Helping the SWAT team as a physician

Looking to get think outside—way outside—the box? Consider joining forces with the police.

By Marcia Travelstead | Career Move | Fall 2020

 

As a SWAT team physician, “You have to think of everything differently,” says Mark Merlin, D.O. – Photo by Jakub Redziniak

Mark A. Merlin, D.O., EMT-P, FACEP

Education

Undergraduate: University of Pittsburgh

Med school: Philadelphia College Of Osteopathic Medicine

Merlin is the CEO and Founder of MD1, vice chairman of emergency medicine at the Newark Beth Israel Medical Center and founder of the N.J. EMS Fellowship Program. In addition, Merlin is one of the foremost authorities in out-of-hospital physician responsive services.

MD1, Inc. is a nonprofit corporation that brings the emergency room to the patient. It deploys highly trained physicians to the sites of crashes, accidents, strokes, heart attacks, natural disasters, mass casualties and other emergencies. The physicians work as part of a team to make sure the most critical patients are alive when they reach the hospital. Merlin is also the team leader of the Tactical Physicians for the New Jersey State Police TEAMS Unit (SWAT team).

What do you like about being a SWAT team physician?

Every day is different. You never know what to expect. You never know where you’re going and who you’re going with. Everything can be fine one minute and crazy the next. You have to do a lot of planning, know your environment and your team of officers very well. You have to think outside of the box. A doctor treating patients outside of the hospital by definition is thinking outside of the box. It’s a completely uncontrolled environment. You have to worry about who’s behind you, who’s surrounding you, who are the good guys versus who are the bad guys. It’s a set of skills that you don’t learn in medical school or in the emergency department. You have to think of everything differently. The treatment is completely different outside of the hospital versus in.

What’s the most challenging part of the role?

Well, there is a lot of paperwork involved for those few moments of craziness, but I don’t think there’s any aspect of it that I don’t like. It’s interesting and constantly changing. Many of the things at the hospital are very routine. A physician does similar things on a daily basis. Outside of the hospital, there’s so much variety every time you go on a job. You never know what’s going to happen or how you’re going to need to take care of a patient. You need to know how to shoot a weapon, how to put on a vest, when it’s safe to go into a house versus not. It’s a combination of multiple specialties all rolled into one. That’s what the challenge is.

What surprised you about this work?

I didn’t anticipate that I would learn so much on a daily basis. I didn’t anticipate there would be so much information I would need to know about what’s going on outside of the hospital. For example, street drugs, the weapons being used, the types of ammunition, the long hours of training that SWAT teams put into a few minutes of an assignment. I didn’t anticipate the training would go on for days, months, years—and it never stops.

How can other physicians get involved?

If you’re a physician who is already trained in emergency medicine or critical care medicine, then you generally do one year of training called an emergency medicine services training fellowship. Part of that training is learning about SWAT teams and being a SWAT physician.

After you finish the training, you go on several SWAT missions. Once that’s completed, a physician can stay on a SWAT team or go with a law enforcement organization and accompany them with all of your medical equipment on their assignments.

You need to know how to form good relationships with law enforcement. Any interactions you have with local police departments are valuable. Any training you have outside of the hospital such as military, EMT or paramedic will be valuable as well. If police departments learn about the skills and abilities that SWAT physicians have, they become more engaged and want to have these types of doctors at their side every time they go into a mission. They know that the outcome can change by having us about.

 

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Hollywood calling

This physician uses his medical knowledge to advise film and TV productions.

By Marcia Travelstead | Career Move | Summer 2020

 

Watching inaccuracies on TV medical shows propelled Robert Scanlon, D.O., to start a media consulting business. -Photo by Amber Jasso

Name: Robert Scanlon, D.O., Medical Media Consulting, Savannah, Georgia

Education

Undergraduate: University of Scranton, Scranton, Pennsylvania

Med school: New York College of Osteopathic Medicine, Old Westbury, New York

Residency: NYU Winthrop Hospital, Mineola, New York

Scanlon, a critical care physician, formed Medical Media Consulting (medicalmediaconsulting.com) to provide technical advice based on his clinical knowledge for film and TV. He offers services for preproduction writing and editing and helps acclimate actors to medical settings.

