How one physician transitioned to virtual medicine

By Marcia Travelstead | Career Move | Summer 2016

 

Gavin Helton MD

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

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

Undergraduate: St. Louis University

Medical School: University of Alabama School of Medicine, Birmingham

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

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

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

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

What is the most challenging aspect of your role?

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

Why did you choose virtual medicine?

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

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

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

What surprised you about virtual medicine?

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

Anything else?

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

 

0 Comments

Career Move: Public health physician

Career Move | Spring 2016

 

Name: Renaisa S. Anthony, M.D., MPH

Work: Assistant professor, Department of Health Promotion and Social and Behavioral Health at University of Nebraska Medical Center College of Public Health

Education:

Undergraduate: University of Minnesota

Med School: University of Chicago

Master of Public Health: Harvard School of Public Health

Growing up, Renaisa Anthony, M.D., MPH wanted to become a veterinarian. But when her undergrad funding ran out, she took a research job and returned frequently to her hometown of Detroit. “That’s when I started to see what I now call health disparities,” she says. “We really did not have doctors that understood the community and limitations of poverty.”

Renaisa Anthony MD

Renaisa Anthony, M.D., MPH, first had her sights on becoming a veterinarian—but transitioned to a career in public health after becoming aware of the health disparities in her hometown, Detroit

She decided then to become a physician to help improve communities. “As I progressed through medical school, it became very clear that taking care of people without insurance and under sourced communities was going to be a challenge,” she says. “I had a really great mentor who said he thought I would be interested in public health.”

Today, Anthony is a dedicated public health physician with numerous awards and accomplishments, including a TEDx Talk, National Medical Association’s Top Doctor Under 40 Award (2011), and the U.S. Surgeon General Award for Outstanding Service on the Prevention of Preterm Birth Conference (2008).

What do you like best about working in public health?

It’s all about health promotion and disease prevention. In addition, it’s about transforming the health of communities in large groups versus one patient at a time.

What’s the most challenging aspect of your role?

Monetary resources on prevention are very limited, and we invest a lot of funding into the treatment of disease. One of the things I’ve accomplished and am most proud of is working with legislators on Capitol Hill regarding the Affordable Care Act. I had the opportunity to testify before Congress on behalf of my patients. To be honest, I boycotted medicine and said I will not proudly wear my white coat until I can proudly take care of people based on their health status and not their insurance status.

What opportunities are available to public health physicians?

I think the sky is really the limit. First of all, I think it’s important to recognize the differences between public health and medicine.

Public health is population-based and community-oriented, whereas primary care is individualized…one patient at a time.

Also, financially, there’s a difference. A doctor who works full time in medicine probably earns more than a public health physician. I don’t make $300,000 a year. I make half of that, but I’m much happier with what I do. I feel my impact is greater.

The biggest question is…is this right for me? How would I fit in with public health? How committed am I to populations versus individuals?

Why did you choose public health?

It fit very well with the intentions I had. I could visualize the communities because I was disadvantaged. I thought of my family, friends and my own health care. My primary health care as a child was getting immunized in the emergency room. I learned later on that by becoming a doctor as well as a public health practitioner, I could take care of people and really have focus on improving population health.

Is there anything that surprised you about your career move?

It’s been a learning curve to understand the currency in academia, which is publications, grants and research combined with education and service. I would say I am very strong in education and service because that’s what I was doing anyway. However, translational, community-based and participatory research that’s really informed by the needs of the community has been a learning curve I didn’t have prior to this. I had a passion and I knew what some of the issues were, but it took me asking the right questions, partnering with the appropriate people and having the right mentors to learn that. I’m still learning how to do that effectively.

People in public health are really passionate about what they do. They are willing to continue doing it even in a fiscal environment where public health departments are constantly having their budgets cut. Public health physicians have to pool resources to be successful, and I didn’t necessarily know that. I work with so many people in public health whether they are in my specialty or not.

What’s your advice for physicians considering public health?

Explore the mission statements of public health schools and find one that resonates. Identify a population they are interested in. For me, it was women and children. There needs to be a population they are passionate about who they can read about, work for, advocate for and direct their attention to. I think it’s also helpful to find mentors—people who do similar work who you can shadow or do informational interviews with. It’s a myriad of experiences that developed into exploring this field.

Anything else?

Be in tune with what your purpose and passion is, and don’t be apologetic for it. Once you do that, follow your heart, be open to the opportunities that come your way, and be willing to take risks. I walked away from a career that, by the time I was 40, I could have been a millionaire. That was hard to do especially coming from an impoverished background. I knew that if I followed my heart and was good at what I did, the money would come. So, I didn’t focus on money. I focused on impact.

 

0 Comments

Career Move: Entrepreneur

Personal experience led this physician to become an entrepreneur.

By Marcia Travelstead | Career Move | Winter 2016

 

Name: Elizabeth Chabner Thompson, M.D., MPH

Elizabeth Thompson

Radiation oncologist Elizabeth Chabner Thompson, M.D., MPH, is also founder and CEO of BFFL Co. (Best Friends For Life).

WORK

Radiation oncologist: 21st Century Oncology, Westchester County, New YorkFounder and CEO: Best Friends For Life (BFFL Co.)

