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



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



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. (

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



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

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

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



High School Sports Physician

Volunteer with your local high school teams to provide care on the field and goodwill to the community.

By Marcia Travelstead | Career Move | Fall 2013


Jeff McDaniel, M.D., volunteers as a team physician for several high school sports teams. His involvement is voluntary but has the added benefit of driving young athletes to his practice, too.

NAME:  Jeff McDaniel, M.D.

SPECIALTY:  Family Medicine, Sports Medicine at Methodist Family Health Center.

LOCATION:  Midlothian, Texas

RESIDENCY:  Palmetto Health Family Medicine, Columbia, S.C.

FELLOWSHIP:  Primary Care Sports Medicine Specialty; Graduated 2010

During his fellowship year, McDaniel served as a team physician for the University of South Carolina Gamecocks, Benedict College Tigers and Airport High School. He currently is a team physician for the Midlothian High School football team and several Mansfield area high schools. Although he works with five high schools in Mansfield, he primarily works with Lake Ridge High School and Mansfield High School.

What do you like best about being a high school sports team physician?

It combines my two loves: medicine and sports. It’s a patient population that is young, active and fun to work with. I grew up in Texas and played football, so I think I can relate and understand to some degree what the athletes are going through and help them recover from their injury and get back on the field.

What kind of commitment is expected?

Usually it’s a Friday night once a week or occasionally a Saturday for the whole season. I do their sports physicals prior to the practice season as well. Generally, the season runs from the end of August through the first part of November unless they go into the playoffs, where that could run into an extra few games. It generally involves four to five hours on a Friday night.

Is there anything that surprised you about being a high school sports physician?

The coaching staff may have one agenda, the physician may have another and the parents may have their own as well. I’ve often run across parents who really want their child to excel. For the physician, that can mean walking the fine line to getting the athlete better yet making mom and dad happy. A lot of it is educating and reassuring the parents. Their child wants to be out on the field but the physician has to make sure the athlete has recovered enough to be on the field as soon as possible but not risking permanent injury.

Have you found being a high school sports physician has benefited your practice?

I feel it has. I’m not paid to be on the sidelines and it’s completely volunteer on my part, but I’m being an active role model. It has given me exposure to this particular patient population as well as to the community. It opens up conversations with regards to being seen on the field. People find out who I am, and that’s the best way to build a practice—word of mouth. I’ve also acquired a number of patients from athletic trainers who know I specialize in concussions.

Are you a team physician for other high school sports besides football?

I do provide care to athletes competing in all sports with the high schools in this area. I don’t get the chance to make it to all the games and be on the sidelines due to scheduling conflicts. For example, the soccer games are often held during the week or over a time when I am working in the office.

What advice do you have for physicians interested in being involved in high school sports?

A fellowship in sports medicine would be one way to start because you get exposure to several levels of competition. Apart from that, one of the best ways for a physician to get involved is to locate and meet with the athletic trainers of a particular program. Really make yourself available to them. If you make it difficult for them to contact you then they are not going to want to work with you. I take the team approach and make myself available to them during practice, weekends or whenever they have a question. I don’t think they have ever abused that and have always been very respectful.


NAME:  Jerry Bornstein, M.D.

TITLE:  Semiretired Orthopedic Surgeon; Medical Director for Los Angeles Unified School District Department Of Athletics.

RESIDENCY:  Los Angeles County General Hospital

Bornstein has been a physician and consultant for high school, college and professional sports teams for more than 50 years.

What do you like best about being a high school sports team physician?

The satisfaction of seeing athletes return to the high functioning ability that may have not been possible without adequate medical care. They may have been unable to continue, resulting in lost scholarship opportunities. In addition, they may have had permanent residuals from the injuries. It is gratifying to see them return to play (RTP) and continue to advance further in their athletic career.

In addition, there is gratification in the contribution of community service in areas where family or other funding for medical care is not easily available.

Is there anything you don’t like about it?