How did you get started as a film and TV technical advisor?

I have both a creative and scientific side to me. I’ve always wanted to contribute to the creative process using what I know. Many medical people would say that some of the films or television shows are not done well enough regarding medical scenes and get frustrated watching those productions. So from a viewer’s standpoint, I have always wanted to formally consult but never knew where to start.

What do you like about the craft?

I think it’s a healthy diversion from my ordinary work life. It’s more of a psychological benefit. As a critical care physician, while we save people, I see a lot of the natural process of dying with patients. It’s a nice contrast to contribute to a creative and enduring process…a project that will last for quite some time.

What’s the most challenging part of the job?

I don’t get to do it as often as I’d like. Medical-themed projects are definitely cyclical. I’ll have enough connections by the time the next cycle comes through to do so as often as I’d like.

Was there anything about doing this that surprised you?

I’m not sure how much the producers and writers recognize the audience’s hunger for technical information. We’re in a time that, thanks to the internet, the average viewer is a high information viewer. They can immediately see the flaws just from their limited experience. Viewers want to learn, digest and be intrigued.

What advice would you give to a physician who wanted to be a technical advisor for media?

First, don’t quite your day job! Secondly, start small and expect to work for no compensation in the beginning. As you acquire opportunities, strike the balance between medical accuracy and the story line. We can’t impose all of the medical facts to take away from the artistic side of the story. For example, “House” was a great series but it wasn’t necessarily about a doctor. Rather, it was about a quirky guy who had an interesting personality, had an even more interesting way of interacting with people, and who happened to be a doctor. You may think, as an advisor, that it isn’t realistic that a doctor who walks around, insults everyone and sees few patients maintains a job. However, advising to throw the story out because it isn’t realistic would be the wrong advice. You need to find out from the director what the expectations are from you. Crossing out half of the script is most likely not going to meet expectations. Approach the project with humility, find out how you can best be of service, and don’t disrupt the artistic storyline.

How can a physician get started?

Start slow. Contact a chairperson of a local film school. Also, connect with a local or state film office. Every state has a list of those that provide certain services. You are starting at the bottom, so you have to start small. If you’re working with a film student pro bono, that’s fine as you’re building up a body of work. Another bonus of working with a film school is the opportunity to work with instructors who are directors, actors, etc., and who know who else is doing production work. Familiarizing yourself with these individuals is not only helpful for students, but also gives you connections. That’s an easier segue into this business.

 

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Doctor by day, jazz singer by night

This family medicine physician pursued her dream of practicing both medicine and music.

By Marcia Travelstead | Career Move | Spring 2020

 

Candace Bellamy, M.D., pursues both her passions: practicing medicine and singing professionally. - Photo by John David Weddings.

Candace Bellamy, M.D., pursues both her passions: practicing medicine and singing professionally. – Photo by John David Weddings.

Name: Candace Bellamy, M.D., is a family medicine physician at Brooke Army Medical Center in San Antonio, Texas

Education

Med school: James H. Quillen College of Medicine, East Tennessee State University

Residency: Bristol Family Practice, Johnson City, Tennessee

Bellamy is a physician by day and a jazz and soul singer by night. To better fulfill her passion, she relocated from Tennessee to Austin, Texas, where she has collaborated with many incredible songwriters and musicians: Ruth Carter (composer for Stevie Ray Vaughn, Robert Palmer, and John Mayall), bass-playing legend Jimi Calhoun (player with Dr. John, Jimi Hendrix, John Lennon, Wilson Pickett, Sly Stone) and Jake Langley (Roberta Flack, Willie Nelson, K.D. Lang). Most recently, she’s also been involved in filming a documentary on women in medicine. Learn more at Candace_Bellamy and healermd.

