Davenport, Iowa

Where rivers flow

By Eileen Lockwood | Live & Practice | Summer 2015

 

Skybridge

Davenport sits at the confluence of the Mississippi and Rock Rivers

A t the confluence of the Mississippi and Rock Rivers between Iowa and Illinois can be found not one city but five, each one an entity onto itself but altogether a formidable population of almost 400,000.

Davenport and Bettendorf, Iowa, and three Illinois locations—Moline, East Moline and Rock Island—are collectively known as the Quad Cities, probably for two simple reasons: tradition and euphony. “Quint Cities” came into being for a while, but it was soon abandoned because the words didn’t exactly roll off the tongue. Nicknames aside, Joe Taylor, the convention and visitors bureau CEO, summarizes, “We’re one destination that happens to be made up of multiple cities.”

iowa davenport skybridge anne jump

The floor-to-ceiling windows of the Davenport Skybridge offer sweeping views of the Mississippi.

Davenport was founded in 1836 and was the site of the first Mississippi River railroad bridge. Taylor notes: “We have everything a big city can offer but without the hassle of a big city.” That includes big-time employers. John Deere, the renowned producer of heavy agricultural and manufacturing vehicles, is headquartered in Moline but also employs about a thousand workers in Davenport. Alcoa, Inc., employs 2,000 in Riverdale, Iowa, a town surrounded on three sides by Bettendorf. Rock Island is home to the largest government-owned weapons manufacturing arsenal in the U.S.

Jason Hagemann, D.O., who practices family medicine with Genesis Health Group in Davenport, notes, “My patients all work at one place or the other (Deere or Alcoa).” Hagemann himself lives in Bettendorf, although he was raised in Davenport.

Genesis was one of the first community hospitals west of the Mississippi when it was founded in 1869 by the Sisters of Mercy. It now serves 10 area counties in Iowa and Illinois. It’s a “top performer” in endocrinology and diabetic care and also has “the best physical therapy care in the region,” notes media coordinator Craig Cooper. Its cardiology care includes advanced equipment and techniques, and it’s one of only three Iowa hospitals with staff and equipment to provide transcatheter aortic valve replacements for patients who would be endangered by open procedures. And also one of “very few hospitals nationwide” to offer Varian Trilogy image-guided, focused radiation that reduces treatment time and protects surrounding healthy tissue.

Fegge Museum Gary

Figge Art Museum

For all hospital employees, though, care expands beyond treatment and the building. From management to janitors, employees are praised for their compassion, and a book has been published chronicling many of their good deeds: Noting the 70th wedding anniversary of a dying patient, staff members bought a cake for a special celebration for him and his wife. Staff members gave shoes to a homeless patient, and then established a drive that brought in 206 pairs for others.

Another player in the Quad Cities health care scene is UnityPoint Health, the 13th largest nonprofit health system in the country. The system serves 88 communities in Iowa, Illinois and Wisconsin. Its Trinity Rock Island campus recently underwent a Heart Center and Emergency Department expansion. The new state-of-the-art Emergency Department features a dedicated trauma room, 22 general treatment stations and more. In 2015, UnityPoint Health-Trinity began offering the CardioMEMS HF heart failure monitoring system—the first in the area to do so.

Hagemann followed a path that would extend around the world before he returned home and joined Genesis for his residency in 2010, becoming a permanent staff member in 2013. He stayed in-state as an undergraduate at Iowa State University in Ames, but then joined the Army National Guard, was trained as a combat medic and deployed to Iraq. He had worked with several DOs in the Army, which inspired him to follow the same career path when he came back home. He applied at the main campus of Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. “I interviewed there—in January,” he says, but learned of a campus in Bradenton, Florida, which he selected for a simple reason. “My wife. She said, ‘I don’t care what you say. We’re going to Florida!’” He now jokes, “All my medical books have sand in them.”

Still, the call to Davenport as a career location was too strong to resist. “It took us away from the beauty of Florida, but this is a better place to raise kids,” he says. The couple now has a 1-year-old and a 4-year-old. “The schools here are excellent and very family-centered,” he notes. Not to mention “lots of museums and dozens of parks.” The newest, and possibly most spectacular, museum is the 10-million-square-foot Science Center at Davenport’s Putnam Museum. The center opened in 2014 and features 45 hands-on stations for children to explore.

Hagemann is especially happy about the number of bike and walking trails, especially along the two rivers. Especially noteworthy are the Hennepin Canal Parkway linking the rivers and the 62-mile Great River Trail.

But the continuing city highlight is probably what Chamber of Commerce spokesman Jason Gordon considers “the amazing downtown renaissance” in the last five years.

In the last several years, more than 1,500 people have relocated to some nine or 10 blocks in the downtown area. The influx has sparked shopping areas, appealing restaurants and entertainment venues.

 

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Visalia, California

Gateway to the Sequoias

By Eileen Lockwood | Live & Practice | Summer 2015

 

Sequoia National Park

Sequoia National Park

When Thomas Fantes, M.D., joined the U.S. Navy, he had no particular thought about an after-service life in the coastal city with one of the nation’s biggest maritime installations. But that’s how it worked out. This is his story.

Fantes was born in Peru, but his family moved to northern New Jersey when he was 4. (At 6’4” and with light red hair, he jokes that he doesn’t look much like a Peruvian.) While studying economics at the then Rutgers College, he decided that medicine would be his life. The promise of government-financed tuition led him to join the Navy. After graduation from New Jersey Medical School, he went on active duty, incorporating internship and residency—and tours of duty in the Middle East and Japan.

Kern River

The Kern River runs through the Sequoia National Forest southeast of Visalia.

After four final years at Naval Station Newport, Fantes and his wife, who was following the same path and is also a physician, was ready for civilian practice. After private practice, followed by ER and community medicine, he decided to settle into a hospital-related environment. “We got out and looked around at a bunch of different places,” he says. “And we thought, ‘You know, (Newport) is pretty nice.’” For them, it still is.

He’s now the medical director of Newport Hospital’s Vanderbilt Wound Center, as well as of the Newport Health Care Corporation, a physician group affiliated with the hospital. The hospital itself is a member of Lifespan.

The city of Newport is probably best known for its huge luxury mansions, labeled vacation “cottages” by the super-wealthy industrialists, mining magnates and southern planters who built them during the Gilded Age of the late 1800s. But that crowd was preceded by a fledgling U.S Navy complex during the Revolutionary War. During the Civil War, it was briefly home to the U.S. Naval Academy, moved from Annapolis to save it from Confederate hands. In World War II, 80 percent of American torpedoes were manufactured in the area, the largest single industry ever operated in Rhode Island. Today, the site is best known for its Naval War College and officer training school, as well as its large Naval Undersea Warfare Center.

Dr Duncan with family

Orthopedic surgeon Ian Duncan, M.D., enjoys Visalia’s proximity to family, its central California location and nearby skiing opportunities.

A number of Newport’s magnificent “cottages” and early Colonial homes are now visitor attractions, in addition to other attention-worthy sites. Also on the water, excursion boats cruise past area lighthouses.

Today the words “sea” and “recreation” are almost synonymous, not to mention shipping and commercial fishing. The city is known as the sailing capital of the U.S. and is frequently the site of the America’s Cup race. At the seaside, the annual Newport Jazz Festival, a staple since 1954, may be the biggest lure of all. Everyday outdoor-lovers can be near the sea, too, thanks to the Newport Cliff Walk bordering the shoreline for more than three miles.

In its own way, Newport Hospital is forging the way into health care of the future. “It’s an exciting time,” says spokesperson Elena Falcone-Relvas, especially with the arrival of a new president, Crista Durand. Among other activities, Durand is “dedicated to making positive change and bringing on new doctors.”

For instance, several cardiovascular services are among recently introduced new and expanded techniques and equipment. It was the first hospital in the state to use a leadless implantable cardiac defibrillator, and its specialists now use the S-ICD System developed by Boston Scientific, the first subcutaneous implantable cardiac defibrillator for treatment of patients at risk for sudden cardiac arrest.

The wound care center itself is an example of, as Fantes reports, “the latest, most advanced treatments.”

In the meantime, Fantes reports that he, his wife and daughter “used to kayak a little, but we’re in the process of selling the boat,” possibly based on two factors. Their daughter, who was 6 when they settled in Newport, is now a college math major, so there’s one boater less in the family. And his physician wife recently became the chief medical officer at a Boston hospital, which, though only a half-hour drive away, is still a time-consuming post.

Work obligations aside, the Fantes adults continue to savor Newport for its surrounding “wonderful open space” where they enjoy walking their dog. Says Fantes: “It’s still a nice little city.”

Kaweah Oaks Preserve

The Kaweah Oaks Preserve offers a stunning view of the Sierra Nevada Mountains.

After crossing Narragansett Bay from Newport, it’s about a 10-mile drive south on mainland Rhode Island to Wakefield, a town where the population is small but the mood is lively. About a stone’s throw south is a protected harbor on the ocean, with many miles of coastline and beaches that attract thousands of summer tourists. “The area is known for its beauty,” says Martha Murphy of South County Hospital Healthcare System. “A lot of people have second homes here and retire here.” That includes professors from the University of Rhode Island in nearby Kingston.