EDUCATION

Undergraduate: Yale University

Medical School: Johns Hopkins University

Master’s: Harvard University

Internship: University of California, San Diego Medical Center

Residency: Joint Center for Radiation Therapy, Boston (Harvard Combined Program)

Chabner Thompson has devoted her life to taking care of women. She focused her career on breast cancer when her mother developed the disease. In 2006, after numerous biopsies and consultations, Chabner Thompson underwent prophylactic mastectomies herself. With her firsthand experience in the recovery process, she decided to design a line of fashionable bags, bras and surgical accessories and began a company, Best Friends For Life, or BFFL.

What do you like best about being an entrepreneur?

It’s when I hear from patients and physicians that they appreciate the ideas that I have brought to life. …The thing that makes me the happiest is when I actually hear from the surgeons, hospitals or from patients that they think the products have made a difference. What I really want is for patients to recover faster with more comfort and dignity. The perception has been that maybe patients don’t need products like mine. However, I think people are realizing now that these little things make a huge difference when it comes to patients recovering faster and getting back to their everyday lives and families.

What’s the most challenging part?

Have you ever had people say no to you 20 times a day? …Those “no’s” are just the most frustrating thing to me. That’s the hardest thing about being an entrepreneur and knowing you have a good thing but not being able to execute. I just have to plug away and keep on trying. I keep asking for one more chance and see what happens.

What advice would you share?

I think you have to be prudent and guard your ideas in some way because there are some people who won’t have noble intentions when you first start out. As physicians, when we ask our colleagues for help and advice on how to treat a patient, our colleagues will answer honestly and try to help us in the best capacity. That’s an adherent principle in medicine. It’s not always an adherent principle in business. So when you are starting out and asking for help, you can’t assume that everyone will have the same intentions you have. Be careful where you go for advice.

What surprised you?

It may not be the fiscally responsible thing, but as physicians, if we follow our good instincts, we would want to give things away. We want patients to get better without any kind of financial hardship. I can’t do that as a business person. …I couldn’t make silly decisions from a business standpoint just because I wanted to be kind. I had to make smart decisions so my kindness can be spread all across the country rather than one place. I had to learn that the primary lesson in being an entrepreneur is that I had to make good business decisions.

Anything else?

I’m not making a pun here, but patients and patience really are the most important things. As an entrepreneur, you have to have patience because things don’t happen very fast. People are busy and don’t necessarily want to take the time to learn about something new. …Just be patient and remember that if it’s really good, it will come together.

 

0 Comments

Got a good idea? Consider bringing it to market as a physician inventor

By Marcia Travelstead | Career Move | Fall 2015

 

Joseph Schultz, MDName: Joseph Schultz, M.D.

Work: Pediatric Emergency Physician, Children’s Healthcare of Atlanta at Scottish Rite; Owner of Splash Medical Devices, LLC

Undergraduate: Duke University

Med School: Emory University School of Medicine

Residency/Internship: NYU, Bellevue Pediatric Training Program

Schultz is a dedicated physician inventor. Twenty years ago, he invented a meconium suction catheter. SplashCap came 10 years later. Other devices he developed include the Schnozzle (pediatric nasal irrigation adapter), EyeCap (eye irrigation bottle shield), AbscessCap (wound irrigator) and EasiEar (disposable metal curette). Learn more at splashcap.com.

How do you handle being both a physician and an inventor?

I work a lot! The inventions/marketing is my day job, and the ER shifts are my night job. Most people think of their night job as being their secondary job, but having the flexibility with the ER makes it work.

Why did you invent all of these products?

It was the frustration with trying to get things done more efficiently at the hospital. I figured out there was a way to do things better.

I spent years developing my first product, a meconium suction catheter, and getting it licensed. I learned about the product development process along the way: engineering, molds, designing, etc. You find that there are always more steps to take along the way. By the time I developed the SplashCap, I already had the knowledge and contacts to make it easier.

What do you like best about being an inventor?

I have the opportunity to link my knowledge and experience in both of my professional worlds to solve meaningful problems.

What are the challenges?

It takes a lot of time, and having two jobs takes away from other things. However, I really like what I do. Some people I’ve talked to have said they have never found a job they liked. I’m fortunate because I’ve found two jobs I like.

Dr. Schultz shows off one of his inventions

What advice do you have for physicians who want to become inventors?

Get feedback from people about your ideas. Be willing to listen to their input and criticism to put you in the right direction. There is no training program out there for inventors, but there are different inventor associations that will give general help.

However, if your idea is a medical device, the development process is more complex. Once you have your idea, whatever it is, you need to determine if you want to license or to start a business. You need to determine the complexity of the type of technology you are working with. Can you do it on your own? Do you have the time to develop the team you need, or should you go the licensing route?

Is there anything that surprised you or you hadn’t anticipated?

How complex it gets and how many different skills are needed. That can be problematic and challenging. There’s always a lot more to learn.

How would a physician go about becoming an inventor?

It’s different from other things that physicians do because you’re focused not on your own physician skills but on your idea, technology or product.

You’ve developed that idea or product, tested it, prototyped it and now are soliciting feedback. Real feedback, not just the feedback you want to hear. You talk with people who have been down the same road.

There is a very large medical device manufacturing industry and there are medical companies that can manufacture most things that you can dream of. Get some free medical trade journals and look for medical device manufacturer conventions. Walk around and talk with people. That would be a good first step for physicians interested in creating a technology. This gives the physician who has never done this the “nuts and bolts” of the medical device industry. You start to learn the time it takes to do the foundation legwork, material specifications, design work, etc., for creating a medical device.

