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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On the Move

The motivation and search for a new practice can take a variety of directions

By Karen Childress | Feature Articles | Summer 2012

 

We are a transitory society, and physicians are no exception.

According to a four-year study by health care research firm SK&A, an average 14.2 percent of physicians make a move, retire or die each year‹with some specialties more mobile than others.

It’s obvious that doctors continue to move around for a wide variety of reasons, leaving hospitals and clinics clamoring to recruit their replacements.

Tommy Bohannon is the Divisional Vice President for Hospital Based Recruiting with Merritt Hawkins. “The most prevalent demographic we see contacting us about making a move are those two to five years out of training. They haven’t made partner or bought the big house, and the kids might not yet be in school, so they are more portable,” says Bohannon.

“Right out of training, most doctors settle within 50 miles of where they grew up, where they trained, or where their significant other has family,” he says. “That move often doesn’t work out, so they shift their focus more to the position itself, but they still give significant consideration to community makeup.”

The second most likely group to consider a career change are doctors in the last third of their career. “The kids are grown, and they’re more financially able to make a move,” he says.

On the other hand, older physicians might be looking to step away from leadership or management responsibilities and take a job where they’re employed, even if they earn less and give up some autonomy, in order to live where they’ve always dreamed of.

Physicians in the middle of their careers move for different reasons, says Bohannon. “These doctors contact us essentially saying, “I love where I live, but I don’t love my job.” Rarely, he says, is it the other way around. The middle-age physician often makes a career move for professional or financial advancement, although today many also move to be closer to aging parents or after a second or third child arrives and they realize the benefits of being closer to family. Even in this scenario, however, the details of the practice are a primary concern.

There are many ways to accomplish the goal of reinventing oneself within the realm of medicine, so there is no reason to become professionally stagnant and feel like toughing it out until retirement is the only solution.

These physicians share what propelled them into a career move.

Retiring the uniform

Col. Jonathan Briggs, M.D., began his career as an optometrist. After a year of practicing, he joined the Air Force.

Though he enjoyed employing his skills as a military health care provider, Briggs soon became restless. “I wanted a broader scope of practice,” he says. “I was able to go to medical school at the Uniformed Services University in Bethesda and remain on active duty.”

He finished his internship year, performed military duties as a flight surgeon in South Dakota for one year, completed his ophthalmology residency at Lackland Air Force Base in San Antonio, then did a civilian fellowship in Miami while remaining on active duty.

This was followed by a long military career where he served on the faculty at the residency training program back in San Antonio and became the chief consultant to the U.S. Surgeon General for ophthalmology. “I sort of had two full-time jobs,” says Briggs.

Col. Jonathan Briggs, M.D., used PracticeLink.com and a
specialty-specific job board when looking for a practice after leaving the military. He started his job search two full years in advance of his discharge date.

Taking what he now recognizes as excellent advice, Briggs started his post-military career job search two full years in advance of his discharge date. Briggs and his wife wanted to settle in the Northwest where they both have family. He used PracticeLink.com and the American Academy of Ophthalmology job opportunity website to target his search in that area.

After considering only two positions, Briggs joined the Wenatchee Valley Medical Center in Wenatchee, Wash., in May, 2011, where he practices with three other ophthalmologists. “I knew I didn’t want to open a practice or join a small group because of my stage in life,” says Briggs, who is now 51. “Wenatchee Valley Medical Center has everything I was looking for. It’s a physician-led group, which is important in terms of leadership and perspective, and it’s been around for a long time. We have the infrastructure that will allow us to adapt to changes we know are coming.” The medical center has more than 200 physicians on staff.

Briggs says he would encourage other physicians considering a career transition to think not just about where they want to be in a year or two, but to take a long view. Briggs feels fortunate to have found a practice that works for him. “There have been no issues or surprises, which has been a blessing,” he says. Location is also a critical factor, according to Briggs. “If you’re not where you want to be living, it will be harder to adapt to any difficulties that may arise. We love it here. We like the smaller town and the outdoor activities that are available.”

Related: Interested in making a career move to the military? ow.ly/b9wo2

Family matters

For Arie Marancenbaum, M.D., the motivation to make a career change was largely family related. Upon completing his residency at San Jacinto Methodist Hospital in Houston, he accepted an academic position there and enjoyed teaching, particularly obstetrics. But Marancenbaum’s family had its own obstetrical event unfolding at the time. “My wife was pregnant with baby number three, and that triggered us to realize that we wanted to be closer to family,” he says.

Related: The Trailing Family: Tips to ensure a smooth and happy transition for everyone. ow.ly/aPE6j

Marancenbaum had attended a wound care presentation during residency and became intrigued with how hyperbaric therapy was used to treat chronic and difficult wounds. While interviewing for positions during residency, Marancenbaum had become acquainted with Dr. Han Pham Hulen, who operates Hulen Wound Care Professionals.

“She called me recently about an opportunity to work with her in a clinic about 20 minutes from Dallas, in Rowlett, Texas,” says Marancenbaum. With most of his family and friends living in that area, the decision to leave academic family medicine and accept this new opportunity was a relatively easy one.

Though he misses certain aspects of family medicine and obstetrics, Marancenbaum says he’s happy with his decision to relocate and work in a cutting-edge field of medicine. “It’s very satisfying work. Some of these patients had no hope. They had wounds for months and nobody could heal them, but we can,” he says.

If it sounds like Marancenbaum takes major change in stride, it may be because he’s used to it. Having grown up in South America, he immigrated to the U.S. where he did his undergraduate work at Southern Methodist University in Dallas before completing medical school in Mexico.

When his previously well-to-do family fell on hard times due to business difficulties, rather than going into residency, Marancenbaum returned to Bolivia for a number of years, where he worked odd jobs to help support his parents. While there, he managed to complete several years of surgical training, but political and economic conditions in Bolivia became untenable.

“There was a lot of turmoil, the streets became dangerous; Bolivia was in an economic depression,” says Marancenbaum. He decided it was time to return to the States.

Arie Marancenbaum, M.D., moved closer to Dallas with his family after his wife became pregnant with their third child. “Change is good,” he says. “Sometimes you get too comfortable where you’re at. When you move, it’s an adventure. …The sky’s the limit.”

His parents, now back on their feet in Dallas, had heard about teaching opportunities opening up in Texas. Marancenbaum returned to the Dallas area where he taught first and second grade for several years while studying to apply for a residency in the U.S. “I loved teaching at Routh Roach Elementary in Garland, Texas. A lot of the kids were from broken homes and were low income, but most of them were reading 150 words a minute by the end of the first half of each year,” says Marancenbaum. His teaching career ended when he was accepted into a family practice residency program at the age of 33.

Now 38, Marancenbaum tells other physicians considering making a career change to go with their gut. “Change is good. Sometimes you get too comfortable where you’re at. When you move, it’s an adventure. You’ll meet new people and make new friends. Most of all, believe in yourself. The sky’s the limit,” he says. It’s easy to imagine Marancenbaum offering this same bit of wisdom to his first and second graders. Some sage advice simply applies across the board.

Back to training

For Dan Lee, D.O., making a career change involved a commitment few practicing physicians are willing -or able- to make. After training as a family physician and completing a surgical OB fellowship, he worked for three years with a small group in Harlingen, Texas, where he had C-section privileges and practiced high-risk obstetrics. But something just wasn’t quite right.

“I was not getting the satisfaction out of practicing medicine that I thought I would,
says Lee.”I was getting burned out on the family practice part of it.”

Lee had originally considered an OB/GYN residency, but as medical school came to a close and he surveyed the landscape around him, he came to the conclusion that the demands of the specialty were inconsistent with a healthy family life.

“To me it looked like a career that ruined families because of the hours,” says Lee. ³But a lot has changed in the past 10 years. With the new work hour regulations, families do survive.

“It was a conversation with his uncle, a gastroenterologist, that made Lee seriously consider leaving practice to train in OB/GYN. “I thought it would be an insurmountable thing to do. He really encouraged me by telling me that I was still young and that four years would go by quickly,” says Lee, who was 34 at the time.

With his wife’s full support, he decided to apply to residency programs and see what would happen. Lee was accepted to several, and chose Oklahoma State University Medical Center, where he’ll complete his second full residency in June and return to Texas to practice in the same small town where he originally worked.

“Given there are not a lot of subspecialists there, as a generalist OB/GYN I’m excited about managing complex cases and doing a lot of surgery that I wouldn’t be able to do in a larger city,” says Lee.

One major concern for Lee in making the decision to do a second residency was financial.

He intentionally chose a program that allowed him to use his family medicine skills to moonlight in urgent care centers and rural emergency departments. “That gave me confidence going in,” says Lee. “It’s unrealistic to have a family on a resident’s salary.”

He and his wife, Sarah, have two small children. Sarah works part time as an occupational therapist. Lee has been chipping away at his medical school loans, and is happy with the fact that he’ll be able to pay those debts off more quickly now that his earning capacity will be higher as an OB/GYN.

“I didn’t do this for the money, but there is a difference,” say Lee.

Lee offers a couple of precautionary notes related to returning to residency. “If you’re promised that you’ll get some credit toward residency for years that you’ve practiced, get that worked out prior to starting the program,” he says. “I ended up doing the full four years.”

He also says doctors should be prepared to receive no special consideration for having been in practice. “It kind of surprised me that first year that I was treated like an intern,” says Lee. “I still had to follow the chain of command. That was a little frustrating. It felt sort of like the faculty wanted to make sure I knew who was boss.”

Asked what advice he might have for physicians considering changing course in terms of specialty, Lee recommends paying attention to sustained desire.

