Veterans Affairs physician

By Marcia Travelstead | Career Move | Summer 2012

 

NAME: Uzma Samadani, M.D., Ph.D.

TITLE: Chief neurosurgeon, Manhattan VA Assistant professor, New York University Neurosurgery

EDUCATION/TRAINING:
Medical school: University of Illinois in Chicago
Residency: University of Pennsylvania

What do you like best about being a Veterans Affairs Physician?

The patients…they are wonderful. They are grateful for their care, have patience, are stoic, polite, brave, courageous. Overall, they are just good people.

I think the amount of courage and stoicism that you see in your VA patients is more than you see in your typical patient population.

Is there anything you don’t like about it?
It can be difficult when you have patients you can’t help. That’s the hardest part of this job for all of us.

Why did you choose to practice neurosurgery?

I always knew I wanted to be a doctor. I loved the idea of helping people with medical problems. When I was in college, I worked in an ophthalmology lab. I was doing microsurgery-cornea transplants on mice. It was phenomenally fun. I liked working with my hands and I liked working under the microscope. That was really the first time I realized I wanted to be a surgeon.

The next year, I worked in a transplant lab and loved it. At that time, I thought I’d never be a surgeon because the lifestyle is terrible and I saw how hard the surgeons worked. Then I went through medical school and I approached each specialty like that was what I was going to do for the rest of my career.

When I went through my internal medicine rotation, I pretended I was going to be an internist. When I went through my psychiatry rotation, I pretended I was going to be a psychiatrist. However, there was really nothing that made me as happy as neurosurgery. From my very first neurosurgery rotation at Cook County Hospital in Chicago, I knew there was nothing else I could do. This is what made me the happiest because I love the surgery part and I love the fact that intervention can completely and dramatically make someone’s life much better. We can cure people…it’s amazing what we can do.

The VA enables me to practice surgery in its purest form without having to deal with all the headaches and hassles that are generally associated with the practice of medicine.
— Uzma Samadani, M.D., Chief neurosurgeon, Manhattan VA

Why did you choose the VA?

The VA enables me to practice surgery in its purest form without having to deal with all the headaches and hassles that are generally associated with the practice of medicine. So, for example, I don’t have to deal with billing and insurance and fighting to do a particular procedure on a patient because I think it’s the best procedure for them. I can go ahead and do it.

I don’t have to justify to the insurance company why I used instrumentation X rather than instrumentation Y. Also, I get paid the same whether I operate or not, so there’s no pressure on me to do extra surgeries. If I see a patient in a clinic and I don’t think they need surgery, I can tell them, “Look,I don’t think you’ll need surgery. I don’t think it will help you.”

Physicians in private practice may also be under pressure to reduce length of stay and procedure cost. I don’t have to worry about that as much. The other advantage of the VA for me is doing research. I spend half my time doing research. The VA makes that possible for me. The database here is the best in any medical system. I have access to a phenomenal amount of data for research purposes.

And you’re also an assistant professor?

Yes, at New York University School of Medicine. I work with a lot of different residents and medical students at NYU SOM. I give lectures in the medical school on brain injury. This summer, I’m mentoring five students with research projects and last summer I mentored three. We are conducting two prospective studies including a clinical trial, and cohort study as well as several smaller retrospective projects all related to brain injury and hemorrhage.

I’ve mentored students every year since I first started, and every summer I’ve had at least one student win a research award or fellowship. All of my students have published papers in the scientific literature. It’s been fantastic working with medical students because they are really motivated. They ask a lot of questions, are incredibly creative and very hard working. It’s been a great experience.

What’s your advice for physicians who are interested in becoming a VA Physician?

I think the biggest advantage of the VA is that it allows you to practice medicine without the extra baggage that comes with it. Also, it allows you to do research, if that interests you. You can practice in the VA system without performing research, however I think the ability to do research is one of the biggest perks of the job and it would be a shame not to take advantage of it.

Was there anything that surprised you about the VA or becoming a neurosurgeon?

Becoming a neurosurgeon is a huge responsibility and a privilege. People literally put their life into your hands. It can be stressful and I knew that when I chose to go into the field. I still have some sleepless nights thinking about how I am going to do a complex case. I am surprised how happy I am and how much job satisfaction I have.

Anything else you’d like to share?

Statistically, I was tied for being the 200th board certified female neurosurgeon in the country. I’m also the first female neurosurgeon to be on the staff at NYU School of Medicine. I would encourage women who are thinking about neurosurgery to find mentors and look at the WINS (Women in Neurosurgery) website for advice.

 

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Correctional medicine

Practicing in correctional facilities can offer a predictable schedule and the ability to care for patients long-term.