It sounds like it takes a great deal of patience.

It’s more like perseverance than patience. Patient people wait for things to happen. You have to continually push to make it happen.

Anything else you’d like to add?

Success is not going to happen overnight. If you think it will take a few months, that’s not likely. For me, I enjoy inventing. So I would say, find something you enjoy doing, whether it’s this or something else. There are physicians and a lot of people in general who are frustrated with their jobs. There are many opportunities, so you have to find out what works for you. Coming up with inventions is not necessarily going to be a quick ticket to success. It’s risky and time-consuming, but if you enjoy it, do it. Otherwise, find something else you enjoy doing.

 

0 Comments

Got the travel bug? Try working abroad

By Marcia Travelstead | Career Move | Summer 2015

 

Steve Caldwell

To help their family of eight get around during their year in New Zealand, the Caldwells bought a van (which they nicknamed “Big Red”) at the start of their trip.

NAME: Steve Caldwell, M.D.

WORK: Emergency medicine physician, McKay-Dee Hospital, Ogden, Utah

EDUCATION:

Undergrad: The University of Utah, Salt Lake City

Med School: Virginia Commonwealth University, Richmond

Residency: Indiana University School of Medicine

Caldwell wanted to practice abroad, so he spent last year practicing in New Zealand. “My goal was to work with a different system and travel a little more with my family,” he says. “I always intended to come back to my job. We had a great experience abroad and plan to do it again when my children are farther along with their schooling. New Zealand is a beautiful country, we had a marvelous experience as a family, and I had a great practice setting.”

Why did you decide to practice abroad?

I’ve been out of residency for about 10 years now. I’m originally from Utah and had been practicing here for about seven or eight years when I started thinking about practicing overseas. I looked into both Australia and New Zealand simply because the demand for physicians is highest in those countries and licensing and getting housing is easier.

I speak Spanish, so I considered a Spanish-speaking country, but I have a big family and was only going to be there for a year, so my wife and I decided to stick with English-speaking countries so our children could make the most of their school year.

Even though we were only going to be gone a year, we sold the home we were living in so we wouldn’t have to worry about managing the rent while overseas. We have six children, so it was a bit of a process. But once we handled all of the details, it was really a special experience and worth every bit of energy and time it took. It’s a beautiful country and the people are awesome. We actually did make it to Australia because I had a conference to attend.

What did you like best about working abroad?

Personally, I like having the shared experience with my family where each of us was out of our comfort zone. Since we all were experiencing something new, we had to rely on each other more. We grew closer together as a family versus anything we had ever previously done.

Professionally, I think working in a different system forced me to step back and evaluate the way I’ve done things for many years, such as my practice patterns and habits I didn’t even think about. Working with senior and junior doctors all over the world brought all of this to my attention. I became much more focused on reading literature and being up to date. It felt like a training program, which reinvigorated me and made me excited about practicing medicine again. It reminded me of why I went into medicine in the first place. I think it both enriched and prolonged my career. When I came back home, I realized that some of things that bothered me were minor annoyances.

What were the most challenging aspects?

Steve Caldwell

The family takes a photo break at the Skyline Gondola and Luge in Queenstown, New Zealand.

There were certainly some frustrations. New Zealand is a socialized system and very cost conscious. It’s much more clinically oriented, and they rely less on diagnostic testing. That’s good, but there were times when I wanted to order a certain test and felt like it was indicated. For example, sometimes I would have to convince a radiologist that a CT scan was indicated. That person hadn’t even seen the patient, and I was given a hard time.

At times, I felt I had to grovel to get things done that I would never have to do in the States. It took me time to get used to the system being less efficient. Their medical records and documentation systems are fairly old. However, at the same time, I didn’t have the pressure to see a lot of patients and be as efficient as I am here. After a while, I realized that it wasn’t about capturing all of the charges and billings, but it was about the patient. Outcomes there are generally very good—in fact, as good as ours in most cases.

What advice would you give a physician who is considering practicing abroad?

Beach kids-Steve Caldwell

Taking a dip at Hot Water Beach on the Coromandel Peninsula.

I’ve talked to a lot of physicians who have asked about it and think it sounds awesome and wish they could do it. A person can think of hundreds of excuses. For me, it was an amazing experience and if my job were flexible enough, I would love to do it every two or three years.

The advice I would give is that it’s worth it. It does take effort and sacrifice. Financially, it’s not beneficial if a person is looking at dollars and cents. However, I can’t put a price on the experiences and the growth I’ve had. It was worth every penny and every ounce of effort. I have a number of colleagues who are now working abroad and plan to stay indefinitely.

How can other physicians find work abroad?

I searched online for physician practice opportunities, and there were several staffing companies that can help with the job search. I looked into many and felt really good about Vista, whom I used.

What came as a surprise to you?

I didn’t anticipate how helpful the hospital would be. Vista was great at helping us get our papers arranged and all. However, the hospital, Palmerston North Hospital in Palmerston North, New Zealand, had a recruiter who was fantastic. She went above and beyond in helping us find housing and get everything settled, which was surprising to me. I thought we would be on our own with housing and transportation. The hospital did everything they could to make the transition seamless. They made us feel valued and appreciated.

 

0 Comments

Embracing the patient-centered medical home model

By Marcia Travelstead | Career Move | Spring 2015

 

Brian Bachelder, M.D.