“If it’s not a fleeting idea, you’ll make it work,” he says. Though he has experienced some stress during his second residency, Lee says it’s been much easier than the first time around.You know how to manage patients more efficiently and your knowledge base going in is much better,” he says.

Though this does make for better time management, Lee admits his hours are long, but says his satisfaction level is high. “My wife tells me I seem much happier now, even though I’m working more hours than when I was in practice.”

Following a call

Upon completing his OB/GYN residency at Parkland Memorial Hospital in Dallas, Victor Obregon, M.D., was in private practice in Seattle for 15 years, during which time he and his family made medical missionary trips to Papua New Guinea. “When we were there for the second time, we knew we’d be back longer term,” says Obregon.

After much prayer and several years of planning, Obregon closed his practice in 2007 and he, his wife, Lori, and son, Alex, then 12, embarked on a four-year mission sponsored by the International Church of the Foursquare Gospel to Papua New Guinea. During his work on the island, located just north of Australia, Obregon and a team of medical professionals (including Sarah, who is an RN), worked with locals to set up medical outreach programs. “We ran them at first, then together with the local people, and the last year or so we were just helping out to get them to the point where they could function on their own. A lot of what we did was networking with the local government and fundraising,” says Obregon.

About once a month, the team would go into remote areas of the island for three to four days at a time to provide medical care. “We did mostly ambulatory tropical medicine and an occasional minor procedure,” says Obregon.

Knowing that he’d eventually return to the U.S., Obregon maintained his Washington State medical license and board certification status. As his missionary work came to its inevitable end, Obregon began contacting health care organizations around the Seattle area. “MultiCare got back to me right away,” he says. It took several months upon returning to the U.S. to complete the interviewing and credentialing process, and he started working for MultiCare, a nonprofit health system with numerous clinics and hospitals in the greater Seattle area, in April of 2011.

It was an adjustment returning to the U.S. after four years abroad, and practicing within a large system required an adjustment after being in private practice. But Obregon is happy with his decision.’

“Thankfully, I’m working with a good team,” he says. Because he had been out of mainstream practice for several years, Obregon initially had a proctor who operated with him and observed his obstetrical work. But after just a few months, he was granted full active hospital privileges. “Had I stayed out longer, more than five years, I would have needed to be retrained,”says Obregon.

For physicians considering taking a break from traditional practice to do volunteer work, Obregon says they should be thoughtful in their decision-making. “If you have an idea that a change is coming, take your time. Make sure that everyone in the family is on board,” he says. “Seek counsel from people who have done it, and make sure it’s the right time financially by going over everything with your accountant.”

Obregon, now 52, says he misses the friends he made in Papua New Guinea and still finds himself thinking in the language of the island.

“This was the most important thing we’ve done in our lives,” he says of his experience abroad. “I have incredible memories…caring for sick babies who probably didn’t make it past their first year, but at least they got to be held and sense that they were loved. They got to see what compassion looked like.”

Stepping up to leadership

Relocation isn’t always necessary for a physician seeking a career change. Sometimes you can grow right where you’re planted. Such is the case for two physicians at Boice-Willis Clinic, one of the oldest private multispecialty groups in North Carolina.

Rheumatologist Nicholas Patrone, M.D., has practiced at Boice-Willis for 22 years. For 13 of those years, he’s worked in an administrative capacity, most recently for five years as chief medical officer and president of the organization, while also providing direct patient care.” This year, I’m transitioning out of being CMO, but will continue as president for another three years,” says Patrone.

At 59, Patrone says it’s time to work a little less. Until recently, it wasn’t unusual for his workday to begin as early as 5 a.m. and end with an extra hour or two at the end of each day to keep up with all of the administrative work. “As president, I’ll deal with policy issues, work with the three local medical schools, and deal with interdepartmental issues,” says Patrone. Over the course of a year, day-to-day CMO duties are gradually being handed off to internist Martha Chesnutt, M.D. “If we’ve recruited another rheumatologist by the end of this year, I may cut back to two to three days a week of patient care,” says Patrone. “I’m ready to have some free time.”

Chesnutt completed her residency at the Greenville Hospital System in South Carolina in 2003 and has been with Boice-Willis ever since. “I was attracted to the fact that it’s a multispecialty clinic where good doctors practice good medicine,” says Chesnutt. “I knew pretty quickly that I had an interest in clinic operations.”

Chesnutt pursued leadership education by attending courses offered by the American College of Physician Executives; through the clinic’s medical liability carrier where she learned about risk management, disruptive physicians, and doctor-patient communication; and through her state medical society. Chesnutt began serving on the Boice-Willis executive committee in 2009.

Taking over the role of CMO feels both exciting and challenging for Chesnutt. “We’re going to be making a lot of changes to meet new requirements,” she says. “I foresee that quality will be a big indicator for reimbursement.” Chesnutt views the fact that Boice-Willis is a freestanding multispecialty clinic as both a strength and a potential weakness, given the changing health care environment. “When we’re together on issues, we’re unbeatable. When we get fractionated, we need to find a common goal to reach,” she says.

Related: Do you need more training in the business of medicine? Learn more about physician MBA programs: ow.ly/b9A3k

Chesnutt has assumed responsibility for a number of departments within the clinic, and by the end of the year-long transition will be managing all of them. She and Patrone meet weekly to ensure an orderly transition. “He’s my mentor,” says Chesnutt.

The somewhat daunting task of getting more than 50 health care providers to embrace change and new technology is interesting to Chesnutt, as is recruiting. “We’re always looking for family physicians, and right now we’re recruiting someone for pulmonary and critical care, as well as for a rheumatologist,” she says. “In the past, we’ve not used many physician extenders, but we’re getting our doctors used to that.”

Ultimately, Chesnutt will spend 30 to 40 percent of her time in the CMO role and continue to see patients during the remaining time. “I would not have credibility if I weren’t still seeing patients,” she says. “If I’m going to be managing physicians, it’s crucial to have a clinical practice.” She advises any physician interested in taking on a management role to avail themselves of the many resources that are available, such as serving on hospital committees to gain leadership experience and taking courses through the ACPE and specialty societies.

For his part, Patrone is delighted to be passing the baton to his younger colleague. “I’m from a different generation of doctors,” he says. “This is such a relief to me. As I phase off responsibilities to Martha, I feel like storm clouds are being lifted off my shoulders.”

The last article Karen Childress wrote for PracticeLink won the 2012 Gold Award for Best How-To Article from the American Society of Healthcare Publication Editors. Read the winning article, Your Ultimate Job-Search Guide, at ow.ly/aPCYR.

 

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Here’s to your health!

North, West, East and South, American cities and hospitals large and small are working to ensure better, longer and healthier lives.

By Eileen Lockwood | Live & Practice | Summer 2012

 

In recent years, gerontology researchers have trekked into a remote mountainous region of Sardinia to interview one of the largest groups of long-lived people in any single area of the globe.

How did they stay healthy for such a long time, and what can other populations do to emulate them? Is it gene selection controlled by isolation? In one area, outside contacts have been almost non-existent since the 11th century. Or is it diet and hard work?

As one 103-year-old told writer Jason Wilson, “Everybody wants to know the secret, but there is none.”

That doesn’t quell the search for answers.

PracticeLink selected four “healthy” cities to learn about reasons for their citizens’ robustness, including the role played by medical professionals. Not all of their approaches are quite the same.

Each city and its hospital(s) have developed programs and activities to promote healthy living. But equally important, each in its own way has become a mecca for physicians seeking new locales and challenges.

Good health—or else!
Burlington, Vt.

When 92 percent of a city’s residents say they’re in good or great health, there has to be a reason—or many reasons. In Burlington, Vt., the explanation combination may start with the fact that Vermonters are legendary for their sturdiness. Abundant opportunities for outdoor activity also play a large role. But the trump card in recent years has been an all-out campaign by the medical community to promote wellness practices.

To set the stage, “It’s a very health-conscious town, and a very active town,” says Steven Grant, M.D., an internal medicine hospitalist with Fletcher Allen Health Care (FAHC) for 12 years.

“For the kind of people who want to come here, it’s a little bit of self-selection. They like a smaller place, a place where having the outside is part of their priorities and where it’s not just fast food around the corner.”

In an arrangement unusual for a small city, FAHC is one arm of a medical “empire” including 30 patient care sites in nearby towns and rural sections of Vermont as well as towns across Lake Champlain in northeastern New York State. FAHC is also the teaching hospital for the University of Vermont’s College of Medicine. Both are on the same campus.

“If you were a ‘triple-threat doctor,’” Grant points out, “meaning clinician, teacher and researcher, you could be doing your research, go to the hospital and meet medical students, all right there, all walkable, all in one place.”

Steven Grant, M.D., has been with Fletcher Allen Health Care for 12 years. The hospitalist enjoys skiing, snowboarding, snowshoeing, hiking, running—and mountain biking. The culture and environment in Burlington, Vt., offers numerous outdoor opportunities.

Clinical convenience aside, he talks enthusiastically about the great outdoors and the ease of getting drawn into the skiing, boating and hiking crowd. “Burlington is in a beautiful location—a city on a big lake and surrounded by mountains on either side. You have the Green Mountains here in Vermont, with beautiful rolling hills, and on the New York side, the Adirondacks, which are bigger and much more rugged.” Plenty of outdoor opportunities—and they all meet his good-place-to-live specifications.

Although he went south for medical school and residency at Emory University in Georgia and Charlottesville, Va., growing up in the Detroit area and attending the University of Michigan cemented Grant’s outdoor preferences. “I grew up in snowy winters, and I was a skier. Snow sports were one of the things that definitely attracted me to the Burlington area.” His more recent favorite, though, is snowboarding. “I switched when my daughter (now 14) was just learning to ski. I said, ‘I need to learn something, too, so then we’ll both be learning.’”