Wakefield, with a population of about 8,500, is physically a part of South Kingston, population 30,600. However, it could be called the business beehive. “One of the biggest focuses is Main Street, with a lot of quaint shops and restaurants, plus two theaters,” notes Nick Pappadia, communications coordinator for the Southern Rhode Island Chamber of Commerce.

Of the hospital, with 100 beds (all in private rooms), Murphy says, “We like to say it provides everything from allergy to urology to everything in between.” Its strongest suit, she adds, is orthopedic surgery, especially joint replacement. “There are patients who choose to come here for surgery from across the state—and Connecticut.” She notes: “Our orthopedic surgeons have performed more MAKOplasty procedures than any other surgeons in the U.S. or the world—to date more than 3,000.”

The hospital has also received important awards and recognitions, including a LeapFrog “A” grade for patient safety, the only Rhode Island institution so cited for three consecutive years. Consumer Reports has given it the highest rating in both patient safety and post-surgery outcomes.

Coastal Medical is Rhode Island’s largest physician owned primary care group practice with 20 locations, including in Newport and Wakefield.

“The quality of life in Rhode Island is amazing,” says Kimberly McHale, director of marketing and communications for Coastal Medical. “The seasons and the ocean, beautiful communities, excellent school systems…. And we’re an hour from Boston if you want something bigger.”

“When your group is owned by doctors, the processes you put in place are patient-first,” McHale says. “We’re run by physicians that care about everything that’s important to patients, and everything that’s important to physicians.”

That means standard in every office is a pharmacist, a nurse care manager for the most chronic patients, and a team in the corporate office to help manage it all, which allows physicians to concentrate on their practice of medicine. nIn the San Joaquin Valley sits a variety of cities and towns, including 17 with notable populations. Visalia is one of the five largest cities. The total valley floor comprises about 6 percent of the state land, but produces almost 13 percent of all U.S. agricultural crops. It follows that the area is known as “the nation’s salad bowl,” but the area also has the third largest oil field in the U.S.

Today, Visalia is home to some 125,000. Because of its proximity to the Sierra Nevada Mountains, the area attracts skiers from around the world. Other recreational prospects are almost unlimited, including snowshoeing, hiking, biking, rafting and horseback riding. Not to mention a multitude of natural wonders, from sky-high Sequoia trees and high waterfalls to some 270 underground caves in Sequoia and Kings Canyon National Parks. Also within easy driving distance is Yosemite National Park.

In the San Joaquin Valley sits a variety of cities and towns, including 17 with notable populations. Visalia is one of the five largest cities. The total valley floor comprises about 6 percent of the state land, but produces almost 13 percent of all U.S. agricultural crops. It follows that the area is known as “the nation’s salad bowl,” but the area also has the third largest oil field in the U.S.

Today, Visalia is home to some 125,000. Because of its proximity to the Sierra Nevada Mountains, the area attracts skiers from around the world. Other recreational prospects are almost unlimited, including snowshoeing, hiking, biking, rafting and horseback riding. Not to mention a multitude of natural wonders, from sky-high Sequoia trees and high waterfalls to some 270 underground caves in Sequoia and Kings Canyon National Parks. Also within easy driving distance is Yosemite National Park.

Ian Duncan, M.D., notes three major factors in his decision to join an orthopedic surgery group in Visalia: proximity to family; central location between San Francisco and Los Angeles; and skiing, a sport he now enjoys with his wife and three children, ages 13, 11 and 6. He performs surgery at the Kaweah Delta Medical Center.

Duncan knew from an early age that his life dream was to be a physician. He enrolled in a pre-med sequence first at Santa Rosa Junior College and then at the University of California, Davis. His choice of specialty came to him almost as a revelation, although a painful one for his girlfriend (now his wife). “She was changing a light bulb,” he says. “She pushed off a towel rack, it ripped out of the wall, and she fell backward onto her wrist and dislocated it, a pretty rare injury. We went to the ER. The doc popped her wrist back in, but he was struggling to do it for a while, so he looked at me and said, ‘Hey, help us out here and pull.’ I pulled down the elbow, and he was able to (finish the job). And from then on I knew that that work was for me.”

After being involved with sports teams in Santa Rosa, where he attended junior college, he concluded that “being in sports medicine and being a surgeon would be a good fit.” He reinforced his choice wherever he went by finding a way to work with at least 20 high school, college and even professional teams. He did so while at the Chicago Medical School (now known as Rosalind Franklin University), during internship and orthopedic residency at Temple University Hospital. He added a second residency at Thomas Jefferson University’s Rothman Institute of Orthopedics.

While at Temple, he worked with three different professional Philadelphia teams, including the Phillies.

In 2012, Duncan returned to Visalia. He had interviewed at several places in the state, but he soon realized that his hometown would be the best fit for him, especially since the need for his specialty was great. “I learned when I was interviewing that there were only six orthopedic surgeons here. (Statistically), that’s 80,000 people per surgeon (in my field).” Bottom line: “Before long, I was extremely busy. And I still do more surgery than just about anybody I trained with.”

And he still makes time to be on the field with football teams at a local high school and a college.

With eight campuses, the Kaweah Delta Health Care District provides state-of-the-art surgical techniques, services and equipment, such as endoscopic ultrasound, a large-opening MRI, brachiotherapy, a lymphedema center and a very new endourology suite for GreenLight laser surgery. Area residents can take advantage of the Lifestyle Center to keep in shape, and Kaweah Kids is a childcare service for employees and medical staff members.

The city itself is hardly lacking in cultural and unique dining experiences, especially in the downtown area. Performances of all kinds, including symphony, are held at the recently restored 85-year-old Fox Theatre, and Friday Nights Downtown attract crowds. A final touch is some 100 murals adorning downtown buildings. The Visalia Rawhide, an Arizona Diamondbacks baseball farm team, adds a sports ambience.

Visalia’s business scene is also alive and well. In line with its agricultural surroundings, the city is home to large food producers, distribution centers and various manufacturing operations such as International Paper, Voltage Multipliers (high-voltage diodes) and Alcoa.

City leaders are keeping busy, too. So far, a huge industrial park has attracted 18 varied businesses with another 27 probably on the way and ultimately room for as many as 150.

Visalia’s fifth new high school is one of several new facilities on the horizon, from a state-of-the-art animal control facility to a new city center consolidating currently scattered administration offices.

As a result, Visalia now exudes optimism for the future—and shows a smiling face.

 

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Newport, Rhode Island

History, water—and fun

By Eileen Lockwood | Live & Practice | Summer 2015

 

Ray Homoroc Cliffwalk Newport RI

The 3.5-mile Newport Cliff Walk showcases some of Newport’s “cottages”—impressive vacation homes, many of which came about in the 1800s.

When Thomas Fantes, M.D., joined the U.S. Navy, he had no particular thought about an after-service life in the coastal city with one of the nation’s biggest maritime installations. But that’s how it worked out. This is his story.

Fantes was born in Peru, but his family moved to northern New Jersey when he was 4. (At 6’4” and with light red hair, he jokes that he doesn’t look much like a Peruvian.) While studying economics at the then Rutgers College, he decided that medicine would be his life. The promise of government-financed tuition led him to join the Navy. After graduation from New Jersey Medical School, he went on active duty, incorporating internship and residency—and tours of duty in the Middle East and Japan.

After four final years at Naval Station Newport, Fantes and his wife, who was following the same path and is also a physician, was ready for civilian practice. After private practice, followed by ER and community medicine, he decided to settle into a hospital-related environment. “We got out and looked around at a bunch of different places,” he says. “And we thought, ‘You know, (Newport) is pretty nice.’” For them, it still is.

He’s now the medical director of Newport Hospital’s Vanderbilt Wound Center, as well as of the Newport Health Care Corporation, a physician group affiliated with the hospital. The hospital itself is a member of Lifespan.

The city of Newport is probably best known for its huge luxury mansions, labeled vacation “cottages” by the super-wealthy industrialists, mining magnates and southern planters who built them during the Gilded Age of the late 1800s. But that crowd was preceded by a fledgling U.S Navy complex during the Revolutionary War. During the Civil War, it was briefly home to the U.S. Naval Academy, moved from Annapolis to save it from Confederate hands. In World War II, 80 percent of American torpedoes were manufactured in the area, the largest single industry ever operated in Rhode Island. Today, the site is best known for its Naval War College and officer training school, as well as its large Naval Undersea Warfare Center.

A number of Newport’s magnificent “cottages” and early Colonial homes are now visitor attractions, in addition to other attention-worthy sites. Also on the water, excursion boats cruise past area lighthouses.

Today the words “sea” and “recreation” are almost synonymous, not to mention shipping and commercial fishing. The city is known as the sailing capital of the U.S. and is frequently the site of the America’s Cup race. At the seaside, the annual Newport Jazz Festival, a staple since 1954, may be the biggest lure of all. Everyday outdoor-lovers can be near the sea, too, thanks to the Newport Cliff Walk bordering the shoreline for more than three miles.

In its own way, Newport Hospital is forging the way into health care of the future. “It’s an exciting time,” says spokesperson Elena Falcone-Relvas, especially with the arrival of a new president, Crista Durand. Among other activities, Durand is “dedicated to making positive change and bringing on new doctors.”

