Physician adviser

Physician advisers serve as the links between providers, administrators and patients.

By Marcia Travelstead | Career Move | Summer 2018

 

 

Clinical experience and administrative interest uniquely position physician advisers to be a link between the two. · Photo by William Hendra

Clinical experience and administrative interest uniquely position physician advisers to be a link between the two. · Photo by William Hendra

Name: Howard Stein, D.O., MHA

Employer: Associate director of medical affairs, physician adviser for care management at CentraState Medical Center in Freehold, New Jersey

Education

Undergraduate: Muhlenberg College, Allentown, Pennsylvania

Postgraduate: Nova Southeastern College (D.O.), Fort Lauderdale, FloridaUniversity of Maryland (MHA), Adelphi, Maryland

Residency: Union Hospital, Union, New Jersey

A physician adviser serves as a liaison between the medical team and hospital administrators. Stein is a national speaker advocating the physician adviser position and the importance of performing multidisciplinary rounds. He left clinical practice in 2003 as his role at CentraState Medical Center evolved into full-time administrative work. He obtained his MHA in 2014, which gave him insight into the administrative and economic aspects of medicine.

What does it take to become a physician adviser?

In general, preparation for the physician adviser position involves practicing medicine for at least five years and showing an interest in utilization, quality assurance, coding, billing or informatics.

What do you like about your role?

I like working on all of the hospital floors and interacting with all of the physicians as they come around to see patients. I also like multidisciplinary rounds; I do six sets of rounds per day. I interact with nursing staff, physical therapists, clinical pharmacologists, pastoral care workers, social workers and case managers. They’re all part of multidisciplinary rounds, so each day we efficiently discuss each patient.

We communicate on an interdisciplinary level so everyone knows what each discipline is working on. I find out what the physician issues are so that I can address them. And when an insurance company is not going to pay for a patient’s stay, I know about it while a patient is an inpatient instead of finding out about it a week later. So we can react to it by either appealing it or by helping the patient obtain an earlier discharge. There are multiple other good things that happen when you do multidisciplinary rounds from a quality and economic perspective.

What’s the most challenging part?

I don’t like how insurance companies take advantage of hospitals and patients by denying them care when it’s appropriate for them to have the care. The physician adviser’s role is to be an advocate for that patient. As denials are issued by an insurance company, the physician adviser reviews the case, talks with the doctors who were involved and makes the decision to appeal the decision or work toward a safe discharge plan if that’s an accurate decision.

Was there anything about becoming a physician adviser that surprised you?

In some hospitals, there’s a large divide between the administration and the medical staff. So, there’s some natural pushback by the medical staff on what the physician adviser does. In some organizations, the physician adviser is looked at as an outsider, not really a member of the medical staff.

I don’t have this problem. Those that do have to work hard to be credible and to gain the trust of the physicians on the medical staff, make them understand that the physician adviser is there to help them and their patients. Physician advisers are not just somebody from administration telling them what to do.

How can other physicians pursue physician adviser roles?

The optimal candidate is a primary care physician, although there are a lot of non-primary care physicians that do it. The primary care physician has a somewhat greater perspective on a wider variety of cases that come into a hospital.

Interested physicians should spend some time with a physician adviser in a hospital to get to see what they do on a day-to-day basis. I suggest joining the American College of Physician Advisors. The other organization that’s very helpful is the American Board of Quality Assurance and Utilization Review Physicians.

There are some conferences each year that I think are helpful. There is also a physician adviser boot camp held yearly. ABQAURP holds an annual conference as well.

It’s about combining the clinical knowledge from practicing medicine for a number of years and learning to understand the utilization rules given by insurance companies and Medicare. Then, the physician adviser needs to be able to teach the medical staff and finance department the ins and outs of the rules to maximize quality and the reimbursement received by using hospital services efficiently and billing correctly.

Anything else?

It’s definitely a field that’s expanding and growing. There are physician advisers now in different fields of administrative medicine. It’s not just utilization, but it’s also quality, informatics, coding and documentation.

Physician advisers are key to successful organizations. Physician advisers bridge the gap between hospital administration and clinical medicine.

 

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How your partner can help

Your significant other’s research can help you make a smooth transition to a new opportunity.

By Jeff Hinds, MHA | Job Doctor | Summer 2018

 

Stack of hands. Unity and teamwork concept.

I’m both an adviser who has helped hundreds of physicians with their job searches and the spouse of a physician who has gone through the same process.

As such, I’ve seen firsthand how physicians struggle to manage all aspects of their search while simultaneously juggling the heavy demands of their current position or training program responsibilities.

Because of this, one of my biggest pieces of advice for physician job-seekers is to lean on all the resources available to help you maximize your efficiency and minimize your stress. One of those resources? Your spouse or significant other—someone who is equally invested in making sure this is a smooth and successful transition.

There are some key areas where your spouse can help ensure you are fully prepared for your job search.

Before you begin a search

At the onset of your search, you should be gathering and updating all of your application materials, such as your CV, cover letter, reference list, etc.

Don’t underestimate the importance of these materials. They not only help you get a foot in the door, but when all else is equal among candidates, it’s often the seemingly minor details that can make a difference in the end.

Pay attention to those details. Have your spouse proofread all your documents to ensure there are no formatting or grammatical errors. This is also the time to take a step back and, with your spouse, define your job-search parameters. Which geographic locations or regions are the best fits for your family? Your spouse can also help you reflect as you determine which practice types or settings are most conducive to both your personality and your career aspirations.

During your search

As you begin applying to opportunities and receiving invitations to interview, it’s time to conduct further research into each location to determine the potential fit for your family. Your spouse can help you with this research.

Similar to evaluating a practice to determine if it matches your clinical skillset, you’ll need to closely evaluate a community’s amenities, recreational opportunities, schools and other organizations to determine if it can support your family’s interests and aspirations.

Two great resources for learning more about a community include the local convention and visitors bureau and local realtors. Realtors “sell” the community for a living and will be able to highlight its major perks and opportunities.

After your search

Once you have selected a position and accepted an offer, there is much more research your spouse can do to ensure a smooth relocation process.

If you have children, you have likely already given some preliminary considerations to the educational opportunities that exist in the area. Now it’s time to explore further and begin making the decision on where to enroll. Does the area offer a great public school system? What private or parochial options should you consider?

It’s also time to start looking further into interviewing realtors and exploring housing options, selecting banks, exploring churches, and getting plugged into recreational options for your kids. All of this research takes time—and present great opportunities for your spouse to help.

Jeff Hinds, MHA, is president of Premier Physician Agency, LLC, a national consulting firm specializing in personalized physician job search and contract assistance.

 

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Your best health care cv

Your CV creates your first impression with an employer. What does yours say about you?

By Debbie Swanson | Feature Articles | Summer 2018

 

Imagine you’re about to make a speech before a distinguished gathering of professionals. While you’re being introduced, you wait nervously—knowing that this introduction will make or break your presentation. Depending on what they hear, audience members will either perk up or tune out.

Your curriculum vitae has that same power. It can portray you as a desirable candidate or cause your reader to yawn and flip to the next applicant in the pile.

Whereas resumes are typically shorter and used for standard job applications, a CV is required for many fellowships, residencies, research positions, graduate schools and more. It’s also the standard job-seeking document for most health care professionals. Keeping an up-to-date version on hand can mean the difference between submitting an application early or scrambling to complete paperwork at the eleventh hour.

Part 1: What to include

Treat your cover letter as your personal sales pitch, recommends physician recruiter Heather Peffley. · Photo by Hillary Muelleck

Treat your cover letter as your personal sales pitch, recommends physician recruiter Heather Peffley. · Photo by Hillary Muelleck

Because it is so comprehensive, a CV is divided into sections. Academic history, work experience and research experience are standard, but other sections may also be included if relevant. Academic sections typically come before professional ones.

Information should be presented neatly and consistently. Begin each section, except for your identification, with a header. List dated entries in reverse chronological order (using a month/year format) and use alphabetical order for undated items, such as interests or skills. Sections include:

Identification: Include your name and contact information at the top of the page.

  • Details to include: Your formal name, address, city, state, country and country code. Provide at least two means of contact: email address, home phone number and/or cell number.
  • Tip: Be sure to include M.D. or D.O. next to your name so recruiters don’t have to hunt for it.

Personal statement: Some career advisers recommend including a personal statement about your goals, while others say a cover letter is a better place to relay this information. If you do choose to include a personal statement, keep it to one concise paragraph.