NAME: Brian Bachelder, M.D.

TITLE: Associate Program Director, Akron General Medical Center, Ohio

EDUCATION:

Undergrad: Dartmouth

Medical School: University of Minnesota, Minneapolis

Residency: University of Cincinnati

Internship: St. John’s Hospital, St. Paul, Minnesota

Bachelder practiced rural medicine for 25 years and was a pioneer in using electronic medical records. An Ohio native, he has been on numerous medical boards in several capacities. He has served as the Mount Gilead High School team physician since 1985 and received the Ohio Outstanding Team Physician Award in 2008.

A patient-centered medical home provides comprehensive, coordinated care centered according to patients’ preferred methods of accessing providers, among other factors. A hallmark of a patient-centered medical home is clear patient-provider communication with a central focus on health IT.

What do you like about the patient-centered medical home model?

I like everything about it. For the most part, it brings together all the facets that make family medicine so unique. Having been involved in electronic medical records very early on, I like to research the data to look at the patient population I take care of. Then I make sure the individuals have all of their necessary preventative medicine and measures. I like electronic prescribing and the data tracking you can do for this to make sure patients have the tests and referrals done that I encourage them to do. I really like the information technology aspect, but the other aspects are equally important as well.

What’s the most challenging aspect?

It’s so easy to start looking at the computer screen and making data entries that you can lose track of the patient. Again, part of what makes family medicine so special is the patient relationships you develop. So having the computer between you and the patient can be a huge distracter for both you and the patient.

What’s unique about the model?

Most physicians think they are doing a great job when it comes to different parts of medicine. For example, every diabetic should have a Pneumococcal vaccine. I thought I was doing a very good job, but when I started entering all of the data into the computer, I found out that 20 percent of my patients had the vaccine. So I made some changes in the practice, some interventions to improve the rate, and after six months, I was up to 98 percent and could name the two patients in my practice who did not have the Pneumococcal vaccine. This practice model allows you to do a much better job of tracking and ensuring patients are getting the treatment they need.

There are so many different recommendations these days for patients to make sure they are getting the preventive care they need, such as colon rectal cancer screenings or women getting pap smears. The computer is great for doing those boring, redundant tasks that may take long-term memory.

Was there anything about this practice model that surprised you?

Probably the toll on the staff. Whenever you go through a change in the office, it takes a lot of energy and effort. It’s not only for the physician’s part but for the staff’s part as well. It’s a lot of work and it can deplete the energy in the office if you let it. You need to make sure your staff is on board with this, they have the necessary tools, and that the expectations are realistic. It can’t be done overnight. It’s not a light switch you turn on and off. It needs to be done over a couple of years.

Starting a patient-centered medical home practice also is expensive. The electronic medical record we have been talking about is a very expensive proposition in terms of hardware, software and the amount of time updating those medical records on a daily basis. So you need to make sure if you are going through this process that there are payment mechanisms to justify doing this. In the Akron, Ohio, area, the third-party payers are reluctant to pay anything extra for the patient-centered medical home. They want the benefits but aren’t willing to pay for them. I think they are slowly becoming more willing to pay, but they want to see a return on their investment.

Could a new physician choose this practice model?

I think there are aspects of this that would have a rapid return on their investment. Medicare is starting to pay for parts of a patient-centered medical home. An example is transitional care. These days, many physicians are not involved in hospital care, so there is a gap from when the patient leaves the hospital to when they are seen in the office. There is no one responsible for the gap. Residents take care of patients in the hospital and see them in the office, so they see the full circle of care that’s needed.

Having the experience of working with inpatients and seeing the gap in care before the patient gets to the physician’s office, they can see how the patient can get in trouble. They want to make sure they follow up on a daily basis making sure patients are taking their medications properly, have scheduled follow-up appointments and have adapted to their environments.

What advice would you give someone who wanted to open a patient-centered medical home?

It depends on the situation. When my residents graduate, I always want to know what their situation is going to be. If they are an in an employed position, such as a hospital or health care system, they need to know if the system has patient-centered medical home principles or is transitioning over and the level of care provided.

If they are going into private practice, they need to know if their partners have the same interest. If they go into a solo practice, they won’t be able to employ all of the principles right away but will develop the business practices down the road.

Anything else you’d like to add?

This is a culture…it’s an environment you create in your office on how you take care of the patient. An important part is the communication aspect, and one form of that is email. The problem with emails is that you have to watch the information shared in them. The system is not always totally secure and can be read by someone else. Younger physicians use emails and texts so frequently that they need to be aware of the hazards involved. I caution my residents to be sure they know the potential risks of these forms of communication.

 

0 Comments

Open a surgery center

Looking for a way to exercise your entrepreneurial spirit and administration skills? Starting your own place might be the answer.

By Marcia Travelstead | Career Move | Fall 2014

 

Gregory Horner

Gregory Horner, M.D., found a way to improve his work environment and offer greater transparency to patients: Open a surgery center.

NAME: Gregory Horner, M.D., Orthopaedic Surgeon

WORK: Tri-Valley Orthopedic Specialists, Inc.; Hacienda Surgery Center in Pleasanton, Calif.