By Marcia Travelstead | Career Move | Spring 2012

 

NAME: Patrick Arnold, M.D.
TITLE: Regional Medical Director
EMPLOYER: Corizon, Albuquerque, N.M.
EDUCATION: Attended medical school at Alabama School of Medicine; post-graduate education at Oklahoma University Health Sciences Center in Internal Medicine.

What do you like best about being a correctional medicine physician?
I’ve been able to address common and uncommon medical conditions in a captive population. That affords me the opportunity to follow patients long-term. I like the support that I get from my colleagues and superiors…the opportunity to practice in what I think is an interesting field.

Is there anything you don’t like about it?
No, but I think for an individual on the outside looking in, the possible experience of practicing within a correctional environment could be somewhat daunting. For me, when I initially entered correctional medicine in 2004, I was somewhat apprehensive. I entered a correctional facility, and the doors were securely closed behind me. I was oriented to the clinical area; it was just like practicing ambulatory medicine in any routine outpatient clinic.

Why did you choose to practice correctional medicine?
I worked in a community-based clinic in rural Mississippi and was looking for a change from that environment. A recruiter contacted me about working in one of the correctional centers. I interviewed as a temporary replacement to earn extra income and ended up working in that facility from 2004 to 2006.

Today, I’m the regional medical director at a New Mexico contract for Corizon, but I do have some clinical duties to perform patient care.

I think correctional medicine is an excellent opportunity for practitioners to practice autonomously and to take care of patients. They have excellent support from the company to practice evidence-based medicine and to develop experience in a managed care setting. more »

 

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Career Move: Locum tenens physician

Travel, extra income and flexible scheduling can attract physicians to locum tenens opportunities.

By Marcia Travelstead | Career Move | Winter 2012

 


Name:
Avishai Meyer, M.D.
Title: General surgeon
Employer: LocumTenens.com
Education: Sackler School of Medicine, Tel Aviv, Israel. Residency at University of Colorado, Denver and University of Nebraska, Omaha. Fellowship at University of Nebraska Medical Center, Omaha.

What do you like best about being a locum tenens physician?
I’m a locum tenens physician on weekends currently in Pierre, S.D. I like the ability to interact with and provide medical care to a rural population in need. Also, it enables me to see what it’s like in the real world of a surgeon. As a fellow at the University of Nebraska Medical Center, I am sheltered from the burden of blame, if you will. Working as a locum tenens physician gives me a taste for what it’s really like to be a doctor and incurring the entire responsibility of the care I am giving. That’s scary but welcome. It’s not just being carried by the attending. I’m doing it myself.


Is there anything you don’t like about it?
It’s sad to be away from my family. I happen to have a 6-week-old child, so not being around is a little upsetting. We also have a 2-and-a-half-year-old, so it’s difficult for my wife. I’m not there to help out. That would be the only complaint I have about it, but that’s my choice.

Why did you choose to practice locum tenens?
I’m making extra money, so I’ll be able to facilitate good things in the near future. Weighing the pros and cons, I thought it was definitely a pro. At this stage of the game, I can only give them weekends. I plan to do this weekend work for a long time.

It’s hard when you’re still in training. You don’t make much money, and you still have student loan debt and those kinds of things. One thing I do have is motivation and the ability to work.

Does the locum tenens company pay for your airfare and lodging while you are away from home?
Yes. My only out-of-pocket is for food and entertainment.

more »

 

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Career Move: Concierge physician

Love the idea of greater accessability, stronger relationships and more time with patients?

By Marcia Travelstead | Career Move | Fall 2011

 

Dirk Frater, M.D., practices concierge medicine in Dallas and Jordan Shlain, M.D., San Francisco.

 

NAME: DIRK FRATER, M.D.

TITLE: Physician
EMPLOYER: E. Barrow Medical Group, Dallas
EDUCATION: Graduate of Yale University. Attended medical school at Albert Einstein College of Medicine in the Bronx. Residency at Parkland Memorial, Dallas.
BACKGROUND: Practiced internal and emergency medicine prior to becoming a concierge physician in 2008.

What do you like best about being a concierge physician?
The main thing is that I get to practice medicine the way it used to be and how I envisioned it when I went into medicine. Just having enough time to communicate with folks and take care of problems in an in-depth way. To really be a patient’s quarterback.

Is there anything you don’t like about it?
No. You have to be willing to be available all the time. That shouldn’t be something that throws you off or makes you regret you’re doing it.

Why did you choose to become a concierge physician?
My day-to-day practice required I spend less time with each patient so I could see more patients each day to maintain my income. I finally drew the line in the sand and said I wasn’t going to see any additional patients. It was a combination of having to do what was required to keep up with costs and how that was affecting how I was able to practice medicine.