For instance, several cardiovascular services are among recently introduced new and expanded techniques and equipment. It was the first hospital in the state to use a leadless implantable cardiac defibrillator, and its specialists now use the S-ICD System developed by Boston Scientific, the first subcutaneous implantable cardiac defibrillator for treatment of patients at risk for sudden cardiac arrest.

The wound care center itself is an example of, as Fantes reports, “the latest, most advanced treatments.”

In the meantime, Fantes reports that he, his wife and daughter “used to kayak a little, but we’re in the process of selling the boat,” possibly based on two factors. Their daughter, who was 6 when they settled in Newport, is now a college math major, so there’s one boater less in the family. And his physician wife recently became the chief medical officer at a Boston hospital, which, though only a half-hour drive away, is still a time-consuming post.

Work obligations aside, the Fantes adults continue to savor Newport for its surrounding “wonderful open space” where they enjoy walking their dog. Says Fantes: “It’s still a nice little city.”

After crossing Narragansett Bay from Newport, it’s about a 10-mile drive south on mainland Rhode Island to Wakefield, a town where the population is small but the mood is lively. About a stone’s throw south is a protected harbor on the ocean, with many miles of coastline and beaches that attract thousands of summer tourists. “The area is known for its beauty,” says Martha Murphy of South County Hospital Healthcare System. “A lot of people have second homes here and retire here.” That includes professors from the University of Rhode Island in nearby Kingston.

Newport Quaint

Downtown Newport is quintessential New England, with the big city of Boston just 90 minutes away.

Wakefield, with a population of about 8,500, is physically a part of South Kingston, population 30,600. However, it could be called the business beehive. “One of the biggest focuses is Main Street, with a lot of quaint shops and restaurants, plus two theaters,” notes Nick Pappadia, communications coordinator for the Southern Rhode Island Chamber of Commerce.

Of the hospital, with 100 beds (all in private rooms), Murphy says, “We like to say it provides everything from allergy to urology to everything in between.” Its strongest suit, she adds, is orthopedic surgery, especially joint replacement. “There are patients who choose to come here for surgery from across the state—and Connecticut.” She notes: “Our orthopedic surgeons have performed more MAKOplasty procedures than any other surgeons in the U.S. or the world—to date more than 3,000.”

The hospital has also received important awards and recognitions, including a LeapFrog “A” grade for patient safety, the only Rhode Island institution so cited for three consecutive years. Consumer Reports has given it the highest rating in both patient safety and post-surgery outcomes.

Coastal Medical is Rhode Island’s largest physician owned primary care group practice with 20 locations, including in Newport and Wakefield.

“The quality of life in Rhode Island is amazing,” says Kimberly McHale, director of marketing and communications for Coastal Medical. “The seasons and the ocean, beautiful communities, excellent school systems…. And we’re an hour from Boston if you want something bigger.”

Coastal Medical is a progressive group—the first ACO in the state, and one of the first practices in the nation to have a successful shared savings plan that resulted in bonuses for the whole company.

“When your group is owned by doctors, the processes you put in place are patient-first,” McHale says. “We’re run by physicians that care about everything that’s important to patients, and everything that’s important to physicians.”

That means standard in every office is a pharmacist, a nurse care manager for the most chronic patients, and a team in the corporate office to help manage it all, which allows physicians to concentrate on their practice of medicine.

 

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Southern Delaware

Beaches, bikes and boats

By Eileen Lockwood | Live & Practice | Summer 2015

 

Rehoboth Beach

A mile-long boardwalk, bandstand and family-friendly fun beckon crowds to Rehoboth Beach.

Endocrinologist Francisco Padilla, M.D., considered himself a big-city guy, having lived in them all his life.

But as fellowship at UConn Health Center ended and he began his job search, he signed up for PracticeLink and received a call shortly after from an in-house recruiter from Nanticoke Health Services in Seaford, Delaware.

Shortly after the call—and now five years later—Padilla his wife, internist Sandra Palavecino, M.D., and their two children are ensconced in Southern Delaware.

“First, it’s safe,” Padilla says of the area. “It’s good to have my kids live in a place where they can play outside without having to worry. Everyone knows everybody. And working in a small hospital is nice. I know the hospital president and the network president, so we can interact. You can be more familiar and close with the administration.”

That close relationship is one benefit Padilla has found in making the move from big city to small—a move that gave him the ability to grow a department.

“If you go to a big hospital where there’s already an endocrine department established, you just have to get plugged in to the department,” he says. “But when you go to a small hospital, you get the opportunity to build something from the ground up.”

There are several examples of innovative services pioneered in Delaware and, in some cases, in the entire Mid-Atlantic region, by the hospital and its practitioners.

“We’re kind of a hidden gem here,” says Nanticoke Memorial marketing director Sharon Harrington. “We’re a smaller hospital, but we have a whole lot of things going on.”

The same can be said for Seaford itself. When Padilla’s not busy with his expanding department, he is an avid bicyclist. Water also plays a role in his family’s life: His wife enjoys paddleboarding and his kids like to kayak.

“Summer is very active here for the beaches,” he says.

On the other side of Sussex County, 35 miles east, Lewes, Delaware, sits on one of those beaches—a resort town where Delaware Bay meets the Atlantic Ocean.

“In summertime, it gets pretty crowded with vacationers from Maryland, Pennsylvania, Virginia, New Jersey and D.C. taking their one-week beach-rental vacations,” says Julie Holmon, M.D. “So we’ll often head out to do big-city things. We’re in this little oasis, but we’re not too far from major cities, even New York.”

She’s happy to be a permanent resident in “a safe, relaxed environment with farms and beaches influencing (our children’s) lives.” Not to mention the work satisfaction for Holmon, who is medical director of the hospitalist program, which started 10 years ago at Beebe Healthcare in Lewes and now has a staff of 20—and the search is on for more.

Holmon was recently named the Best Hospitalist for 2015 by the Delaware chapter of the American College of Physicians. After graduating from the University of California, Irvine, Holmon and her attorney husband, Chris, headed east, where she earned her medical degree at Johns Hopkins University, followed by residencies at Christiana Care Health System in Newark, Delaware, and Alfred I. duPont Hospital for Children in Wilmington.

Her plan was to practice internal medicine and pediatrics, and she soon signed on with a physician in nearby Milton.

She was already familiar with Beebe due to a residency rotation, and she loved the area. “I was also struck by how innocent the children were whom I was seeing (at the doctor’s office),” Holmon says. “Even girls as old as 12 and 13 were still climbing trees, in the 4-H Club and playing sports. They were not smoking and dating and things like that. I thought it was wonderful that they seemed to grow up slower down here than where I grew up in California and where I trained in Baltimore and Wilmington.”

Holmon has discovered bountiful outdoor activities available for her own children, a 10-year-old son and a 7-year-old daughter. She’s been especially pleased at the number of small-group beach nature camps with different nature themes.

In addition, Holmon notes, “My kids have been taking sailing lessons since they were 5.”

The great outdoors also caters to adults. Fishing, kayaking, windsurfing and hunting are very popular, but Holmon’s personal favorite is bicycling on a nature trail that extends from Lewes to Rehoboth. “It’s a great way to get to Rehoboth Beach without getting on any highways,” she says. Rehoboth is the area’s best-known and most popular of five public shore locations in the area. Adding to the oceanfront ambience are two nearby state parks, fine dining and a variety of specialty boutiques.

Not surprisingly, with its huge waterfront, the city is a popular boating center with a good number of docking slips.

Meanwhile, at Beebe Healthcare, action is going full speed ahead, not only with physicians and the newest equipment to provide high-quality care, but also with efforts to bring care closer to where patients live and programs to help them maintain good health, and of course provide top-notch care when needed. The mix includes a cancer center complete with state-of-the-art equipment.

In other areas, president and CEO Jeffrey Fried points out, “We’re targeting high-risk patients with chronic conditions, trying to set up a safety net so they can be treated quickly.” Outpatient walk-in care is also available in many county locations.

An electrophysiology capability has recently been introduced to correct heart arrhythmias. In line with that effort, the Dr. Dean Ornish Program for Reversing Heart Disease will soon begin at the Beebe Health Campus in Rehoboth.

Julie Holmon MD

Julie Holmon, M.D., has discovered plenty of outdoor opportunities for her family in southern Delaware. “My kids have been taking sailing lessons since they were 5,” she says.

As for patient self-care, Fried notes the Healthier Sussex County Initiative started in 2012. It’s designed to engage area residents to do more to take care of themselves. “The goal,” he says, “is to make Sussex County the healthiest county in the country.”

Also helping the area’s health needs is a new Bayhealth hospital slated for groundbreaking soon in Milford, known as the Gateway to Southern Delaware.

The Bayhealth team is actively recruiting new providers in preparation for the forthcoming, totally new 150-bed facility. That means all new equipment and technology, too—“they’re not bringing anything over,” says senior physician recruiter Marc Powell, who is based in Bayhealth’s Dover facility, Kent General Hospital, about 20 miles north.

At the top of the state is Wilmington, the state’s largest city. The Christiana Care Health System is headquartered there, a major teaching facility that includes two full-service hospitals with a total of 1,100 beds. It’s the largest private employer in the state. It also hosts a number of forward-looking agendas to build its reputation as a center of innovation, both in medical advances and care regimens. It’s recognized as a regional center for excellence in cardiology, cancer and women’s services.