But his outdoor pursuits don’t end there. Add snowshoeing, mountain biking, biking to work, hiking and running, plus “doing weights a few days a week.” He concludes, “I like to keep some variety going. And if you ask most of the doctors I work with, they all do the same. It’s just part of the culture.”

The long-term, overriding reason for the region’s good health probably lies in the many and aggressive efforts by FAHC to establish programs encouraging healthy practices by residents. Penrose Jackson, director of Community Health Improvement for the hospital, ticks off some of the initiatives covered by her team, which has grown from about two members in the 1980s to more than 60 now: Poison prevention, child passenger safety, pre-diabetes and diabetes checkups, early hearing screenings for babies and children, tobacco cessation programs. Most ambitious, though, are three more wide-ranging efforts.

Aggressive Community Health Teams teach people to take better charge of their own health and be better proactive patients. “The results have been pretty remarkable around reduction of admissions and readmissions to the hospital,” she reports.

A community needs assessment partnership with other organizations is a brief intervention program available to some 150,000 persons in the hospital’s care area.

FAHC is also a major player in the Vermont Blueprint for Health. It features health teams, including physicians, that establish medical homes so patients can have their care monitored, learn about services they may not have known about and be reminded of routine tests.

Grant’s own career “journey” began with a suggestion from his wife, a UVM graduate, that he might like the town. “I took one look around during a beautiful sunny day,” he reminisces, “with all of the Christmas lights on downtown in our cobblestone-street mall, and I said, ‘Yeah, I think this town will do for me.’”

The influence of students and faculty from the city’s colleges has generated a lively town atmosphere that includes unusual restaurants, concerts by nationally known groups and a large jazz festival every summer. Grant points out that there’s plenty of big-city activity just an hour and a half away in Montreal. As he summarizes, “It really is a paradise of different opportunities that you can have here.”

Though colleges and the hospital are the mainstays of the local economy, the Burlington region supports almost one-third of Vermont’s manufacturing employment, which includes everything from electronics industries and health care software to the Vermont Teddy Bear Company, now a worldwide provider of the cuddly pets. The area is also headquarters for one of the largest commercial oven companies in the U.S., a snowboard manufacturer and Bruegger’s Bagels.

As for the city’s “hale and hearty” status, the secret is out. Gallup-Healthways surveys cite it as one of America’s Top 10 well-being smaller cities. Among other kudos, Men’s Health Magazine has christened it number one.

The lure of the ocean
Oxnard, Calif.

After working several years in Palm Springs, Calif., including a few as assistant medical director of the Desert Regional Medical Center there, Jeffery Davies, D.O., answered to the call of the sea—and an excellent job opportunity. A year ago, he relocated to the Oxnard area, where he accepted the position of chairman and medical director of the ER at St. John’s Pleasant Valley Hospital in Camarillo, the sister institution of St. John’s Regional Medical Center in nearby Oxnard.

“My wife is from this area,” Davies explains, “so that’s probably the biggest pull. I wanted to be closer to her family, closer to Los Angeles (about 60 miles away)—and to the ocean. I thought, ‘This is the place I could live for the rest of my life.’” Lifestyle possibilities and his professional goals seemed to be in sync.

Jeffery Davies, D.O.

With a recent change in hospital leadership, the goal, he says, was to rehaul the entire medical system and upgrade the quality of care. “I liked the chance for problem solving and to grow the ER,” he says.

Davies cites upgraded cardio procedures as one good example of the new regimen. Medical involvement doesn’t stop when atrial fibrillation patients go home, he says. “Now we’re trying to improve communication with their primary physicians every time they come into an ER situation. For every single patient, an automatic copy of the procedure is sent to his or her physician, including every single medicine we’ve prescribed. We also have an educational discharge program,” he says.

Promoting good health is an ongoing activity throughout the St. John’s domain, such as through anti-diabetes and obesity education programs among youths and a Healthy Beginnings program for mothers-to-be.

A perfect growing climate enticed farmers to the area, and at the nearby Oxnard Harbor District, the Port of Hueneme attracted the attention of the U.S. Navy in World War II and major shippers after that. Today, cargo worth some $7 billion passes through every year, and 4,500 jobs in the county are related to these shipping activities.

Green technology and recycling are also part of the area’s fabric. Two examples are the greenhouses of Houweling’s, where probably billions of tomatoes are grown hydroponically under glass, and Gills Onions, one of the U.S.’ largest family-owned onion growers. Then there’s Agromin, a huge “organic management” company that produces “rich, living compost,” mulch and other top-notch products for farmers in the area.

“In Michigan, the place shuts down in the winter, and there’s pretty much nothing you can do,” Davies says. “Here you can get out every day and walk and hike and play golf and do all the other great outdoor things.” Not to mention excursions up the coast. As he says, “It’s a great, great opportunity and a great location. I was handed a golden gem. It’s called the Gold Coast for a reason.”

Along “Tobacco Road”
Raleigh, N.C.

In spite of being one of the country’s largest tobacco-raising regions, the North Carolina “Research Triangle” of Raleigh, Durham and Chapel Hill is viewed as one of the healthiest areas in the state, according to Alan Wolf, the media relations coordinator at Rex Healthcare, one of three large hospitals in Raleigh. Each city is home to a major university well-known for its strong scientific investigations.

The Gallup-Healthways sleuths have dubbed this City of Oaks (nicknamed for its many trees of the same name) one of the healthiest large cities.

A good place to pinpoint some reasons might be the Senior Health Center operated by Rex Healthcare in southeast Raleigh. Its director since 1985, Leroy Darkes, M.D., has been an energetic crusader for wellness among a large African American community. An Atlantic City native with undergrad and medical degrees from Rutgers University, Darkes made his way South after several frustrating years with HMOs in Camden, N.J.

At that point, he reminisces, “I got a call to come down to Raleigh, and I came out of curiosity.” His reaction to a Rex offer: “I was actually thrilled.”

The assignment was to develop an inviting medical “home” that would provide treatment and tests, plus instruction on healthy living. “My mission,” he says, “was to build some bridges in the community that really had felt disenfranchised—and to be consistent and persistent.” At a gathering to discuss goals for the new center, one participant was the general manager of a local radio station. “I’ll get you on the air once a week,” he promised Darkes. Here was a golden opportunity to connect with potential patients and explain benefits of the facility.

“Long story short,” says Darkes, “I’ve done more than a thousand hours of community broadcasting. It has become a significant staple as far as dissemination of essential information. Once folks started calling in, it became rather addictive.” Before long, he was explaining his mission from the pulpits of churches, enlisting civic organizations to help promote men’s awareness of, among other things, free prostate screenings. Screening sessions were set up at churches. “I chose prostate as our vehicle,” he reports, “but the principle could be (and was) applied across the board.”

Twelve acres of woods, gardens and lake comprise the grounds of the Umstead Hotel and Spa in Cary, N.C., just outside Raleigh.

Besides Rex Healthcare, Raleigh is home to two other hospitals, each promoting better health practices.

WakeMed Health & Hospitals has been aggressive in developing new treatment methods and speedier access to necessary care. It opened North Carolina’s first freestanding children’s emergency department, and has a dedicated ICU, both staffed 24/7 by pediatric intensivists. Among adult services, it became an early participant in mothers’ milk banks, has one of the highest-volume heart centers in the U.S.—and the sole neuro-ICU in the county.

Duke Raleigh Hospital, a sister facility to the large Durham institution, offers a variety of better-health activities, events and lectures, holds an annual community education event focusing on heart disease, a free-care clinic for uninsured adults and special diabetes programs for women and the Hispanic community. It also sponsors a weekly farmers market from April to November.

Rex Healthcare, opened in 1894, derives its name from an 1800s tanner, John Rex, who bequeathed building funds. Today’s mix includes a satellite in nearby Cary. Besides Darkes’ senior center, Rex’s activities include a few other good health stories. For instance, thanks to a chef’s initiative, all fryers were removed from the kitchen in April, the first such action in the state.

All of the above are enhancements to the beauty and charm of North Carolina’s tree-filled capital. Gracious Victorian and early 20th-century homes dominate a 30-block area, Historic Oakwood, where spring and Christmas tours are reminders of the gracious days of yore.

Children might yawn among Victorian houses, but not in Pullen Park, a downtown green area with kiddie-style train and 1911 carousel. There’s a lake with pedal boats and other rides. The park borders the Pullen Aquatic Center and a hiking trail, additional enticements for healthy activities. The Greenway network system is also a popular walking and biking area.

For the culturally inclined, Raleigh provides theater, ballet, symphony and opera—but the Triangle has a clamp like no other area on the college basketball scene. From North Carolina State University in Raleigh itself to Duke University in Durham, the University of North Carolina in Chapel Hill and Wake Forest University in Winston-Salem, the “Big Four” routinely reach NCAA tournaments. Fans respond accordingly. And—big surprise—the territory linking this quartet has an appropriate nickname: Tobacco Road.

The Iowa Way
Cedar Rapids, Iowa

“Iowa has the richest land, the lowest illiteracy rate . . . and the most moral and forward-looking cities of all the States.” That’s a quote from Sinclair Lewis’ Arrowsmith, the Pultizer Prize-winning novel about a young Midwestern doctor trying to make his way through a career life more complicated than he had expected. Its copyright is from 1924.

The world today is 1,000 percent different from the era Lewis wrote about. But to a certain degree, the description of Iowa still seems apropos.

