How one physician transitioned to virtual medicine

By Marcia Travelstead | Career Move | Summer 2016


Gavin Helton MD

When it came to practicing virtual medicine, Gavin Helton, M.D., was surprised both by how quickly patients developed new relationships with physicians, and how quickly they embraced technology.

Physician: Gavin Helton, M.D., Medical Director of Ambulatory Medicine, Mercy Virtual Care Center, Chesterfield, Missouri

Undergraduate: St. Louis University

Medical School: University of Alabama School of Medicine, Birmingham

Residency/Internship: Mercy Hospital (formerly St. John’s Mercy Medical Center), Internal Medicine, St. Louis

Gavin Helton, M.D., was born and raised in Mobile, Alabama. Both of his parents were nurses. After serving as the chief medical resident at St. John’s Mercy Medical Center (now Mercy Hospital), Helton remained on the teaching staff there and practiced primary care in the St. Louis area for 17 years. In November 2014, a steering committee within Mercy identified him and presented him the opportunity to be Mercy Virtual’s medical director of ambulatory medicine. Initially he turned down the opportunity, saying that he didn’t know what it entailed, had more than full-time work, enjoyed practicing and wasn’t looking for a career change. Several weeks later, however, a physician from the committee approached him and asked to discuss the potential of virtual care to address the current unmet needs of their patients. Helton thought of his own complex, chronically ill patients and the gaps in care inherent in the current system. He also saw the need to assist primary care physicians with their often-overwhelming task of caring for these patients and decided to make the move into virtual medicine.

How does virtual medicine work, and how do you like practicing it?

Virtual care allows for identification of the obstacles to care, and we address those in a proactive, preventative manner. This approach prevents unnecessary emergency department utilization and hospital admissions while improving quality of life for the patient. We have developed the program to be part of each individual patient’s care team. I am careful not to replace anyone. I work very closely with the primary care physician, subspecialists and care management … to fill the gaps in care. The focus is shifted from hospital care to patient-focused care—delivered where and when the patients require it. We deploy peripheral devices, like blood pressure monitors, pulse oximeters and scales into the home. These connect wirelessly to a computer tablet to keep us updated on a patient’s condition. We’ve also been adding a triage software that allows for interaction between the patient at home and the virtual care team located at Mercy’s Virtual Care Center in Chesterfield, Missouri. Through centralized monitoring and data analytics, virtual care allows timely and effective therapeutic medical intervention. I document within the electronic health record, which allows all care team members to communicate in real time. The virtual care team, PCP, subspecialists and care management are on the same page.

What is the most challenging aspect of your role?

I certainly miss my former patients; however, I have developed strong relationships with virtual patients, their caregivers and other members of the health care team.

Why did you choose virtual medicine?

I made the difficult decision to leave my practice of more than 5,000 active patients in order to develop a program of helping significantly more patients.

Do you have any advice for physicians who might like to pursue virtual medicine?

The opportunities for a telemedicine physician are limitless, including personalized patient care in any specialty without geographic or time barriers. My advice to other physicians is to be comfortable challenging the accepted norm. Be willing to think out of the box and have a health care system willing to invest in the infrastructure required to be successful in this environment. No special training is required and all specialties will benefit, provided they are open to non-traditional solutions. While we visit virtually with our patients, at other times, we can send out patient education and questions they can view or answer at their convenience. Simplified, virtual care is the leveraging of technology to allow for a patient care continuum with a combination of traditional care team members working hand in hand with the virtual care team.

What surprised you about virtual medicine?

I have been surprised by how quickly new relationships have developed and how quickly patients of all ages and backgrounds successfully embrace the technology. They become more engaged in their care, and subsequently patient outcomes and satisfaction improves.

Anything else?

My initial concerns were [about whether I could] develop personal relationships with patients and their caregivers as I had done the previous 17 years. Absolutely! I have found being in the home and more frequent contact allow for an individualized approach to care. I get to know the patients and caregivers in the comfort of their home environment. I was also concerned my clinical skills would deteriorate if I [was] not at the physical bedside. I have found that in focusing on the sickest 5 percent of our chronically ill, I have the opportunity to spend more time focusing on the clinical challenges associated with caring for these complex conditions, and I believe we will develop a new standard of care as we have the ability to medically intervene in a more timely fashion and can follow up on these changes as frequently as the patient’s situation dictates.



Which employer type is best for you as a physician?

Trying to decide which interviews to pursue, which to take and which to turn down? One way to narrow your focus is to evaluate employer types and determine which one is best for you.

By Matt Wiggins | Financial Fitness | Summer 2016


Residents and fellows come in two breeds: Those who, after training, pursue the job they want and those who take what comes their way. After years working with OnCall Advisors to help thousands of physicians transitioning from training to practice, I am convinced of one thing: A passive approach toward interviewing leads to problematic employment situations, discontentment on the part of both the employer and the physician, and early termination.

Of the physicians we’ve worked with, most who’ve faced the early demise of their first practicing positions don’t completely understand what happened. How did these jobs they’d worked toward for so long go so badly? What happened after they were hired that caused such rapid deterioration of their situations?

The truth is that the fissures probably didn’t start after they were hired. Most likely, the problems started during the interview process. These physicians weren’t actively engaged in determining where they wanted to work, so they failed to identify potential problems that should have steered them away from specific employers. Therefore, a mismatch was more likely, and the groundwork for a career detour was laid.

But you’re not destined to make the same mistake. In fact, one way to avoid it is to understand some of the basic differences among employer types. I’ve written an overview that will give you a good starting point to identify which employers would be a good fit for you. This overview provides a framework within which to evaluate them. Once you know more about each type, you will be able to seek and take interviews with the employers whose opportunities would most likely result in a successful fit.