  • Details to include: Two to three sentences explaining where you are in your career, what your goals are, and why you are a good fit for the position.
  • Tip: Include a personal statement if you’re using a recruiting service, as it helps recruiters identify you and understand your strengths.

Education: Only include schools where you earned a degree or certification. If you transferred or withdrew from a school, you should omit this from your CV but be ready to provide details if asked.

  • Details to include: List the institution’s full name, the degree/certification obtained, month/year bestowed, major and minor(s), thesis or dissertation (if applicable), city, state and country.
  • Tip: Include the dates of your degrees. “This provides [verifiable] confirmation of your credentials and demonstrates experience or rank, often required for positions,” says Heather J. Peffley, PHR, FASPR, physician recruiter at Penn State Health in Hershey, Pennsylvania.

Professional certifications and licenses: List all of your current medical accreditations, certifications or licensures.

  • Details to include: Name of the accreditation, state (if applicable), year it was bestowed and expiration date.
  • Tip: There’s no need to include license numbers on your CV.

Awards and honors: List any honors and awards you have received, such as volunteer recognitions, academic distinctions, professional recognitions, military decorations and scholarships. Don’t overlook anything that might be relevant. “Were you a chief resident?” asks Peffley. “If so, include that.”

  • Details to include: Name of the award/honor, the year you received it and the granting organization. Include a one-line description if necessary. If an item is self-explanatory, no elaboration is needed.
  • Tip: “From a resident perspective, I wouldn’t go past college,” says Zachary Kuhlmann, D.O., OB-GYN residency program director for KU School of Medicine-Wichita. “For practicing physicians, I’d stop at college/medical school and residency.”

Professional experience: Provide a complete timeline of all your paid employment since medical school. If you served in the military, you can include it here or in a separate military experience section.

  • Details to include: Dates, job title, employer name, city and state for each position. Describe the role—including clinical experiences you gained, skills you developed and results you helped to achieve. If you have changed careers, highlight skills that will transfer to the medical field.
  • Tip: Use a month/year format for dates, advises Peffley. “This is a requirement for foreign nationals [who] require visa sponsorship and has been adopted as a best practice on CVs,” she says.

Research experience: List any research you have conducted or assisted with.

  • Details to include: Dates, funding granted, the name of the research leader, your role/title and a brief summary of the project and your responsibilities.
  • Tip: Review your research outcomes before your interview. “If you have research listed, be sure to know about it so if someone asks you about it, you can tell them,” Kuhlmann says.

Publications: List all published work you authored, co-authored or contributed to, including journal articles, abstracts or presentations. Your CV should become an archive of all your publications.

  • Details to include: Title of article or presentation, type of item, your role, date presented or published and where it appeared.
  • Tip: Jot down each presentation as it occurs, so you don’t forget. “In residency, you lose track of some of the presentations you may give,” says Stephanie Kuhlmann, D.O., associate professor of pediatrics at KU School of Medicine-Wichita. “You forget about all the little things you do. Even though they’re kind of small, they can get you a promotion. Every little thing you do can go on you CV.”

Teaching experience: Include any involvement in teaching, tutoring, classroom assisting, curriculum development or similar activities. Training fellow undergraduates, through peer mentoring or student orientations, may also be applicable.

  • Details to include: Name of the institution where you provided instruction, your role, the subject and month/year.
  • Tip: Teaching is a valuable skill in the medical profession. Adding teaching experience to your CV may give you an opportunity to talk about it later during your interview.

Volunteer experience: List unpaid work and community involvement. If your volunteer service includes sitting on more than one board or you have a highly relevant board appointment, consider creating a separate section for board memberships.

  • Details to include: Name of the organization, type of organization (if necessary), your title, dates involved and a brief description of your contribution.
  • Tip: Trim this section by including only the most significant or relevant positions. Including brief volunteer stints or unrelated items could detract from more impressive endeavors.

Extracurricular activities and interests: Include non-professional pursuits, such as participation in sports, music and art as well as any certifications.

  • Details to include: List each item and be ready to discuss. These items also make good small talk over lunch or in meetings.
  • Tip: Use this area to demonstrate that you are a well-rounded individual and to showcase relevant skills. For example, distance running can demonstrate self-discipline, and performing in an orchestra requires teamwork. “I’m OK with putting some eclectic things on a CV, but phrase it in a professional manner,” Zachary Kuhlmann recommends.

Professional affiliations: List career-related groups, committees or societies you have participated in.

  • Details to include: Name of affiliation, dates involved and position or role.
  • Tip: Typically, it’s best to focus on current affiliations. If you do include lapsed memberships, be prepared to explain the reason you left. It may come up in an interview.

Other qualifications: Provide non-medical talents or skills, such as foreign language fluency, cultural experiences, personal interests or special motivators.

  • Details to include: List a brief summary of each item. Be prepared to verify and discuss.
  • Tip: “When I reviewed CVs from medical students, what I remember most was their life experiences,” says Jacqueline Huntly, M.D., president and founder of Athasmed, LLC in Savannah, Georgia. “If you have experiences that aren’t typical or things you achieved or overcame, it can help give a feeling for you as a whole—not just data on a resume.”

Part 2: What to know

Some of the most memorable CVs Jacqueline Huntly, M.D., has reviewed included unique accomplishments or interests. · Photo by Amber Jasso

Some of the most memorable CVs Jacqueline Huntly, M.D., has reviewed included unique accomplishments or interests. · Photo by Amber Jasso

Some parts of preparing your CV are common sense, but other important considerations aren’t so obvious. Here are some do’s and don’ts to keep in mind.

Don’t go it alone

Even if you have first-rate medical credentials, grammatical errors or poor organization could jeopardize your chances of being taken seriously.

“If there are grammatical errors or inconsistencies in the personal statement or publications, you’ve got to wonder how that will reflect in basic care,” Kuhlmann says. “Will they miss something?”

Whether you enlist assistance from the start or do so later while reviewing your first draft, it’s smart to bring in a set of trained eyes. A career counselor or writing professional can make sure your material is polished. Plus, industry standards change frequently, and a professional will ensure your document reflects current best practices.

In addition, you should seek the opinion of one or two people who know you well. Consider family members, mentors or trusted colleagues. They can help you project an authentic tone and personality. They may even point out strengths and skills you’ve overlooked.

Perfect your language

Tone and word choice play important roles in shaping a reader’s first impression of you. Huntly explains, “[Your CV] must convey that you’re a professional with good use of language.”

Reviewing example CVs can give you a sense of the right language to use. Get samples by contacting your medical school’s alumni office, asking colleagues and mentors or looking online.

Some tips for achieving a professional tone:

  • Use strong verbs. For example, “executed” and “spearheaded” make powerful alternatives to “worked.” To get ideas, consult a thesaurus or search online for “resume verbs.”
  • Replace buzzwords or jargon with simpler language.
  • Avoid repetitive phrasing or overused words. Variety will make your CV more compelling.
  • Define project names and spell out acronyms.
  • Minimize superlatives. Words like “very” or “best” rarely add value, and when overused, they reduce your credibility. “Don’t embellish. What you put down should speak for itself,” says Huntly.

Dealing with employment gaps

Your employment timeline is one of the most scrutinized sections of your document. Prospective employers hope to see a flawless record, beginning with medical school. But that may be unrealistic.

Instead of worrying or trying to hide lapses in employment, it’s best to address them, according to Kelly Sennholz, M.D., an emergency medicine physician in Denver. “Put it all out on the table, because it will come up,” she says. Two or three weeks are insignificant, but any lengthier gaps should be documented and labeled with a neutral or positive descriptor, such as educational travel, cultural pursuits, relocation, etc.

Early in her career, Sennholz took time away from medicine to start a company, which she documents on her CV as “time creating a business.” “I keep the description simple, so they can’t decide if they like or dislike it,” she says. “I have answers ready if they ask, and they always do.”

Be ready to talk about any employment lapse if an interviewer asks. Take the opportunity to present it in a flattering light. “For example, if you traveled to Africa and you toured some medical facilities, perhaps there’s a story or vignette you could use [about] what you were learning while traveling,” Sennholz suggests. “They’re looking for red flags, personal flaws, so don’t give them one.”

Even a less-than-ideal career gap can be presented positively. “It’s not a career death sentence,” says Zachary Kuhlmann of a gap. “But be prepared to discuss it and how you’ve grown and how that experience made you better.”

Scattered work history? Don’t worry

Not every physician follows a straight path from college to practice. Some start in a different area of health care, while others may initially pursue a non-medical career. So don’t worry if your work history seems lacking. Instead, put a positive spin on what you’ve done.