What do you like about being a singer, and how did you get started?

I love being able to create songs, record in the studio, perform live and connect with people. I think that’s part of the reason I ended up in family practice, because I love people. I grew up loving music thanks to my mom, who introduced me to the music she grew up listening to: The Supremes, The Temptations, Smokey Robinson, all of the Motown greats. Growing up, I was told I should sing, but I wanted to be a doctor. Once I got out of medical residency and started practicing, I decided I needed a hobby. Someone was offering voice lessons, and I thought I would give it a try. Once I started voice lessons, I auditioned for the musical “Hello Dolly” and got a part singing in the chorus. I was hooked from there and started my first band and eventually moved to Austin to pursue music.

I love that music connects us to each other and that it creates memories. Even today, I can think of songs that were a meaningful part of my childhood.

How does performing work with your schedule as a physician?

It can be challenging at times, especially now that I’m directing a documentary, “Healer,” that focuses on women doctors. It’s really a balancing act, but I’ve always been a person with a lot of different interests who likes to stay busy, so it works for me.

Was there anything about singing that surprised you?

I think the thing that surprised me the most was that I would write songs, because I moved to Austin to sing and I thought that, in and of itself, would be work. The first time I sat down and co-wrote a song with Jimi Calhoun and Ruth Carter, they had a total of 70 years of songwriting experience. At that point, I didn’t even have one year of experience. It was very humbling but at the same time, they made me feel welcome.

What advice would you give to a physician who wants to be a professional singer?

I would say to go for it. Start taking voice lessons and connect with your community of musicians. Decide what genre you want to sing, and start going to music events and introducing yourself to other musicians. It’s a great way to find musicians to work with and build your music community.

How would you recommend a physician start?

Look online and see who’s offering voice lessons in your area. If you’re in a small area with limited access, you can find voice teachers online and take lessons using Skype. You can also travel to voice teachers who offer lessons. Music has brought me so much joy. From songwriting to recording and performing, it has been an amazing experience.

Music has brought me so much joy. From songwriting to recording and performing, it has been an amazing experience.

 

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Leading a nonprofit while treating patients

This physician formed a 501(c)(3) to see his vision of helping others through music come to life.

By Marcia Travelstead | Career Move | Winter 2020

 

J. Mack Slaughter M.D. combines his passions through the nonprofit he formed, Music Meets Medicine.

Name: J. Mack Slaughter, M.D.

Work: Emergency medicine physician for Team Health, Texas Health Southwest (Fort Worth) and Texas Health Cleburne

Education

Undergraduate: Texas Christian University

Med School: University of Texas Southwestern Medical School

Residency: University of Texas Southwestern Medical School

Slaughter began his career as an actor in a local theater as a child. At 17, he was cast in a band that toured with acts including Jessica Simpson, Bon Jovi and Beyoncé. Now, Slaughter combines his passion for medicine and music through his nonprofit, Music Meets Medicine, which donates instruments and teaching time to teenagers being treated in children’s hospitals. Slaughter also works for TeamHealth, which offers emergency medicine, hospital medicine, critical care, anesthesiology, orthopedic surgery, general surgery, obstetrics, ambulatory care, post-acute care and medical call center solutions to more than 3,000 facilities nationwide.

What’s rewarding about leading a nonprofit?

As a doctor, when you’re working day in and out with life-threatening diseases, you’re doing so much intellectually. What’s great about the nonprofit world versus medicine is that it helps you to reconnect emotionally.

What’s the most challenging aspect?

I love it. However, the one negative I could say is that it does take time away from my family. I have a 3- and a 4-year-old, and I want to spend as much time with them as possible. In addition to the nonprofit, I’m also working a full-time job, so I’m getting pulled in a lot of different directions. However, when my children get older, they’ll be able to get involved with the nonprofit. I won’t have to choose between giving back to the community and spending time with my family. I’ll be able to do both at the same time.