MEDICAL SCHOOL: Johns Hopkins Medical School

RESIDENCY: UCLA Medical Center Department of Orthopedics, Los Angeles

FELLOWSHIP: Tufts University School of Medicine, Boston; New England Bone and Joint Institute

Horner earned a Big Ten football scholarship and majored in biomedical engineering before heading to Johns Hopkins University School of Medicine. Residency in Los Angeles and Upper Extremity fellowships at the New England Bone and Joint Institute and Tufts followed.

He serves on the board for the California Ambulatory Surgery Association (CASA). He was later elected to serve on the national board for the Ambulatory Surgery Center Association (ASCA).

Horner acquired Pleasanton Surgery Center in 2006, which he syndicated to a group of surgeons. Under Horner’s management, it became one of the most profitable ASCs in California. The group recently sold Pleasanton Surgery Center.

Horner has subsequently cofounded multiple other centers, including Tracy and Hacienda Surgery Centers in California and others throughout the Midwest. He is now undertaking multiple ASC projects as managing partner of HealthPoint ASC Management, LLC.

How did you get involved with opening a surgery center?

There were two problems with working at the hospital. First, they simply didn’t cater to my needs. They responded to what the hospital wanted rather than the surgeons.

Secondly, the hospital, due to its inefficiency, was very expensive. My patients were facing larger financial responsibilities, so it was becoming problematic for them.

I heard that Pleasanton Surgery Center was available, so I bought it and syndicated it to a group of 15 surgeons. It has become a haven for them. The nurses and techs were handpicked and were focused on us. It became not only an incredible place to work but also incredibly efficient.

We raised the morale of surgeons and it was less than half the price of the hospital for many surgical cases our patients needed. As a result, we were able to lighten the financial responsibility on our patients. That augmented our practice.

Was that your first experience with opening a surgery center?

Yes. I bought it and basically it was “baptism by fire.” At the time I purchased it, I was also taking a bunch of business classes simultaneously while trying to run the place. I wouldn’t say learning the business was easy, but I had the skeleton to put the knowledge in from already being a surgeon.

I learned a lot about finance, particularly cash flow, cash management, revenue cycle management and purchasing cycle management. Basically, those categories were the most important for me to learn.

It was a tough five months, but after buying it, we were profitable within three months and were making substantial distributions soon thereafter.

What did you like best about opening a surgery center?

There were two things, and I can’t decide which one I liked the most. First, I got a really great feeling from the other surgeons whose lives and careers were greatly improved. Second was opening the door to reducing costs for my patients.

I still get letters all the time about how great the care is and how great my surgical facilities are. They appreciate the centers’ affordability and don’t understand why a hospital can’t match this type of quality. It makes me feel good because we have to make this system better and make health care better. It’s through affordability and transparency that we can achieve this goal. We make our costs extremely transparent so our patients know exactly what to expect.

What was the most challenging part of the process?

I wish I would have taken the time to learn a little more about finance before buying it. I really encourage entrepreneurism to any doctors coming into this new world of medicine. To that end, it is critically important that doctors learn about finance. It’s a very important topic for any practice. There are so many things to understand.

Was there anything that surprised you about opening a surgery center?

What surprised me were the lack of transparency and the high cost of health care. A patient can pay three times as much money going to a hospital. There is no way they could know there is an alternative.

I was shocked when I realized how affordable we can make health care. We still became one of the most profitable surgery centers in the state. It is only through transparency that we can foster consumerism and get patients to shop for high-quality, affordable health care.

How would a physician go about opening a surgery center?

Many turn to management companies to do it for them. That’s not necessary; they can bring in a consultant like me, for example. I’ve been working with doctors helping them get through the stages of developing and opening a surgery center. It’s a matter of taking the time to see how the business works. It’s not reinventing the wheel these days.

There are plenty of models and information available to guide physicians through the process of opening a surgery center. Especially for surgeons, it’s a really integral part of your actual practice. Without that extra income, it’s getting increasingly difficult to have a comfortable lifestyle as a surgeon.

Any other advice?

I think the other thing that might be helpful as an alternative is to go out on your own and joint venture with a local hospital. Keep in mind both quality and affordability when you approach the hospital. Although affordability is a scary word, a surgery center can still be profitable and affordable at the same time. A surgery center will help your practice and your patients, which will ultimately better your community.

By Marcia Travelstead

 

0 Comments

Adding research to your responsibilities

Using medicine to answer questions is the goal of physicians who have added research to their professional lives.

By Marcia Travelstead | Career Move | Summer 2014

 

Jerry Brewer, M.D.

“It’s satisfying to answer questions that actually make an impact,” says Jerry Brewer, M.D., who researches skin cancer. “I think that’s what it boils down to…trying to make people’s lives better.”

NAME:  Jerry Brewer, M.D.

WORK:  Mayo Clinic, Rochester, Minnesota

MEDICAL SCHOOL:  Wayne State University School of Medicine, Detroit

RESIDENCY:  Mayo School of Graduate Medicine, Mayo Clinic College of Medicine of California

FELLOWSHIP:  Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine

Jerry Brewer, M.D., is a dermatologic surgeon who studies skin cancer in the setting of lymphoma, with a special focus on studying melanoma in those with suppressed immune systems. One of his current projects is investigating the rise in melanoma development and its possible associations with tanning bed use.

What do you like best about being a research physician?

There are so many questions that need to be answered. Being a research physician certainly takes more time and effort out of my day, but it’s satisfying to answer questions that actually make an impact. I think that’s what it boils down to…trying to make people’s lives better.

How does research help you in your practice?