Understanding the employer types

I caution you against viewing this as an absolute benchmark for all similar employers. Each employer is different, and you will need to evaluate each on its own. Also remember that there are other criteria to evaluate, such as average turnover, technology and flexibility.

Small Private Practices. First, allow me to state the obvious: There is a wide range of private practices, and they are as unique and varied as physicians in a practice. I will merely point to common financial strengths and weaknesses across most small private practice situations without addressing the myriad other differences and nuances.

Small private practices tend to offer the most potential financial rewards, opportunities for partnership, fewest bureaucratic speed bumps, and greatest flexibility for schedules and workplace autonomy. They also, however, come with the greatest degree of potential risk. Because they don’t have the protection of large institutions or corporations, any problems, even small ones, could wreak havoc on the practice. A few years ago, for example, we worked with a small private practice that went out of business simply due to basic financial mismanagement by a key partner. In this case, one of the strengths of small private practices, less bureaucracy, also led to a single person’s actions taking the company down. Therefore, if you are risk-averse, this may not be the route to go. If you can tolerate more risk for more potential rewards, however, you may want to pursue interviewing with small private practices.

Large Private Practices. Large private practices have some of the same dynamics as small private practices but lack the extremes. Due to their size and numbers, these large groups can offer better benefits and pose less risk, but they also offer slightly lower potential for financial reward. Your salary may be competitive, and you may be offered a small stake as a minor partner, but your chance for dynamic income growth is lower than it would be in a smaller group that could double its revenue in any given year. If you like the idea of small private practice but want lower risk and better benefits, you may want to interview with large private practices.

Hospitals. On the risk scale, hospitals are far from almost any type of private practice. This will vary greatly due to the size and location of each hospital, of course, but hospitals are typically slower-moving and prone to fewer big mistakes. The day-to-day changes don’t normally have drastic effects on your employment. Also, turnover can be lower because you may receive less individualized attention on a month-to-month basis. In general, however, pay is lower in hospital settings than in private practices, and benefits are average.

Government. Being employed as a physician by the U.S. government is the ultimate safety play. There is no threat of the government going out of business, and it has taxing authority, if necessary, to raise revenue to pay your salary. The tradeoff is often a significantly lower salary. The government does, however, typically offer a slate of fairly good benefits, and if you remain in government employ until you retire, or if you suffer a catastrophe or disability, the government will take good care of you. For these reasons, if you want very little risk and can live with less pay and pretty good benefits, you may want to interview for a government-employed physician position.

Applying the evaluations

After reviewing the evaluations of each option, I trust you will be more informed about some of the benefits and drawbacks of these major types of employers. If you feel that one is better suited for you than others, pursue employment with that type of employer and minimize the amount of time and focus you give to the others. If you’re still unsure, begin considering other factors like location, schedule autonomy and career advancement opportunities, and other preferences like your desire to do research, have your own practice or see patients in only one location.

I hope that by being judicious in whom you interview with in the first place, you will land in a more favorable position and will experience longer-lived success in your next or first job!

Matt Wiggins is the lead advisor and partner at OnCall Advisors, which helps physicians educate themselves on the non-clinical aspects of their lives. For more information like this on other life in medicine topics, check out their “Attending Life” online video curriculum at



Medical apps for STDs, statins and cancer-screening

These three medical apps help physicians treat STDs, reveal the costs and benefits of screening for cancer and recommend statins based on patient particulars.

By Iltifat Husain, M.D. | Summer 2016 | Tech Notes


This issue’s apps include a great statin management app from the American College of Cardiology, an STD treatment app from the Centers for Disease Control and Prevention, and an evidence-based cancer-screening app. In addition to helping physicians make the best treatment decisions for their patients, all three of these apps are free to download and use.

STD Treatment Tx Guide by the CDC

The CDC isn’t new to the App Store—their STD Tx Guide app has been in the store since 2013. Whereas previous iterations of STD Tx Guide were OK, their most recent version of the app is a must-have for physicians. This version, released in January 2016, contains the most recent updates to treatment algorithms for sexually transmitted diseases.

In addition, the app itself now has key functions that were not present prior. When you open the app, you can go through the conditions immediately. Not only are sexually transmitted diseases listed, but so are other conditions such as sexual assault.

STD Treatment app

Price: Free. App Store: Android:

My favorite feature of the updated app is that the information is now native to the app. Previously, all the information for treatments and conditions had to be accessed online through the app, but now, almost all the information is native. This means you can use the app even when you don’t have an internet connection, and it loads significantly faster than before.

Ways the app could improve. A more thorough “More Info” section for each of the conditions would improve this app. Currently this section has short paragraphs and great references, but more details about diagnosing, managing and caring for conditions would be welcome.

The “Sexual History” section could also be improved if it lost its PDF feel and were instead optimized for mobile devices.

Key ways to use this app. Use this app if you need the latest information on the medication regimen for an STD, if you have a pregnant patient and need to figure out what medication would be OK during pregnancy, or if you have a patient who is allergic to penicillin and needs an alternative treatment regimen.

ePrognosis: Cancer Screening

ePrognosis is a decision support app created by the authors of the popular GeriPal blog in collaboration with health experts at the University of California, San Francisco and Harvard Medical School. This cancer-screening app focuses on colorectal and breast cancer screening for geriatric patients.