What about your nonprofit work surprised you?

I think that one of the most important lessons that I learned along the way is that you need to learn to trust. When you dream of something and create it, you want to hold your cards close to your chest. You want to control the growth. You need to learn to trust other people with that dream and let them run with it and see where it goes. If it goes somewhere a little different than what you originally envisioned, then it’s probably going to be in a positive way. Trust others and develop a dream team. Originally, I thought it was only going to be me working all of the time. I was surprised by what it could be when I opened up to others.

What advice would you give a physician who wanted to start a nonprofit?

If that’s something you’ve dreamed about and have wanted to do for a while, taking a step forward and gaining that momentum as early as possible leads to really great things.

What’s the best way to get started?

You need to start with a 501(c)(3) application. You’ll feel like you’re drowning in paperwork! The stack of necessary documents sat on my desk while I was an undergraduate at TCU. I kept looking at it and thinking, “Maybe tomorrow.” To really get it going, you have to have patience and determination to get through the paperwork first. Once that’s completed, it’s all about you putting your vision out there and talking to others about it. Then, it starts to gain momentum and moves forward. There was a lot of internet research. Also, at the time, I was an undergraduate, so I had very little in the way of financing. However, some of my friends had parents who were lawyers who helped me get through all of it. My classmates also helped with fundraisers and other activities as well.

 

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Caring directly for the people

A direct primary care physician embraces an entrepreneurial spirit and leaves insurance behind.

By Marcia Travelstead | Career Move | Fall 2019

 

An entrepreneurial drive and desire to take control of her practice led Julie Gunther, M.D., to open a direct primary care business. – Photo by Two Bird Studio

Name: Julie Gunther, M.D., spark MD, Boise, Idaho

Education

Undergraduate: Harvard University

Med school: University of Washington School of Medicine, Seattle

Residency: Ball Memorial Hospital, Muncie, Indiana

Gunther opened her direct primary care practice, spark MD (sparkmd.com), in downtown Boise in 2014. She is a board certified family physician who is passionate about her relationship with her patients. A Boise native, Gunther lives with her husband, two daughters and an extremely obedient three-legged Golden Retriever.

What do you like about being a direct primary care physician?

I didn’t realize how important nor how restorative autonomy is to being the doctor I wanted to be. I had a great moral conflict when my name was on the door of a clinic but I had no influence into a patient’s experience. I absolutely love having my own business.

I opened the spark MD by myself with a loan and a dream. My first patient in 2014 was a previous patient of mine who fell and needed care before I was open. The space I was going to move into wasn’t renovated yet, so in the meantime, I moved into a space without air conditioning. My patients waited in their cars. Later, when I acquired more patients, my former nurse joined me.

Is there anything you don’t you like about being a direct primary care physician?

Direct primary care is a superior health care delivery model in my opinion, both for patients and providers. But just because I’ve changed to this model, it doesn’t mean the accountability with people is very different. There are still patients who struggle to take care of themselves. Still people who don’t regard time or boundaries. Still people who want more from you than you can give. No matter what health care model you work in, you have to face the truth about whether you still want to take care of people. People are exceptionally imperfect. There are a lot of physicians looking for alternative business models, but what they need to ask themselves is, “Do I still want to be in clinical medicine?”

One thing that’s different and may be uncomfortable for some is having the patient pay you. Also, growing a direct primary care business is slow. You have to believe in yourself and have a plan and, to be quite simple, to learn not to take things personally.

What surprised you about direct primary care?

One thing is how much work entrepreneurship is. I’m a workaholic, and I can take a beating. It doesn’t bother me; I just work harder and faster. But direct primary care can be a steep climb.

Another surprise is how the stress is different. This has been a nice surprise. I’m still stressed at work, but it’s not the stress that feels like it’s taking bone marrow from me. For me, owning my own clinic is empowering. It’s freeing. It’s work and stress, but it doesn’t feel like it’s killing me.