The difficulty in obtaining necessary care for those unable to afford private services. Also, parental interferences both on and off the field, which can affect proper evaluation and care. The medic needs to be able to do his or her job. I have also witnessed an increasing feeling of entitlement some athletes are developing, even at the high school level, in addition to disrespect for upper authorities.

What is your role as Medical Director of Los Angeles Unified School District Department of Athletics?

Training health care professionals such as resident physicians, EMTs, ATCs, RNs, etc. in on-field protocol and the initial evaluation/care of injuries. This is done via seminars and on-field supervision. They evaluate injuries and determine whether the athlete is able to return to play and to initiate treatment as indicated.

I deal with assigning medics’ schedules, intra-week schedule changes and other emergencies as they arise. I am on-field game day either covering a game or at a game with one of the medics, supervising and teaching. In addition, I am always available by phone to medics, athletic directors and coaches to answer any questions they might have.

Is there a problem getting physicians to volunteer?

There can be difficulty getting medical coverage for games in many areas. For physicians, there could be insurance concerns, time constraints and/or the feeling of incomplete knowledge/training for on-field tasks. Therefore, the use of other health care professionals becomes necessary.

Is there anything that surprises you after all these years of being involved as a high school team physician?

The lack of commitment and involvement on the part of some athletic directors and administrators in an important segment of a high school student’s educational life.

What’s your advice for physicians who are interested in getting involved in high school sports?

Gain training, which is readily accessible in a number of ways. First, become involved by shadowing or following a team physician who has experience. Secondly, read books or access the internet. There are a number of publications on team physician protocol. Thirdly, take a course. The American Association of Sports Medicine offers courses every year on team physician care. By doing all of these things, the physician will feel more comfortable on the field.

—By Marcia Travelstead



Career Move Featured Physician on Dr. Oz!

Blog | Career Move


Infectious Disease specialist Tracy Zivin-Tutela, M.D., who was profiled in our summer 2013 Career Move article, will be featured on the Dr. Oz Show this Thursday, Dec. 5.

Zivin-Tutela frequently provides medical context for various media outlets. In our summer article, she gives tips for other physicians looking to do the same. Check out our interview with her here, and visit Dr. Oz’s site to find out when the show is playing in your area. (You can find local times by changing the zip code in the top righthand corner below the search bar.)





Physicians in the media

Share your knowledge with the general public by being willing and available for media interviews.

By Marcia Travelstead | Career Move | Summer 2013


Tracy Zivin-Tutela, M.D., provides medical context for various media outlets. If you’re interested in doing the same, Zivin-Tutela advises approaching your local newspapers, online health forums, local TV stations and the public relations department at your local hospital.

NAME:  Tracy Zivin-Tutela, M.D.

TITLE:  Physician at Westside Infectious Diseases; St. Luke’s-Roosevelt Hospital Center, Division of Infectious Diseases

RESIDENCY:  UMDNJ – Morristown Memorial Hospital

FELLOWSHIP:  St. Luke’s-Roosevelt Hospital Center-Columbia University, New York City

Zivin-Tutela has been featured on The Dr. Oz Show, local news stations in the New York City area, NBC National Affiliates, and numerous online articles.

What do you like best about doing media interviews?
I like to educate the broad population. As physicians, we are born educators. I especially like the opportunity to dispel myths among the community regarding the latest health issues and how people can protect themselves, as my specialty is Infectious Diseases.

What are the challenges?
The nature of the media business is time constricting, and so the thing I like the least is that I don’t always have the ability to leave my own patients to give advice to the larger audience of patients. The TV stations will call and ask if I can speak on a topic and will either arrange for a camera crew to come to me or will pick me up to take me to the studio. It’s usually their decision, not mine, and it’s usually within two hours. That’s really the biggest thing that I don’t like about it.