Stanley Mathew, M.D., can attest to it. Mathew, whose parents immigrated to New York City from India, has had a much more cosmopolitan upbringing than the young Martin Arrowsmith. His medical degree is from the Medical University of Lublin, Poland, followed by residency at New York Medical College. Along the way to his current position at St. Luke’s Hospital in Cedar Rapids, Iowa, he co-founded a firm that, as he describes it, conducts clinical trials and services pharmaceutical clients in drug discovery and development.

Seeking work in 2009 after his residency, he learned of an opening with St. Luke’s. From the beginning, it was a fit. “I came out for an interview that went phenomenally,” he reports. “New York City is a great place. I never thought I’d leave, but when I finally moved to Cedar Rapids, I couldn’t believe how nice, accommodating and warm the people were. The New Yorker in me thought it was all a façade, but the longer you live here, the more you realize it’s the real deal.”

Stanley Mathew, M.D., did his residency in New York City—and never thought he’d leave it. But after an interview brought him West, he made his home in Cedar Rapids, Iowa.

Among other discoveries: “There are more bike trails and joggers than I have ever seen. There are a lot of very nice parks in the area that have great walking trails.” This lifestyle coordinates well with his specialty, physical medicine and rehabilitation. “We talk a lot about exercises,” he says. Mathew follows his own advice, taking advantage of “more opportunities to be outdoors, going for hikes and heading to the gym a few times a week.”

The city itself, second largest in the state, offers a multitude of opportunities for outdoor exercise and fun, including 74 parks, miles of trails, golf courses and aquatic centers. Opportunities multiply at the nearby Pleasant Creek State Recreation Area for hiking, biking, snowmobiling, cross country skiing and horseback riding.

It all verifies the area’s high ratings in the annals of healthy cities. So does RAGBRAI, an acronym for the Register’s Annual Great Bike Ride Across Iowa.

In the meantime, numerous good-health incentives are incorporated into the general routines at both Cedar Rapids hospitals, St. Luke’s and Mercy Medical Center. Among other efforts, Mercy schedules adult vaccinations in its lobby, has held a Save Your Lungs event at a local mall and was the first hospital kitchen in the region to replace its deep fat fryers with convection/steamer ovens.

St. Luke’s “healthy roster” includes programs on childhood obesity, blood pressure checks and fund-raising walks. “There’s also a nice track on the hospital’s third floor,” reports Sarah Corizzo, the media relations specialist. “It’s mostly for heart rehab patients, but city people can use it, too.”

If Mathew needed any additional proof of hardworking, indomitable Iowans, his best example could be the city’s recovery efforts after its worst-ever flood of 2008, when water rose 31.12 feet and inundated more than 7,100 properties in a 10-square-mile area, at least 14 percent of the whole city. Four days later, 2,680 local residents attended three public open houses to discuss plans for recovery, reinvestment and revitalization. Four years later, several new and rehab projects are complete, and the work continues.

Says Mathew: “Over the last two years, the city has become more vibrant, with more restaurants and stores opening up in downtown, and the rest of the city is still growing and doing well.”

Business and industry are also doing well. Cedar Rapids is noted as the largest corn-processing city in the world, not a surprise to anyone who has passed farm fields in late summer. It’s also the second-largest producer of wind energy in the U.S., and one of North America’s leading bio-processing and food ingredient centers. But the best news may be that employment is expected to grow 14.2 percent within three years, the strongest forecast of any American metro area.

Also alive and very well is its cultural and recreational life. The city is part of the Iowa Cultural Corridor Alliance, which includes 150 organizations in 11 eastern counties. Orchestra Iowa has been a staple since its founding in 1921. There are performances at the opera theater and plays in at least four theaters. A children’s museum keeps company with others devoted to history, African American culture, art and collectible cars, as well as a museum and library devoted to the state’s large Czech and Slovak heritage.

And, just for fun, there’s the whimsical Cedar Rapids slogan: “City of Five Seasons.” It all started in 1968 when an advertising agency touted the city’s short commute time as evidence that there’s more time for enjoying life—a fifth season.

Eileen Lockwood is a frequent contributor to PracticeLink Magazine.

 

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Love where you land

By Teresa Odle | Feature Articles | Summer 2012

 

Justin F. Klamerus, M.D., thought he would be content to remain at Johns Hopkins after his medical oncology training and join the hospital’s lung cancer faculty.

Like many young physicians, Klamerus’ plans changed, and he returned to his roots in northern Michigan, where he’s putting his skills and training to good use as director of cancer services for a collaborative group of cancer centers that includes Northern Michigan Regional Hospital in Petoskey.

Plans change for many reasons. Sometimes the reason comes out of the blue, or in an unexpected job offer, or when a young physician realizes a year or two into their first job that it’s not a good fit.

Elizabeth Bell, Director of physician services, Corvallis Clinic

Preventing a problem from occurring in the first place saves time, money and trouble for everyone, especially if a physician leaves soon after they’ve joined. “It’s really hard on patients, particularly with primary care providers,” says Bell.Often, it’s as simple as the weather or distance from home and has nothing to do with colleagues, patients or the work. No matter the reason for the disillusionment, poor fit with both the employer and the community often can be prevented.

The best way for young physicians to prevent repeating mistakes made by those who’ve come before is to learn from colleagues and pause to prepare for job interviews and transition to practice.

“As with most anything in life, including when a medical student makes the transition from classroom learning to learning with patients, there is a big leap,” says Klamerus. “I think the same leap exists for young physicians entering their first job.”

Retention wreckers

Employers understand the damage caused by physician turnover. Keeping physicians happy is a big priority. And most physicians enter their first job searches with big ideas about long-term relationships.

Still, there are too many variables and unknowns for every first job to work out right.

Derrick R. Ward, M.D., became a partner at Kansas City Allergy & Asthma Associates, P.A., after two years. “You have to know the situation you’re getting into when you join a practice,” he says.

“Most people have no idea what questions to ask, how to go about the process, and how to figure out for themselves what sort of environment they really want to be in.” says Lawrence D. Ward, M.D., MPH, FACP, an internist who recently began a position as vice chair for clinical practice at Thomas Jefferson University Hospital in Philadelphia and is current chair of the American College of Physicians Council of Young Physicians.

In his previous position on Temple University’s faculty, Ward helped conduct yearly meetings to talk with residents about timelines for applying and focusing on practice choices. He has heard young physicians talk about issues such as lack of support or flexibility in their first jobs.

Of course, it can be tough to make the transition from residency to practice, and that can be compounded when a job doesn’t turn out quite as expected, when expectations are misaligned, or when the community turns out to be a poor fit.

“You have to know the situation you’re getting into when you join a practice,” says Derrick R. Ward, M.D., a board-certified allergy, asthma and immunology specialist with Kansas City Allergy & Asthma Associates, P.A.

He has been with the five-physician practice—his first job—for nearly five years, and became a partner after two years.

When Derrick joined the Kansas City practice, he says he felt confident clinically, but less prepared for the day-to-day operational aspects of running a business. “I feel like you don’t really get that in medical school,” he says. “You’re trying to learn everything else, and there’s not a lot of time to learn business at the same time.”

Preventing problems

Make the most of the support you have while still in residency to prepare for your job search and prevent some future surprises and disillusionment.

“Read articles that tell you the questions you need to ask and think about,” says Lawrence Ward. (See sidebar at right.)

Derrick Ward says it helps to talk with physicians close to your age who understand the current climate and who have been hired recently. They can help you understand average salaries and current bonus structures, relocation and how most practices handle weekend call with new physicians.

“You need comparable numbers and comparable experiences,” Derrick says. He adds that when he started looking for a job, he sent e-mails to graduated fellows he knew and talked to others. “And I have tried to do the same thing for people who have come to me after I left training.”

Deborah M. DeMarco, M.D., FACP, associate dean for Graduate Medical Education at the University of Massachusetts Medical School, says that her administrative director often helps young physicians out.

Related: What to do when starting somewhere new: ow.ly/aPx9y

The university also offers practice management workshops for all of the university’s 500-plus residents to help with skills such as looking at a contract and what to look for in a practice.

Formal help from programs to prepare you for your job search and the reality of practice vary.

Klamerus says that the Association of American Medical Colleges has recognized the need for business training by putting forward core competencies that address system-based practice issues. How formal the business preparation is depends on the residency training program, says DeMarco. “For example, family medicine programs have as part of their accreditation requirements that they have to have a practice management curriculum.”

Take advantage of the resources offered while you’re in training. The University of Massachusetts Medical School, where Deborah M. DeMarco, M.D., is associate dean for Graduate Medical Education, offers practice management workshops for residents.

The recruiters and other contacts you meet when interviewing can also help.

“Obviously we all tend to sell our organization, but we’ve got to be transparent about what young physicians will experience when they get here,” says Bell. “Because if they get here and it’s not what they understood it to be, they’re going to leave.”

Once you start at the practice, it’s often up to you to seek help from mentors and others.

Derrick Ward says he is fortunate to have an excellent administrator who helped explain to him how to read financials, for example. Some employers have formal orientation and mentoring programs to provide resources to new physicians.

Bell says Corvallis Clinic believes in a team approach. “We have a group of people, not just a physician, be mentors to our young physicians,” she says. The formal program includes checking in with the physician regularly on issues such as staffing and information technology.

The clinic even provides new physicians a “cheat sheet” at the end of orientation with photos of key staff and contact information to make it easier for them to get help. A practice development committee meets quarterly to review the young physician’s progress. You can take informal steps on your own initiative to garner similar support at a new job.

Give pause

Katherine Pryor, senior physician recruiter for the UMass Memorial Medical Center in Worcester, says that in spite of repeated visits and discussions with physicians and their spouses, some just find the location unsuitable.

“We tell them to first talk to each other about where they want to be,” she says. For instance, do they want to be near their parents?