Among its more “humanistic” programs are the Value Institute and Lean Six Sigma Training, the first striving to develop care improvements at affordable costs, and the second to increase quality of care by upgrading employee knowledge and skills. On the lighter side, Musicians on Call is a Wednesday-afternoon program in which instrumental and vocal artists go to patient rooms, using their skills as a way of cheering patients.

 

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The do’s & don’ts of your next interview

A successful interview is one step to landing your dream practice. Do the wrong thing, and you can hurt your chances.

By Vicki Gerson | Feature Articles | Summer 2015

 

Michael Atha MD

In his search for new colleagues, Michael Atha, M.D., reviews CVs from 25 to 30 candidates who have already been screened by an in-house recruiter. About 15 to 20 of those get a phone interview, and fewer still are extended a site visit.

True story: While arranging an interview for a physician, a recruiter asked the candidate if she’d be bringing anyone to the interview.

“Would you mind if I bring my little dog?” the candidate asked. “She is well-behaved and can sit in my lap.” The recruiter—surprised by the request—told the candidate that the dog couldn’t attend due to health reasons at the facility. Although the physician interviewed well—without her dog—she wasn’t hired for the job.

If you are now or soon will be looking for a new practice, there are certain behaviors that could prevent you from getting hired (leave your dog at home), and others that can make you stand out as a good fit. We’ll cover interview do’s and don’ts here to help you land your dream practice.

Do be sensitive to your environment

A candidate from the big city hoped to make the transition to a quiet, rural life in cowboy country. He arrived to the interview in a fancy suit and even fancier car, and was critical of the cowboy boots and pickup trucks he saw. His recruiters had to take him aside and give him this advice: People will accept outsiders—if you’re not critical of their lifestyle.

Consider that experience as one reason that face-to-face interviews are so important. Bruce M. Guyant, DASPR, regional director of physician recruiting at LifePoint Hospitals for Colorado, Utah and Nevada, says site visits are a great way for recruiters and candidates (and their families) to evaluate if the job and community fit is right in practice, not just on paper. The last thing an employer wants is for a physician or spouse to be unhappy and request to leave shortly after being hired.

William J. Salyers, Jr., M.D., MPH, interviews residents and faculty candidates at the University of Kansas School of Medicine in Wichita, where he is chief of the gastroenterology division and program director for the internal medicine residency program.

“You must fit the culture of our practice and the culture of our community,” he says. “I don’t want them looking for a new job in 18 months.” To help gauge fit, Salyers spends an entire day with candidates, including lunch and dinner.

Do your soul-searching before you go on an interview

Being confident in who you are and the direction you’d like to see your practice grow is also important.

Jake Deutsch

Jake Deutsch, M.D., suggests researching the practice before your interview so you know what questions to ask. With enough preparation, your real personality will be able to shine through.

“A candidate should come into the interview with a sense of direction as to where they want their career to go,” Salyers says. “If the person is searching and deciding what they still want, it’s difficult to know if that person will be a good fit or not. I don’t want to bring someone out to meet with us if this is the situation, because it would be difficult for them to fit in.”

Don’t make it all about you

Steve Elliott, practice manager at Ponderosa Family Physicians in Aurora, Colorado, says the best candidates are able to communicate what they are able to bring to the table and how their skills might enhance the practice. They are focused on the practice as a whole, not just what it’s able to offer them.

“Do they have an interest in understanding the long-term benefits of joining our practice, or are they only focused on the short-term benefits of first-year salary or first-year schedule?” he asks. “Do they have an appreciation for that opportunity and how they might contribute or fit in long-term? Are they focused on ‘I,’ or is there some genuine ‘we’ in there too?”

Michael Atha, M.D., is a hospitalist with Critical Care and Pulmonary Consultants, which provides hospitalists to Denver-area facilities. He hires five physicians in a typical year—but the group is expanding to cover a fourth hospital, so there will be 10 new doctors joining the practice this year.

To fill an opportunity, Atha examines CVs from 25 to 30 candidates who have already been screened by an in-house recruiter. He will speak with 15 to 20 candidates on the phone to pre-qualify them for in-person interviews. Often, he hears answers that don’t get them the in-person interview—such as answers to the question, “Why do you want to join his group?” Common no-go answers include, “I want to live in Denver,” “I like the great outdoors, so I want to work here,” and “I love to ski, so I’d love to work at your facility.” Atha expects to hear more than location as a reason for interest in joining the group. He’s impressed when a candidate has done some research on his group and about different practice models in Denver. He likes to hear that the candidate has taken the initiative to speak with other physicians in the area and learn that his group comes highly recommended.

Jake Deutsch, M.D., is the founder and clinical director of Cure Urgent Care in New York City.

He says it’s important to be prepared and know everything about the practice where you are interviewing. Know who the partners are, and come to the interview ready to ask basic questions about the company. Show your real personality so employers know what it would be like to work with you on a day-to-day basis and can determine your fit for the group.

Don’t limit yourself before learning all the details

In a typical year, Matthew Hess, human resources manager for
Northwestern Memorial HealthCare in Chicago, completes face-to-face interviews with 40 physician candidates to fill 15 opportunities. Before he gets to the interview point, however, he sorts through hundreds of CVs.

One mistake Hess notices candidates make is when they articulate expected work hours that don’t line up with the facility’s needs. For example, there’s not much flexibility for a candidate who wants to work only eight hours at a time when all the immediate care clinics are 12-hour shifts. An emergency room physician who doesn’t expect to work weekends or holidays? Likely not a right fit for his facility either.

The biggest interview mistake Deutsch encounters when hiring candidates is that many don’t inquire about clinical hours or partnership tracts.

“Hours spent working on call will be one of the biggest factors in job satisfaction,” he says. “Be clear what the requirements are, and speak with other physicians in the practice to get the real story. In addition, if there is an opportunity to become an owner in the practice, get the specifics before signing on the dotted line.”

Do be concerned with first impressions

Younger physicians hail from a generation well-known to be more casual than its predecessors. But when it comes to your interview, err on the side of formal, conservative dress. Don’t be like the candidate who showed up to an interview in a short-sleeved Hawaiian shirt, khaki shorts and sandals, causing the hospital CEO to stop the interview and refuse to proceed.

Elliott says candidates need to be personable, pleasant and comfortable in their own skin. They need to pay attention to how they interact with every person in the office, both in person and on the phone. “We also pay attention to other interactions such as how respectful they may be to a waiter at a restaurant or other miscellaneous interactions,” he says. “We want to get a good feel for how they are going to interact with our team of physicians, our staff, our medial community and our patients.”

Do get granular

When Elliott is interviewing a physician candidate, he says it’s important for him to know how new physicians are equipped to handle the real-world pace of practice.

That means it’s up to you, the candidate, to communicate your experiences with patient volume, call volume and reviewing lab results and other documents. Share examples of how you kept pace in residency and maintained a positive attitude.

During the in-person interview, Hess also wants candidates to get specific. You may say that you saw six patients every day, but Hess wants to know more. What type of patients? What were the diagnoses? And if you’re hired, what do you want to specialize in at the hospital? “Most of them are not prepared for these questions,” he says.

Do get all your questions answered

Throughout the interview process, go into every step intending to get an offer. Get all your questions answered during the interview process, and don’t pass full judgment on the opportunity until all the facts are gathered.

Your goal should be to gather enough information to determine if you would be a good fit for both the practice and the community. Once you’ve collected all the facts, then you can make your evaluation. Not a fit? That’s OK—as long as you professionally inform the practice of your decision.

If it is a fit, make an effort to review the details of your offer and contract so that you completely understand what will be expected in your new role.

“Many doctors don’t understand the terms of the contract until it’s too late,” says Hess. “Even though the contract is spelled out for them, and we go over every detail, many of them still don’t understand this is an employment contract. They are just excited to be getting a job.”

Don’t ramble

Being concise in your answers shows knowledge and focus.

“No one wants to hire someone who is going to give you the run-around whenever you have to communicate with them,” Deutsch says. That goes for when it comes to communicating both positive and negative outcomes.

Some candidates avoid talking about bad outcomes—all the more reason to have already thought about a concise explanation. “Don’t make yourself look incompetent because you are squirming when the difficult subject is breached,” Deutsch says.

It’s also important to know the job description. When a candidate shares career goals that aren’t in tune with the opportunity, it can give the impression that the candidate is looking for a short-term position, not a long-term career.

Do be gracious even if you’re not interested

It’s important to establish a good relationship with the group that interviewed you—even if you’re not interested in the job. If you decide to take another offer, you may be asked to provide feedback on what factors you liked or didn’t like about the offer or opportunity. Do it professionally. “Don’t burn any bridges,” Atha says. “We’ve seen candidates we’ve interviewed several years ago who come back to us later at a different point in their life.”

Vicki Gerson is a frequent contributor to PracticeLink Magazine.

 

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Culture check

How to determine an organization’s culture—and how you will or won’t fit in.

By Teresa Odle | Feature Articles | Summer 2015

 

Internist Rebecca S. Lee, M.D., medical director of North Shore Physicians Group in Danvers, Massachusetts, has practiced primary care in her hometown for eight years. “I am kind of born and raised where I practice, which I really love and which is part of our culture,” she says. This is not to say that every physician at North Shore Physician Group’s Danvers location also was born and raised in the area. “But it is more of a community feel,” she says.