Some candidates feel non-medical employment isn’t worth mentioning, but that’s not always the case. For example, a former school teacher could emphasize teaching, multitasking and time management skills, all of which are useful traits for physicians.

If you’ve been hitting the books for several years without accumulating much work experience, you can still emphasize how you learned and grew during that time.

“There are ways to demonstrate initiative and leadership skills even though they occurred in an educational setting,” Peffley says. “Include details about your ranking, any accolades or awards you received, etc. These elements may be translated into skills also earned through work experiences.”

Whatever your background, the key is to shine a spotlight on your achievements and skills, while showing how you’ve spent your years productively. “Trust who you are and respect the decisions you’ve made along the way,” says Huntly. “Even if you’ve made a mistake, focus on what have you learned from it.”

What not to include

Though your CV is a highly detailed document, it’s not completely comprehensive. A few pieces of information are best left out. Omit personal details, such as age, sex, gender identity, family structure, religious affiliations or marital status. “By indicating this information, you are essentially inviting someone to make an assumption about you and/or your abilities—and not always in a positive light,” says Peffley.

Immigration status is another area that may provoke a biased reaction, but applicants requiring visa sponsorships may need to open that conversation anyway. Peffley explains, “You may simply add ‘citizenship status: requires visa sponsorship’ on the CV.”

Most experts suggest you leave off the names and contact information of your references. This protects their privacy and enables you to share the most current information with prospective employers. Including “references available upon request” is unnecessary, as it’s assumed applicants will supply references.

Finally, never include anything that’s not 100 percent accurate. False or intentionally misleading information has no place in a professional document and can permanently damage your reputation.

Part 3: The cover letter

In addition to your CV, you’ll need one other document: a cover letter. This letter should be uniquely targeted to every opportunity. Peffley suggests you consider it your personal sales pitch, explaining, “[Use it to] illustrate why an employer interests you, and how you may positively contribute to—more importantly, impact—their organization.”

Letters are usually one or two pages and have a friendlier, more personalized feel than the CV. They are organized in three sections:

The introduction: A short paragraph that explains where you are in your career, touches on your goals and identifies the opportunity you are applying for.

The body: One to three paragraphs that identify what makes you a good fit for this position, mention any mutual connections and highlight any unique qualifiers. Peffley suggests explaining where you get your motivation and drive. “Outlining what inspires you may prompt the reader to want to learn more,” she says.

This can also be the place to put a positive spin on any potentially questionable areas in your CV. “Letters can be an appropriate spot for addressing issues,” Huntly advises. “If you’ve followed a different path or changed directions, give reasons why that was part of your journey and convey that you are committed now.”

The conclusion: A paragraph thanking your readers for considering you, reiterating your interest and expressing enthusiasm about hearing from them.

As with your CV, a cover letter with grammatical errors, inaccurate statements or poor word choices will work against you, so it’s best to consult a professional. To save time down the road, formulate one or two generic versions, which you can later tailor to suit each application.

Loosely translated from the Latin for the course of one’s life, a curriculum vitae should be a comprehensive record of your noteworthy accomplishments. Creating this document can feel daunting. But if you reach out for help and update your CV annually, you’ll maintain a current CV that reflects your achievements and presents you as a desirable candidate.

Debbie Swanson is a frequent contributor to PracticeLink Magazine.

 

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Notes from the other side of the interview desk

Ever wonder what’s happening on the employer’s side? An in-house physician recruiter shares notes.

By Therese Karsten | Feature Articles | Summer 2018

 

Over my three decades of working in health care and countless physician interviews, I’ve learned that the job-search process looks a little different from my side of the interviewer’s desk. I wanted to roll back the curtain to show physician candidates what happens on the recruiter’s side, so I polled others in the field for their take. Their answers can help you land and plan your interviews.

We will probably Google you

A recruiter’s Google search of Brent Herron, M.D., illuminated the “why” behind his request for an atypical schedule: charity work that made him a great candidate. · Photo by Jamie Rubeis

A recruiter’s Google search of Brent Herron, M.D., illuminated the “why” behind his request for an atypical schedule: charity work that made him a great candidate. · Photo by Jamie Rubeis

After reviewing your CV to confirm that you meet the basic criteria, there’s a good chance a recruiter, administrator or physician will turn to Google before inviting you to interview. This isn’t an attempt to dig up dirt; employers simply want to connect the dots. We’re looking to confirm that you’re a promising candidate, and we’re crossing our fingers that we don’t to see any red flags.

At some organizations, an online search is a routine part of the vetting process; at others, they’re conducted unofficially. For example, a curious senior partner might look while reviewing CVs on her home laptop.

Checking out social media profiles is still a hotly debated practice. Some hospital systems prohibit recruiters from searching anything other than official databases.

“Google searches incur the risk that the recruiter will turn up photos or indications of age, gender or country of origin that could be used as grounds for discrimination,” explains Christy Bray Ricks, MHA, FASPR, senior director of physician recruitment for LifePoint Health. One of Ricks’ former employers prohibited online searches not only to prevent inadvertent exposure to information associated with an equal opportunity protected class, but also because information on social media can present a skewed picture.

“There simply isn’t a way to forget information about extramarital affairs on a blog. No way to un-see the small town newspaper’s lurid and detailed account of a patient death,” Ricks says. “That information may not be accurate or relevant to the employment decision, so better to avoid it entirely.”

Not all organizations play by those rules. Many contend that anything that pops up in a search engine is fair game for review. Whether you agree with the practice or not, the smart thing to do is to prepare to be Googled. Open a browser window in incognito mode, Google yourself and see what pops up. Do a search for every name and nickname that might be associated with you, and don’t stop at the first page of entries. Then ask a tech-savvy friend or family member to do the same and see what they can find.

Look at your public footprints through the eyes of the senior partners at your previous employers. If you’d be proud to show a photo to those physicians, then it’s fine to keep public. Pictures of you with your dog, out with friends, even holding a glass of wine are all great. But no photos, posts or memes about alcohol impairment or recreational drug use should be publicly visible.

With the legalization of marijuana in several states, many younger physicians assume it’s no big deal to post memes and photos implying recreational use. Not so. Health care employers in Colorado, Oregon and California are worried about adverse selection—individuals who want to move to their states for unlimited legal access to their drug of choice.

Candidates should also delete photos that are distinctly unflattering, disturbing or sexually suggestive. Ask friends and family not to tag you in any posts that they would not show a prospective boss. I recently saw a female resident whose teenage cousin had tagged her in a string of selfies with zombie and witch filters. The photos weren’t scandalous, but they showed tongues out, strange hand gestures and cleavage—the kind of thing a 17-year-old’s friends would love. Thankfully, the resident removed the photos within a few days, but even that brief posting could have cost her an interview invitation if a physician interviewer had picked that week to Google her.

Bruce Guyant, Director of Provider Growth and Integration for Novant Health in North Carolina, also warns physicians to think twice before posting about their political or social activism. “With my previous hospital system, we had to back away from a candidate who blogged and posted extensively about a particular hot-button issue,” he recalls.

It was a tough decision. “At the end of the day, though, the CEO could not shake the concern that this physician’s weekend and evening activities would attract attention and impair her ability to build a practice in a conservative community,” Guyant says. “They worried that her activism could result in isolation for her—and evening news footage of protestors in front of the hospital.” He acknowledged that she would fit beautifully in more politically diverse markets, but her public expression of her views could make her and the facility a target.

Google results aren’t always a deterrent for employers. Sometimes a search reveals unique stories that help a candidate be successful. For example, I’m working with Brent Herron, M.D., a family medicine resident. Herron wants an atypical schedule: working late some days and taking some Fridays off to train for triathlons and manage endurance sports events. Typically, that kind of flexibility is earned over time, and practice administrators worry about priorities when a candidate asks for Fridays off even before interviewing. Several practices passed on Herron without reading anything other than his schedule criteria.

So I asked a hospital-employed practice to take a second look at Herron and sent along a link about his community involvement. Before going to medical school, Herron started a nonprofit that helps endurance athletes raise money for the nonprofit of their choice. He explains, “The inspiration came from my father being diagnosed with multiple sclerosis and my realization that everyone has a ‘multiple sclerosis’ in their life that motivates them.”

The practice considering Herron cares for a large, urban, younger adult demographic—exactly the kind of working adults who would value weeknight appointments. Once his prospective employers understood why Herron made the request, they began to see how his schedule could work well for their practice.

Another kind of Google hit that makes our day? An engagement announcement or wedding website. It’s wonderful to see pictures of a happy, glowing couple, and the narrative about what you enjoy doing together in your spare time usually confirms what we have already heard about why you’re a good fit for our community.

