their relationship with their spouse or how much they hate their job, we head in those directions. I was a psychotherapist for 15 years before I became a medical doctor, so we can cover both the physical and emotional aspects of their life and health.

Is there anything you don’t like about your work? What I don’t like is that the current health care system doesn’t do enough to address prevention and proactive health care. It’s really focused on crisis management. For example, it doesn’t work on nutrition until the person has diabetes. If more attention was placed on dealing with the underlying problem, then we’d have fewer people dealing with the serious health issues they have now.

Was there anything that surprised you about practicing integrative medicine? It was when I really started looking at the spiritual aspect of my patients’ health and well-being. I first started probing into spiritual health when I had my own personal injury. That’s when I realized how important it was to ask those big-picture questions: What am I doing here? Where do I want to go? What’s my meaning and purpose in life? To what and whom do I feel connected?

I thought that if I asked those questions of my patients, I would be put on the sidelines with my medical colleagues.

However, my medical colleagues instead said they knew these questions were important, they just didn’t have the time to explore them with their patients. What happened was those doctors started referring to me instead of isolating me. I think it’s important to say that I don’t have a religion I am pushing on anyone. It’s more about asking those big questions in order to discover what patients feel connected to.

What advice would you give a physician who wants to practice integrative medicine? I would suggest reaching out to physicians who are already practicing it. I think that’s really helpful. Integrative medicine has actually been around a long time (it used to be called holistic medicine), and now there are formal fellowship training programs in integrative medicine.

Physicians who practice integrative medicine are doing different things. For example, there may be an integrative medicine specialist who added acupuncture to the list of tools in their toolbox. Another practitioner might have added nutritional or herbal remedies. Someone else might be using bodywork, health coaching, sophisticated biochemical testing and treatment, or some other modality to help their patients.

The other thing is to have an open mind regarding science and research. We know so much more than we did five years ago, but what we know now was a mystery back then. I think it’s helpful to stay humble about how you think health and medicine work, as the research will inevitably shift your understanding as time goes on.

Anything else you’d like to add? Integrative medicine is a mixture of what you bring to the world and what you explore about yourself. If a physician is looking to make a difference in their patients’ health while at the same time honoring the quest for their own best life path, this is the type of medicine he or she would want to work in. Most of us go into medicine to help others on a deeper level, and this is a great opportunity to do just that.



How one physician transitioned to virtual medicine

By Marcia Travelstead | Career Move | Summer 2016


Gavin Helton MD

When it came to practicing virtual medicine, Gavin Helton, M.D., was surprised both by how quickly patients developed new relationships with physicians, and how quickly they embraced technology.

Physician: Gavin Helton, M.D., Medical Director of Ambulatory Medicine, Mercy Virtual Care Center, Chesterfield, Missouri

Undergraduate: St. Louis University

Medical School: University of Alabama School of Medicine, Birmingham

Residency/Internship: Mercy Hospital (formerly St. John’s Mercy Medical Center), Internal Medicine, St. Louis

Gavin Helton, M.D., was born and raised in Mobile, Alabama. Both of his parents were nurses. After serving as the chief medical resident at St. John’s Mercy Medical Center (now Mercy Hospital), Helton remained on the teaching staff there and practiced primary care in the St. Louis area for 17 years. In November 2014, a steering committee within Mercy identified him and presented him the opportunity to be Mercy Virtual’s medical director of ambulatory medicine. Initially he turned down the opportunity, saying that he didn’t know what it entailed, had more than full-time work, enjoyed practicing and wasn’t looking for a career change. Several weeks later, however, a physician from the committee approached him and asked to discuss the potential of virtual care to address the current unmet needs of their patients. Helton thought of his own complex, chronically ill patients and the gaps in care inherent in the current system. He also saw the need to assist primary care physicians with their often-overwhelming task of caring for these patients and decided to make the move into virtual medicine.

How does virtual medicine work, and how do you like practicing it?

Virtual care allows for identification of the obstacles to care, and we address those in a proactive, preventative manner. This approach prevents unnecessary emergency department utilization and hospital admissions while improving quality of life for the patient. We have developed the program to be part of each individual patient’s care team. I am careful not to replace anyone. I work very closely with the primary care physician, subspecialists and care management … to fill the gaps in care. The focus is shifted from hospital care to patient-focused care—delivered where and when the patients require it. We deploy peripheral devices, like blood pressure monitors, pulse oximeters and scales into the home. These connect wirelessly to a computer tablet to keep us updated on a patient’s condition. We’ve also been adding a triage software that allows for interaction between the patient at home and the virtual care team located at Mercy’s Virtual Care Center in Chesterfield, Missouri. Through centralized monitoring and data analytics, virtual care allows timely and effective therapeutic medical intervention. I document within the electronic health record, which allows all care team members to communicate in real time. The virtual care team, PCP, subspecialists and care management are on the same page.

What is the most challenging aspect of your role?

I certainly miss my former patients; however, I have developed strong relationships with virtual patients, their caregivers and other members of the health care team.

Why did you choose virtual medicine?

I made the difficult decision to leave my practice of more than 5,000 active patients in order to develop a program of helping significantly more patients.

Do you have any advice for physicians who might like to pursue virtual medicine?

The opportunities for a telemedicine physician are limitless, including personalized patient care in any specialty without geographic or time barriers. My advice to other physicians is to be comfortable challenging the accepted norm. Be willing to think out of the box and have a health care system willing to invest in the infrastructure required to be successful in this environment. No special training is required and all specialties will benefit, provided they are open to non-traditional solutions. While we visit virtually with our patients, at other times, we can send out patient education and questions they can view or answer at their convenience. Simplified, virtual care is the leveraging of technology to allow for a patient care continuum with a combination of traditional care team members working hand in hand with the virtual care team.

What surprised you about virtual medicine?

I have been surprised by how quickly new relationships have developed and how quickly patients of all ages and backgrounds successfully embrace the technology. They become more engaged in their care, and subsequently patient outcomes and satisfaction improves.

Anything else?

My initial concerns were [about whether I could] develop personal relationships with patients and their caregivers as I had done the previous 17 years. Absolutely! I have found being in the home and more frequent contact allow for an individualized approach to care. I get to know the patients and caregivers in the comfort of their home environment. I was also concerned my clinical skills would deteriorate if I [was] not at the physical bedside. I have found that in focusing on the sickest 5 percent of our chronically ill, I have the opportunity to spend more time focusing on the clinical challenges associated with caring for these complex conditions, and I believe we will develop a new standard of care as we have the ability to medically intervene in a more timely fashion and can follow up on these changes as frequently as the patient’s situation dictates.




Return to Top

Page 1 of 41234