One of the key tenets of the app is the understanding that screening and testing can lead to harm. The authors list, for example, some potential harms of colorectal cancer screening, such as severe abdominal pain and the need for hospitalization. These potential harms have been well documented in medical literature, so one goal of the app is to help physicians and patients determine whether screening would benefit them or cause more harm than good.

ePronosis app

Price: Free. App Store: Android: Currently not available

ePrognosis lets you choose colorectal or breast cancer screening or both and then presents you with a standard set of questions. These questions take approximately two to three minutes to fill out. It would be much quicker to flip through the questions while you’re with the patient. For example, one question asks whether the patient has difficulty walking a quarter mile without help from other individuals or special equipment.

Once you go through all of the prompts and questions, you are presented with a meter that ranges from “Harms” to “Benefits.” The meter’s arrow shows to what extent the decision tools within the app recommend screening for that particular patient. My favorite part of the app is the “Learn More” section. In this section you are able to tell your patient their chance of harm if the path of screening or testing is chosen. ePrognosis presents this in an easy-to-explain format with a graph that shows 1,000 units (to represent patients) and highlights how many of those units would experience harm in the first year due to testing. It’s a great graphical representation that makes sense for patients.

Ways the app could improve. It would be great if more data about the decision tools ePrognosis uses were presented in the app. You are able to access information about the decision tools used in the “Information” section, but the “Calculations” section isn’t very detailed and can be difficult to go through. Additionally, there is currently not an Android version.

Key way to use this app. Use this app with elderly patients for whom you are considering colorectal or breast cancer screening. Discuss the results with your patients and show them the graph in the “Learn More” section to help them see how many individuals would be benefitted versus harmed by testing based on their individual variables.

Statin Intolerance by American College of Cardiology

The American College of Cardiology has a great number of medical apps in the App Store. One of my favorites is Statin Intolerance.

This app is useful because the fact that a patient reports muscle aches does not necessarily mean he or she is truly intolerant to statins. If a patient has side effects to the first statin prescribed, cardiologists will often try utilizing other types of statins. Statin Intolerance helps you determine which would be best.

Statin Intolerance app

Price: Free. App Store: Android:

The app has three basic sections: Evaluate, Follow-Up and Compare. The “Evaluate” section is the most comprehensive; this is where you input risk factors, medications, patient demographics and symptoms. This section takes a few minutes to complete and is pretty detailed. In the “Follow-Up” section, you are presented with more specific advice such as titration of meds and other types of statins to use. In the “Compare” section, you can learn significantly more details about statins, such as their half-lives and whether they are lipophilic or not.

Ways the app could improve. The “Evaluate” section could be designed significantly better. Overall this section feels cumbersome to use.

Key way to use the app. If you have a patient who is having side effects to the first statin prescribed, you should consider using this app.

Iltifat Husain, M.D., is the editor-in-chief and founder of, the leading physician publication on digital medicine, and an assistant professor of emergency medicine at Wake Forest University School of Medicine.



Negotiating your work visa sponsorship as a physician

If you’re an IMG physician, you have an extra job-search consideration: finding an employer who will sponsor your visa. Here’s what you need to know about finding a willing sponsor.

By Ann Massey Badmus, J.D. | Legal Matters | Summer 2016


When searching for job opportunities, physicians have tons of considerations—location, compensation, paid time off, work schedule, quality of life and more. But most IMG physicians have an additional consideration looming over their heads: immigration. If you’re a physician with a work visa, you are well aware that your prospective employer must support or “sponsor” your work visa for you to be able to practice medicine in the U.S. As a matter of fact, without an employer’s agreement to sponsor, there’s really no need to discuss any other aspect of a potential offer.

Knowing this, many physicians ask how and when to bring up the need for sponsorship. They also want to know which sponsorship details should be discussed, negotiated and included in the employment contract. As with all things legal, there’s no one-size-fits-all approach, but here are some tips to make your search to find that willing sponsor a little smoother.

Start your search on time

For the best chance of getting your preferred location and employer, you must start the job search early enough to meet immigration deadlines. In order to do this, J-1 physicians must know the dates when their states of choice accept J-1 waiver applications. You also need to start the search a year before your residency or fellowship ends. For example, a second year internal medicine resident looking to work in Texas needs to know that J-1 waiver applications are accepted beginning September 1, 2016, for the 2017 year cycle. He or she must have an employer lined up by July 1, 2016, for a fighting chance of winning one of the 30 waiver slots in that state.

Similarly, H-1B residents or fellows should start their searches a year before graduation. Ideally, you should look for H-1B cap-exempt employers. If you’re unable to secure a cap-exempt job offer, however, starting your search a year ahead lets you apply for an H-1B cap visa on April 1 of your last training year.

Communicate your immigration status

Some employers are very familiar with work visas, but many are not. Those who have little or no experience in this area may shy away from considering visa candidates. Because you have limited time to search for a job while completing your training, it’s usually best to screen out employers who are not open to sponsorship.

Because of anti-discrimination laws, employers cannot ask you about your citizenship or immigration status before offering you a job. They’re not, however, required to sponsor a work visa once they learn you need one. To avoid wasting time interviewing for a job that won’t meet your immigration needs, include your immigration status in your CV and mention the necessity of sponsorship at the earliest opportunity. Doing so will eliminate employers whose policies do not allow sponsorship and will open the door for you to discuss sponsorship with the employers who are willing to consider it.

Have legal help on standby

Immigration is a complicated legal process that can be confusing and discouraging to employers. Because its complexity may be off-putting to many employers, it’s important to reassure them that the work visa application will not be burdensome or interrupt their operations. To ensure this is the case, you should meet with an experienced immigration attorney before or shortly after starting your search.