Google searches can also fill in the blanks for employers. I once had a terrific practicing candidate with a three-month gap on his CV. Gaps like this can be a red flag because they are often associated with substance abuse rehab. He had quit his job and listed his availability date as three months in the future. After a Google search, everything made sense. He remains unnamed here because he prefers that no one on planet Earth remember he was (excruciatingly briefly) a contestant on reality TV show “The Bachelorette,” which required him to stop practicing for three months.

We’ll talk to more than just your references

“There is an extended, diverse pool of people involved in vetting a candidate,” explains Brian Pate, M.D., chair of pediatrics at KU School of Medicine-Wichita. “You can’t predict who they might know at your training facility.”

Pate says it’s common for other department physicians, staff or facility administrators with ties to your training institution to have feedback about a candidate’s reputation. “The important thing to know is that, unlike formal references from your program director and faculty, the informal opinions afford 360-degree exposure,” he says. “If a physician is accountable and professional only to those above him or her…we often learn about it.”

Once during a hospital tour, Pate says a faculty member recognized a candidate as a former peer. “We unexpectedly received detailed feedback of how this individual was perceived as difficult to work with by peers, learners and hospital staff,” Pate says. “This information contributed to the overall impression of the applicant.” He encourages physicians in training to remember that preparing for a successful interview begins with a daily commitment to professionalism and best practices in their current positions.

Ricks agrees. “It surprises me that candidates don’t realize how much networking goes on in physician recruiting,” she says. “Most health systems are on a shared candidate management system. …If a candidate interviewed at a sister hospital in another state and didn’t get the job, I can call my colleague and find out how that interview went and get details that might not have made it into the database.”

It works the other way, too. “Networking can be a real plus for candidates who have made a good impression,” Ricks says. And a referral from a trusted colleague grabs a recruiter’s attention.

Shared databases can also reveal discrepancies between a candidate’s account of competing offers—and the truth. For example, physician recruiter Christopher Link recalls a candidate who was considering one offer from a group in the Midwest and another from Link’s employer in a different state—both HCA facilities.

“Maybe [the candidate] simply didn’t believe us when we told her that we stay in close touch as soon as we see that a candidate is engaged with another HCA hospital. It simply doesn’t make business sense for two hospitals in the same system to get into a bidding war,” Link recalls. “[The candidate] repeatedly tried to leverage our offers against each other using partial truths and omissions about the other offer in an attempt to secure better terms.”

We’re evaluating you on your presentation

Personal, handwritten thank-you notes to his interviewing team helped Sultan Mahmood, M.D., stand out—and get the job. · Photo by Danielle Shearon

Personal, handwritten thank-you notes to his interviewing team helped Sultan Mahmood, M.D., stand out—and get the job. · Photo by Danielle Shearon

When recruiters and administrators talk about “presentation,” they don’t mean beauty, style or media-perfect diction. But how you choose to present yourself when you make a first impression matters—because your judgment is what’s really on display.

According to Mary Wine, administrator at Advanced Orthopaedic Associates in Wichita, Kansas, overly casual attire sends the wrong message. “I haven’t had anyone show up in scrubs yet, but I have seen candidates show up for a formal interview in khakis and an open collared shirt,” she says.

Unless you have explicit instructions to the contrary, you should interview in a suit and tie or the female equivalent. “First impressions are lasting,” Wine says. “Effort shows that you are serious about wanting to join my group. Formal business attire demonstrates that you will know how to dress on the day I need to take you to meet hospital administrators with whom we have important contracts.”

Interpersonal skills are also important. Guyant says that if an applicant mumbles in a phone message, there will be no call back. “I am assuming that you are putting your best foot forward when contacting a prospective employer for the first time,” Guyant explains. “Accents are not an issue, but clear and comprehensible verbal communication is a job requirement.”

“The first opportunity a candidate has to demonstrate that is on a phone message to the recruiter,” he says. “If you mumble, whisper or speak so fast I can’t understand you, it’s likely that my patients and medical staff would end up confused and frustrated with you. I will put my time to more productive use, and I instruct my recruiters to do the same.”

Another element of professional presentation is the post-interview thank-you note. Since most communication today takes place by email, an interview panel takes notice of handwritten notes.

“Dr. Sultan Mahmood, a gastroenterologist I recently signed, sent thank-you notes to everyone on his itinerary, including me,” recalls Marci Jackson, FASPR, physician recruitment manager with Marshfield Clinic Health System in Wisconsin. “The front of the note was a family picture: the physician, his physician wife and his two children. With each note, he thanked that person for something specific.”

Mahmood says taking notes throughout the interview day was the key to personalizing these notes. Otherwise, minor details about each interviewer fade quickly from memory. “Having been on the receiving/interviewing side as a fellowship interview,” he says, “I knew that a personalized note can make a difference.”

Jackson agrees. “During an interview, it’s difficult to get the full measure of someone’s personality,” she says. “The courtesy and warmth demonstrated by Mahmood’s special thank-you note lent depth to our final impression of him. …I think it was important in the department’s decision to offer.”

We get wary when you say you’re open to any location

Andrew Walker, CMSR, FASPR, director of physician recruitment and contracting for CarePoint Healthcare, says recruiters get skeptical when physicians say they’re interested in 10 or more states. “I just know what I will hear when I screen this physician. He’ll say he is open geographically and is really focused on finding the right job,” Walker says.

There are other reasons physicians may give. One might say that since he doesn’t have family in the country, he’s able to settle wherever he finds the best job. Another might say she’s spent her whole life on the East Coast and is ready to experience something new.

However, we recruiters interpret these explanations in the context of our own experience. We speak to hundreds of candidates—month after month, year after year. And we’ve learned it’s easier to attract a candidate who is interested in a specific region. “If I’m recruiting for my site in Utah, I know that the candidate likely to accept if offered and put down roots in my community is the one who has a good reason to want to live here,” explains Walker.

That reason does not necessarily have to be family, but there had better be a well-articulated explanation if decision-makers are going to take the candidacy seriously.

“Recruiters know from experience that physician candidates underestimate the pressure they will get from family about living a 10-hour travel day away,” Walker says. If your extended family lives near each other—but five states away from your job—the pressure to move home and raise your kids near family will only intensify over time. Your remote job will probably last a few years, at most.

Recruiters can tell when a candidate is all-in for the long-term—hell-bent on becoming partner and gunning for a department head job in five years. Great cultures are built by these passionate physicians. “If my group has two candidates with roughly equal credentials … the one who is fired up about building a life here and genuinely excited about our practice is going to have an edge,” says Walker.

Candidates can jump to the top of employers’ hot lists by adding details in their cover letter to explain their interest in the area. For example, a candidate might write: “I’m interested in this job because my older brother and his family live in [suburb name], and my best friend from college lives downtown. Our wives are also friends, and we visit or vacation together almost every year.”

Or perhaps: “I have no ties to [city name], but I visited twice for medical conferences, and my husband and I simply fell in love with your city. Everywhere we looked, everyone we met reinforced the feeling that this was our ideal home. We are also looking at [other city] and [other city], but your city is our No. 1 choice, and we are excited about starting to explore.”

We can’t tell you everything

Most employers won’t tell you why you didn’t get the interview or the job. Typically, hiring managers and recruiters can only say they are moving forward with another candidate. This zipped-lip protocol developed as so many rules do: through lawsuits.

Any further discussion runs the risk of an EEOC complaint or, at the very least, unpleasant discussions with legal counsel, internal ethics committees and HR executives about a candidate’s complaint. Even at small practices that aren’t subject to EEOC regulations, the rationale for hiring decisions isn’t shared with the candidates.

Another thing employers and recruiters won’t tell you? Any troubling details about the practice itself or the local economy. Ricks wishes more candidates would do their due diligence on the job market instead of blindly trusting a prospective employer’s projections.

“Operational leaders call it ‘optimization’ when they eliminate unsustainable practices,” says Ricks, adding that this euphemism often means that “the physician is out of a job or has to move to another community.” To avoid getting “optimized” out of a job, Ricks recommends asking your interviewers: “Have you laid off or decided not to renew any physician contracts in the past five years?”

Before accepting a job, you should be sure that the employer is financially sound and that the area can support another physician in your specialty. Google the hospital system to find out what other news outlets, patients and employees are saying about an employer. You can also ask neutral third parties, such as the local chamber of commerce, to verify demographic trends.

We want you to find a good fit

Even though we can’t tell you everything while you’re interviewing, physician recruiters and employers want you to find a good fit. We’re always working to make the application and interview process easier to navigate. Once you understand what the process looks like from our side of the interviewer’s desk, you can put your best foot forward—and help us help you land the right job.