How do you prepare for an interview?
Being an expert is only as good as staying on top of things. Sometimes the TV station will give me a topic and I don’t even know the story that’s about to break because it’s not in the news. A lot of times, they’ll tell me to talk about a subject and I’ll have to ask what it’s regarding. Sometimes I don’t know the whole story and that’s a little frustrating.

Do you ever know in advance what your questions are going to be?
The Dr. Oz Show did go through questions in advance, but most of the others did not. I was literally asked the questions on camera at that moment, which is stressful. It’s not enough just to know the information. It’s my obligation to give honest, accurate and up-to-date information.

I also have to translate the information from doctor language into language everyone watching can understand. Sometimes when a physician takes some time to answer a question, it is not because they don’t know the answer. It’s because they are trying to word it in a way that basically a child can understand.

You mentioned doing an appearance on Dr. Oz. What other appearances have you made?
The local news channels in the New York tri-state area. I had an appearance on the NBC Nightly News with Brian Williams. I have probably done about 30 over the last five years in addition to phone and online interviews.

If a physician would like to appear on television, what recommendations would you give?
Don’t be afraid to approach your local newspapers, your online health forums, your local TV stations and the public relations department at your local hospital.

I’m not employed by the hospital, but the public relations department is thrilled when I do something that represents them. I think it’s very easy to go to your local newspaper and tell them about a topic that is interesting. It could be a new heart medicine for older people, for example. You could offer to do a series every once in a while on a medical brief. Having done that, it that could turn into an appearance on a local TV channel and can snowball after that.

For example, ABC, NBC and CBS take interviews and put them into a type of database that all of their affiliates all over the country have access to. That is another way that TV stations all over the country look for you because they have seen you on a local TV channel.

I don’t think it’s necessary to hire a public relations person, just reach out. Then, my main advice is to make sure you are responsible and honest with your information that you disseminate into the mass population, and to stay current. Even though I only get one to two hours from notification, I still go online to see what is going on. Something must have happened that’s going to be in the news today.

Medicine is ever changing. Things I learned in medical school are not necessarily fact today. I really need to stay on top of things. In addition, I’m obviously comfortable with the subject they’re asking about or I wouldn’t be doing the interview.

Is there anything about doing media interviews that surprised you?
What surprised me were the reactions of my patients, my parents and their friends. There were 70- and 80-year-olds that said they saw me on TV and remembered me when I was small. My patients send me emails, and they are proud and it makes me proud. That is something I was totally unprepared for.

Do you have future plans regarding TV appearances? Maybe have your own show?
I have a lot of people who ask me why I don’t do this full time. First of all, no one has approached me. And secondly, I really love practicing medicine and taking care of patients. I like doing TV interviews on the side. I don’t know if I’d like it as well if I wasn’t still practicing full time. I don’t know if I’d get skewed by the media or if I’d be out of touch with what’s current if I wasn’t still practicing. So, it’s a nice hybrid to do both.



Airline Medicine

Emergency medicine with a twist provides care to those in the air.

By Marcia Travelstead | Career Move | Spring 2013


NAME:  David Streitwieser, M.D.

TITLE:  Emergency medicine physician; Medical director for MedAire, Inc. at Banner Good Samaritan Medical Center, Phoenix

Medical school: University of California, San Diego
Residency: Valley Medical Center of Fresno

What happens if someone has a medical emergency while on a flight? It used to be that this call was made throughout the cabin: “Is there a doctor on board?” Now, that call is likely to be made to a company like MedAire, who through their MedLink service provides in-flight telemedicine services to airline personnel through emergency medicine physicians and support staff.
David Streitwieser, M.D., started with MedAire 25 years ago. “We have a lot of experience, we’ve seen a lot of situations, and we’re comfortable at handling anything from a telemedicine standpoint,” he says.

What is your typical day like?
There are two ways we staff the call center. Monday through Friday for eight hours a day, we have a doctor who is dedicated to that call center. He or she basically stays in that call center taking as many calls as possible while on duty. After those hours, the calls are taken by the doctors who are on duty in the emergency department. The doctor may be seeing patients when a call comes in, or may be able to break away from charting or whatever else and take the call.