This attorney can evaluate your specific immigration background, explain the visa process requirements to you, and prescribe a plan to get you practicing medicine in the U.S. as quickly as possible. Most importantly, the attorney has the credentials and expertise necessary to speak with potential employers and address their questions or concerns about the legal process. Your employer will feel more comfortable knowing you’ve already lined up help to meet the legal challenges of your work visa.

Disclose and negotiate visa expenses

Like any legal process, a work visa application involves expenses, including both attorney fees and government application fees. As previously mentioned, immigration laws are not straightforward, but employers and physicians must be careful to understand and follow all requirements of a work visa and green card before and after an application is approved. The immigration attorney will help both you and the employer navigate the complexities to avoid violations, however unintended.

Employers are required by law to pay some of the attorney fees and costs involved with the work visa and green card applications. For example, at minimum, employers must pay the ACWIA (American Competitiveness and Workforce Improvement Act) fee charged by the government for the H-1B petition, and in some cases, the employer is required to pay all fees, including attorney fees, for the H-1B visa. The immigration attorney can advise you on how the fees and costs should be shared.

Also, if you want the employer to pay more than the required minimum, you should be sure the employer’s agreement to do so is stated in your employment contract. It’s important to know that you and the employer cannot agree that you will pay (or reimburse them for) any fees the employer is required to cover.

Put it in the employment contract

Without a doubt, visa sponsorship is critical to your ability to work. Yet many physician contracts don’t include the language necessary to commit the employer to sponsorship for either the work visa, green card or both. Physicians should work with their employment or health law attorney and immigration attorney to add such language if it’s not already included in the contract. Additionally, they should ensure that the contract does not contain any language requiring the physician to reimburse mandated employer immigration costs upon termination of employment.

Ann Massey Badmus, J.D., is head of the immigration section of Cowles & Thompson, P.C. Since 1993, she has helped thousands of foreign-born physicians and their employers get work visas and green cards. Learn more at



How to make the most of your CV gaps

A gap in your work history doesn’t have to work against you. These expert tips will help you make the most of your career timeline.

By Anish Majumdar | Job Doctor | Summer 2016


I recently worked with an emergency medicine physician who was wrapping up her residency and hunting for a new opportunity. Her program was among the top 10 percent in the country. Her teaching experience and volunteering background were first-rate. There was just one problem: Her four-year residency had taken five years to complete.

During a phone consultation to discuss her career, I brought it up, half-thinking it might have been just a typo on her CV. No typo.

After a lengthy pause, she explained that a close family member had unexpectedly died during her first year of residency. In the aftermath, it was impossible simply to continue on with training, so she’d opted for a one-year leave of absence. Love of medicine had brought her back.

Do you think an employer is more likely to hire someone who owns this part of her journey or tries to ignore the issue? The truth is, ignoring it never works.

Recruiters and hiring agents aren’t robots—they’re people like you and me. They get that life happens. They’re also trained to spot inconsistencies on someone’s CV and will, if they’re not addressed, assume the worst. “Five years to complete a four-year residency? Probably due to poor performance. Pass.”

This is why it’s critical to control the message you’re putting out there, especially when it comes to vulnerabilities. Abide by the following tips.

Create a “Career Note” within your CV

Inserting a brief one to two line “Career Note” directly within the “Work History” section of your CV is one of the most effective ways to address a gap. By placing it in a reader’s line of sight, you enable him to pick up on the relevant details without getting distracted from the rest of the document.

Work Gap Example #1: Taking time off to deal with a personal loss.

Career Note: Undertook a one-year leave of absence to cope with a loss in the family. Strengthened personal relationships, managed household affairs, and volunteered for monthly community health clinics (April 2014 – April 2015).

Note the last part about health clinics. If you took on anything remotely career-related during your work gap, be sure to mention it. This sends a clear message to hiring agents that you remained “in the mix” and continually developing during this period.

Work Gap Example #2: Taking time off to pursue training in another field.

Career Note: Pursued Master of Health Care Administration Degree at University of XYZ between 2014 and 2016, with a goal of incorporating knowledge into a hospital leadership position.

Answering why you pursued this training is a great way to get a reader to understand your thinking. I would also recommend placing the “Education” section near the start of the CV to showcase this training. If it’s currently in progress, it’s fine to list it as follows:

Master of Health Care Administration – University of XYZ (Expected Graduation December 2016)

Share your story within the cover letter

Great cover letters offer a glimpse of the person behind the qualifications: what inspires, challenges and differentiates them. In other words, it’s a prime opportunity to spin your work gap into a positive differentiator instead of a negative. The trick is to frame it in a way that adds value to your candidacy.

Use the CARB formula when broaching a gap within the cover letter: challenge, action, results and benefits. Here’s what I wrote for my five-year residency client (altered to maintain confidentiality):

“During my second year of residency, I faced a moment that shook me to my core and made me question my commitment to medicine. My mother, on a visit from New Zealand, suddenly passed away. I found myself without an anchor, adrift, and took a one-year leave of absence to recover and keep our family whole. What I discovered was a greater sense of purpose, an unshakeable belief that circumstances would not alter the course of my journey as a doctor. Upon finishing my residency, I will have completed more than 1,000 clinical hours, executed a significant body of research and gained specialized training in medical education and simulation. I am a stronger, more focused physician because of what I’ve gone through, not in spite of it.”

Proactively address it during the interview

Congrats, you’ve made it past the screening process and have received an invitation to the big game. Don’t blow it by being unprepared to address obvious holes in your career!