Therese Karsten, MBA, CMSR, FASPR is the director of physician recruitment for HCA Physician Services Group.

 

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What’s your student loan strategy?

Managing your student loans effectively takes an understanding of the payback programs available.

By Jason Dilorenzo | Financial Fitness | Summer 2018

 

 

College debt

When it comes to practicing medicine, you’re an expert. When it comes to providing strategic repayment guidance for your student loans, you might need some help.

Of the five income-driven repayment (IDR) plans available today, there are really three that are most suitable for today’s house staff with federal student loan debt:

  • Income-Based Repayment (IBR)
  • Pay As You Earn (PAYE)
  • Revised Pay As You Earn (REPAYE)

Income-based repayment (IBR)

IBR was launched in 2009. It’s a federal repayment program that limits monthly loan payments to 15 percent of your discretionary income. To be eligible, a partial financial hardship must exist, meaning that 15 percent of your discretionary income, calculated on a monthly basis, is less than what you’d be required to pay on a 10-year standard repayment plan.

This hardship exists for most trainees with federal student loan debt, as 15 percent of the discretionary income of a single resident with a $50,000 salary would result in a roughly $400/month payment. The 10-year standard monthly payment on $220,000 of debt, by comparison, would cost about $2,500/month. Clearly, a hardship exists.

IBR is also a qualifying repayment plan for the Public Service Loan Forgiveness (PSLF) program. Taxable loan forgiveness is granted through IBR after 25 years of repayment. However, payments in IBR are capped at the 10-year standard payment amount established when the borrower entered IBR. Because of this cap, many attending physicians would pay off their loans through IBR before the 25-year forgiveness period expires.

IBR is the least-used IDR plan by today’s graduates since the introduction of the following programs.

Pay As You Earn (PAYE)

PAYE was launched in 2012. Similar to IBR, PAYE limits payments—but to 10 percent of a borrower’s discretionary income instead of IBR’s 15 percent. Under PAYE, taxable loan forgiveness is granted after 20 years of repayment. The payment cap is also the borrower’s 10-year standard repayment amount. PAYE is a qualifying repayment plan for PSLF as well.

Only borrowers who have no outstanding balance on a federal student loan issued prior to October 1, 2007, and who took out a federal student loan on or after October 1, 2011, are eligible.

Revised Pay As You Earn (REPAYE)

REPAYE became available in December of 2015, and it may make sense for continuing house staff to consider entering the program. Here’s a brief summary of its features:

  • 50 percent of accruing interest is paid by the government (making unsubsidized loans partially subsidized)
  • Payments of 10 percent of discretionary income required (just like PAYE)
  • PSLF eligible
  • If you switch into REPAYE from IBR, the 10-year forgiveness clock won’t reset (unless you consolidate)
  • Household income will be used regardless of how you file taxes
  • 25-year taxable forgiveness for graduate students
  • No cap to payments (10-year standard in IBR & PAYE)

A note about enrolling

Once you enter one of these IDR plans, you cannot be removed from them (although you can switch between them as appropriate), even if the hardship that qualified you does not exist after training, when you’re making more income.

Therefore, a critical part of your repayment strategy is to perform an analysis and determine the best course of action based on your salary and sector of employment AFTER training.

Paying it back

I’m often asked: “If I can afford to make larger payments than required in an IDR plan while I’m in residency, should I?” This is an extremely important question, and my answer is somewhat counterintuitive.

I generally believe you should not pay more than required through an IDR during residency, because those overpayments likely compromise both your subsidy savings and your potential loan forgiveness.

In addition, unlike in forbearance, interest is not capitalized while you’re in training and have the hardship that qualifies you for these programs.

If you’re an intern or a PGY2 and your required payment is less than $100/month, you might be able to afford $400/month. But instead of overpaying on your loans, I would suggest placing that extra in a money market or savings account. Even if you get 1 percent return on those funds, it’s actually outperforming the accruing interest on your loans because the interest isn’t capitalizing during your training.

If your employment after training no longer positions you for significant loan forgiveness, you’ll be able to apply this savings toward the repayment of accrued interest before it capitalizes. If you remain employed by a non-profit or government entity after training, you can retain this savings and allocate it to other vehicles.

Refinancing is an option

In addition to the opportunity for savings available through federal programs, the private refinancing marketplace has recently become both crowded and competitive for many graduate health professionals. Refinancing reduces the interest rate on the loan portfolio, saving the borrower a substantial amount of interest cost over the life of the loan.

In order to achieve these savings, however, you must forgo all federal loan benefits, including forgiveness. As such, a suitability analysis should be conducted in order to assess the applicability of those benefits for each borrower. Only once suitability has been determined and the risks are understood should an application be submitted.

Jason DiLorenzo is founder and executive director of Doctors Without Quarters, which helps physicians strategically manage their student loans. Since 2010, he has spoken at medical schools, hospitals and conferences nationally on the topic of student loan legislation and its impact on early-career physicians.

 

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How tight is the job market in your specialty? Summer 2018 issue

The PracticeLink Physician Recruitment Index can help you gauge the relative ease or difficulty of your job search.

Summer 2018 | Vital Stats

 

What’s your competition like? For job-seekers of all kinds, it can be hard to know. A simple PracticeLink.com search for opportunities in your specialty will give you an indication of the demand for physicians like you, but without knowing who else is vying for those jobs, it’s hard to get an accurate picture of supply.

How many other candidates in your specialty are actively looking for jobs at the same time? And how does that number correspond to the number of opportunities available?

That’s where the PracticeLink Physician Recruitment Index comes in. The Index is a relative indication of the ease or difficulty of job searches in various specialties based on supply and demand information gathered by the PracticeLink system quarterly. The larger the “Jobs per candidate” number for your specialty, the better your potential standing in the market.

PracticeLink Physician Recruitment Index

The Most-Challenging-to-Recruit Specialties are those specialties with the highest demand-to-supply ratio in the PracticeLink system. The specialties on this list likely won’t come as a surprise to candidates; they’re often narrow fields.

The Most-In-Demand Specialties represent the specialties that have the most jobs overall posted on PracticeLink—specialties for which the demand for physicians is highest. For the Index, we then rank those in-demand specialties according to the supply. Those at the top represent specialties with the most jobs available and the fewest candidates per job.

After reading these Indexes, ask yourself: Do these Indexes match my experience of searching for a job in my specialty? Do I need to widen or narrow my job-search parameters as a result?

This PracticeLink Physician Recruitment Index was pulled April 2018. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.

 

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Live & Practice

By Liz Funk | Live & Practice | Summer 2018

 

In small towns and metropolitan cities across the country, the great outdoors meets locals just footsteps from where they live and work. For physicians looking west, there’s Billings, Montana, where seeking outdoor adventure is a lifestyle, and Salt Lake City, Utah, a new hotbed of arts and culture that sits beneath the Wasatch mountain range.

Looking east, physicians will find rural sophistication mixed with a New England ski town vibe in Lebanon, New Hampshire. And for those who want to escape the snow for the sun and surf, Fort Lauderdale, Florida, beckons.

Billings, Montana

A drive through the area's breath taking scenery confirmed to John Pender, M.D., and his family that they'd soon make Billings home. · Photo by Erik Petersen

A drive through the area’s breath taking scenery confirmed to John Pender, M.D., and his family that they’d soon make Billings home. · Photo by Erik Petersen

In Billings, there is an undeniable sense of adventure, and that’s a big part of why people move there. Many of the physicians who work in Billings aren’t native to the area, but they chose Billings for the chance to interact with diverse patient populations or raise their kids in a place that offers affordability and endless outdoor recreation options. It doesn’t hurt that the weather cooperates: Billings has close to 300 days of sunshine a year.

The city of Billings calls itself “Montana’s Trailhead,” a nod to the outdoor opportunities for locals and visitors alike. As the largest metropolitan area within a 500-mile radius (Calgary, Alberta, and Denver, Colorado, are among your next closest options), Billings boasts a strong sense of community, progressive regional commerce and unlimited access to the outdoors.

John Pender, M.D., a bariatric surgeon and chief of surgery at Billings Clinic, recalls that one day a flier for the Montana hospital came across his desk. At the time, he was on the academic faculty at East Carolina University, acting as a fellowship director for surgical fellows. “I thought, ‘Montana, that sounds interesting,’” recalls Pender. “And here we are.”