Bell says that the number-one reason her practice has lost first-time physicians is because they had moved away from their families.

Klamerus emphasizes that, before selecting practices to talk with and forming questions to ask, you should pause for self-reflection.

“I think a lot of young trainees make decisions to go to undesirable areas they don’t want to live in, their family doesn’t like, or that are too far from their family—yet they take the job because it pays well or because of some short-term gain from the decision,” he says.

Pryor agrees, adding that some young physicians “go for the gold” partly because of enormous loan debts. “I don’t know if they give enough thought to: Do I want to live here; can I get along with these people; do I want to work with these people?”

The self-reflection period before the search begins definitely should involve those most impacted by the decision, namely spouses. “We encourage physicians to bring their spouse or significant other to our practice management seminar,” says DeMarco. It also helps to include a mentor—the peer who can help keep you grounded in the reality of today’s practice and offer expectations.

When it’s not working

Self-reflection can help if you feel trapped in a bad first job, too.

Klamerus advises people to pause and “think about the reasons for their dissatisfaction, what those really are.”

Sometimes, there are issues that physician leaders can address, such as compensation or weekend time off. Other issues are not so easy to fix—like the area’s climate or geography.

“A job is not like a residency,” says Lawrence Ward. “You’re not locked into it.” He says young physicians should go into the job search with this frame of mind: If you get into the position and realize you have made a mistake, first try to work it out. But if you can’t do so professionally, realize you can leave. Ward says knowing it’s OK to change takes some of the pressure off.

“They feel so much anxiety in choosing that first job, and they want to get it perfect. Sometimes it’s just not perfect. And sometimes it’s necessary in a professional way to change jobs.”

(Before you make a decision to restart job search, do be sure you fully understand the implications of ending your agreement.)

Self-reflection can also help you decide if any disillusionment is from general adjustment to practice or specific to the practice, colleagues or situation.

Unless you based your decision purely on compensation or geographic location, there probably were some characteristics about the practice and physicians that attracted you in the first place, and it might be time to reflect on those as well.

If the decision was based purely on compensation, that’s a lesson for your next search.

Derrick Ward warns against making a decision based purely on geography if possible. He says young physicians who do should be sure they have not signed a contract with a non-compete clause. “These can really hamstring you if you leave the practice; there’s a good chance that you’ll have to leave town because the clause can lock you out of the geographic area.”

Most of all, physicians who are unhappy should work with the practice to correct whatever is fixable and maintain the same openness and transparency that’s most valued during the job search, even when departing.

With all that Bell orchestrates at Corvallis to help new physicians, some still have issues, but remain silent about their concerns.

“I check in often with new physicians,” says Bell. “I invite them to my office for coffee, have lunch with them; we talk a lot. In spite of that, I occasionally get people who are unhappy after 18 months, but have never said a word.”

Bell says that all young physicians should talk about their concerns and give the organization an opportunity to fix things for them. She adds, “You need to be really frank with people about how things are going for you, and if they’re not receptive, you’re in the wrong place.”

Klamerus says that carefully thinking about long-term goals before the initial job search can help prevent much turnover among young physicians. “What are your five-year, 10-year and 25-year goals?” he says. “It sounds cliché to say that, but it should be in every part of the decision you make.”

And if the first job doesn’t work out, Klamerus adds: “Life is too short to be in a job that you’re not fulfilled by. You should remedy that because you won’t be good to us if you’re not satisfied.”

Related content

For more on managing your first year of practice, these PracticeLink articles can help.

Who’s the happiest?

10 signs of a well-run practice

Setting up a new practice

Create a free physician profile: PracticeLink.com/Physicians

For more helpful career content, please visit PracticeLink.com/Magazine.

Teresa Odle’s last feature for PracticeLink Magazine was “10 signs of a well-run practice”. Read it here.

 

 

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What Employers Want

The small details that can help you land the job you want

By Karen Edwards | Feature Articles | Summer 2012

 

When Linda Welniak, M.D., left residency, she went to work at a family medicine practice in Milwaukee, where she happily worked for the next 15 years. When the economy tanked a few years ago, however, the small group she worked for had to downsize. “I was let go, and for the first time since residency, I had to look for work,” she says.

Not only did Welniak face contractual restrictions, but she found herself competing for jobs with younger physicians. “It wasn’t easy,” she says.

Downsizing, a competitive specialty, a spouse relocation, a move closer to family, completion of training, or other circumstances may have you, like Welniak, joining the ranks of job-seeking physicians. And when that happens, you’ll want to be ready.

But let’s face it. There is a physician shortage today, and just about any resident will tell you they spend almost as much time fielding job offers as diagnosing patients.

However, when you’ve got your eye on a particular location, employer or experience, you’ll want to set yourself apart from the competition. That’s when it pays the most to consider the small details that can make a big difference in hiring decisions.

Here’s what employers really want.

Lara Pierce, M.D., left some old but relevant information on her CV to show potential employers that she had ties to the area. Local ties can move your CV to the top of the stack.

Candidates who know what they’re looking for

Before starting your search, the first thing you should do is sit down—with a significant other if you have one—and determine what kind of job you want and what kind of place you want to work in, says Patrice Streicher, an associate director with Vista Staffing Solutions.

“Assess what you want, then you can better target your search,” she says.

What you should look for is a cultural fit with your personality. Just knowing if a place is right for you, she says, will affect the way you approach the interview and ultimately the job.

Lara Pierce, M.D., a third-year family practice chief resident at Clarkson Family Medicine in Omaha, made location her first job-search priority. She knew she wanted to return to her home state of Texas, in a rural practice close to the Fort Worth area. She also knew she wanted to do obstetrics. Determining all that ahead of her job search was helpful, she says. “It helps you weed through the phone calls and emails you receive once you begin residency,” she says. “I called clinics and hospitals in the area where I wanted to move and asked if they would have positions opening soon.”

Well-organized documents

Once you’ve decided what you want, your next step is to polish your résumé or CV. A résumé is not a curriculum vitae, although most physicians and recruiters use the term interchangeably. The résumé is a short, one- to two-page listing of skills, experience and education.

The CV is a summary of educational and academic backgrounds, teaching and/or research experience, publications, presentations, honors, awards, affiliations, etc.

“If this is your initial contact with the employer, use a résumé,” says Streicher. “Then follow up with a CV.”

Before sending a résumé or CV, Eric Dickerson, managing director for Academic Physician Recruiting Practice, suggests having others review it first. “You’re more likely to catch typos and spelling errors, which can turn off prospective employers,” he says.

Another turn-off is a disorganized CV.

Debbie Gleason, in-house recruiter for The Nebraska Medical Center

Debbie Gleason, in-house recruiter for The Nebraska Medical Center, suggests listing work positions in reverse chronological order so your current position is at the top. Put your training in sequence as well so your medical school training doesn’t suddenly appear in the middle of your residency.

“You don’t want an employer to pull out a sheet of paper to figure out your CV,” says Gleason.

Related: Is your CV helping you? ow.ly/aPnGH

Candidates with ties to the area

If you really want to make an impression, add what recruiters refer to as “BLT” to your CV or cover letter.

“It stands for born, licensed, trained,” says Scott Manning, director of provider recruiting at District Medical Group in Phoenix.

If you’re looking for a position in a certain area, list any of the BLTs you may have in that community. Manning says your résumé will move to the top, as most recruiters are looking for long-term employees and a tie to the area reassures them you’re likely to stay.

When Pierce went looking for her job in Texas, for example, she deliberately left some old but relevant information on her CV. “My husband and I had both worked for an ambulance company in the area,” she says. “I thought it would show I knew the area and had worked with some of the doctors there.”

Of course, such information could also be included in a cover letter or the email you send introducing yourself and telling why you’re interested in the position.

Writing a cover letter will also force you to take that initial soul-searching step, says Ronald Kanner, M.D., residency training director at North Shore-Long Island Jewish Medical Center. “In it, state why you’re seeking the position and what you can bring to the table,” he says.

“List a BLT or if you know someone who works here—that can mean a lot too,” says Manning about a cover letter.

Don’t think you have a connection? “Check professional networking sites to see if you know someone who works in the place where you’re seeking a job,” suggests Streicher.

Instead of relying strictly on the interview process, consider moonlighting at the place you’d like to work like Nate Alvis, D.O., did. “It turned into a working interview,” he says.

Nate Alvis, D.O., a family medicine resident who will soon practice in Iowa, did just that. “I called a local doctor I knew who worked at the place I wanted to work,” he says. But rather than ask him for a recommendation, Alvis let his colleague know he’d like to moonlight there. “It turned into a working interview,” he says.

Welniak did something similar. She had been turned down—twice—by a place she wanted to work. So when a recruiter called and told her about a locum tenens position there, she took it. “Within a few weeks, they were asking me to stay,” she says.

By then, she had accepted another position, so when the locum position ended, she left. “If you can let the employer see what you can do and how you interact with the staff, it might lead to a permanent job,” she says.

Related: Create a free physician profile at PracticeLink.com/Physicians to connect with recruiters at 5,000 facilities.

Good references

“References are important and have to be impeccable,” says Sally Mounts, president of Auctus Consulting Group. “Just be sure you approach people with good verbal and writing skills and the enthusiasm to recommend you.”

Reference letters can come from someone in your current practice’s leadership, a peer you’ve worked with, and maybe a subordinate.

It’s called 360-degree feedback. “And it’s increasingly important in business today,” says Mounts. “Employers want to know you’re a team player and that you work well with everyone.”

When you ask someone to be a reference, help them out by reminding them of when and how long they’ve worked with you, why you’re currently looking for a job, and why the employers you’re considering are attractive to you. That information will be helpful whether they’re writing a letter or simply speaking with your potential employer on the phone.