Try to weave the explanation in naturally during conversation, before you’re asked about it. Here’s how you can broach being laid off at your previous appointment:

“While leaving my last job was challenging on many fronts, both professionally and in terms of the impact to my family, I wouldn’t change a thing. My last position taught me that in order to be an effective physician, you need to be part of an organization that shares your values and is committed to empowering staff to create a truly world-class institution. Sometimes a hard experience can clarify your beliefs, and that’s what happened here.”

Above all, remember this: The seriousness of an employment gap—and how much of a career liability it will be—rests largely on how you feel about it. Come to terms with it personally, and these tips will help take care of the rest.

Anish Majumdar is a career strategist, certified résumé writer and founder of



Duluth, Minnesota

Duluth’s outdoorsy culture has contributed to a recent influx of new residents. Both newcomers and long-time locals enjoy year-round outdoor activities such as camping, fishing and hiking. And because people from outlying rural areas travel to Duluth for their health care, physicians stay busy with a diverse patient population.

Live & Practice | Summer 2016


Husband-and-wife physicians Brandon Hankey, M.D., and Kelsey Schultz, M.D., needed to think strategically as they searched for jobs during their second year of residency at Michigan State University in Grand Rapids. Hankey had chosen a specialization in emergency medicine, and Schultz had chosen family medicine. Naturally, they needed to make sure they ended up in the same city. They both received offers from St. Luke’s Health Care System in Duluth, Minnesota, and by both physicians’ accounts, the situation has been more than ideal.

“When we were looking for jobs, we wanted a great mix of pleasant people but also an environment that was still busy and professionally challenging. We wanted a future-minded city. Duluth was perfect for us. I would put Duluth in the same list as Asheville, North Carolina; Burlington, Vermont; and Ithaca, New York. It’s a city that’s the right size but really unique,” says Hankey.

“Duluth is 80,000 people, which is big enough to have a busy Level II trauma center with all the challenges I want for my career. You see a nice mix of people from the city and people from the country, especially those who work in the timber and mining industries. You see a great cross-section of people,” says Hankey, who works in the emergency room at St. Luke’s Hospital, a 267-bed facility.

Schultz agrees, saying, “I have a really wide scope of practice. I work in Two Harbors, Minnesota. I have a rural family practice, both inpatient and outpatient, that affords me a lot of variety. I like the huge variety of practice. It’s a wonderful patient population as well. They’re really grounded, down-to-earth people. You get a lot of interesting pathology and pleasant people overall.”

Schultz’s practice is in a more rural area, but the commute is easy. And Duluth is a comfortable place to live. Hankey and Schultz just closed on their first home in Duluth, a six-bedroom Victorian house. Hankey says this is small by Duluth standards. Other houses in their neighborhood have up to 14 bedrooms.

Hankey shares an interesting bit of Duluth trivia: “At the turn of the 20th century, Duluth had more millionaires per capita than any city on earth.” Schultz adds, “It has a lot of beautiful Victorian architecture. The homes and neighborhoods in Duluth are just beautiful.”

Duluth, MN

Duluth, Minnesota

Meghan Anderson, a physician recruiter for St. Luke’s Health Care, says, “As far as the city goes, there is definitely a personality type that is attracted to Duluth. There is a big outdoorsy community. Of course, we have hunting and fishing and things you would picture for north Minnesota, but we also have a big running scene, a mountain biking scene and a big hiking scene. People who live here like to be outdoors and be active. They’re hiking and camping even in the winter. People do it all year long.”

Schultz says, “Once you set foot in Duluth, you realize it’s a special place. It’s worth the winter. Something people say is, ‘The cold seals in the freshness.’”

“In 2014, we were ranked the No. 1 outside city by Outside magazine. That really speaks to the lifestyle and to the recognition of the fact that there’s a diversity of outdoor offerings,” says Anna Tanski, president of Visit Duluth. “It’s not just skiing. People take in all that Lake Superior has to offer.” She says that paddleboarding, canoeing and kayaking tend to be the most popular water sports. She also says that Lake Superior influences the culture beyond recreation activities.

“I’m a lifelong resident here, and our life is centered around Lake Superior,” says Tanski. “It is focused on the outdoors. It’s ingrained in part of our culture, and it creates an active community.”

While Duluth has a tight-knit population of 86,000, the city’s role as a health care hub draws a much larger patient population from surrounding areas. Anderson says that figure is closer to 450,000, explaining, “People drive a long way to get their health care. If you look at where we are on the map, we are on the tip of Lake Superior, so there’s not much between here and the Canadian border. We see a lot of patients from Wisconsin and from the upper area of Michigan.”

To serve this diverse group, St. Luke’s Hospital stays current with state-of-the-art equipment and facilities. “The most notable thing is that we just completed an expansion to our surgery center,” says Anderson. “We just built a bunch of ORs. We also built a hybrid operating room. That just opened in August of 2015. Everything that the physician uses, everything comes down from the ceiling; there’s nothing on the floor. We have a da Vinci robot, and a dedicated operating room for the da Vinci robot. We also have dedicated ORs for open heart surgery and neurosurgery.”

Hankey says another advantage to working at St. Luke’s is the friendliness of the hospital staff. “Duluth is the classic ‘Minnesota nice.’ This is the most pleasant, professional staff I’ve ever been lucky enough to work with. The people make Duluth a great place.”

St. Luke’s Health Care System also has primary care clinics throughout the region, including the one in Two Harbors where Schultz works.

Essentia Health is another of Duluth’s major health care players.

“Physicians are vey much attracted to Essentia Health,” says Kris Olson, vice president of physician and professional services. “We are a physician-led organization, so there’s a really strong focus on keeping the patient and the family a priority.”