One of Pender’s primary motivations for moving to Billings was the opportunity to diversify his areas of practice, rather than narrowing his focus. “Being in a university, they really want you to subspecialize,” he says. “I got pigeonholed to do one or two operations. Coming up to Billings, Montana, has allowed me to be a general surgeon.”

Pender says that Billings Clinic epitomizes the idea of “big city medicine in a small town.” The hospital serves patients from Montana, Wyoming, North and South Dakota, and treats approximately 750,000 people each year. “When you’re eight hours from the next competitor, you really get to practice medicine,” says Pender.

Winter weather is a factor in treatment, too. Given that some patients live several hours from the hospital, both physicians and hospital administrators have to devise innovative solutions for patients who have chronic health challenges and who don’t live close enough to return regularly for follow-up appointments. “It creates opportunities for people to think outside the box,” says Pender. “We have a great outreach program through which the clinic provides a car or even a plane to get us out to these small communities to reach patients.”

The clinic is physician-led. “The governance policy states that the CEO will always be a physician,” says Rochelle Woods, physician recruiter at Billings Clinic. “Physician leaders are at every level, from the board to department chairs.”

More than 450 physicians and advanced practitioners cover more than 50 specialties in the 304-bed hospital, which sees 50,000 visits per year to its Level II Emergency and Trauma Center. As the largest health center in the state and the region’s tertiary referral center, the clinic has 13 regional partnerships in Montana and Wyoming. It was ranked as the best regional hospital in 2017-2018 by U.S. News & World Report, and is currently recruiting for almost every specialty, from cardiology to pediatric gastroenterology.

The hospital’s record isn’t the only point of acclaim. In 2016, Billings was named the “Best Town for Outdoor Activities” by Outside. With close proximity to fly fishing streams, the Rocky Mountains, the Yellowstone River, the sandstone bluffs known as the Rimrocks, and a 40-mile trail network that loops throughout the city, residents never tire of the outdoor offerings.

For physicians and their families, “It’s an easy city to acclimate into,” says Woods. “People come for the outdoor activities and the accessibility, so the majority of people are not from Billings. Unlike the Southeast or the Midwest, where most people move because they have family, people move to Billings for the outdoor activities and to raise kids where they can easily be outside.”

The welcoming and friendly nature of the people who call Billings home also makes the city ideal for newcomers, according to John Brewer, CEO of the Billings Chamber of Commerce. “Despite the connectivity and big-city amenities, Billings maintains a small-town feel with people who seek authentic connections and take the time to look you in the eye and make you feel welcome,” he says. “Ask people what they love about Billings and you will receive responses that in some way relate to the goodness of the people in the community.”

Though the great outdoors is one of the area’s main attractions, it easily coexists with a vibrant arts and culture scene. Popular annual events include the Magic City Blues festival, Symphony in the Park and the Big Sky State Games, an Olympic-style competition held each July. There are farmers markets, car shows, street dances and evening festivals during the summer, which residents can enjoy in between rappelling the Rimrocks, strolling along the Yellowstone River, or skiing nearby mountains, just to name a few options.

“Billings has balance,” says Brewer. “It’s large enough to experience the community at your own pace, but small enough to still run into friends at the grocery store. In Billings, despite the national economic challenges, business is strong, residents are enjoying life, and the scenery is as wonderful as the quality of life.”

That quality of life, says Pender, has made a huge difference for his family. “All year round, we do stuff as a family—hiking, camping, floating on the Yellowstone River. It really has brought us closer as a family.”

Salt Lake City, Utah

Salt Lake City, Utah, is celebrating an era of new vibrancy. The redevelopment that heralded the 2002 Winter Olympics has helped reshape Utah’s capital into a hot spot for arts, culture and community—not to mention outdoor adventure, as the city is nestled in a valley beneath the towering Wasatch Range. In addition to the excellent quality of life, physicians in Salt Lake City enjoy a patient-centered approach that prioritizes the well-being of the community.

Tim Johnson, M.D., spent his undergrad and med school years at the University of Utah. Then it was on to Rochester, New York, where he completed his residency at the University of Rochester before doing a chief year in 2006. But though he only has great things to say about his experience as a physician in Rochester, he still missed Utah, and decided to move back and start working for Intermountain Medical Group in 2006.

Johnson practiced general internal medicine at the hospital for five years before being named regional medical director of Intermountain Medical Group. In 2015, he became an administrative medical director, and in 2017 was promoted to senior medical director. Even in his leadership role, he still sees patients on Thursday mornings.

“Intermountain is very patient-centered,” he says. “From a clinical perspective, as I practice medicine, I get to think about what is best for the patient. It doesn’t mean I don’t think about the financial aspects, but it’s not the first thing I think about.”

“Safest care, patient quality of care, patient access to health care…those are first,” he adds. “I love that we have a sense of duty not just to our patients, but also to our communities.”

In addition to the 504 beds at Intermountain Medical Center, which has a da Vinci robot, expanding telemedicine service and a cancer research center, the health system has another 21 hospitals across Utah, plus one in Idaho. According to Intermountain Healthcare physician recruiter Deanna Grange, about 39,000 employees and 1,500 physicians work for Intermountain’s wide network of hospitals and clinics.

“We’re a not-for-profit, integrated health system,” Grange says. “Even though the future is constantly changing, we’re in good shape because we’re a united front.”

Intermountain Healthcare currently has about 100 openings for physicians in specialties including neurology, psychiatry, gastroenterology and OB-GYN.

“If someone is serious about their profession yet requires almost-immediate access to year-round recreation and a very high quality of life, they’d be hard pressed to find a more ideal location,” says Shawn Stinson, director of communications of Visit Salt Lake.

According to Stinson, those who are unfamiliar with Salt Lake City, or who have not visited in the past 10 or 15 years, will likely be pleasantly surprised by what they find in the Salt Lake City of today. “Trust me when I say, those of us who have lived here for some time know, understand and appreciate the perceptions that Utah’s capital city is saddled with, but those days are fading rapidly,” he says. For instance, while many first-time visitors might associate conservatism with the city, Salt Lake City has an incredibly strong LGBTQ community, and in 2016 elected Jackie Biskupski, an openly gay woman, as mayor.

Sitting in the shadow of the Wasatch Range, Utah’s capital attracts professional skiers, climbers and cyclists as well as weekend warriors who take advantage of the rock climbing, biking, hiking, snowshoeing, camping and fishing options, not to mention Nordic skiing or snowboarding at the 10 world-class ski resorts within an hour of downtown.

Unbeatable access to the outdoors makes for an incredible lineup of annual events, which include Oktoberfest at Snowbird and Tour of Utah, a week-long professional cycling race. Summer outdoor concerts and year-round festivals also highlight the arts and culture scene, which Stinson says is “on par with some of the nation’s finest.”

“There’s so much to do; I don’t have to travel virtually anywhere,” says Johnson. “I’m looking out the window now at the beautiful mountains. In 10 minutes, I could be hiking up the trails or snowshoeing. Ski resorts are 12 miles away from my house. A lot of people that are interested in Utah are interested in outdoor sports, and there is the opportunity to be very active here.”

When Johnson reflects on his decision to move home to Utah, he’s certain it was the right move.

“My values align with Intermountain’s and what I’m trying to accomplish, and I feel completely engaged in helping Intermountain achieve amazing things for our communities and our patients,” he says.

Lebanon, New Hampshire

 A love of skiing and the outdoors brought Gillian Sowden, M.D., from Scotland to New England. · Photo by Cate Bligh

A love of skiing and the outdoors brought Gillian Sowden, M.D., from Scotland to New England. · Photo by Cate Bligh

Sitting at the crossroads of New England is Lebanon, New Hampshire, a small town in a picturesque region that is home to top health care and educational institutions. With four distinct and beautiful seasons—and outdoor recreation options to match—the area offers sophisticated rural living and is a decidedly great place to work, play and raise a family.

Many major and minor highways lead to and from Lebanon, but the spirit of the outdoors permeates everything in this iconic small town in New Hampshire’s Upper Valley. Dartmouth College and Dartmouth-Hitchcock Medical Center serve as focal points for Lebanon area business and culture, employing thousands of people between them, and are both sources of pride for a town that recently celebrated the 250th anniversary of its founding.

For Gillian Sowden, M.D., a Dartmouth-Hitchcock Medical Center physician, the fact that she became a psychiatrist working in New England is in some ways a surprise. Sowden grew up in Scotland, and wanted to be a vet for most of her young adult life.

“In Scotland, you have to decide what you want to study right out of high school,” she says. “At 16, I could have gone to college. I was a huge science nerd. I studied biology and wanted to figure out a way to have a career that combined my love of learning and science with helping others.”