Dr Lee

“We try to make decisions based on finances and hours and such, but I think you also need to go a little bit with your gut,” says internist Rebecca Lee, M.D., about finding a place where you’ll fit in.”

Reaching that community feel in Lee’s practice didn’t happen overnight or even organically. It took effort. Lee helped open the new practice near her home and had a say in everyone hired, from physicians to front-end staff.

Across the country, in northern Arizona, internist Derek Feuquay, M.D., also has worked hard with his group, Flagstaff Medical Center Hospitalists, and Flagstaff Medical Center administration to create an excellent culture in the group practice and hospital.

According to Feuquay: “We have created an employed practice where people just don’t show up and work together; they are friends, colleagues and teammates.” Feuquay and his wife both joined the group about six years ago, and he became the lead physician in 2011.

When successful teams are formed, it’s because the hiring parties were able to look beyond training, certifications and clinical skills and to something more ethereal: “fit.” So how does a physician seeking a new opportunity evaluate their fit? And just why is the organization’s culture so important?

What is culture?

Of course, culture has dual meanings in health care today. Cultural competence is all about understanding the body of knowledge and beliefs or the backgrounds with which patients identify because patients’ values and customs can influence their belief systems regarding health.

The same holds true for culture within a health system, hospital or group practice. Many of the beliefs and values are intangible—or at least difficult to pinpoint and measure. Louis Caligiuri, director of physician contracting and recruiting for North Shore Medical Center in Boston, which is affiliated with North Shore Physicians Group and the larger Partners Healthcare Network to which both belong, says that communication is a big part of the North Shore culture. “The lines of communication are open, and we try to be a physician-led organization.”

Much of that can’t be measured, but Lee points out that she receives notification whenever one of her patients is seen in a Partners facility. That’s something an incoming primary care physician might want to know.

Other examples of culture include the mission, vision and values of an organization. Some of these are formal and published, driving how everyone from the medical director to the billing staff conduct business.

“The culture of our organization is one that supports professionalism,” says Jonathon K. Foley, M.D., FACS, president of Cape Girardeau Surgical Clinic in Missouri. Foley, a general surgeon, says that the group focuses on “getting the right people, the most efficient processes, and the best technology to support the work of the organization.”

Not every practice or hospital has formalized their culture. Other times, the leadership believes they have a particular culture, but word may not have gotten to the rank and file physicians or staff. Those that are most successful at having and sticking with positive cultures have identified and are driven by core values.

For Cape Girardeau Surgical Clinic, getting to the point they now are at grew from intentional behavior and actions, says clinic administrator Sarah Holt, PhD, FACMPE. “Years ago, we discussed as a group the kind of practice we wanted to become.” Included in the group’s culture is a focus on applying formalized governance in “a fair and systematic manner,” says Holt, along with valuing individuals and the group as a whole. In addition, Holt says, “We hire the best people we can find.”

Kevin Bartow MD

Kevin Bartow, M.D., is the newest physician partner at Cape Girardeau Surgical Clinic. He suggests that candidates ask all their questions while they’re interviewing, including how work is distributed.

Why is culture important to job seekers?

Although physicians seeking new opportunities have much to consider and weigh, many recognize the significance of cultural fit when evaluating an organization. According to Caligiuri, some of the physicians he interviews mention that the organization’s culture is an important factor. “Some are explicit about it,” he says.

And although physicians often are prepared to evaluate compensation or benefit packages, they might not realize the effects an organization’s culture has on the bottom line or physician benefits. “Culture drives satisfaction or dissatisfaction with compensation, call, salary and benefits,” says Holt. She adds that culture also contributes to satisfaction with one’s colleagues—an important factor in a specialty such as surgery, where respect and collaboration are key. If not present in the culture, “problems develop, fester and finally erupt,” says Holt.

Foley agrees. “The work we do is too stressful to spend energy fighting the organization,” he says, adding that the organization “needs to support the work of the physicians and staff so that we can accomplish meaningful work.”

For those who vet, interview or hire new physicians, it’s crucial to make sure that the culture is a fit for both the new physician and for the organization. Caligiuri uses the hospitalist program in Partners as an example. There tends to be more turnover in hospitalist positions simply because some physicians work in the job for a few years and then move on to a fellowship or other position. If a new hire also is not a fit with the organization, then turnover increases more, which can add to costs for the organization and upset a carefully developed culture.

Feuquay says that when he first arrived in Flagstaff, rapid growth meant equally rapid hiring of hospitalists, and some of the hires were not good fits. Even though the group and hospital continue to expand, both have settled into a more steady and purposeful way of handling their growth and success.

“Nothing makes an employed hospitalist feel more comfortable than a stable organization that continues to support their group,” says Feuquay.

Megan Nordvedt, manager of medical affairs and physician recruitment for Flagstaff Medical Center, says cultural fit is everything when physicians join a new organization. “If a physician feels the culture is familiar and comfortable, warm, welcoming and professional, they are sure to perform better and stay with the hospital a long time.”

In turn, a culture that encourages happy physicians and staff and respect for those who care for patients ultimately results in better productivity and patient care. “We have had patient satisfaction scores above the 90th percentile for almost three years,” says Feuquay. “This is because when doctors come to work happy, they take good care of patients and people leave the hospital happy.”

How to evaluate culture

“We try to be very clear when recruiting about how our group members interact with each other,” says Cape Girardeau’s Foley. This includes expectations about how hard the group expects its surgeons to work, along with expectations regarding open communication and “camaraderie with other surgeons, and how we have developed a high-functioning team,” he says.

Kevin N. Bartow, M.D., the newest physician partner with Cape Girardeau Surgical Clinic, says that the group’s executive team meets every Monday morning to check out from the weekend and review patients’ statuses. Bartow had done a rotation with the surgical practice and was aware of its openness. He suggests that physician candidates ask plenty of questions when discussing opportunities with potential groups. “For example, do you have policies that outline benefits for all physicians? How is work distributed?” He also suggests inquiring about compensation for the next two to five years. Holt advises to also ask about details regarding how compensation is distributed and whether any component of compensation is based on production.

It may help to ask how physicians in a group practice assign new patients to physicians, along with how new physicians contribute to strategies and decision-making in a practice or hospital. Other considerations include consistency of policies and procedures and how they’re applied. Often, talking with the practice administrator as part of the process provides clues to communication, governance and decision-making.

Lee recommends that a potential hire come back after the initial interview and shadow the physicians for a day to see what the practice is like. “But even if you can spend an afternoon with someone” she says, it is helpful to get a feel for the culture.

At the very least, candidates should be sure to speak to as many physician peers as possible. “For hospitalists, make sure you meet other hospitalists and ask them questions,” Feuquay says. “Meet other subspecialists and ask them questions.” He says the hospital tour often gives potential hires a chance to see how others perceive the hospitalist group, which can be a selling point for applicants.

Throughout your interview, tour and site visit, observe communication and interactions. “Pay attention to the way the physicians interact with one another, with nurses, specialists and managers,” says Nordvedt. “How is everyone working together, and how do others achieve the work/life balance outside the hospital?”

Sometimes it is tough to identify signs of low morale, physicians who anger easily or hidden hierarchies, but the more people you talk with and the more time you can spend touring and visiting hospital or practice locations, the more likely you can spot signs of cultural fit. How employees treat patients, vendors or one another may provide clues to how organized, hectic or stressful the culture is on a typical day, and whether everyone buys into the mission and vision of the organization.

Owen J. Dahl, MBA, FACHE, of Owen Dahl Consulting in The Woodlands, Texas, says he advises asking for meeting minutes if possible, or at least to review a meeting agenda from group practices or medical staffs. “Notice if the agenda focuses solely on finances.” He says there may be nothing wrong with that, but if the first agenda item focuses on patient quality of care, that sends an altogether different message than if every agenda for the quarter focuses on finances. It’s up to the candidate to decide which type of message or value fits with his or her beliefs, styles and vision for this new opportunity.

Jonathon Foley MD

Finding candidates who support the group’s culture is key for Jonathon Foley, M.D., president of Missouri’s Cape Girardeau Surgical Clinic. “The work we do is too stressful to spend energy fighting the organization,” he says.

Feuquay recommends asking for a tour of the hospital and town. All candidates who visit his group have a tour of the Flagstaff area with a group member’s spouse, who is a real estate agent. Finally, remember to be observant not only throughout the planned activities, but during your entire site visit. So many clues to the potential employer’s culture are better ascertained through observation. As soon as you arrive, observe the feel of the waiting room and check-in or admissions area. Dahl suggests noting details such as whether notes and signs that inform patients about payment and policies are professional in appearance. If your tour takes you into clinical areas, observe nuances such as lighting, cleanliness and organization. Even the employee break room atmosphere might give a clue about the culture.

One of the best ways to assess cultural fit is to evaluate the intangible feelings you have when making the recruitment visit. Lee encourages physicians to go with their guts. “We try to make decisions based on finances and hours and such, but I think you also need to go a little bit with your gut and where you think you will have the best time,” Lee says. “You are going to be spending a lot of time at work, and you need to genuinely enjoy the folks you are working with.”

Teresa Odle is a frequent contributor to PracticeLink Magazine.