More than 800 physicians—and 13,000 total employees—help Essentia address the changing needs of health care through 68 clinics and 15 hospitals throughout the Upper Midwest.

“If you’re a high-end specialist, you can participate in the architecture of that program and have a direct say in what takes place,” Olson says. “You’ll be involved in the programming, the operations, and the understanding of what we do.”

In Duluth, it’s possible to find a successful work/life balance.

“It’s a really neat, four-season, multifaceted location,” Olson says. “You get the opportunity to work and play in the same place. …It’s fun to recruit to Duluth. It’s really the icing on the cake.”



Tacoma, Washington

If you’re in Tacoma, you might overhear someone ask, “Is the mountain out today?” in reference to Mount Rainier, a local landmark sometimes hidden on overcast mornings. On clear and cloudy days alike, the mountain embodies the area’s outdoor culture. No wonder runners, hikers and nature enthusiasts adore this northwest Pacific town.

Live & Practice | Summer 2016


Rebecca Whitesell, M.D., has seen much of the U.S. “My dad worked for the National Parks Service when I was growing up, and we moved all over the place,” Whitesell explains. Now a pediatric orthopedic surgeon at Mary Bridge Children’s Health Center (operated by MultiCare Health System), she attended high school in Texas and stayed in the state to attend Texas Christian University, where she majored in pre-med.

Her decision to study medicine stemmed from personal experience. She explains, “When I was young, I was a pretty serious dancer. Unfortunately, I also had several injuries. I had an orthopedic surgeon that I really liked. I thought what he did was really cool. That’s how I got truly interested in medicine.”

Rebecca Whitesell MD

“I can look at Mount Rainier right outside of our operating room,” says Rebecca Whitesell, M.D., who moved to Tacoma after completing fellowships in Atlanta.

She earned a master’s of public health at the University of North Texas before heading to medical school at the University of Texas Health Science Center in San Antonio. Whitesell then stayed in the South for her residency at the University of Alabama and completed fellowships in Atlanta.

When she started interviewing for jobs, she wanted a new experience. “I interviewed and immediately fell in love with the people in Tacoma. It was really the right time for me, coming out of residency. I liked the setting, and I was very drawn to what I’d be doing and who I would be working with.”

She also liked the surroundings. “I can look at Mount Rainier right outside of our operating room,” Whitesell raves. And according to Matt Wakefield of Travel Tacoma + Pierce Country, the mountain is a big part of the Tacoma experience for everybody who visits.

“When you come to the area, if you’re flying in, you’ll see Mount Rainier,” he says. “It’s iconic. It’s the tallest mountain in the contiguous 48 states. You can see it from Seattle. Whenever the clouds part even a little bit, the mountain is front and center. A phrase people say is, ‘Oh, is the mountain out today?’ It means, ‘Did the clouds part enough?’ When you see it, it looks magnificent.”

Wakefield says the mountain provides plenty of space for recreation. “There are 130 hiking trails on the mountain. There is snowshoeing in the winter. It was named the No. 1 place in the country to view wildflowers.”

Another popular Tacoma destination for outdoor activities is Five Mile Drive. Says Wakefield: “It’s this five-mile stretch of roads with views of the Puget Sound. On the weekends, it’s closed until early afternoon so people can go running. There are lots of people here who are really into the outdoors and fitness, and we have an infrastructure that supports them in that.”

It makes sense that the Tacoma population is health-conscious. After all, health care companies are major area employers. Amber Bishop, a recruiter for MultiCare Health System, says, “MultiCare is a not-for-profit organization with more than 11,000 employees. The employee population is spread through two counties, staffing 120 sites of care.” MultiCare has five hospitals, each of which uses da Vinci robots. A sixth hospital is under construction, and MultiCare also operates the MultiCare Institute for Research & Innovation in Tacoma.

One benefit of working for MultiCare Health System is that their processes take full advantage of electronic patient records. MultiCare was an early adopter. The organization started using electronic patient records for their outpatient clinics in the late 1990s.

Naturally, the size and growth of the organization affect their recruiting efforts. “At any given time, we probably have more than 100 searches open, and that includes primary and specialty care,” says Bishop. “Right now, urgent care is a big focus.”

Bishop says there are many benefits to working for a larger health system. “Because we employ so many different providers, they have a built-in network to refer their patients to. Any specialty you can think of, we have in our system.”

That includes Whitesell’s specialty. “In medical school, everyone always says, ‘I’m going to be a cardiologist,’ or, ‘I’m going to do internal medicine.’ They made up their minds. I knew I was interested in orthopedics, but I went through medical school pretty open-minded. When I did my third-year rotation in surgery, I fell in love with surgery. When I did my first surgery in orthopedics, I was like, ‘I’m never doing anything else ever again.’”

It’s clear that Whitesell’s work isn’t just a paycheck for her. She says, “There’s something about taking care of kids that’s infectious in a good way! There’s an element of taking care of a kid and taking care of their parents. You take care of them in different ways.”

And when she’s not taking care of families, Whitesell enjoys taking care of her 10-month-old chocolate lab. She and her puppy go for walks and occasionally go running together.

“I really love all the outdoor activities,” says Whitesell. She also appreciates Tacoma’s versatility and overall feel. “It’s a big enough place that you can have anything you want living in a city,” she says “You’re close enough to Seattle, but Tacoma doesn’t feel like the suburbs. You’re living in its own place.”



