Physician Astronaut

By Marcia Travelstead | Career Move | Spring 2017

 

David Wolf, M.D

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

Name: David Wolf, M.D.

Work: Astronaut, cosmonaut

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

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

Medical School: Indiana University School of Medicine, Indianapolis

Internship: Methodist Hospital, Indianapolis

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

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

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

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

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

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

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

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

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

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

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

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

 

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What it’s like to work at an FQHC

By Marcia Travelstead | Career Move | Fall 2016

 

Daniel Bow, D.O.

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

Name: Daniel Bow, D.O.

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

Undergraduate: Eastern Michigan University, Ypsilanti, Michigan

Med School: Michigan State University, East Lansing, Michigan

Residency: Botsford General Hospital, Farmington Hills, Michigan

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

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

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

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

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

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

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

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

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

 

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Integrative medicine evaluates a person’s many facets

By Marcia Travelstead Marcia Travelstead | Career Move | Winter 2017

 

Practicelink molly roberts sf 037

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

Name: Molly Roberts, M.D., MS

Work: CEO and president of LightHearted Medicine, San Francisco

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

Med School: University of Arizona, Tucson

Residency: University of Arizona

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

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

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

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

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

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

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

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

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

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

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

 

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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.

 

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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.

 

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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.

 

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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.

 

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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.

 

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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.

 

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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

 

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