Do you have any advice for physicians who are interested in the concierge model?
They should be encouraged. There’s more and more opportunity that’s going to be created for smart young doctors who want to work hard and want to really be involved in their patients’ care.

In your experience, do you think a physician new to the profession could begin as a concierge physician?
You have to build up a practice—have a track record, if you will—for patients to be willing to make that kind of move to a concierge practice.

Do you have a hybrid concierge practice?
I’m strictly on a retainer model. My concern with the hybrid model is treating patients differently than others. I want to treat everyone the same.

Was there anything that surprised you?
Mostly just how respectful patients were of my time. There’s still some folks who had a problem and then didn’t call. Part of the reason for me doing this was for them to be able to get ahold of me whenever they need me.

How would a physician get started on the path to becoming a concierge physician?
Speak to physicians who are doing it. There is a course offered by NPI, National Procedures Institute, which is an effective introduction to the topic. I think the key for most concierge physicians is that they really want to practice medicine the old-fashioned way where you are the patient’s main source of information, advice, referral and recommendation for problems large and small. If a physician really wants that kind of involvement, then they should aspire toward this type of practice because that’s what they’ll be able to do.

 

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NAME: JORDAN SHLAIN, M.D.

TITLE: Physician
EMPLOYER: Current Health, San Francisco
Education: Graduate of University of California, Berkeley. Attended medical school at Georgetown University.
BACKGROUND: President, American Academy of Private Physicians (AAPP); Northern California medical director for Lufthansa Airlines.

What do you like best about being a concierge physician?
I have the time and ability to think through a lot of the nuances that is medicine. For example, two people can have diabetes, but their circumstances can be wildly different. I have the time and ability to really get involved. It’s not that I think I’m a better doctor, I just have the luxury of more time. Furthermore, I have the lifestyle that gives me more time off for myself. I get to enjoy my life.

Is there anything you don’t like about it?
No, nothing.

What if a patient needs you on a holiday? Would that be a downside?
Not really. The beautiful thing is the Internet, text messages and the phone—there’s a lot of methods of communication. Part of the promise I make to my patients is that they can always get in touch with me, 365 days of the year. I have partners. If I’m not working that day, my partners are. They still have the ability to contact me if they want. Like any doctor, there are no holidays. You’re always on call, so it’s no big deal.

You became a concierge physician early in your career. Is that unusual?
Totally unusual. As president of the association (AAPP), we give conferences. There’s usually 50 to 100 physicians in their 50’s wondering if they should switch models and go into this. I tell them that as soon as patients buy into a practice, they have the loyalty to the doctor. That’s an asset you can sell someday when you decide to retire or you decide to sell your practice.

So, you don’t have to be an older, established physician to go into concierge medicine?
No, but you have to have the ability to ride it out for a few years. You might only make half of what you’d make in routine primary care initially, but you might triple that amount once you get established. Never take your eyes off the prize. Always deliver on your promise, which is that you’ll be good, available and incredibly helpful. People will pay for value all day long. Health care is no different. Doctors are just small businesses.

What about new physicians who would like to do this?
It’s really hard. You need to have some patients. You need to find a private doctor who’s growing, and join that guy. Make sure you have a good contract and you’re part owner. That could take awhile because you have to build a practice. Once you become established, then you start talking to your patients and put out a survey to see if they would join at $1,000 a year, for example.

Was there anything that surprised you about your practice?
How appreciative my patients were. How much they loved it, and how much they disliked the other model.

What advice would you give physicians who would like to become a concierge physician?
It’s your future. You should invest in yourself. No one is going to look out for you like you are going to look out for you. If you want to be independent and want to have some control of your destiny, this is how you do it. If you want to learn more about it, American Academy of Private Physicians (aapp.org) is a great resource.
Also, don’t skimp on your website. Aesthetics are important.
…Once you do this, it’s so liberating. You can’t believe you ever did it another way.

 

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Hospitalist

Long hours and flexible scheduling mark a hospitalist’s career

By Marcia Travelstead | Career Move | Summer 2011

 

NAME: Clay Schneiter, M.D.Hospitalist, Clay Schneiter, MD

TITLE: Physician

EMPLOYER: Sound Physicians

What do you like best about being a hospitalist?

My schedule. As hospitalists, we work shifts. At the end of the day, we turn our pagers off and we’re done. At my former hospitalist job, I worked seven days on and seven days off, so that was a nice schedule. In my current position, I’m required to work 15 shifts a month. It leaves you with 15 to 16 days off a month. You also have the option of working as much as you want to. For example, you can work 20 to 22 shifts a month. I can work more to make more. However, it’s nice to only be required to work 15 to 16 days so I can see more of my family. The shifts are scheduled for 12 hours from 7 a.m. to 7 p.m. or 7 p.m. to 7 a.m.