Portsmouth, New Hampshire

Summer in Portsmouth means locals and tourists don their sunglasses and enjoy the coastal town’s wealth of activities: swimming, kayaking, bicycling, running and enjoying seafood (practically a sport in and of itself). And as locals will tell you, the outdoor activities aren’t limited to summer. Admittedly, however, most people take a break from swimming in the winter.

Live & Practice | Summer 2016


Gareth Davies, M.D., didn’t need to be sold on Portsmouth. He had spent time in New Hampshire and already knew he loved its New England feel, so when he got the chance to move back after his residency, he didn’t think twice.

“I am originally from Pennsylvania, but I went to Middlebury College in Vermont. In college, I knew I liked biology—from microbiology to organism-type biology. The year 2000 I was a freshman there, and that was the first year that neuroscience was offered as a major. I noticed that every course that I signed up for was one of the neuroscience courses.” Naturally, Davies declared a neuroscience major.

“I knew I wanted to go to medical school. I made that decision in high school actually,” says Davies. And at Dartmouth Medical School, Davies felt right at home. “I fell in love with New Hampshire.”

As Davies neared the end of his residency at Penn State University, he felt a pull to return to New Hampshire.

Gareth Davies

Already familiar with New England, Gareth Davies, M.D., was drawn to New Hampshire after residency at Penn State. He’s now a neurosurgeon at Portsmouth Regional Hospital.

“I was thinking about where I would like to settle. I started looking again at coastal New England. I always loved the coast. I was looking for a vibrant small town with a young population, like Portland or Portsmouth or the Cape. From there, I started looking at what practices were hiring. One of my mentors from my residency had done his residency with one of the neurosurgeons at Coastal New Hampshire Neurosurgeons.”

Davies liked what he saw there. He says, “I was immediately very impressed by their neurosurgery practice.” So he accepted a neurosurgeon position with the group, which is operated by Portsmouth Regional Hospital, part of HCA.

Dean Carucci, CEO of Portsmouth Regional Hospital, says, “Portsmouth Regional Hospital is a leading provider of cardiovascular surgery as well as neurosurgery.” The hospital has 209 beds and operates a Level II trauma center. It stays up to date with state-of-the-art equipment. Carucci says, “Portsmouth has dedicated cardiovascular operating rooms as well as a hybrid room. In addition, we have three distinct catheterization labs and an interventional radiology suite. The facility has also invested in high-end imaging including a 3-T MRI, 3-D mammography, 3-D echo, EBUS [endobronchial ultrasound] and a host of others.” Portsmouth Regional Hospital also operates outpatient facilities in the area.

State-of-the-art operating rooms are a plus for Davies, who has felt drawn to surgery since the beginning of his career. “I’ve always leaned more toward surgery because I enjoy having a defined problem and being able to go in and fix it. I like when I can respond and fix something structural.”

When Davies isn’t in the OR, he’s outside enjoying Portsmouth. “I fell in love with Portsmouth as a town. It’s very outdoor-oriented. It seems most people like to run, hike and sail.”

Portsmouth residents as a whole tend to enjoy the outdoors and exercise avidly, according to Valerie Rochon, interim president and tourism director of the Greater Portsmouth Chamber of Commerce. “It’s a lifestyle choice to live here and be on the seacoast. It’s a quality-of-life choice. You’re making the decision to have a much higher quality of life.”

Rochon recommends visiting the beaches, trying out Portsmouth Kayak Adventures, enjoying the boardwalk or even sailing on a replica of a 16th-century barge. “We are so involved with the water,” she says. She recommends families with kids who want to get even closer to marine life visit the Blue Ocean Society, explaining, “It’s the organization within the Seacoast Science Center, which is the marine mammal rescue organization for all of New England.”

If this lifestyle sounds appealing, you should know that Portsmouth Regional Hospital is hiring. Carucci says: “We are currently recruiting heavily for vascular surgeons, hospitalists, psychiatric physicians and primary care, both internal medicine and family practice.”

Pleasant surroundings aren’t the only perks of the workplace. Davies says other hospital employees are one of the best parts of his job. “Across the board—from management to the other physicians and nurses and techs—people are very respectful. Because people are so respectful, it’s a pleasant place to work. Everyone is very proud of the community and very focused on providing top-level care for the community. People get close to their patients.”

Davies considers Portsmouth the perfect size. He says it offers just the right amount of amenities for doctors who have busy schedules.

“When I was thinking about where I wanted to live, the important thing for me was looking at what was offered in the area and what would it actually be like to live there. There’s a tendency to think that there’s so much more to do in a big city. In the daily life of the average physician, you tend to work long hours, and you work late regularly. I don’t know that you necessarily need access to the thousands of restaurants in a big city.”

Davies is engaged, and he has a dog. What could be better than taking your dog for a walk on the boardwalk, enjoying the sun and breathing in the sea air? In Portsmouth, it isn’t a vacation. It’s your life.



Galveston, Texas

If you ever dreamed of combining a challenging medical career with a beach lifestyle, consider working in Galveston. This historic beach town is a short commute from a 600-bed hospital with a brand-new brain and spine institute. And to sweeten the deal, Texas has no state income tax.

Live & Practice | Summer 2016


When Hashem Shaltoni, M.D., moved to Houston in 1999, he thought he would only be in the area for a year. He had graduated from medical school in Lahore, Pakistan, where he expressed an interest in neurology early on. “In medical school, I realized I was spending more time to really understand neurology than my peers. I found that I was unique. I understood it better. I stood up many times and asked neurology questions in class.” When Shaltoni’s father had a silent stroke, it sparked Shaltoni’s specific interest in stroke training and interventional neurology.