Another surprise about DPC is how much it lets patients see behind the scenes and learn what physicians really do. I have the opportunity to represent my profession to patients very differently. Another surprise was the direct primary care community, which is amazing in terms of mentorship. A few physicians who led the charge early on in this movement have set a remarkable standard of cooperative learning. When I found out about direct primary care, that put all of the pieces in place.

What advice would you give someone who wants to practice direct primary care?

Step one for anyone with interest in direct primary care is that you must fundamentally ask yourself if you still want to be a physician. That’s a really scary and hard question because physicians feel tired, trapped, burned out, scared… They don’t realize there is so much out in the world, so much they can do.

My recommendation is to take time off, think about what brings you joy. You can become something else if you no longer want to be a doctor. Entrepreneurship has so many forms.

Step two is to go to dpcfrontier.com, which has a map of all the declared direct primary care practices in the country. Find someone near you, call them, take them out to lunch and make arrangements to go see their clinic. From there, plug yourself into the direct primary care community. Google the phrase “direct primary care.” There are videos, talks and how-to books (one of which I’ve written) that’s all readily available.

Step three is to stop being afraid. I think the biggest risk is staying in medicine while hating it, and having it jeopardize your health, your marriage or your future. If you need to get out, get out and make your situation better.

Anything else?

I believe that one of the rewards that we owe ourselves is to find joy in our work. There are people who are so grateful for what a normal doctor tries to do. Physicians are deserving of joy, and moments of joy are one of the greatest things about being human. I encourage my physician colleagues to be brave and believe in themselves. If they’ve grown away from the vision they had of being a doctor, they can get it back. They can get out there and be a great doctor, and people will pay for that.

 

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Teaching mindfulness in medicine

Through retreats, a podcast, workshops and more, one physician educates others about the importance of wellness.

By Marcia Travelstead | Career Move | Summer 2019

 

Physicians are not alone, says Kathy Stepien, M.D. “There is nothing in their situation that hasn’t been experienced by others,” she says. – Photo by Kaley McGoey

Name: Kathy Stepien, M.D., FAAP, MA, PT

Title: Director and CEO, Institute for Physician Wellness

Education

Undergraduate: University of Wisconsin, Lacrosse

Med school: University of Washington School of Medicine, Seattle

Residency: Marshfield Clinic at St. Joseph’s Hospital, Marshfield, Wisconsin

Stepien is a board-certified pediatrician who has a master’s degree in philosophy with a special interest in ethics. Prior to becoming a physician, she worked as a physical therapist for 13 years. She founded the Institute for Physician Wellness in 2016, a mission-driven organization with a goal to support self-care and the professional development of physicians and physicians in training. The organization provides continuing medical education workshops, conferences, retreats and consultations in North America and beyond.

What do you like about being a physician educator?

A big part of what I do as an educator is to bring people together and help them realize the majority of physicians are struggling with physician wellness. I enjoy helping physicians learn that they are not alone in needing to create a map for themselves that will help support wellness throughout their careers.

What surprised you about the work?

I did not anticipate how extraordinarily lonely and isolated many physicians feel. It is breathtaking at times to know so many physicians are struggling, and struggling to such a depth, to be able to simply do what they trained and love to do. We know that greater than 50 percent of physicians in America report symptoms of burnout: depersonalization, emotional exhaustion and decreased feelings of accomplishment. We know that numbers that high cannot be contributed to a personal trait of physicians; burnout is caused by a broken medical system. The model by which we delivery care to our patients needs revamping.

What advice would you give someone who wants to educate physicians?

First, I’d ask what it is you love. I teach on physician wellness because it is something I love doing and find incredibly important. I dislike the thought that people have given so much of themselves to medicine, so many years of education, training and work only to find they are miserable. If someone was interested in physician education, they should think about what it is that they enjoy. It may be pathophysiology, biochemistry, public health, or how to use a computer effectively to support our work. Topics are endless. I would talk with other physicians who are teachers and ask them what their paths looked like.