Are all of your calls from airlines?
The majority are commercial airlines but there are other clients, including some companies with their own aviation departments. We handle their needs whether they are in the air or on the ground when they are traveling. We also handle some private yachts that could be anywhere in the world who may have a medical event. There are also some commercial vessel tankers for which we handle medical emergencies.

What do you like best about your job?
It’s interesting because you get to apply your medical knowledge, especially your knowledge of emergency medicine, to situations outside of the emergency department.
For instance, somebody in an aircraft could be having chest pain. We know how to handle that in the emergency department. We know what things we are worried about and we know what things are available to treat chest pain. On the aircraft, we find out what symptoms the patient is having, what diagnostic capabilities and what treatment modalities are available and tailor it to fit the individual interaction. It’s a unique type of practice and the more you do it, the better you get at it.

Does it take a lot of experience to become a physician with your group?
We hire new doctors every year for our practice and we have to train them how to take the calls. They are monitored for their first year or so with me reviewing their patches or calls. There is always another doctor around to help them if they run into trouble. They are never alone. That seems to work fairly well.

How does the schedule work?
The shift where the doctor is dedicated to the MedLink calls—those are fixed hours. That schedule is run separately from the work schedule of the emergency department. So the days the physician is not scheduled to work in the emergency department, he or she can sign up to work those MedLink shifts. It’s only the experienced doctors that get to work the MedLink shifts.
When a physician works in the emergency department, he or she is expected to take calls while on duty. That’s part of the job. The physician who is the dedicated MedLink physician is in a voluntary extra work situation.

What are the challenges?
There are times when I get really busy in the emergency department and MedLink gets extremely busy. That’s extra stress, another responsibility. If you know emergency medicine, then you know physicians are frequently interrupted by any number of distractions. This is another distraction from the flow of care. However, we are actually working on other ways of handling the calls during those peak times.
Regarding the calls, we have many full-time communication specialists who do a lot of the documentation. There are a surprising amount of phone calls involved with handling an airline medical event. The airport where the flight is going to land needs to be contacted to arrange for emergency medical services. The airline itself may need to be notified regarding that particular flight. We have those calls delegated to the communication specialists. We maximize the efficiency of the physicians by getting the information and making decisions and leaving the rest of the work to the non-physicians. That works out well for our practice regarding patient flow and other responsibilities.

Approximately 45 emergency medicine physicians provide telemedicine care for in-flight emergencies from the ground through MedAire’s MedLink service. Full-time communication specialists help document the calls and maximize physician efficiency.

What advice would you give a physician who would like to do what you’re doing?
The physician will want to do emergency medicine and if he or she has an interest in this type of telemedicine, then he or she will need to work for a group that has this type of capability. There aren’t going to be many of them out there.

There is a website for MedAire and International SOS. The physician could get linked to our group. There is also a chapter in the American College of Emergency Physicians (ACEP). They have a section on airline medicine.

Is there anything that surprised you about working as a MedLink physician?
When I started with MedAire, we didn’t know if the model (MedLink) we chose was even going to work.

There were emergency physicians who were used to directing paramedics or nurses on air ambulances who needed medical advice. However, would this type of model allow the physician to give meaningful advice to airline personnel calling with needs for airline passengers? (By the way, the woman who started MedAire had been a flight nurse.)

Initially, this was a very small operation. We found it was effective. We could give good advice and make reasonable decisions and really help people. The only other alternative for the airline prior to MedLink was if there was a doctor onboard the flight. Some of the airlines had a doctor employed by them who was basically an occupational medical doctor. He or she would do employee physicals and might be on call for emergencies but did not practice emergency medicine and may not be available around the clock. There was nothing like MedLink.

I also think it was a surprise to me how much of a need there was in the airline industry for this kind of service. Having done it, I can see that it is a win-win situation. It’s great for the airlines, their passengers and the physicians taking the calls.