Being a research physician develops a certain expertise. For example, I believe I have developed into one of the many experts in melanoma and other areas of oncology. By doing the research, I have been able to keep up to date on what’s new in treating certain forms of skin cancer.

Is it difficult to include both research and clinical work into your practice?

Yes, it’s a challenge. There’s certainly a lot of after-hours and weekends that go into being a productive researcher. There is money out there in the form of grants but they are very difficult to get. If a researcher is fortunate enough to get a grant, that can pay for more research time.

Is it common for physicians doing research to also have a practice?

It is at Mayo Clinic. The philosophy here is that the patient comes first. Even the top researchers are still involved in patient care at least in some form. There are, however, some physicians here that do strictly research. I think it’s fortunate that at Mayo Clinic, we can have a balance of seeing patients and doing research as well.

Did you always want to do research?

I always knew I wanted to be a surgeon. I wanted to work on cutting out cancer, and the rest just fit as my career developed. I’ve always been a curious person. The challenge for people entering medicine is that it’s hard to know what it’s going to be like until they are in that phase of their career. For me, the fit of a research physician was what my personality was looking for.

What’s the most challenging part of the field?

I hear people say if you find a job you like, then you’re one of the luckiest people alive. I truly get up every morning and feel lucky for the type of job I have. It’s an amazing opportunity for me to do the things I do and I’m so grateful for the opportunities I’ve been given here at the clinic where I work. It’s very fulfilling to take care of patients, cut cancer out and also have so many resources to do research.

Was there anything about doing research that surprised you once you started?

Probably the ongoing learning curve. You’re never really done learning as a physician, but that holds true even more as a research physician. I’m still taking classes on how to do better research. The more you learn, the more you realize there is always something to learn. There’s always something to improve upon, something to do better.

How did you end up studying patients with melanoma or lymphoma who have had an organ transplant?

When I was fresh out of fellowship, I applied for a grant to the dermatology foundation with the help of a really key mentor in my life. I think that a lot of paths people take are significantly influenced by their mentors, and I happened to have one who was very bright and knew of some of the hot developing areas in the field of cutaneous oncology. One was skin cancer in the setting of lymphoma. So I applied for this grant and got it, which helped fund some of my time in research for the next three years. I’ve always had an interest in melanoma. That spurred me to think of melanoma in people with immunosuppression and later to start looking at epidemiologic projects pertaining to melanoma.

Any advice on how a physician should get into research?

I would say if you love it, then just do it. There are setbacks, pain and heartache that you go through, especially if you write grants. Each time you write one, it’s a ton of effort to try to put it all together. However, even if you’re not successful, you learn from it and the next time you have more knowledge and experience. Be OK with setbacks. Go after it if you love it. We need people answering questions and making medicine better from a research standpoint.

How would a physician go about applying for a grant?

There are a number of websites out there. If you work at an academic center, there are most likely a lot of internal grants available. The National Institutes of Health is a popular choice. There are also societies pertaining to different specialties in medicine that have money available for grant applications. It takes a little effort, but there’s a lot out there a physician can find.

By Marcia Travelstead

 

0 Comments

Direct primary care

Give up the grind for a practice that gets closer to your patients.

By Marcia Travelstead | Career Move | Spring 2014

 

Albert Fuchs

“I don’t know of any doctor who’s doing it this way and wants to go back to seeing 20 patients a day, spending 7 minutes with each of them and then looking to some third party to collect the fee for that encounter,” says Albert Fuchs, M.D., owner of his own direct care practice in California.

NAME:  Albert Fuchs, M.D., FACP

WORK:  Owner of his own direct primary care practice in Beverly Hills, Calif. (albertfuchs.com)

MEDICAL SCHOOLUniversity of California, Los Angeles

RESIDENCYUniversity of California, Los Angeles

Spending more time with patients is an attractive idea for both physicians and those who need their care. Internist Albert Fuchs, M.D., began his direct care practice about six years ago to enable him to do just that. Paying an annual retainer fee—typically $2,800 at his practice—grants patients 24/7 access to Fuchs, same-day appointments and predictable primary care service fees. What’s the difference between direct primary care and concierge medicine?

I don’t think there is any. My website does not use the word “concierge,” although I don’t object to it. It sounds much fancier than what I do—and much more expensive. Although, a lot of people call what I do concierge medicine.

I think eventually patients will settle on a name for it. I don’t think paying directly for a service deserves a special name. When you go to an accountant or lawyer and you write a check, it’s not “direct” legal care or “concierge” accounting. It’s just getting an accountant or a lawyer. So what I do should be called medicine and the traditional model should be called “insurance” care or “third-party” care. As this catches on, it will be called medicine. A patient goes and sees any doctor and they pay for them. You may have to have a catastrophic policy such as when you wreck your car. However, for an oil change or tire change, you don’t go to some third party to figure out what’s covered, how much you pay and who’s in your mechanic network.

What do you like best about  practicing direct primary care?

I love the time I have to spend with each patient. I love not having to think of excuses to run out of the room and having the time to answer all of the patient’s questions and be available. If one of them has an issue today, I can see them today, not two weeks from now. The extra pay isn’t bad either, although that took a few years.

Are you available 365 days a year to your annual fee patients?

I am, but the office isn’t open every day. We still have office hours, which are Monday through Friday, 9 to 5. All my patients have my cell number,  and over the phone I am available 24/7.