If they are already a practicing physician and are interested in teaching other physicians, whether it’s about physician wellness or whatever specialty they have, it takes reflection. They need to understand what their skills are, what skills they would like to develop, and how much time they have to commit to this versus their clinical practice and other responsibilities.

Anything else?

Physician wellness is not optional. It’s not an add-on for when time allows. It is essential to being an excellent physician. Want to be a great doctor? It must include self-care. I’d also like to add that every physician should recognize that they are not alone in medicine. While they may feel lonely or struggling with a variety of issues, there are physicians around them that they can reach out to. There is nothing in their situation that hasn’t been experienced by others. Personal and professional development occurs throughout our careers.

 

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Physician coach

Choose a specialty and study marketing to become a coach to other physicians.

By Marcia Travelstead | Career Move | Spring 2019

 

As a coach, Dike Drummond, M.D., helps physicians all over the world from the comfort of his home office. – Photo by Matt Rommel

Name: Dike Drummond, M.D.

Work: CEO and founder of The Happy MD

Education:

Undergraduate: Indiana University, Bloomington, Indiana

Med school: Mayo Medical School, Rochester, Minnesota

Residency: Shasta Cascade Family Practice Residency, Redding, California

Drummond is a physician coach, trainer, consultant and health care speaker who specializes in burnout prevention. He created The Happy MD and has trained a team of six certified physician burnout coaches, all of whom are also physicians. Drummond and his team provide coaching services. He is also the author of Stop Physician Burnout. Drummond has worked for 140 different organizations and has trained around 30,000 physicians.

What do you like about being a physician coach?

I like working with physicians from all over the world on important life changes from the comfort of my home office. My presence on the internet is quite extensive. When I come into my office every morning, my inbox is like Forest Gump’s box of chocolates: I never know exactly what’s going to be in there. But I know it’s always going to be physicians or physician leaders talking about burnout and burnout prevention.

Happy, healthy doctors take better care of their patients. We know that is true. So for me, I’m always working with somebody who wants to change something about their life. It’s always an important transition, because burnout marks their transition. They can’t go any farther in the current direction of their career. They have to make a change, and burnout is the motivation.

I help physicians get clear on what they really want and help them make that transition. The doctor, their family, their teams and their patients all benefit.

What’s the most challenging part of your job?

It’s really not applicable to me; I was chosen to do this work. I burned out of my family practice after 10 busy years. After I burned out, there was about three or four years I wasn’t sure what came next. I was a walk-in clinic doctor working part time and had completed coach certification training.

Then my ex-wife and I created a training company that taught leadership training for people in the Navy’s LEAN Six Sigma Black Belt Certification program. It became clear to me that what I needed to do was to help burned out doctors.

The only thing I don’t like 100 percent is the size of the need and how busy we have become.

Was there anything about doing this that surprised you?

One is how much of the action doctors take in their day-to-day practice is unconscious reflex activity. They learn a way of doing things in residency and they become creatures of habit in their practice.

A lot of what I do is to help physicians wake up by showing them that simple changes can make a big difference in how they feel and how they enjoy their practice. They’ve been out there asleep for a while and are finally waking up. It’s pain that’s waking them up to the fact that they might not want to keep doing what they’ve always done. I help them get clear on their new goals and take new actions to get there.

The second thing that surprised me is the error in the English language when it comes to the word burnout. We call burnout a problem, and that isn’t true. By definition, a problem has a solution. Burnout is a dilemma, a never-ending balancing act. You address a dilemma with a strategy.

What advice would you have for physicians who might want to coach other physicians?

Remember, coaching is a business. Anyone can coach. The hard part is the marketing and sales that go into acquiring clients.

Coaching is a skillset, and it’s very different from what doctors are used to. For example, doctors are used to being right. They’re used to being the boss and telling people what to do. That’s not what a coach is. Some physicians may not like being a coach because of this difference in philosophy.