Shaltoni moved to the U.S. and did a preliminary residency in internal medicine at the University of Texas Health Science Center in Houston. “Our agreement was: ‘We will check you out, and you check us out.’ I thought it would be just one year in Houston. But in the first few months, I was really impressed by the neurology chairman.” At the end of his internship, Shaltoni was accepted for a residency in neurology at the University of Texas.

“I got into UT because they liked me, and I thought it was a cool city. But I still felt like I lived in Houston temporarily because I was going to do my fellowship somewhere else.”

But by the time he needed to choose a location for his fellowship, Shaltoni felt so connected to the Houston area that he wanted to stay. “I really liked the city. It’s large. It’s handsome. It has great diversity. And I got married.”

So Shaltoni stayed for two fellowships: one in neurology and one in vascular neurology. Today, Shaltoni works for Clear Lake Regional Medical Center, part of HCA. Clear Lake is located between Houston the Galveston Bay shoreline.

Shaltoni uses his education to serve his community. In fact, he established Clear Lake’s Brain & Spine Institute to offer advanced care to patients living near the coast. “Our goal is to provide neurology and neurosurgery care to the community,” he says. “I’ve recruited three new neurosurgeons, and I’m recruiting for two more neuroscientists. Now, highly complicated cases no longer need to be transferred to the medical center in downtown Houston.”

Galveston TX

Galveston, Texas

Michael Herrera, a physician recruiter for HCA, says of the center: “It is our flagship hospital. It has 586 beds. It is located between the downtown Houston area and Galveston, Texas. For those interested in working here, it’s in an ideal place in terms of being close to the city and being close to the beach.”

The town itself is also pretty ideal. Leah Cast, public relations manager for the Galveston Island Convention & Visitors Bureau, says, “Galveston is unlike any other place. People take pride in Galveston. It’s a mix of having a beautiful tropical atmosphere with that southern charm and southern hospitality. People definitely feel at home.”

Cast says Galveston and the outlying areas have a “huge outdoor culture.” She raves, “It’s this small island that is tropical but also very historic. We have 32 miles of beaches. The island is 32 miles long but only two and a half miles wide. When you drive to work in the morning, you can see the sun rise over the Gulf of Mexico.”

But the island life isn’t isolated. With a population of 50,000, Galveston boasts a bustling downtown. Residents enjoy boutique shopping, outdoor musical performances and excellent restaurants with coastal fare. Cast adds, “We have a beautiful historic downtown. It’s a gorgeous place and at the center of a lot of outdoor special events and activities. Top chefs move to Galveston. We have a great food scene that is really high quality compared to what you’d think of for a beach town.”

Another unexpected benefit of this coastal town is its job opportunities. Galveston’s proximity to Houston and several midsize towns between the two cities provide a patient population large enough to keep medical professionals busy.

“HCA has 160 hospitals in 20 states. We have a pretty big presence in the greater Houston area. We have 10 hospitals in the greater Houston area and several more in south Texas,” says Herrera, adding that there are several draws for physicians contemplating a move to Texas. “We seem to attract a lot of attention from physicians who are looking for a warmer climate, and we have no state income tax. Real estate properties are a good value here. You factor all those in, and it’s a great place to live and work.”

Shaltoni and his wife are optimistic about raising their son, who is now 18 months old, in the coastal Texas area. “From my experience, the schools are fantastic,” Shaltoni says. “I started late to have a family, so I have friends who have kids who are 8 or 9 or 12. I see them and the way they’re raised. Everybody is happy.”

Shaltoni’s son will start day care soon, and Shaltoni says he is lucky to have a wife who understands how Shaltoni’s work is not just a job but also a calling. “I went to school for a long, long time. My dad was always like, ‘When are you finishing school?’ I was dedicated to really learning what I was learning. Now, I feel blessed that I live in a country that has allowed me to make a difference.”



Christine Bourbeau, FASPR

Snapshot | Summer 2016


Christine Bourbeau

Recruiter Christine Bourbeau

Director, Physician Recruitment

Saint Francis Hospital and Medical Center

Hartford, Connecticut

Bourbeau, a Connecticut native, has been recruiting physicians for more than 25 years. Learn more about her opportunities by contacting her at or through

What surprises physicians the most about their first job search? How ill-prepared they are for it. They don’t learn about preparing for an interview in residency or fellowship; there’s no class that prepares them for a formal interview.

How can physicians better prepare for their job search? Prepare themselves for being asked more behavioral interview questions. We’re not just asking them what they want to do and how many patients they want to see in a day; we’re looking for the right fit, and the behavioral interview questions help us to learn more about the physician and how they will interact with their patients and colleagues. They should leave the interview feeling that they have gathered together all of the information they need to make the right decision.

How has the recruitment experience for physicians evolved over the years? When I first started out recruiting more than 25 years ago, 95 percent of the physicians would come to town, buy a house and settle down. Now, the majority of doctors that I’m recruiting are renting first to see if the job is going to work out and if their family is going to be happy in the area.

What’s most important for you when recruiting physicians to your community? That they will fit in with the people they will be working with. First impressions are lasting impressions. There’s a lot of information we as recruiters gather from the physician after spending a day or two with them, and this information is just as valuable as the “formal” interview process.

How does PracticeLink help? When a physician asks me for help identifying a job that’s not in my community or state, I always ask them, “Are you registered with PracticeLink?” I tell them that it’s where they need to go to find their job. I explain that it’s a way for them to deal with in-house recruiters like myself—you don’t have to sign up with an agency. I tell them that 95 percent of the people who do what I do use PracticeLink. I’m always pushing them to PracticeLink.




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