Manning doesn’t put much stock in reference letters. “Did you ever see a bad one?” he asks. “They’re helpful and I’m happy to take them, but I’ll still want to call your referrals so the responses aren’t so crafted.”

“I didn’t gather referral letters,” says Ariz Anklesaria, D.O., chief resident at Wright State University Department of Psychiatry in Dayton, Ohio. “But I did ask people if I could use them as references. I think it’s a good idea to tell them what aspects of yourself you’d like them to ‘sell’ during a call.”

RELATED: Will you do me the honor? How to get the best references: ow.ly/aPo3R

Sometimes, those making the recommendations will ask you what they should say. “When I asked physicians if I could use them as referrals, they asked me about the kind of work I was looking for,” says Pierce. She told them she wanted work in a rural practice—so when a small Texas community called, her references knew what to say.

If you ask others to serve as referrals for you, remember to ask the person first. It’s more than good manners—it’s one of those small details that can make a difference.

“I once called someone who didn’t know they were listed as this applicant’s reference,” says Gleason. “It didn’t make a good impression.”

Candidates who have done their homework

Once you’ve landed an interview, your work has just started. Remember, it’s the small details that will move you ahead of your competition, so go online and learn everything you can about the organization, the staff and the community.

“It’s unacceptable today to know nothing about the organization to which you’re applying,” says Manning. “Go through every piece on the Web site about the organization.”

You should know the size of the hospital, the makeup of its staff, and what procedures they do and don’t do.

Daniel Ahoubim, M.D., a chief resident who will soon serve a sleep medicine fellowship in Miami, goes a step further. He says he makes a point to read research papers written by medical staff before the interview. “It shows you’re interested,” he says.

In addition to online research, Dickerson suggests applicants put together a list of 15 to 20 quality questions to ask at the interview.

Remember that an interview is as much a fact-finding mission for you as it is for the employer. Determine what you need to know before going in for an interview, and don’t leave until you have the answers to those questions.

Anklesaria says he puts together a template for each place he interviews. On it he lists salary, location, the number of patients he’ll be expected to see, etc. If those points aren’t raised during the interview, he’ll ask about them. “I then create a table for comparison purposes,” he says.

The last bit of prep work to consider is rehearsing answers to what are typical interview questions. “Practice them,” says Kanner, “But don’t recite them like they’ve been memorized.”

Marissa Oller-Cramsie, D.O., a chief resident in neurology at North Shore-Long Island Jewish Hospital, says her mother and her husband both give her practice interview questions before an interview. “My mother interviews at her job, so she asks some pretty good questions,” she says.

Professionalism and honesty

“The moment you close your car door in the parking lot, you’re interviewing,” says Streicher. That means being professional with everyone from the valet to the front office staff.

You might even be careful en route to an interview. You never know if the person sitting behind you on a flight, for example, is connected to the hiring organization.

In addition to acting professionally, arrive early. “Today’s hospitals can be like labyrinths,” says Dickerson, “So arrive at least 15 to 20 minutes early. It may take that long to find where you need to be.”

If you’re serious about the position, you’ve arrived well-groomed and conservatively dressed. You’ll turn down the alcohol at dinner—or stick to just one drink, and only then if everyone else ordered one before you. When it comes to the interview, make eye contact with the interviewer and offer a firm handshake to continue the process on a positive note, says Mounts. “These may be small details, but they can make a difference.”

“During the interview,” Mounts continues, “be positive, outgoing and interactive.”

Lean forward when you respond to questions, suggests Kanner, and of course, “Answer every question truthfully and honestly.”

RELATED: Questions to ask during the interview process: ow.ly/aPr2V

That’s especially true if you have red flags somewhere in your background. If you’ve been sued for malpractice, or your license has been placed on probation, you can be sure the recruiter will eventually find out.

“It’s always better to hear that information from you. Don’t let us drag it out of you,” says Manning.

“Be open, honest and transparent when addressing red flags,” says Dickerson.

Mention them early in the interview process—preferably during a pre-screening phone call, says Gleason.

Also remember, patient satisfaction is important today—as is marketing and awareness of how your practice habits can affect an employer’s bottom line. Give the interviewer the impression that you understand these areas and you know how to be a team player, says Gleason.

Arrogance, nonchalance, anger and any signs of disrespecting another’s time and position are examples of interview turn-offs to avoid.

“For me, the deal-breaker is disrespecting a patient,” says Kanner.

Thoughtful follow-up

In most cases, interviewers will end the interview. At that point, thank them for their time, and if you know, tell them you’re interested in the job. “Don’t leave me wondering if you want the position or not,” says Gleason. Again, a small detail that’s too often overlooked.

If you haven’t received an interviewer’s business card yet, now’s the time to ask. And don’t leave until you’ve also asked, “What’s the next step?”

“You want to have another encounter scheduled before you leave,” says Streicher. “If not, you won’t know what to do next.”

If the interviewer gives you a timeline for a decision—two weeks, for example—and you haven’t heard anything by then, it’s all right to call or email to ask if a decision has been made.

“Two weeks can become four weeks in a busy place,” says Gleason. Welniak agrees. “Hearing back from an interviewer often took time,” she says. When she did check in, though, she says she was more likely to receive responses to emails than phone calls.

After the interview, send a thank-you card or email. If you are rejected for a job, accept it graciously. “You might ask what deficiencies precluded you from the position,” says Dickerson. Or you can simply ask the interviewer if it’s acceptable to stay in touch.

“You don’t know what position might come up in the future, so it helps to stay on that person’s radar screen,” says Mounts. Don’t be a pest about it, she warns, but a quarterly follow-up should be fine. And it will give you a jump over any potential competition.

Finally, when it comes to a job search and the small details that will land you the position of your dreams, there are really only two pieces of advice to remember, says Streicher: Be yourself—“That way you’re comfortable with every part of the process,” she says—and know yourself. “A sure way to succeed in a job search,” says Streicher, “is to apply only for those jobs in which you’re interested and for which you’re best suited.”

Karen Edwards is a frequent contributor to PracticeLink Magazine (PracticeLink.com/Magazine).

 

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Easing regulatory burdens

To promote efficiency and save costs, the federal government has issued new regulations covering telemedicine, staff privileges and other subjects.

By Jeff Atkinson | Reform Recap | Summer 2012

 

In 2011, President Obama issued an Executive Order (No. 13563) directing each agency of the federal government to review its existing regulations and repeal or modify regulations that are “outmoded, ineffective, insufficient or excessively burdensome.”

The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services responded with revised regulations on multiple issues. The new regulations affecting physicians reflect changes in the way medicine is practiced and an increased use of technology.

Credentialing for telemedicine

Telemedicine is a method of providing clinical services to patients from a distance. It can include communication and examination of patients by audio-visual electronic communication as well as non-simultaneous services such as teleradiology. Telemedicine facilitates providing services to rural locations and giving prompt access to experts in a variety of settings.

Under old CMS rules, a provider of telemedicine services (who often was affiliated with a major hospital) had to be credentialed not only at his or her home hospital, but also at any hospital at which the patient was being treated.

CMS concluded “that our present requirement is a duplicative and burdensome process for physicians, practitioners, and the hospitals involved in this process, particularly small hospitals….” CMS also noted that small hospitals may not have the expertise to evaluate physicians in a wide range of specialties.

Related: Read more about health care reform at ow.ly/aP0Q5

A new final rule, issued in 2011, allows hospitals obtaining telemedicine services to rely on the credentialing process of the provider’s home institution rather than go through its own credentialing process.

Under the rule, the hospital at which the physician is based must provide the hospital at which the patient is located with evidence of the internal review of the physician’s credentials.

The rule provides “[a]t minimum, this information must include all adverse events that result from the telemedicine services provided by the distant-site physician or practitioner to the hospital’s patients and all complaints the hospital has received about the distant-site physician or practitioner.”

CMS estimates that the streamlined credentialing process will save approximately $1,500 per physician credentialed in time spent by physicians, hospital administrators and attorneys. The new regulation and official comments about the regulations are available online at ow.ly/aP0Zq.

Hospital privileges to non-physicians

CMS issued a proposed rule in October 2011 to allow more flexibility for hospitals to grant privileges to non-physicians.

Under the proposed rule, if state law allows certain categories of non-physician practitioners, those practitioners also may obtain privileges to work at hospitals within the scope of their practices. Examples of such practitioners include advance practice registered nurses, physician assistants, physical therapists, speech language pathologists and doctors of pharmacy.

The proposed rule states that being a member of the medical staff is not a prerequisite to being granted privileges. The hospital may treat the non-physicians as members of the medical staff, but is not required to do so. Another option for hospitals is to have additional categories of staff membership such as “associate” or “limited” memberships for non-physicians.

For multi-hospital systems, CMS said it did not believe that a separate medical staff is necessary for each hospital within the system. Instead, multi-hospital systems, if they wish, could grant practitioners privileges which would encompass more than one hospital.

CMS has sought comments about whether clarification of the rules on this issue was necessary. Under a related proposal, systems with more than one hospital will have the option of having a single governing body for all the hospitals in the system rather than separate governing bodies for each hospital.

Other efficiency initiatives

Other proposed regulations to streamline procedures and save costs include:

• Increased use of pre-printed and electronic standing orders.
Hospitals may use such orders as long as they “have been reviewed and approved by the medical staff in consultation with the hospital’s nursing and pharmacy leadership” and “are consistent with nationally recognized and evidence-based guidelines.”