You have four kids. How does that work with your on-call hours?

Daddy has to occasionally get up and take a phone call from a patient.

What are the challenges of this type of practice?

The rough part is the transition. There are some short-term risks because there’s no guarantee that any physician will get enough patients to succeed. However, I don’t know of any doctor who’s doing it this way and wants to go back to seeing 20 patients a day, spending 7 minutes with each of them and then looking to some third party to collect the fee for that encounter. Patients and doctors both hate that. The only reason that’s happening is that it’s status quo.

Why did you choose direct primary care?

It actually wasn’t my idea. My wife was thinking of ideas such as this and bouncing them past me. One of my patients, who I had been taking care of for a long time, said she felt bad because she has a lot of questions and would call me on the phone, and she knew I wasn’t getting compensated for that. She said she would much rather pay me a retainer, know that I was there when she needed me and didn’t have to compete with a lot of other people for my time. That’s what planted the seed. I spent about a year investigating it and finding out what was legal and how it might work, and then I made the jump.

It sounds as though you would have to build up a clientele before doing this. Is this a practice model that would work for a newer physician?

For the most part, doctors are afraid to try it. I don’t know what the experience of a physician right out of residency would be. When I started it five or six years ago, people hadn’t heard of it. It’s a much better known practice model now and patients might be much more willing to enter a new practice of a direct primary care physician. I’m just not sure. I think 90 percent of the hesitation is that as an industry, we’re all scared. I wouldn’t discourage a trainee from trying it.

Do you have any advice for how a physician should get into this?

I would make phone calls to people who have been doing this for a few years and ask very specific questions about how to make the transition. Twice a year, I get calls from physicians thinking about it who find me on the web. They have questions about how to set up contracts, how to break the news to their existing patients and what to expect during the transition. You don’t want to reinvent those steps. Far from wanting more competition, I think most of us are delighted to talk with physicians because we think this is better for both doctors and patients.

Did you end up losing a number of patients in the transition?

Yes, I have a very small practice now in terms of numbers of patients. However, it’s much better in terms of revenue. I knew going into this I would lose over 90 percent of my patients. From that small nucleus that stayed, I built up a new practice, essentially.

That’s why I’m not sure that having a large successful practice before transition is important because most of those patients aren’t going to stay with you. Most of those people want somebody in their insurance network. One important point I want to make is the 90 percent of your patients who go to other doctors…you want them to leave happy. So the way you present it to them and the way you handle your separation needs to be pleasant. You don’t want them to refer to you as the jerk that fired them. You want them to leave happy thinking you are a terrific doctor but they just can’t afford your services right now. You want them to understand why you are doing what you are doing.

Have you ever had a patient leave and then come back to try your new practice?

Yes, in fact just last week I had that experience. That happens all the time. They’re frustrated by the primary care they are getting so they come back.

Is there anything that surprised you about this once you got into it?

The biggest surprise was how many of my older patients saw the value in this and wanted to keep me. The older, sicker patients already saw how the Medicare system is failing them and they are happy to pay more for the attentive care.

Physicians should ask themselves, especially the younger ones, whether they want to spend their careers working for insurance companies or for patients. There is plenty of room in our niche and physicians and patients both will like it better. Physicians owe it to themselves to spend the next several decades getting paid for what they love to do, not to be getting paid for what disappoints them and the patients both.

Marcia Travelstead

 

0 Comments

Physicians who write

Got an idea for a book? It’s possible to combine your medical experience with your creative side.

By By Marcia Travelstead | Career Move | Winter 2014

 

Looking to write? “Writing is a way to reach a lot of people. You are in control and have a greater capacity to protect the integrity of the message than in other media,” says David Katz, M.D., MPH, who has authored or co-authored 15 books and more than 1,000 articles.

NAME:  David L. Katz, M.D., MPH

WORK:  Founding Director of Yale University’s Prevention Research Center; Current Medical Director for The Integrative Medicine Center at Griffin Hospital in Derby, Conn.

EDUCATION:  Dartmouth College (BA); Albert Einstein College of Medicine (M.D.); Yale University School of Public Health (MPH)
Katz practiced internal medicine for more than 15 years and worked as an emergency medicine physician early in his career.

Katz is also editor in chief of the journal Childhood Obesity, president-elect of the American College of Lifestyle Medicine, and founder and president of the nonprofit Turn the Tide Foundation.

He has published nearly 200 scientific articles and textbook chapters, innumerable blogs and columns and nearly 1,000 newspaper articles. He has authored and co-authored 15 books, including multiple editions of textbooks in both nutrition and preventative medicine.

His extensive media portfolio includes being an on-air contributor for ABC/Good Morning America, a writer for The New York Times syndicate and a columnist for O, The Oprah Magazine. He’s also a blogger/medical review board member for The Huffington Post, a health contributor to U.S. News & World Report, one of the original 150 ‘thought leader’ influencer bloggers for LinkedIn; and a health writer for Everyday Health.

For more information about Katz, and his latest book, Disease Proof, visit davidkatzmd.com.

How did you get started writing?
I was invited by my residency director, who decided to do a book. For colleagues who want to get involved in writing and to establish a reputation, one tip I can offer is that when opportunity comes knocking, be sure to open the door.

It takes a tremendous amount of time to write a book. In fact, there was a stretch of time that I was on a three-book deadline simultaneously. There was a point where, for approximately three years, I had one day off a year—literally—because there was such a backlog of work. I would do my day job during the week, and that would leave my weekends for writing.