Instead, she left home to attend ski school in Norway. But even though she made the British biathlon team for Nordic skiing and shooting, she realized it was not going to be a career.

Because she didn’t want to stop skiing, she applied to medical schools in the U.S. that had ski programs and earned her undergraduate degree at Williams College. She met her now-husband at Williams, and decided to stay in the U.S. to attend medical school at Harvard.

“I went to med school thinking, I’ll do anything but psychiatry,” she says. “But in my first psychiatry rotation, I was struck by the relationship between patients and the physician.”

While Sowden completed her residency in Boston, she and her husband often talked about where they wanted to settle with their twin boys. “We were looking for a cute New England town that had an academic center because that felt like home.” They found Dartmouth-Hitchcock, and as Sowden says, “It’s been perfect.”

“This place is so unique,” she says. “It’s this small New England ski town with a massive medical hub. At the same time, you have all the amenities of a city here because of Dartmouth College. You have Division I athletics, a million festivals, events and theater.”

Professionally, Sowden has found Dartmouth-Hitchcock to be a perfect fit. “My colleagues are incredibly smart and capable physicians, but they are also very grounded and down-to-earth, kind people. It’s fun to be able to collaborate in such an intellectually stimulating yet warm environment,” she says. “I also work with medical students, and it’s important to me to combine that. It’s open and engaging, rather than that pressure cooker feeling.”

“It’s very collegial, very respectful,” agrees Kyle R. Hayman, manager of talent acquisition for clinical operations at Dartmouth-Hitchcock. “People work well together. We are trying to achieve the healthiest population possible and essentially transform health care not only in our region, but ultimately setting the standard for our nation.”

The 396-bed academic medical center is the hub of the Dartmouth-Hitchcock system, which includes four affiliate hospitals and 14 ambulatory clinics spread between New Hampshire and Vermont. With a network of 1,135 physicians and 10,000 employees, the hospital network serves around 1.9 million patients across the upper northeast.

In 2016, Dartmouth-Hitchcock Medical Center was named one of “100 Great Hospitals in America” by Becker’s Hospital Review. Innovative facilities include the Williamson Translational Research Building, which accelerates lab research into patient care, and the Center for Surgical Innovation, a state-of-the-art facility dedicated to improving surgical procedures.

“We have an MRI and CG machine that is able to move in and out of our operating room,” says Hayman. “For surgeries that are really delicate, that can make the difference between restoring someone’s ability or causing permanent disability. It’s curing cancer versus missing a bit of a tumor. It’s priceless to the individual patient.”

Right now, Dartmouth-Hitchcock has recruiting needs in virtually every area, according to Hayman, citing primary care, psychiatry, dermatology and neurology as acute needs. As for what would entice someone to live and work in the Upper Valley, there is no shortage of reasons.

“If you like to downhill ski, cross-country ski, hike or camp, this is the place. We have lakes and rivers if you like to boat or kayak or row,” says Hayman. “I also hone in on our location; we’re just a couple hours from a handful of larger cities. It’s nice to be in a small, safe community with fantastic public schools and activities for children, and also be able to drive an hour or two and experience a big city for a night or the weekend.”

The Lebanon area may also be attractive for physicians whose partners may be looking for employment, as the city is a hub for business. Though the resident population is 13,500, the daytime population, due to commuters and shoppers, is over 50,000. According to Rob Taylor, executive director of the Lebanon Area Chamber of Commerce, many of the region’s flourishing companies can “trace their lineage back to the college or the hospital.”

Lebanon is also home to miles of scenic trails, as well as the “Northern Rail Trail,” which is built on the former railroad bed between Lebanon and Concord, New Hampshire. “We have many recreational opportunities, from boating and cycling in warm months to skiing and skating in the cold months,” says Taylor.

“The nature of this area was the biggest attraction,” Sowden adds. “Everything we read said this was one of the greatest places to raise kids. It really rang true. My kids have the life I wish I had. Don’t get me wrong, my childhood was good, but theirs is just awesome. This winter, they are skiing every weekend. They’re little ski stars already at age 5.”

Fort Lauderdale, Florida

In Fort Lauderdale, residents enjoy miles of sand and ocean and great weather year-round. Gaining a reputation as a “mini Miami” because of its sophisticated, welcoming culture, this city of 2 million knows how to enjoy life and all the area has to offer. Physicians will discover diverse patient populations here, not just the significant Medicare demographic.

Adam Lessne, M.D., has been a physician at Gastro Health in Fort Lauderdale for a year and a half—a position he’s been working toward since high school.

Lessne attended Nova High School, a magnet school in Florida. Already with a strong sense of his career ambitions, he applied for and was accepted into a seven-year medical program at Boston University.

After graduating from Boston University, he landed at Mount Sinai Medical Center, where he completed his residency, then completed a fellowship at Albert Einstein College of Medicine. While he says he enjoyed his time in Boston and New York, he wanted to live and work in a place that was closer to his family and friends.

When Lessne interviewed with Gastro Health, he says that “meeting the partners sealed the deal.” In his discussions with the practice’s physicians, he learned that they do community work in area hospitals, where they take care of patients whether they have insurance or not.

Patients who are treated at Gastro Health are essentially visiting a patient-centered medical home for their digestive system. If a patient needs a procedure or a surgery, they can often be seen the next day. There is a pharmacy service, a radiological service and fusion center on site, so if a patient has an acute problem, it can be treated then and there.

Gastro Health has more than two dozen locations in South Florida, employing close to 100 gastroenterologists. According to physician recruitment manager Alexis Feldman, “there is no shortage of need for physicians in the Fort Lauderdale area.”

Gastro Health is recruiting gastroenterologists in Palm Beach County, the Naples/Fort Myers area and Broward County.

Gastro Health, Feldman says, “is an excellent option for gastroenterologists who are interested in private practice with the support of a large, financially stable organization.” Despite the organization’s corporate structure, she adds, each care center “maintains an individual culture and family that makes each office feel like home.”

Many physicians in the region encounter this welcoming atmosphere not only in the office, but also saturated in the culture and communities of Florida, particularly in the lively and sophisticated downtown areas. Says Feldman: “In my opinion, the best part of southeast Florida is the diversity. Fort Lauderdale and Miami draw people from all over the world, which has created a community where all are welcome.”

“Greater Fort Lauderdale is a very welcoming and diverse destination,” agrees Jessica Savage, vice president of public relations for the Greater Fort Lauderdale Convention & Visitors Bureau. “We embrace residents and visitors of every culture, origin and sexual identity. Our area is also very cosmopolitan. We have an extraordinary culinary scene, an eclectic mix of foods, and top chefs putting creative twists on their dishes.”

Locals and visitors can relax along the New River during Sunday’s outdoor jazz brunches, taking in the beautiful weather and water views, or stroll down Las Olas Boulevard and experience shopping, galleries, restaurants and nightlife. Popular annual events include the Las Olas Art Fair, the Tortuga Music Festival, the Fort Lauderdale International Boat Show, and the Fort Lauderdale International Film Festival—among many, many others.

There is also the outdoors, which is focused on the water culture of the region. As Feldman says, “If you love the beach, Fort Lauderdale offers miles and miles of sand and ocean. I moved down here from Chicago three years ago and can attest to the true bliss that such easy access to the beach and consistent sunshine brings.”

In addition to swimming and sunning, residents can find adventure on biking trails and nature walks—or, like Lessne, by taking to the canals with his paddleboard or exploring the rivers on his inflatable kayak.

“Being outside is the best part of South Florida,” he says. “Here, even in the winter, you can be outside….I make fun of my friends in the northeast when it’s Christmas Day and I’m walking around in shorts and sandals.”

For now, Lessne is happy to have come full-circle, making his way back to his original goal of being a gastroenterologist in a place where he is close to family and can regularly enjoy time with his nephews, siblings and parents.

“I feel very lucky that I found the right group, the right partners and a place that allows me to focus on professional development,” he says. “I’m thrilled to be in the perfect place.”

 

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Fraud and abuse issues facing physicians

The federal government is stepping up investigations of fraud and abuse. Physicians can take steps to reduce the risks.

By Jeff Atkinson | Reform Recap | Summer 2018

 

Security sign in the hand of the engineer.

A Texas internist with a home health care practice along with two others billed Medicare for more than $40 million in services, including for services that were not rendered or were not necessary.

A Detroit physician billed Medicare for unnecessary opioids and pain-killing back injections. The prosecutor said that over a three-year period, the doctor prescribed for a single patient 2,640 Norco, 100 Percocet, 2,138 Soma, 1,220 Valium pills, and 4,200 doses of Promethazine with codeine.