• Patient self-administration of medications.
Hospitals will have the option of allowing patients (or caregivers) to self-administer medications issued by the hospital as well as medications the patient has brought to the hospital. The practitioner responsible for the patient’s care will have to approve the arrangement, and procedures will need to be in place to ensure the safety of the administration of medications.

• Interdisciplinary care plans.
Instead of having a patient’s nursing care plan be separate from other parts of the patient’s record, hospitals may use interdisciplinary care plans that incorporate a nursing plan.

• Revising HIPAA rules.
While maintaining privacy rights for health care records, the Department of Health and Human Services plans to reduce the burden associated with distributing notices of privacy practices under the Health Insurance Portability and Accountability Act (HIPAA). In addition, the department plans to make it easier to distribute students’ immunization records to schools. The department estimates the changes in rules could save up to 2 million “burden hours” and $120 million.

• Uniform ID number for health plans.
The Department of Health and Human Services plans to establish “unique health plan identifiers” of a standard length and format for each health plan. Currently, a wide range of identifiers are used, and this results in misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty in determining patient eligibility. The department estimates this change will save providers and health plans $4.6 billion over the next 10 years.

For reasons of pragmatics as well as politics, the administration directed CMS and the Department of Health and Human Services to pause and consider how existing regulations can be made more efficient.

The most recent round of rules and proposed rules should indeed save time and money, although there also will be costs in implementing the new rules.

Jeff Atkinson (JAtkin747@aol.com) teaches health care law at DePaul University College of Law in Chicago.

 

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Ask the right questions the first time around

By Teresa Odle | Feature Articles | Summer 2012

 

“First is knowing what questions to ask, and second is knowing what to do with the answers,” says Lawrence D. Ward, M.D., MPH, FACP, of Thomas Jefferson University Hospital in Philadelphia and the American College of Physicians Council of Young Physicians.

Once you ask the questions that will help you make an informed decision, it helps to have someone you can bounce the answers off of. “If they tell me in the interview that I get one nurse per five physicians, what does that mean,” says Ward.

Here are a few questions to ask:

• What sort of staffing support will I have (nursing, billing, transcription, marketing, other)?

• Do you have an Electronic Health Record (EHR)?

• What is your payer mix?

• Do any of your physicians have flexible schedules to account for outside endeavors or family commitments?

• Will I have any inpatient responsibilities? If so, how are my office patient responsibilities managed during that time?

• Will I be purely a consultant physician or have admitting privileges?

• How often will I take evening and weekend call, and what is the usual volume of calls?

• Are there evening or weekend office hours?

• What is your compensation plan based on (work units, reimbursement, straight salary), and for how long is my salary guaranteed?

• Is there a path to partnership?

• What are the benefits, including retirement? How long until I am fully vested for retirement?

• What type of governance structure do you have, and how do physicians fit in the structure?

• Is there a succession plan in place for new physicians?

• Will my clinical responsibilities include traveling to other facilities (such as satellite offices or nursing homes), and how far or how often?

• What kind of orientation, support and mentoring do you have in place for new physicians?

• How are new physician schedules altered to gradually acclimate them to the practice and EHR?

• What is the current real estate market like in the community?

• Does the community offer access to my family’s religious, educational and extracurricular needs?

Download and share these questions online at ow.ly/bBZQU

 

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Tactics for finding unadvertised jobs

Most physicians today identify positions based on ads, fliers and online postings. What's the plan when the city you want seems to have no job possibilities?

By Therese Karsten | Job Doctor | Summer 2012

 

The internet has transformed physician job search. We rarely talk about the “old school” tactics used by the pre-internet generations because so many physicians find jobs just by clicking a response link.

But if you aren’t finding advertised opportunities where you want to live, it’s time to dig deeper in the toolkit.

Message, message, message

Tell everyone in your environment where you want to practice and why you want to live there. You need a Tweet-length message that people hear several times in different contexts:

“Do you have any health care contacts in Denver? My husband has an opportunity to transfer there with his company and we have family and friends there.”

Program director, program coordinator, faculty and a few attendings should all know where you want to practice. Think outside the physician box, too. We learn about candidates through phone calls and emails from parents, in-laws, siblings, neighbors and former med school buddies.

The other residents and fellows should know where you want to go.

One resident found me because she posted notes on her program’s bulletin board saying, “I need Denver!” She changed it regularly, the next month titled “I MUST Get to Denver” and the following month, “Get Me To Denver Task Force Update.”

Fliers had photos of her and family skiing, hiking the Rockies, or attending a Broncos game. The best was a map of metro Denver with a red arrow pointing to “My in-laws live here,” and another red arrow to the other side of town—45 minutes away—labeled “I want to live HERE.”

It was funny, memorable, and it resulted in a resident forwarding an email that led to an interview that ultimately led to a job.

A surgery resident who was dead-set on getting to Kansas City used T-shirts to spread the word. He had a wardrobe of sports team T-shirts and never passed up an opportunity to talk about his sartorial homage to his dream location—his parents’ and siblings’ new home city. His program coordinator connected him with a recruiter who had a newly posted opportunity.

Refresh your message to your network by giving them updates on your search. An outrageous awful interview story, an anecdote about something cool that happened on your rotation in that city, or a thank you for a suggested contact will reinforce that connection of your name with that city in people’s minds.

Set up a rotation, or moonlight

Practices in the most competitive cities are very big on the idea of “try before you buy.”

A rotation often clinches a job offer even if the practice wasn’t actively recruiting. If you are a fit with their culture and practice philosophy, a smart practice will make it happen. You can also try out a facility by moonlighting there. (The extra money isn’t bad, either.)

A founding partner who hadn’t set a retirement date may realize that two years from now is the perfect time to transition. Or maybe the new satellite office the hospital is asking the group to open becomes viable if they add one more physician.

Active, not passive internet search

Some physicians won’t post their CV or profile on internet job search sites or their specialty organization career tab because they don’t want to be contacted about locations other than the target city.

That’s short-sighted. If you’re looking for a job in a highly competitive market, the value of having a lot of oars in the water outweighs the annoyance of spam.

Manage response volume with an email account exclusively for job search. Every few days, log in and put the target city name in the “search” field. Set the field to find matches in the entire email, not just the subject line. Recruiters sometimes put the state or suburb name in the subject line, then describe the location as “20 minutes from downtown ______” in the body of the ad. Drag the search results to another folder for follow-up. “Select All,” “delete” the rest.

Some internet sites push new or newly updated profiles out to employers. Your name, desired practice location and summary might land in recruiters’ inboxes even before we post ads for a new search. The “push” alerts also connect you to recruiters working on highly confidential, off-the-grid searches.

Refresh your online CV or profile every couple of months. When you click “update,” your profile could go out to every employer with an open search in the specialty and region. The update may spark a call about a position that has re-opened or expanded parameters since your initial posting.

Opt-in to the “alert” or “notification” feature that emails you when sites post a new or updated job matching your criteria. It’s good to be an early respondent for jobs in competitive locations. The likelihood of an interview invitation is much higher if you respond while the search is still fresh.

Follow-up a week or so after you’ve submitted your CV. Check in a few weeks later with that recruiter to remind her that you are still trying to get to that community. Follow-up is not pestering—it’s our job to communicate with candidates. A physician who is committed to the location is more likely to accept if offered, and stay long-term if hired. That’s a win for us, and a win for you.

Network through alumni programs

One of the most effective networking tools is the commonality of having been educated or trained at the same institution as someone else. You have a shared experience and have been shaped by the same culture and educational process.

Call the alumni coordinator for your college, med school and training institutions and ask if you can be connected with fellow alumni in health care who live in the state and city where you want to practice. You may strike gold and find a university alumni club chapter in the target city.

Some alumni coordinators will build a query, search their database and share the Excel spreadsheet once you’ve given the secret alma mater handshake and showed them what you’re going to send out. Others will send an email to physicians on your behalf. Alumni staff can walk you through tips for mining the alumni website yourself.

Many universities have a filter that allows you to inform an alumnus that you would like to connect—but blinds their personal data in case they don’t want to communicate. Why? Universities that help alumni network benefit because graduates who feel connected to their alma mater donate and help future graduates.

If all you have is a name, search on LinkedIn, Facebook, Twitter or search engines. Be expansive and don’t limit just to alumni in your own specialty or recent grads. All it takes is one or two contacts to make the effort worthwhile. In addition to possible job contacts, physicians where you hope to practice will help develop your understanding of what’s going on in the local medical community. They might even share rumors of group mergers and acquisitions or gossip and history behind a practice implosion that no employee of the hospital system or practice would dare relate to a candidate.

Six degrees of separation

You may not get to Kevin Bacon, but the one-off connections may get your CV forwarded into the hands of someone who has a job for you.

Contact in-house recruiters who have jobs posted in other specialties in the right location. Call hospitals in the suburb where you want to live and work, saying “This is Dr. Smith, and I’m looking to relocate to the south side of your metro area and find a hospital-employed or private practice opportunity in my specialty. Who do I need to talk to in your facility?”

You can also ask hospital recruiters if they know of any needs at any other groups in the area.

Use search engines to identify private practices in the zip codes that you want. Email or fax in your CV with a cover letter. State what you are looking for, when and why you plan to live in that community. The recipient of your CV usually does not have a job for you—but he or she knows someone who does.

Perseverance pays off

Start your search for the unadvertised job early, and expect to spend more time on the search than peers who are kicking tires in multiple states. It’s worth the effort, though. Physicians who truly love where they live tend to have more stable career paths and seem happier than those who just “ended up” somewhere! l

Therese Karsten, MBA, CMSR (therese.karsten@hcahealthcare.com) has been recruiting physicians into hospitals, managed care and private practice groups for more than two decades. She is a senior in-house recruiter with HCA.