 

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The when, what and who of your site visit

When an employer is interested, chances are they’ll bring you in to interview in person. We help you navigate that visit like a pro

By Chris Hinz | Feature Articles | Summer 2015

 

Allan Sison, M.D., knew exactly what he wanted from his 2014 site visit to Texas Children’s Hospital and Baylor College of Medicine. As a pediatric hematologist/oncologist, he had already honed his leukemia research bona fides at Johns Hopkins University. So it was important to discover if Houston was a good fit for his flourishing bench scientist and clinician skills.

Although administrators had their own interview agenda—even asking him to do a “job talk” to evaluate his research achievements—Sison wanted assurances that Baylor would support his contributions and ambitions long-term.

“Since I was coming from a place that was very highly focused on laboratory and clinical research, I was interested in finding out how these institutions value their faculty,” he says. “Were the lab researchers as important as the clinical researchers, and were the researchers as important as the clinicians? That’s what I wanted to know.”

Whether you’re interviewing for your first or next opportunity, making the most of a site visit is critical. A face-to-face meeting allows you to assess the situation by what you see, hear and intuitively feel. Meeting decision-makers is your chance to nail the parameters and potential of the job while getting a feel for future co-workers too. Although the schedule will be tailored to your circumstances, knowing a few basics, what questions to ask and what concrete steps to take to learn about the community will help you find the right job in the right place.

As Sharee Selah, director of physician recruitment services for the University of Maryland Medical System, notes: “It’s like anything else you do. You have to be willing to put time and effort into it. You shouldn’t approach this any differently than you did in learning to practice medicine. That means putting in energy and resources before the visit to get results from it.”

When, What and Who

Although there’s no one-size-fits-all model for site visits, familiarizing yourself with three basic “W’s”—when, what and who—will help you prepare.

When does a visit take place?

Site visits occur either when administrators have an immediate position to fill or they’re intrigued enough with a candidate’s CV to meet and keep the person on their radar. Sometimes a face-to-face is the first time the two sides talk, but for the most part, a site visit follows a prescreening telephone or even Skype interview concerning the job and the person’s qualifications for and interest in it.

If you make the cut, you may participate in a follow-up phone interview with someone higher in the administrative or medical food chain. For instance, since Baylor’s position involved a three-year National Institutes of Health grant, Sison had to apply for funding. That meant several phone conversations with the division chief in addition to the screening interview prior to his visit.

What does the visit include?

A site visit is designed to integrate many different tasks in a relatively short, albeit intense, daylong or overnight stay. During that time, you’ll not only be navigating various interviews, but also exploring the medical facility, touring the community and attending a social event. Even though site visits follow a somewhat standard format, they’re still tailored to each candidate, depending on the specialty, job opening and even type and size of the organization. Meeting with stakeholders who may be key to your understanding of the practice—or your success working in it—are a crucial part of your day.

In addition to meeting a cross section of people who make the practice work, you may have to participate in other activities germane to the job. Because Sison’s potential position was 75 to 80 percent research, he had to deliver a talk during his two-day visit on progress in determining if blocking a molecule—called CXCR4—on the surface of leukemia cells from interacting with healthy bone marrow cells can make the malignant cells more sensitive to therapy.

Who should join you?

You’re the star of your site visit, but your spouse and/or children have important roles, too. Some recruiters prefer that candidates come alone so they have no distractions. But since family members are often the major reason physicians reject offers, it’s helpful to include your partner for his or her real-time impressions. It’s not universally the case with children, however. Although some organizations are amenable to everyone being present initially, administrators often prefer that you wait until there’s an offer at hand before including your whole family. As much as you love them, your children can create logistical challenges. That’s not to say that recruiters won’t adjust, however. For instance, when a recent candidate for a job at Chattanooga, Tennessee-based Erlanger Health System asked if he and his wife could bring their youngest child along, Lee Moran, director of physician recruitment, happily obliged. She resolved the only strategic issue—dinner with the partners—by scheduling it at a restaurant within walking distance of the hotel so his wife could leave if it got too long for their little girl. “Luckily for us it was a pediatric group,” says Moran. “It was probably a better situation to work around than if he were meeting with cardiologists or surgeons.”

Who foots the bill?

A potential employer should pick up the entire tab for your site visit. That usually includes airfare, hotel, meals and other incidentals such as a rental car, airport parking and even baggage fees. It doesn’t cover personal expenses, such as toiletries, sightseeing trips or the mini-bar. Even though most groups do the booking for their candidates, in some cases you have to pay upfront with reimbursement later. Whatever the plan, get it in writing.

Also, although your partner’s travel expenses should be included, make sure you understand the situation with children. Not all practices underwrite the entire family unless a candidate accepts the job and/or returns for a suggested second visit. But they all should be willing to pay whether or not an offer is extended or accepted.

Finally, keep in mind that this is a professional visit, so only submit reasonable, related expenses. You don’t want to shoot yourself in the foot like the candidate who tried to charge an employer for a six-pack of beer purchased in the middle of the night before his big interview—a move that brought into question the soundness of his decision-making abilities.

Getting answers

Formal face time with senior partners, administrators and others is a site visit’s main event. During your initial phone conversations, you likely answered screening questions to see if you had the training, skills and interest in the job. After returning home, you’ll probably have additional conversations to tie up loose ends. But this is your opportunity to dig deeply. Because there’s a lot at stake clinically, financially and emotionally, it’s important to steer the discussion toward topics that could make or break your success. The reassuring news is that anything important to you is fair game.

Selah suggests that your goal should be to fill three information-gathering buckets before the visit ends. The first includes questions related to any aspect of the job that affects your daily ability to see patients. The second focuses on inquiries about the culture or potential fit with other physicians, support staff and the greater medical community. The third concerns geography. Will the area meet your family’s social needs? “You need to come away with more than just information about the nuts and bolts of the job,” says Selah. “You want to see if it’s the right culture, the right team, the right infrastructure and the right place. Everything should align with your professional and personal priorities.”

So what should you explore? Although there are many plum areas, the following subjects are ripe for the picking:

Position

Why is there an opening and how long has the organization been recruiting? Given today’s physician demographics, it’s easy to assume that you’re filling a retiring colleague’s shoes when there may be other things afoot. You want to know if you’re part of a succession/expansion plan—or simply walking through a revolving door.

Dr. Mona Amini

Personal thank-you notes helped psychiatrist Mona Amini, M.D., MBA, stand out in an interview.  “If the opportunity is something that you really want, it shows that you took the time and effort because you really care,” she says.

Kelvin Shaw, M.D., learned from a spate of interviews how important it is to keep digging until you hear the full story. He nixed one small opportunity after getting the physician-owner to finally admit that she’d retain 51 percent control; he’d never be a full and equal partner. His persistence eventually landed more conducive buy-in arrangements in Dallas and then Houston, where he’s now part of Allergy & Asthma Associates, a 40-member allergist and ENT team. “You have to know structure upfront,” says Shaw. “It doesn’t do any good to work for several years and then realize, ‘Oh, I’m never going to be a full partner.’ Then you have to leave and start over again—or stay and be bitter.”

Clinical expectations

What will be required of you, and does it match your expectations? Be sure to get an accurate picture of day-to-day life. How many patients will you be seeing? How much time can you allot for each one? And what’s the competition? Knowing who’s out there is especially important if you’ll need referrals to build volume and stay busy.

Osteopathic family physician Julia McDonald, D.O., MPH, knew what she wanted her practice to look like. So when administrators at Maine Dartmouth Family Medicine Residency in Augusta invited her for a site visit, she targeted questions that would clarify whether or not the physician-faculty opening mirrored her requirements. By the time McDonald finished, she believed that she’d be a good faculty preceptor fit. Moreover, the private practice and clinical patient care roles were to her liking. “They didn’t provide 100 percent of what I was looking for, but since I’m new to medicine, I’m certainly open to different ways of doing things,” she says. “The fact that they were even considering things I was considering made me excited to work here.”

Practice dynamics

How collegial is the group? Since surveys repeatedly show that a poor cultural fit is the major reason people leave their jobs, focusing on the work environment should be front and center. Who makes decisions? How are disagreements handled? Who are potential mentors? Even though you can gauge dynamics by watching and listening, asking will fill in the blanks.

When Vanessa Wear, M.D., was interviewing for a diagnostic radiology position in 2010, it was important to her to know the parameters of the job, including the daily workload, call schedule and weekend coverage. So when interviewing at Chicago-based Wellington Radiology, a private-academic practice servicing two Advocate Health Care Center hospitals, she zeroed in on questions that would give her the best idea of what would be expected of her. Also, since culture was key, Wear was very interested in how happy her potential colleagues seemed in their jobs and how well everyone got along in the office. For instance, although many factors entered into her decision about Wellington as a great place to use her breast imaging expertise, it registered over lunch with co-workers that they seemed to enjoy one another and were genuinely interested in each other’s lives. “I think it’s very obvious if people are happy or not in their jobs,” Wear says. “Yes, everyone can fake it for a little bit, but people’s true feelings come out…whether it’s a frustrated eye roll during the interview or everyone having a great time at lunch.”

Structural support

Can you deliver quality care with the nurses, ancillary services and systems in place? It’s appropriate to ask about anything that could impact a flourishing practice. Do you have to share nurses? Does the group encourage advance practice providers? What bureaucratic hoops exist to alter equipment? You want evidence that the organization has both infrastructure and flexibility.