A New York City doctor took more than $25,000 in payments in exchange for referring patients to a particular laboratory.

Five physicians in a California cardiology practice were accused of performing nuclear stress tests without first determining whether the test were medically necessary (or at least not having a consultation appointment within 30 days of the tests).

For the first three cases, prison sentences were (or are likely to be) imposed. For the fourth case, the cardiologists agreed to settle the case for $1.2 million.

The cases are part of an increased focus by law enforcement on fraud and abuse in health care.

Coordinated enforcement

The federal government takes the lead on many investigations, but it has ample help from state investigators and from insurance companies that alert the government to suspicious billing. A formal structure has been established to facilitate the coordination: the Healthcare Fraud Prevention Partnership, which includes most major insurance companies as well as the FBI, the Department of Justice and the U.S. Department of Health and Human Services.

Federal laws used to fight fraud and abuse are criminal and civil. Criminal laws include the False Claims Act, health care fraud, mail fraud and wire fraud. In addition, civil laws are used to impose monetary penalties and to exclude providers from participation in Medicare, Medicaid and other federal health care programs.

Since 2007, the Medicare Fraud Strike Force has charged more than 3,000 individuals with fraud. In fiscal year 2016, the federal government collected $3.3 billion as a result of health care fraud judgments, settlements and administrative dispositions. The government says the fraud control program returned $5 for each dollar invested.

Exposure by whistle-blowers

Employees of health care providers also may be part of the mix. Whistle-blower laws give employees—often disgruntled ones—a percentage of the amounts recovered for improper billing.

For example, a nurse employed by a Houston surgical center reported that a gastroenterologist performed many colonoscopies in less than two minutes, failed to follow proper sanitation procedures, and failed to perform procedures necessary to catch cancerous lesions. The case settled for $1.6 million, and the nurse will receive part of the settlement.

Investigation techniques

One of the government’s tools for enforcement is data analysis, which may include looking for outliers (a process sometimes referred to as “anomaly-detection models”), such as providers who are ordering a substantially larger number of services than would be expected for similar providers. Investigators also study data from past fraud cases, then program their computers to look for similar patterns.

In addition, CMS applies a “social network analysis” on the “birds of a feather…” theory. Providers should be careful of who their friends are.

If reliable information of an overpayment exists, CMS has authority to suspend Medicare payments to a provider. In FY2016, CMS made 508 suspensions on that basis.

The inspector general says that the Fraud Prevention System (FPS) “is not as effective in preventing fraud, waste and abuse in Medicare as it could be.”

The report suggested the FPS identify aberrant providers more promptly because, by the time action is taken, more overpayments by the government have been made and the providers may have fewer assets from which to collect.

Preventing problems

Physicians, their office managers and billing services can take steps to prevent small problems from becoming big problems. If a government payer or insurance company wants more documentation regarding a claim, respond promptly.

For billing procedures, extra attention should be paid to high-value and high-volume procedures.

If CMS determines that a provider has received an overpayment and a refund to the government is due, payments should be made promptly (generally within 60 days).

If a physician is serving in an administrative or advisory position for a referral source or an entity to which the physician may make referrals, the agreement should be in writing, reflect fair market value, and not be a remuneration in exchange for a referral.

Jeff Atkinson is a professor for the Illinois Judicial Conference and has taught health care law at DePaul University College of Law in Chicago.

 

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Evidence-based apps for physicians

These apps put help for specific conditions at physician fingertips—and patient bedsides.

By Iltifat Husain, M.D. | Summer 2018 | Tech Notes

 

Each of the apps in this article help clinicians practice evidence-based medicine at the point of care and in clinic and hospital settings.

Frailty Tool

Price: Free Apple: apple.co/2DQtNDn Android: bit.ly/2EGQ6x4

Price: Free Apple: apple.co/2DQtNDn Android: bit.ly/2EGQ6x4

As cardiac procedures such as transcatheter aortic valve replacement (TAVR) have become more popular in the elderly, it has become even more critical to determine which patients are at a higher risk for mortality and disability following the procedure.

Since TAVR and aortic valve replacements (AVR) performed on the very elderly are still relatively new, integration of consensus algorithms and scores has been suboptimal.

In order to solve this problem, researchers published the FRAILTY-AVR Study last year in the Journal of the American College of Cardiology. Researchers wanted to compare seven different frailty scales in order to predict poor outcomes following AVR in the elderly. The Essential Frailty Toolset (EFT) was found to be the more predictive for one-year mortality and disability.

This toolset is now easy to access through the Frailty Tool, an app developed by physician Jonathan Afilalo, the first author of the FRAILTY-AVR study.

The EFT is relatively easy to use, having only four main components that can essentially be performed at a patient’s bedside (as long as you have key lab values).

It’s important to note the Frailty Tool app isn’t exclusive for TAVR and AVR procedures. The frailty app can be utilized for other procedures or simply to assess frailty in your elderly patient.

GOLD 2017 Pocket Guide

Price: $2.99 Apple: apple.co/2ul4auC Android: bit.ly/2pGRb19

Price: $2.99 Apple: apple.co/2ul4auC Android: bit.ly/2pGRb19

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is a global initiative and organization that works with health professionals and public health officials to improve prevention and treatment of COPD. They focus on evidence-based strategies for COPD management.

When GOLD released its 2017 Pocket Guide, they also released an accompanying medical app. The comprehensive app covers the whole spectrum of COPD, from definition and diagnosis to management of stable COPD versus acute exacerbations.

This isn’t the first COPD application that has been available to download, but it’s the first one that is completely comprehensive and focused on COPD. The GOLD 2017 Pocket Guide has everything in one app.

The app is relatively easy to navigate and lets you favorite high-usage tools for quick access, such as the ABCD assessment tool, CAT assessment and mMRC dyspnea scale.

The only concern with the GOLD 2017 Pocket Guide is that their last app didn’t receive frequent updates.

EBM Stats Calc

Price: Free Apple: apple.co/2IQFSvI

Price: Free Apple: apple.co/2IQFSvI

Joshua Steinberg, M.D., is back at it with another great application: EBM Stats Calc. Those who read this column know we feature Steinberg’s medical apps frequently. We find them to provide a great deal of functionality while being simple to use. EBM Stats Calc is another one of his apps that fits the bill.

Steinberg wants EBM Stats Calc to help clinicians and educators do more effective clinical reasoning by helping with the math. The app:

  • Calculates the number needed to treat from event rates
  • Calculates post-test probability from sensitivity, specificity and likelihood ratios
  • Demonstrates diagnostic principles to learners dynamically

Iltifat Husain, M.D., is editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine. He’s also assistant professor of emergency medicine and director of medical app curriculum at Wake Forest School of Medicine. Learn more about our contributors on page 20.

 

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David A. Jenkins, D.O.

Snapshot | Summer 2018

 

David Jenkins, D.O., used PracticeLink to find his new hospitalist practice in Dallas. · Photo by Rachel Moore

David Jenkins, D.O., used PracticeLink to find his new hospitalist practice in Dallas. · Photo by Rachel Moore

Title: Hospitalist

Employer: Envision Healthcare

Med school: University of North Texas Health Science Center (2006)

Residency: Saint Louis University (2009)

Jenkins and his husband, Don, love to travel and spend time with their two Scottish Terriers.

What surprised you about your first post-residency job? Being a hospitalist allows you many opportunities to move around quite easily. I think I was most surprised that my first job only lasted two years.

What’s your advice for residents beginning a job search? Start early, and keep motivated when seeking opportunities in the location where you’d like to live. Keep your options open. Consider locum tenens to get into a group or hospital and see if it’s a fit before making it permanent.

What was the most important factor in your job search? For me, geographic location was most important. We had lived in the Dallas-Fort Worth area for many years, but had moved to Nashville. We always wanted to get back to the DFW area.

How did you find your job? PracticeLink opened up many doors that I initially had not considered. I ran across PracticeLink, uploaded my CV, was able to tailor my job search in a way that was most valuable for me. I quickly got an abundance of leads.

Any other advice to share? If you’ve seen one hospitalist group, you’ve seen one hospitalist group. Each group is different and comes with different goals and values. Don’t be shocked if your first hospitalist group is not the right fit. Sometimes you may not realize this until you’ve been working there. The right one is out there!

How did PracticeLink help you in your job search? My PracticeLink account was easy to set up. My initial search gave me a few leads, but the email notifications actually helped the most. I received the most recent new job openings and could network immediately with those hospitalist groups. PracticeLink allowed me to secure a job in my ideal geographic location, Dallas!

 

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