 

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Don’t let your next IT project crash your practice

By Evan J. Foster, Esquire, Bruce D. Armon, Esquire | Legal Matters | Summer 2012

 

Physicians and medical practices are at the vortex of the electronic health care delivery system. Droids, tablets, smart phones and other devices are changing the way society generally, and health care practitioners individually, gather, store and transmit useful (and sometimes not-so-useful) information.

Many physicians and their practices are moving quickly to implement electronic health record systems, e-prescribing functionality or to generally enhance their current technology to take advantage of the incentives offered to “meaningful users” of health information technology under the Health Information Technology for Economic and Clinical Health (HITECH) Act or because of their participation in an ACO.

Selecting the wrong vendor or the wrong technology, however, can be a big mistake and result in cost overruns, delayed billing or reimbursement, and lost time and productivity.

To help ensure the success of your next IT project, consider these dos and don’ts in evaluating and selecting the vendor and technology.

Do due diligence on the vendor and the technology.

Many physicians and practices do little, if any, due diligence on their vendor or the technology.

At a minimum, practices should talk to others using the same vendor and technology. These conversations should include practices that are in the implementation process, those that recently completed implementation, and those that have been using the technology for a significant period of time.

Talk to other practices of similar size, with a similar number of locations and within the same specialty, if applicable. Your vendor should be able to provide references.

If you are considering using specialized features or functionality, or have what you believe are a unique set of circumstances, you need to do additional homework and ask additional questions. You should also do some Internet research and review the vendor’s support forums. This information can help identify potential problems and let you better understand the vendor’s approach to handling customer concerns.

Don’t automatically take a solution offered by an existing vendor.

With the demands on your professional time, it is tempting to simply accept the proposal from your external practice consultants. Resist the urge.

Though there may be advantages and efficiencies to be gained from expanding your relationship with a current vendor, this can also backfire if the relationship turns sour.

Having all of your critical practice functions performed by one vendor makes you totally beholden to that vendor and creates a “single point of failure” should the vendor run into financial issues or otherwise goes dark. Transparency in understanding the financial relationship between your practice consultant and the product(s) they are suggesting is important. Use the same caution and perform the same level of due diligence as you would with every third-party vendor. You should insist that the IT component be severable from the remainder of the services provided to ensure you can transition a portion of the services you are receiving while keeping others in place.

Don’t skip acceptance testing.

As technology evolves and systems become more complex, the chance of something not working correctly increases dramatically. It also becomes harder to troubleshoot and correct problems once they arise, often involving multiple vendors and/or systems.

Engage in a formal testing and acceptance process. This is especially important when software must exchange data with other systems or must be compatible with existing software or hardware. To ensure the vendor stays committed to resolving all issues, consider holding back a portion of the payment until acceptance is achieved, or tie payment to achievement of certain milestones.

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Do demand financially backed service levels.

With many vendors now offering systems delivered as “software as a service” or from the “cloud,” performance issues are not confined to the walls of the practice.

Connectivity, bandwidth and load on the vendor’s systems can all impact the day-to-day operations of the practice, and continual poor performance can reduce buy-in and confidence in the system. To address these concerns, ask the vendor to commit to or guarantee certain levels of uptime, availability and performance of the technology or system. These are typically called service levels.

In addition, consider asking the vendor to provide service levels for support issues, such as time to return a phone call or email. In all cases, to ensure that the agreed service levels have “teeth” and are not just window dressings, practices should demand a credit of fees in the event a vendor fails to meet a service level, with multiple or repeated failures giving the practice the right to terminate.

Do have all agreements reviewed by your attorney.

When you purchase a product or service, you will need to sign various agreements, and you are responsible for all terms and provisions included in the documents.

In addition to the various vendor contract documents (such as software license, subscription or services agreement), there will likely be numerous exhibits, schedules and appendices. The devil is in the details of every single document.

Beware vendor proposals, quotations, statements of work or policies that include legal terms that you are told are standard. Don’t assume they don’t require legal review. Be on the lookout for “moving targets,” such as terms contained on a vendor’s website or vendor policies that are subject to change. Consider attaching the current version to the contract and requiring the vendor to seek your approval before it can be changed.

Regardless of what the sales team told you, if a provision is important or meaningful, get it in writing and make it part of the contract. Part of the reason to have your attorney review the documents is that you may not know what to ask for or expect as part of the agreement. When in doubt, err on the side of over inclusion.

Don’t assume pricing is all-inclusive.

It is imperative that you understand what the purchase price includes and excludes.

Get the total cost for the entire purchase. Understand the incremental costs if you add physicians or staff to the technology. Understand the costs if you need to delete a user because he or she is no longer employed by the group. Recognize there may be a cost if you are switching from paper to electronic. Who will pay these costs? Is there an annual maintenance fee? Will your fees automatically increase over a period of time? Are there any caps on fees?

Do plan for the worst case.

No one likes change, and most people do not welcome change. Changes in technology can be disruptive, frustrating and make one question the original decision. There can be installation delays, training delays, and other glitches.

You will get through the process, though it may take longer than anticipated. Be sure that everyone—from the most senior physician to the most junior staff person—receives meaningful and directed training from the vendor. Delineate in the agreements how much time and resources the vendor will devote to training and follow-up questions. If you are switching from one system to another, make sure both systems are operational for a short period of time to ensure no data is lost or changed.

Do schedule patients accordingly.

During the initial transition phase, it will take longer to enter the data from a patient visit. Leave ample time so physicians can accurately enter all data related to patient interactions. As the physician becomes more nimble with the system, there will be less down time between patients. Set realistic expectations accordingly for everyone to minimize angst and anger.

E-health care is here to stay. Getting there and staying technologically current in the most cost-efficient and least disruptive manner is a challenge and an opportunity to improve the performance and perception of the physicians and the medical practice as a whole.

Evan J. Foster, Esquire (efoster@saul.com) is an associate in Saul Ewing LLP’s Healthcare Technology Contracting group. He advises physicians, physician practices, hospitals and health systems regarding the acquisition of health information technology and related data privacy and security issues. Bruce D. Armon, Esquire (barmon@saul.com) is a partner in Saul Ewing LLP’s health care group. He assists physicians, physician groups, health care entrepreneurs and hospitals with regulatory, corporate and transactional matters

 

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The Advantage

Seeking out a healthy organization will make a difference in your life and practice.

By Patrick Lencioni | Remarks | Summer 2012

 

In the field of medicine, there is quite obviously considerable time spent on addressing the health of patients, but perhaps there is less time spent on the health of the organization providing the care.

Finding an organization where productivity and morale flourish and politics and confusion are minimized is essential to the well-being of any medical professional. Because healthy organizations typically out-perform their counterparts, a healthy hospital or medical facility will attract and retain the best doctors, nurses and staff and ultimately provide better care.

The environment

You may already know how it feels when your workplace seems unproductive and the employees seem undervalued. Understanding what organizational health is and what it looks like can help you evaluate future employers and find a functional, effective work environment.

According to our work and the model found in The Advantage, healthy organizations:

1. Build a cohesive leadership team. The first step is all about getting the leaders of the organization to behave in a functional, cohesive way. If the people responsible for running an organization, whether that organization is a corporation, a department within that corporation, a start-up company, a restaurant, a school or a hospital, are behaving in dysfunctional ways, then that dysfunction will cascade into the rest of the organization and prevent organizational health. And yes, there are concrete steps a leadership team can take to prevent this.

2. Create clarity. The second step for building a healthy organization is ensuring that the members of that leadership team are intellectually aligned around six simple but critical questions (see page 68). Leaders need to be clear on topics such as why the organization exists and its most important priority for the next few months. Leaders must eliminate any gaps that may exist between them so that people one, two or three levels below have complete clarity about what they should do to make the organization successful.

3. Over-communicate clarity. Only after these first two steps are in process (behavioral and intellectual alignment) can an organization undertake the third step: over-communicating the answers to the six critical questions. Leaders of a healthy organization constantly—and I mean constantly—repeat themselves and reinforce what is true and important. They always err on the side of saying too much, rather than too little. This quality alone sets leaders of healthy organizations apart from others.

4. Reinforce clarity. Finally, in addition to over-communicating, leaders must ensure that the answers to the six critical questions are reinforced repeatedly using simple human systems. That means any process that involves people, from hiring and firing to performance management and decision-making, is designed in a custom way to intentionally support and emphasize the organization’s uniqueness.

Joining a healthy organization early in your career will greatly increase your chances for growth and development and ultimately job satisfaction.

Assessing the culture

Before you even consider a new position, the interviewing process can be very revealing. Here are some of the signs to look for to help gauge an organization’s health.

1. Do the people interviewing you appear to be on the same page about where the hospital is headed, who they are and what they value? If you interview with more than one person and they are not on the same page regarding the hospital’s goals, direction and culture, it could be an indication the company is not focused on organizational health.

2. Does the interviewer seem interested in getting to know you beyond your specialty or skill set? Great organizations are looking for employees (or in your case physicians) that fit their culture from the executive suite down to the cashier. If they are not asking questions beyond résumé skills, that may be a red flag.

3. Does the organization appear to have a process for bringing in new doctors? Is there any kind of orientation where the leaders lay out expectations, talk about the culture and share business plans and goals? If the hospital does offer this to new physicians, this could be a good sign that the organization is trying to foster a healthy culture.

There are few organizations that have a more important mission than those in the medical field. Finding an organization where employees thrive and politics are minimal can literally make all the difference.

Patrick Lencioni is the author of 10 business books including the new release The Advantage: Why Organizational Health Trumps Everything Else in Business, and the national best-seller, The Five Dysfunctions of a Team. He is founder and president of The Table Group, a management consulting firm.

 

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