Wear says she didn’t ask too many questions about the radiology equipment during her interview. She just assumed any successful practice would have quality scanners necessary to diagnose patients and navigate their breast biopsies. But in retrospect, she’d be more pointed in her equipment inquiries, especially about the ability to make modifications. Fortunately, Wear had flexibility in changing some technology. Besides bringing new expertise to the practice, she benefited from the relatively small size of the group (20 physicians), which made it easier to accomplish her goals than it may be in a larger organization. “I was fortunate that everyone was OK with the changes that we made,” she says. “There was some hesitation, but they understood that I had specialized in breast imaging and knew what I was doing.”

Compensation

What will your package include? It’s important to learn how your salary and buy-in will be structured. What are bonuses based on? What’s the mix of payers? Be thorough in your inquiries, but don’t make financials your lead-in. “We all work for money,” says Craig Fowler, vice president of recruiting at Atlanta-based Pinnacle Health Group and president of the National Association of Physician Recruiters. “But you need to ask about compensation in the right way at the right time. You don’t want to be the person who obsesses about it. That sends the wrong message.”

Kegley Davis

Kisha Davis, M.D., interviewed for her first post-residency practice while nearing her due date. She recommends that young physicians ask clearly about any policies at a potential employer that could impact their personal choices, parenting or family life

Shaw entered the interview fray in 2003 eager to find an ideal allergy position either in Chicago, where he had completed fellowship training, or in Texas, his home turf. Since he needed to know that he’d have a patient base to support his practice, he asked how full his potential colleagues’ schedules were and how far into the future they were booked. Confident enough in the answers to accept a position in Dallas, Shaw used similar inquiries two years ago when relocating for a faster growing Houston opportunity. “If you’re fighting over the same pool of patients with 10 other physicians, you need to know that the pool will be big enough,” says Shaw. “Some people can come into a crowded situation and make something of it, but for others it may not be acceptable to grow slowly. So you have to figure out, ‘Is this is really a good situation?’”

Future and family

No one can predict the future, particularly with an ever-evolving health care system. Yet having a feel for the organization’s challenges and plans might help you minimize surprises. Also, because your personal and professional lives are bound to intersect, getting a handle on work/life balance is critical. What’s the call schedule really like? Will you be home for dinner? Is there time for a healthy family life? Check with the practice’s younger doctors to gauge their experience.

During her first job search in 2007, Kisha Davis, M.D., had an obvious reason to address a topic often tricky to navigate during a site visit. Because she was in the late stages of pregnancy, talking frankly about family for this family medicine graduate was very pertinent. She needed to know that the Maryland-based community health center’s administrators were open to a delayed start date. Delighted by the answer, Davis took the job, even though she eventually moved on to a White House fellowship before her current position as medical director of Gaithersburg, Maryland-based Casey Health Institute. She now urges young physicians to inquire about any policy that could impact their personal choices, parenting or family life. “When it gets to the point that you’re strongly considering a practice and a practice is strongly considering you,” she says, “it’s better for both sides if you ask, ‘How can you accommodate me?’”

The final lap

Once the heavy lifting is done, you’ll likely close off your visit with dinner. Even though social events are usually for decompressing, you can still learn about the company you’ll be keeping. One Connecticut gastroenterologist, for instance, was impressed when eight of 10 physicians in the practice he eventually joined showed up for a Monday evening meal. “It really spoke volumes about how much they prioritized bringing someone new into the practice.”

No matter how well everything goes, however, it’s unlikely that you’ll leave your site visit with an offer. You may have every indication that the group wants to pursue talks further, yet administrators rarely put an agreement on the table before the close of business that day. They’ll likely want to assemble input from all relevant parties first. “Our philosophy is that if we’re going to ask people to be involved in interviewing,” says Mike Krier, senior physician integration specialist for Milwaukee-based Aurora Health Care, “we better get their thoughts and feelings about a candidate to make a determination. That’s unlikely to occur before the candidate leaves.”

Because you also want to evaluate the opportunity, it’s to your advantage that other steps must occur. In fact, you may want a second visit to confirm your initial findings. Whether or not you anticipate another face-to-face, make sure you understand what happens next. You may be fortunate in that someone is assigned to walk you through the process. If not, don’t be afraid to get specific about timelines and variables that might affect your search. Also, if you perceive a great possibility, stay in touch.

McDonald didn’t have to wait long to know that her Augusta, Maine, primary care practice wanted her. During the site visit, administrators signaled their interest, even mentioning the pay structure. Within a week, she had an offer. Even though the scale was largely set in stone, the practice sweetened the pot by agreeing to loan repayment and a sign-on bonus. It was just enough to close the deal with a group that had been on McDonald’s radar since before training. “The culture just struck me as my tribe of people,” she says. “I really admire the physicians and staff. I love the way medicine is practiced and want to be a part of it. I can imagine being here for the rest of my career.”

As for Sison, he wasn’t anxious that he didn’t receive an immediate offer after either his first or second site visit since he was interviewing at two other institutions and assumed Baylor administrators were talking to other candidates too. He just kept in contact until the division chief made an official offer to join the institution’s academic hematology community. Sison accepted, confident that this position would offer the promotion potential that had eluded him in his prior job because of senior colleagues on the same career path. At Baylor he met physicians who arrived as fellows or young faculty and stayed long enough to be promoted. Sison’s takeaway? Leaders there valued promising researchers and made their progress a priority. “It proved to me that my development as a junior faculty member was important and that I would have a long-term future here.”

Chris Hinz is a frequent contributor to PracticeLink Magazine.

 

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Keep interest and leverage while interviewing

How to address contractual or legal items in an interview that could negatively affect your candidacy.

By Clark Jones, JD, MBA and Jeff Hinds, MHA | Legal Matters | Summer 2015

 

You’ve cleared the phone screen stage of the interview process and now have an on-site interview invitation. Congratulations are in order; many other candidates were likely filtered out following the phone screen. But don’t get too far ahead of yourself just yet!

The employer deemed you worthy enough for an on-site interview via the contents of your CV and successful phone interview, but much more can be learned about you as a candidate—both positive and negative—through face-to-face interactions.

Conversations during the phone interview are often broad; expect more detailed conversations during your on-site visit. More specifically, a few contractual or legal items will be discussed during the in-person visit, and how you address these topics could significantly affect your candidacy.

Work hours and call schedule

During your interview, your work expectations must be fully and clearly defined. You’ll need to understand the minimum number of hours you will be scheduled each week and if a defined weekday and weekend call schedule per month is expected. Inquiring about these expectations is perfectly reasonable.

However, this is not the ideal time to express concern or set demands or limitations on what you consider acceptable.

Even if you are not fully comfortable with the expectations that have been presented, it is in your best interest to wait until an offer has been extended before you proceed with negotiation. If your concerns or demands are too pressing, you risk losing the position before it is even offered. You will have more leverage, and the employer will be more receptive to negotiating such items, after they have chosen you as their top candidate.

Compensation

Discussing compensation during an interview should also be handled delicately. In many cases, the employer will lead the discussion by asking if you have any salary requirements or expectations. Getting the employer to come forward with the first number is preferable. When asked about your salary requirements, a good response would be something like: “Compensation is not the top priority in my job search. I’m most interested in the professional and personal fit within the organization and community. If both sides agree that it’s a good fit, then I’m sure we can come to a fair agreement on compensation.”

If that doesn’t satisfy the push for a specific number, you can rephrase it by saying: “I’m really not focused on a particular number at this time. Share with me what you had in mind.”

If this is your first employed position after residency or fellowship, your response can be expressed this way: “This is my first position out of training, and I’m not completely certain what to expect. Please share your thoughts about compensation.”

Some variation of these sample responses will typically help get the employer to respond with the compensation number or range first. Again, don’t feel the need to commit to or negotiate the number given at that moment. Simply thank them for giving you a better idea of what to expect, then share that the information will be helpful as you look at the opportunity in its entirety. You will be in a much better position to negotiate after you have received the contract. In addition to having more leverage with the actual contract in hand, it will also give you more time to collect other offers or compensation data to strengthen your position.

Background issues

If you have been terminated in the past, have a gap in your employment or training history, or possess an unfavorable malpractice claim on your record, be prepared to discuss these items in a manner that reduces employer concern.

First, be completely honest and don’t hide the fact that you’ve had a past issue. When addressing the subject, your goal is to remain positive and not over communicate more specifics than necessary. The more detail you share about the issue, the more concern you may create for the employer.

Be brief and succinct in your explanation while sandwiching the issue between positives. For example, if you were terminated, start by talking about what you enjoyed about the position, then briefly introduce the issue that led to your departure. Immediately follow up by sharing what you learned from the situation and why you are a better person and clinician today after going through the experience. By presenting the situation as a “lesson learned” scenario, you can ease the concerns the employer may have about this issue arising again. Being negative or blaming former employers or colleagues is the last thing you want to do. Though everything you say may be 100 percent correct, the employer doesn’t know both sides of the story, and you may come across as someone difficult to get along with.

Clark Jones, JD, MBA is partner at Jones, Schneider and Stevens, LLC and general counsel at Premier Physician Agency, LLC. Jeff Hinds, MHA is president at Premier Physician Agency, LLC, a national consulting firm specializing in physician job search and contracts.