Another opportunity came along around 1996-97, when I was just starting my practice in internal medicine. The hospital that I was affiliated with thought we might grow the practice with a column in the New Haven Register. I wrote a weekly preventative medicine column. The column in the New Haven Register re-circulated in other Connecticut papers. For a number of years, it was farmed out to The New York Times syndicate. I did the column in the New Haven Register, and the next thing I knew, I had a monthly column in O, The Oprah Magazine for eight years.

What do you like best about being a physician author?
What I like best is making a difference in the world. I hope my epitaph will be that I made a difference. Writing is a way to reach a lot of people. You are in control and have a greater capacity to protect the integrity of the message than in other media, and the other media has certain inconveniences attached.

When I worked for Good Morning America, I had to get up at 4 a.m. to get into Times Square. For the most part, I can write in my pajamas and write when I want to write. With the increasing opportunities for online writing, I blog. I’m what LinkedIn calls an “influencer.”

It used to be that you’d write a blog or anything else and hope that people would find it or it would find them. I’ve got close to14,000 people following me on Twitter and about 93,000 on LinkedIn. If I write anything, I can tell them all. I can push a button and reach out to about 100,000 people. I like this medium because now we have a means to invite people to participate in the dialogue.

What’s challenging about being a writer?
You are never done. There’s never a complete escape. At any moment, if you are a writer, ideas pop into your head and you’ll feel obligated to try to capture them. In clinical care, as demanding as it can be, you’re either on or off. When you’re finished and you’re not on call, you’re done. If you’re a writer, there are always words. There’s no escape from words; they are always there. One can certainly relate to artists who went crazy. There is a certain poignant madness to it all.

What surprises you about being an author?
The field of writing, which you may think of as rudimentary, actually is a very special power. There is a widely respected, hugely influential power in writing. In some cases, it can influence life or death situations. That’s the happy surprise…the incredible impact. An unhappy surprise is that there is sort of a subculture in publishing that a lot of what prevails is predicated on what people think others want to read. It’s very hard to break through.

What advice would you give other physicians who want to write?
First of all, only write if you’ve got something to say. You shouldn’t write because you want to be a writer. You should write because words are percolating up in you and you’ve got to express them. Secondly, have somebody to say it to. Know who you are trying to reach. Third, what is the particular objective? There may be an expected action, something you want to change with your writing. The fourth would be consistency. If you really want this to be a significant part of your career, you have to make it part of your weekly routine. You cultivate an audience by consistently reaching out to them, becoming a voice they trust and turn to looking for guidance.

In terms of where to get started, there are all sorts of options to get published. You can try local newspapers or establish your own blog online. It used to be harder because the options were fewer. There are real advantages in cultivating social media to let people know about your writing.

 

NAME:  Joseph Shrand, M.D.

TITLE: Medical Director, CASTLE (Clean And Sober Teens Living Empowered), High Point Treatment Center, Mass.; Instructor of Psychiatry, Harvard Medical School

RESIDENCY: The Institute of Living, University of Connecticut, Hartford Hospital

FELLOWSHIP:  Massachusetts General Hospital, McLean Hospital

Shrand has served as Medical Director of the Child and Adolescent outpatient program at McLean Hospital, has run several inpatient psychiatric units, and was, until recently, the Medical Director of the Adult Inpatient Psychiatric Unit for High Point Treatment Centers in Plymouth. He serves on various boards involved in national mental health issues and global fair-trade concerns.

He helped design the Independence Academy, the first sober high school on the South Shore of Massachusetts.

For more about his books, including Outsmarting Anger: 7 Strategies for Defusing Our Most Dangerous Emotion and Manage Your Stress: Overcoming Stress in the Modern World, visit drshrand.com.

What do you like best about being an author?
I really enjoy having to formulate an idea to make it readable. The book I’m writing now is synthesizing state-of-the-art neuroscience and psychiatric science so that anyone can read it.

I like working with writers, and it’s really an education for me to be an author. I’m responsible for the content and the writer is responsible for the process. I work with a fantastic writer, Leigh Devine, who helps me stay focused. We have a great rhythm and have put my first two books together. There’s something wonderful about being able to express one’s self in writing.

What’s the most challenging part about being an author?
When I’m looking at my words in print, I’m always thinking I could have done it better. I don’t think it’s about being a perfectionist; it’s about striving for clarity. I feel my responsibility regarding writing in this genre is to be crystal clear so the person who is reading it can understand what I’m saying and apply it to their lives right then. If I’m writing something narrative, like my stories, then I want to make sure I take my readers through a whole range of emotions.

Any surprises?
When I started writing at this level, I had my own writer, editor, publisher—then another editor, a publicist and a copy editor. I had no idea how many people were involved in this. I didn’t own the book anymore, and that was fearful. However, what’s incredible is that so many people are invested in what you have to say that it becomes their book, too. I think that’s cool!

What advice do you have for other physicians who want to write?
Write! What I would recommend is to go to writer’s conferences and meet people. Write down new ideas, and document them by text or email. Don’t undermine your own creative process, because it’s amazing! Physicians have something to say. We’re into this very interesting time of our professional development. People will be interested in what physicians have to say whether or not it’s about medicine.

By Marcia Travelstead

 

0 Comments

 

Return to Top

Page 2 of 41234