I like the ability to practice inpatient medicine as opposed to outpatient clinic practice. I prefer the flow…higher intensity of more ill patients versus clinic patients. I have a good group of people to work with. I practice with about 24 physicians. Eight or nine of us are on during the day. We get along well—it’s a congenial atmosphere. Everyone looks out for one another versus everyone being in for themselves trying to one out somebody for more patients, more money.

What don’t you like about being a hospitalist?

The days can be long. The 7 a.m. to 7 p.m. shift is probably a longer day than for somebody who has their own outpatient practice. For a hospitalist, it’s a 12-hour day opposed to an 8-hour day. With this day-to-day kind of work, I probably see my children less than somebody who goes in a little later. They may have breakfast with their kids and maybe see them a few hours before they put them to bed. Some days, I don’t see my kids at all. I’m gone before they’re up and I’m home after they’ve gone to bed. We have to cover the nights, so that’s a little rough. You can find yourself at 35, 40, 45 years of age and still covering the night shift.

Of those 15 shifts I work a month, three have to be night shifts. Although, nights pay a little better. You’re seeing more patients, you’re probably billing more.

Why did you choose this job?

Originally, schedule. Getting out of residency, I liked the seven on, seven off schedule. I also liked inpatient versus outpatient. For me, it was less boring for lack of a better word.

Do you have any advice you’d give to other physicians who are considering becoming hospitalists?

For hospitalists, it’s a pretty wide-open field in the job market. There are opportunities almost everywhere. So you need to make sure you’re happy in the city or the part of the country you’re in. Hospital work is hospital work across the board. The last place I worked was in a part of the country we weren’t really happy with. I liked the job very much but didn’t like that part of the country. That’s why we moved to Denver, which is more suitable for our family lifestyle. So that would be my advice: Make sure you are happy and your family is happy in the place you’re living.

Was there anything that surprised you about being a hospitalist?

I don’t know if “surprised” is the right word. It can be frustrating to see a patient continuously come back to your emergency room due to bad lifestyle choices after you’ve counseled them extensively and helped them out with the hospital’s resources to get them on track to making the right choices. The taxpayer is responsible for every unfunded, uninsured patient regardless of their lifestyle choices.

The other thing physicians who are getting into this field should realize is that your workload gets harder as years go by. I think there’s a misconception that when you get out of residency, it’s going to be easier. It’s really the opposite. Life gets a little more intense when you’re out of training rather than when you’re in training. The buck stops with you ultimately as opposed to when you’re in training and there’s always somebody to co-sign your order.

How would a physician go about finding a job such as yours?

I’d start with the geographical area you’d be happy in then start the search there. Target where you think you’re going to be happy mentally and emotionally first, and then try to find the job based on that. Others may say to go for the most accredited or widely recognized hospital wherever it is. Maybe you want to work, for example, at Johns Hopkins. Just make sure you’re happy at home first.

Do you have any objective tips on how to land a hospitalist job?

I always use this adage: A good doctor is a good doctor. They’ll find work anywhere regardless of training, background, gender or ethnicity. A good doctor will be well received. Interviews for hospitalists don’t tend to be real intense. I think it’s a buyer’s market for the physician because of shortages. Be yourself, be honest, and if you’re ready to work, there’s a place for you. Stay in the game. Medicine is always changing.

Are you looking for hospitalist jobs? Check out what’s available on PracticeLink.com—it’s FREE to search! www.practicelink.com/jobs/Physician/Hospitalist/

 

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Cruise ship physician

A prime cabin, 24/7 food, diversity and the cruising life await

By Marcia Travelstead | Career Move | Spring 2011

 

NAME: Adriana Yates, M.D.
TITLE: Senior physician
EMPLOYER: Carnival Cruise Lines

Adriana Yates, M.D.

Adriana Yates, M.D.

What do you like best about being a cruise ship physician?
A lot of things. The ship is amazing! As a doctor, you are a senior officer, so you have the best quality of life on board. You have one of the best cabins with a steward to clean your cabin and wash your clothes every day. You have food available 24 hours a day. You are provided with uniforms and have the opportunity to meet people from more than 60 different countries. You can go to different lunches and dinners that are available for guests and crew. You can go to the lounges, shows, work out at the gym or get off at the ports of call. You also have 24-hour Internet access.

What don’t you like about being a cruise ship physician?
The only thing I don’t like is being away from my husband, family and friends for a couple of months. The good thing is that my husband can come with me, but not for long periods of time. more »

 

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