 

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Federal laws change payments to providers

Congress, federal regulators and the Supreme Court each have taken actions affecting payments to physicians and hospitals.

By Jeff Atkinson | Reform Recap | Summer 2015

 

The law that threatened to reduce physicians’ pay for Part B Medicare services has been repealed. In April of this year, President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The passage was a rare act of bipartisanship on a major issue. The act passed the Senate by 92-8 and the House by 392-37.

Had the law not passed or another temporary fix been implemented, physicians’ pay for Medicare services would have been reduced by 21 percent. Under the old law, which had been in effect since 1997, a “Sustainable Growth Rate” formula was applied that would automatically reduce payments if budget targets were not met.

In addition to providing what has been termed the “doc fix,” the new law also extended for two years the Children’s Health Insurance Program (CHIP) and funding for community health centers.

Payments based on quality

At the outdoor signing ceremony, President Obama said, “Not only does this legislation permanently fix payments to doctors, but it also improves it because what it starts doing is encouraging payments based on quality and not the number of tests that are provided or the number of procedures that are applied.”

Under MACRA, physicians will receive a 0.5 percent increase for Medicare services for each of the next five years. During this time the government will develop “Alternative Payment Models” and “Merit-Based Incentive Payment Systems.” Providers’ performance will be assessed in four areas: quality of care, resource use, meaningful use of electronic health records and clinical practice improvement.

By 2020, bonuses and penalties will be utilized to reflect these measures. Bonuses can provide up to a 12 percent increase from the base payment rate, and penalties can deduct up to 4 percent from the base payment rate. In 2022, bonuses can be up to 27 percent and penalties can be up to 9 percent.

Under the merit-based system, clinicians who receive the highest scores relative to benchmarks also could earn additional “exceptional performance” payments. A technical advisory committee within the Centers for Medicare & Medicaid Services (CMS) will develop details of the payment models.

Impact on physician groups

In a program already underway, payments to physician groups are adjusted by a “value-based payment modifier.” The program is being phased in, starting with large physician groups.

In 2015, payments were subject to adjustment for group practices of 100 or more physicians serving Medicare patients. There were 127 such groups: 14 groups received an upward adjustment of 1 percent; 11 groups received a downward adjustment of 0.5 or 1 percent; 81 groups received no adjustments based on their quality and cost data; and 21 groups received no adjustments because Medicare had insufficient data to make calculations about cost and quality. Quality measures are based on the Physician Quality Reporting System.

In 2016, physician groups of 10 or more will be subject to the program, and in 2017 all physicians, including solo practitioners, will be covered. Starting in 2017, potential reductions in payments will be increased to 4 percent, although solo practitioners and groups of 99 or less will not be subject to downward adjustment during their first year in the program.

Hospital-acquired conditions

One of the initiatives under the Affordable Care Act to promote quality and save costs is the Hospital-Acquired Condition Reduction Program. The program is designed to reduce preventable conditions, particularly infections, that the patient did not have upon admission to the hospital but that developed during the hospital stay.

The CMS reports that the program currently saves Medicare approximately $30 million annually. Those savings come from not making payments for treatments of conditions that CMS deems to be preventable.

Under another part of the program, CMS gives hospitals a score based on their record regarding preventable conditions. The higher the score, the less well the hospital did. Starting in 2015 the hospitals that rank in the quartile with the highest scores (i.e., the poorest records) will have a 1 percent reduction in their payments. For 2015, approximately 724 hospitals have reductions in their payment rates.

In some situations, reductions in payments might be due to poor record keeping. When a patient is admitted, it is important for the hospital and physicians to determine and document the patient’s condition. For example, if a patient has pneumonia or bed sores, even if those are not the reason for admission, those conditions should be part of the patient’s record so that the illnesses are not regarded as hospital-acquired conditions.

Another CMS program, the Hospital Value-Based Purchasing Program, will adjust payments to hospitals based in four quality domains: clinical process of care, patient experience of care, outcome and efficiency.

For 2015, the number of hospitals that will experience a positive change in the payments is slightly larger than the number of hospitals that will experience a negative change.

Accountable Care Organizations

Accountable Care Organizations (ACOs) have had a somewhat bumpy path in the quest to deliver high quality, cost-efficient care. ACOs are groups of physicians, hospitals and other health care providers that join together to give coordinated care to Medicare patients (as well as other patients). “Pioneer ACOs” were the first to join the program.

In the first performance year (2012), there were 32 Pioneer ACOs. Since then, 13 of the Pioneer ACOs have dropped out. CMS reports that Pioneer ACOs have saved the Medicare program $118 million for which the ACOs received $76 million in bonuses. Other ACOs have joined the program. In 2015, there are 405 ACOs participating in Medicare’s Shared Savings Program.

Court challenge of Medicaid rates

In March of this year, the U.S. Supreme Court issued a ruling regarding a challenge to reimbursement rates paid by the Medicaid program (Armstrong v. Exceptional Child Center, Inc.). In this case, providers of habilitation services to persons covered by Idaho’s Medicaid plan argued that the rates being paid were insufficient and violated the Medicaid Act.

Section 30 of the Act requires that a state’s Medicaid plan “assure that payments are consistent with efficiency, economy and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan….” The issue before the Court was whether this language gave providers the right to sue in federal court to challenge the reimbursement rates. The Court held the providers did not have such a right.

In an opinion written by Justice Scalia, joined by three justices with Justice Breyer concurring, the Court held that the only remedy Congress intended was for the Secretary of Health and Human Services to withhold Medicaid funds. Private parties could not sue under the act.

Justice Breyer explained that the requirement of Section 30 of the Medicaid Act is “broad and nonspecific” and that when it comes to ratemaking, “administrative agencies are far better suited to this task than judges.”

The process of setting reimbursement rates for physicians and other health care providers will be an ongoing balancing act that will include assessments of quality of care and efficiency. For the federal health care programs, the primary forums for setting rates will be legislatures and administrative agencies, but not the courts.

Jeff Atkinson teaches health care law at DePaul University College of Law in Chicago.

 

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New features make your job search easier

By Brian Brown | PracticeLink Tips | Summer 2015

 

We’re in anniversary mode here at PracticeLink as we celebrate 20 years of being the most widely used physician recruitment tool and helping physicians and advanced practitioners find their dream practice.

It is our goal to empower you with industry insights and job search and career guidance through PracticeLink.com, PracticeLink Magazine and in person at physician specialty conferences and our national Career Advancement Workshops and Job Fairs.

We appreciate hearing stories about your successes and your challenges in your search for your first or next practice, as each encounter gives us an opportunity to discover new ways we can support your search.

Recently, I met a physician who intended to complete residency in June, located her dream job in Texas and accepted the offer—only to lose out on the opportunity because she applied for her Texas license when she got the offer, not before. Unfortunately, her Texas license won’t be awarded until December, and the facility was forced to move forward with another candidate.

I wish I would have met her last year and shared with her that California, Florida and Texas are among the states with the longest licensing periods, which have been known to take as long as nine to 12 months. As we talked, I shared with her the importance of building enough time throughout your job search for all the necessary steps—including licensing.

Keep in mind that some states (Kentucky, Louisiana, Maine (Medical), Nevada (Osteo), New Hampshire, New York, North Carolina, Ohio, Rhode Island, South Carolina, Utah, Virgin Islands and Wyoming) require registering with the Federation of State Medical Boards (FCVS) before you apply for a state license.

The Career Resources section of PracticeLink.com has many other suggestions to improve your job search—and we’ve recently launched a technology update to further empower you.

This new technology platform gives you more options to search and apply for your desired practice opportunities through PracticeLink.com. New features include even more control over your profile privacy, new ways to search for jobs, and more powerful keyword searches. Here’s a look at what’s new for job seekers:

1. Better control of your PracticeLink profile

In the new PracticeLink, you are able to control who sees your Candidate Profile. For example, you can choose to be visible to recruiters at most facilities, but hidden from specific employers in which you’re not interested. By offering you greater control over your profile, we aim to empower you to the maximum in your job search.

2. More choices for your geographic preferences

Need to limit your search to a particular area—or are you open to a broader region of opportunities? The choice is yours. You now have the ability to let in-house recruiters know exactly what state you’re interested in, or select a group of states or entire region in which to focus your search.

3. Ability to upload your CV

Upload your CV and attach it to your PracticeLink profile during the registration process, and you’ll give in-house recruiters even more information to help determine the opportunities for which you may be a good fit. If you’ve chosen to limit your visibility from specific hospitals or health systems, your CV will be hidden from those employers as well. As you’re applying to jobs through PracticeLink, you can now send your stored CV directly to the recruiter you’re contacting.

4. Better search tool

Search for jobs by keywords to find opportunities with your particular focus or in locations that offer your hobby or desired amenities. Try “kayaking” for example to find a community in which water plays a role. This feature will allow you to search for positions by more than just specialty and location and help you find a place where both your personal and professional lives can thrive.

Wherever you are in your job search, PracticeLink can help. Please give our Physician Relations team a call at (800) 776-8383 or email. We provide free job-search advice, can sign you up to receive alerts of newly posted jobs in your specialty, and help you connect with the opportunities that will fit you best.

We look forward to helping you find your dream practice!

Brian Brown is the manager of PracticeLink’s Physician Relations Department. Reach the team at (800) 776-8383 Option 2.

 

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