If they’re a doctor considering becoming a coach, I recommend they attend an exploratory coaching class. The difference between having coaching as a new skillset and being able to make a living at it as an independent coach is the ability to acquire clients and have them pay you.

If you plan to coach other physicians, make sure you attend an executive marketing program, choose your niche and learn to market now.

You decide what it is that you want to coach physicians about. My theme is burnout. There are all sorts of other challenges a physician coach could choose to address, such as physician entrepreneur, physician mom, etc. Decide, then notice where those you choose to coach congregate online and what the conversations are.

 

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Answering the call of rural medicine

Returning home gave this physician the chance to care for the people who matter most to her.

By Marcia Travelstead | Career Move | Winter 2019

 

Family brought Lori MacPherson, M.D., back to practice in a rural area. There are other benefits: "I don't have to be in a big city and fight traffic with the added stressors." -Photo by Zayne Williams

Family brought Lori MacPherson, M.D., back to practice in a rural area. There are other benefits: “I don’t have to be in a big city and fight traffic with the added stressors.” -Photo by Zayne Williams

Name: Lori MacPherson, M.D.

Employer: Affiliated with Cox North Hospital, Mountain Grove, Missouri

Education

Undergraduate: Missouri State University, Springfield

Medical: University of Missouri-Columbia School of Medicine, Columbia

Residency: Cox Family Practice Residency, Springfield

Professional accomplishments for MacPherson include board certification in family medicine, being in the top 10 percent of her medical school class and being featured on “Mystery Diagnosis” on the Oprah Winfrey Network. She enjoys kayaking, canoeing, hiking, camping and scuba diving. MacPherson practices in Mountain Grove, Missouri, which has a population of about 4,500.

What do you like about being a physician in a rural area?

I don’t have to be in a big city and fight traffic with the added stressors. It’s only an hour away to drive to a good size mall in Springfield, Missouri.

We have fresh air. It’s easy to get someone to help you do things. We keep an eye out for each other, so when we see something unusual, we act.

I do administrative work for a hospital that’s an hour away. Physicians there ask me why I stay here. The bottom line is, as doctors, we’re all working hard to maintain our livelihoods no matter where we live.

What are the challenges?

As a doctor and a family doctor in general, I’m a caregiver. Being in a small town, I tend to know a lot about my patients and their families. It can be very difficult at times. When I do something as simple as go to Walmart, it’s hard to get out of there because I get stopped and asked questions.

For example, one time a lady grabbed her husband to talk to me about his symptoms because he wouldn’t make an appointment. I have two sons, one who’s outspoken. When he was little, he’d say to people, “Can you please quit asking questions because we really want to get out of here?”

I also am no longer on Facebook because people want me to diagnose over the internet and not make an appointment.

Was there anything about working in a small community that surprised you?

Honestly, no. When I was in medical school, I was required to do a rural medicine rotation, so I came back here. I worked with a physician who is my mentor, David Barbe, M.D. Same thing in residency. I had the experience early on and I did all of my rotations with him. He was inaugurated as president of the AMA.

I would ride with him to deliver babies 30 minutes away, and he would give me life advice about what it was like to really be a rural physician.

It’s not 8 to 5 even if you don’t deliver babies. He really prepared me well for this career, so there were very few surprises.

What’s your advice for physicians who are considering a rural practice?

Try it out and take it for a test drive. Take the time to do some rotations in the area that you want to consider going.

I came back here because I married my high school sweetheart and he wanted to come back.

If you’re in a relationship with someone, it’s important for your spouse or significant other to be 100 percent on board with living in rural area.

If they’re not happy, the physician won’t be happy.

It’s been an honor to take care of my patients and family members. I continue to learn so much from my patients each and every day.

I’m fortunate that I was able to return home and take care of people who matter to me.

 

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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

Education:

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.

 

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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

Education

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.

 

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