Wilderness Medicine

International travel awaits physicians with a thirst for adventure— who don’t mind paying their own way

By Marcia Travelstead | Career Move | Winter 2013


NAME: Gregory H. Bledsoe, M.D., MPH

TITLE: Board certified emergency medicine physician; Founder and CEO of ExpedMed Expedition and Wilderness CME


Medical school: University of Arkansas for Medical Sciences

Residency: University of Arkansas for Medical Sciences; Two years in International Emergency Medicine

Masters of Public Health: Johns Hopkins Bloomberg School of Public Health

“There are some really remote places that, even with our technology, it’s difficult to reach people.” —Gregory Bledsoe, M.D.

Bledsoe has been an instructor and medical consultant for the United States Secret Service. He was the personal physician to former President Bill Clinton during Clinton’s tour of Africa in September of 2002 and served in Uganda and Senegal on the advance team of President George W. Bush when the President visited the African continent in July 2003.

His international medical experience includes travel to 40 countries, serving as a field physician in Honduras, teaching disaster preparedness in Tanzania, leading a nutritional survey among the Beja tribe in northeast Sudan, working as a medical consultant in Beijing, and acting as the medical officer for ships in both Antarctica and the Arctic.

What do you like best about wilderness medicine?

I was able to go on medical trips overseas with my dad, who is a surgeon. In high school, I went to Haiti and when I was a resident and medical student, I went to Honduras. I finished residency in 2002 and had a two-year fellowship in international health from 2002 to 2004. I did a lot of international work and remote medical work from 2002 to 2009.

When I was in medical school, I was taught how to handle patients who were in the hospital. There was a certain amount of control. In the field, however, a wilderness physician can’t control the weather or patient type. There isn’t the technology or stability. That really fascinates me.

How do you get the time off from your current practice?

That’s one of the reasons I practice emergency medicine. I choose my shifts and when I work. It gives me more flexibility than if I had an office-based practice such as a family practitioner or surgeon. It’s one of the benefits of working in emergency medicine.

Is there anything you don’t like about wilderness medicine?

For most of the trips, the difficulty is from the funding aspect. Even for the big trips that you see on the news, the expeditions to various places, often the physician on those trips has to pay for his or her own way. Finding someone to fund your trip, even if you are the physician, can be very difficult. So I think that’s a downside and why more physicians are not involved in wilderness medicine. It’s not because physicians aren’t interested. It’s a fascinating way to practice medicine.

What’s your advice to someone who wants to practice wilderness medicine?

Even if you are an excellent physician in your area of expertise, working in the field is different. I always advise physicians to get some training. ExpedMed runs conferences so whether it’s our conference or another conference, make sure you know of the risks. It’s unfortunate but there are malpractice risks even out in the field.

Knowing the body of information depending on the trip or project you are working on is a must. You need to be educated and have significant field experience.

The way you get yourself known is like anything else. It’s by being there, participating in trips and projects. The fastest way to start is volunteer work. Then, if it’s something you enjoy, there are volunteer agencies, nonprofits, etc. that won’t pay you a salary but will cover your expenses. There are a few jobs available for those who want to do it full time, but those jobs usually go to physicians who are fairly well-known and have significant field experience.

Was there anything that surprised you about practicing wilderness medicine?

What I’ve found in every community I’ve been to is that there are some good practitioners of medicine, maybe nurses or local physicians. They are very knowledgeable, however they don’t have the facilities, medicines and equipment necessary to diagnose and treat patients. I’ve been impressed with the medical knowledge among the local physicians, but often the infrastructure is so poor that they can’t get the patients the medicines and treatments they need.

The other thing that surprises me is that it’s amazing how many Western travelers go to remote places without any thought as to what will happen if they get sick or injured. So many people have rose-colored glasses. They think somebody is going to come and get them off a mountain. You need to have a plan. Many veteran travelers get into a lot of trouble because they think a cell phone or radio call will result in a rescue. It’s not that easy. There are some really remote places that, even with our technology, it’s difficult to reach people.

