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


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 (, 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, 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.



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


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.



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


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.



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


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.



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.




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