What’s your schedule like on one of these trips?

It depends on the circumstance. If you work as a ship physician, sometimes you’ll have another physician on the ship and you’ll be able to rotate call. However, if you’re the only physician on a trip, you are definitely on call for 24 hours. You just have to deal with whatever comes along. It depends on the project and your resources.

—By Marcia Travelstead



Workplace Clinics

With a focus on prevention, this physician found his balance

By Marcia Travelstead | Career Move | Fall 2012


NAME: William Bray, M.D.
TITLE: Family practice physician for WeCare TLC
Medical school: Indiana University
Residency: Ball Memorial Hospital in Muncie, Ind.
As a workplace clinic physician, who specifically do you work for?
My employer is WeCare. They are a Florida-based company that specializes in employee-based clinics. There are others out there that do similar things. WeCare manages the on-site clinic for Subaru, which has a very large automobile production facility in Lafayette, Ind. Subaru employees and dependents are eligible to use the clinic.

What do you like best about being a workplace clinic physician?
I like the focus on prevention. I also like that it’s not necessarily a production-based environment. I like that I can spend more time with patients and I can focus on keeping them well. I have the resources and support to do that effectively.

Is there anything you don’t like about being at a workplace clinic?
So far, no. It’s a really nice blend of disease management and preventative care. Personally, it’s not as demanding on my time because it is more productive. I’m not dealing with insurance companies and collections. It’s an employer-funded operation, so instead of spending time with insurance companies, I’m spending the time with the patients.

Why did you choose to join a workplace clinic?
There are a number of reasons… such as a chance to get back into family medicine. I previously was in a practice that was occupational medicine and family practice. It soon became full-time occupational medicine. This was really a chance to be part of something where I see health care needs to go. That is, with the focus on prevention versus a system that’s motivated by illness, if you will.

Have you always been located in Indiana?
Yes, I have, except for the five years I was a flight surgeon for the United States Air Force. That was the only time I was out of Indiana. I was stationed in Florida and Germany at that time. I continue to serve as an Air Force Reservist. My employer has been supportive of that.

What’s your advice for physicians who are interested in joining a workplace clinic?
Stick with the things that make you happy in life and you enjoy doing. I’d take a long look, especially for younger physicians, at where health care is headed in our country and weigh that into the decision. There’s something to be said for being in a private practice, going into that model. Maybe the rewards are there for some people. I think this is a neat change and I’m looking forward to a future with it.

Was there anything that surprised you about your career choice?
I was surprised I finally accepted this model. It’s a unique and different way of delivering health care. I was a little surprised at myself after years of doing things a certain way that I came to accept that this could work.

How would a physician get started on the path to becoming a workplace clinic physician?
Do your research. Not only on the company that you are providing a service to but the company you will be actually working for. Be prepared to accept the different model and delivery of this health care. Think outside of the box.

Would a workplace clinic physician be a model a new physician could go into immediately out of residency?
Yes, in fact in a way, it is almost ideal because in residency, you get some training about the business of medicine but many times, it is limited. In this particular model, you can focus on patient care fresh out of the program, which is primarily what you did the whole time in residency. I think it would be an easy transition for a young resident coming out of the state residency programs to embrace. It’s a model that requires very little business savvy or business sense because you are not dealing with insurance companies, collections or worried over bad debts. It’s a completely patient-centered medical environment.

Anything else you’d like to share?
I’m very happy and pleasantly surprised with the opportunity and I think as with anything, this is a novel concept to a lot of people. Time will tell if this is the direction health care will go. I don’t know if the government will be able to solve our health care dilemmas and I don’t know if physicians as a whole are motivated to change. It might be the employers in the country that force the reform. I think when the employers push, that’s when things will happen because ultimately employers pick up a lot of the health care tab.

– By Marcia Travelstead




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