Upham’s Corner Health Center: Dorchester, Mass.

This neighborhood center serves a diverse population in the heart of Boston.

By By Marcia Travelstead | Practice Extreme | Winter 2014

 

Upham’s Corner Health Center in Dorchester, Mass.

Upham’s corner, mass., is a section of Dorchester,  one of Boston’s largest neighborhoods. It also happens to be one of the most diverse, a melting pot of families, singles and rich mix of cultures. It is easily accessible from I-93 and is located along a major commuter route into Boston.

In 1971, a committee of 30 residents gathered to help plan Upham’s Corner Health Center (UCHC, uphamscornerhealthctr.com) to address the community’s health care needs.

Today, UCHC “provides comprehensive, personalized and continuous health services” as one of eight Boston neighborhood health centers affiliated with Boston Medical Center.

More than 70 percent of the people who come to the health center live below the poverty level, according to Roksana Pirog, UCHC’s marketing and promotions manager. Three-quarters of those served by the Center primarily speak a language other than English at home.

UCHC staff speaks several languages to accommodate the community: Spanish, Haitian Creole, Arabic, Cape Verde Creole (Dorchester has one of the largest Cape Verde populations outside of the country itself), Italian, Polish, Russian, Hebrew, Mandarin, Cantonese, Chinese and Vietnamese.

UCHC has several programs that work cooperatively with outside organizations, such as those working for violence prevention, and a clinic that lets teens meet confidentially with health care providers­­—or even get help preparing for college.

Burak Alsan, M.D., recently served as the center’s medical director. He majored in biology at Harvard, attended Loyola’s Stritch School of Medicine in Chicago, and completed his residency in both Internal Medicine and Pediatrics at the Harvard Combined Program.

What are the advantages for physicians to practice at UCHC?
There is a sense of fulfillment, a mix of common and uncommon illnesses and inspiring coworkers.

What are the challenges?
The feeling that you can only do so much with the short patient visits to make a difference in patients whose lives are so complicated.

What about UCHC sets it apart from others?
Upham’s has a deep connection to the recent immigration community of Dorchester, specifically Cape Verdean. What makes it unique is the deep roots within the staff to the community. Most of our staff is from the area and some have even been patients themselves even from childhood. It really gives a soul to the health center that is very unique.

What might a physician encounter in practice at UCHC?
A city and community health center with a passion for hard work and compassion. The patients, coworkers and city are dedicated to helping each other and making a difference in everyone’s life.

—By Marcia Travelstead

 

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Challenges of the insurance exchanges

Insurance exchanges offer multiple plans as they seek to balance desires for broad coverage and affordable care.

By Jeff Atkinson | Reform Recap | Winter 2014

 

The six-month open enrollment period for obtaining health insurance through exchanges under the Affordable Care Act (ACA) got off to a bumpy start when 8.6 million people tried to visit the federal government website in the first week, millions more visited state websites, and the computer systems could not handle the initial surge. But as the computer systems improved and the volume of inquires per day decreased, operations have become smoother. Open enrollment continues through March 31.

In 36 states, the exchanges are operated by the federal government or a joint effort of the federal and state governments. In the remaining 14 states, the states operate the exchanges.

Insurance mandate for most
The purpose of the exchanges is to make it easier for individuals without insurance and small businesses (fewer than 50 employees) to obtain insurance. Under the ACA, people are mandated to obtain private insurance subject to a few exemptions. The exemptions include being covered by other government insurance programs, including Medicare and Medicaid, or having an exemption for religious reasons.

Individuals who do not acquire insurance and do not qualify for an exemption will be obliged to pay a penalty—also referred to as a “shared responsibility payment.” In 2014, that amount is a relatively modest $95 per person or 1 percent of income, but the amounts and percentages increase in subsequent years.

To facilitate comparison shopping for insurance, the ACA provides for standardization of insurance policies. Insurance companies are not allowed to discriminate on the basis of pre-existing conditions, and lifetime limits on coverage are prohibited. The types of services covered will be the same within a given state, although individual states may vary the types of services covered, including by requiring coverage of more services than the federal government’s minimum “essential health benefits.”

The requirement of having policies with the same level of benefits was modified in November when, in response to pressure from the public and political leaders, insurance companies were allowed to renew existing policies on the same terms as they had been issued, even if the policies do not meet the new requirements of the ACA.  It will be up to the insurance companies to decide whether to reissue the old policies as well as offer the new policies required by the ACA.

Premiums vary by state
The cost of premiums varies from state to state. As the exchanges opened, the U.S. Department of Health and Human Services said the nationwide premium average turned out to be 16 percent lower than earlier projections. The amount of premium that a person pays will depend on the proportion of costs covered by the plan chosen by the individual. The ACA established four “metal levels” of coverage. A bronze level plan will cover 60 percent of a patient’s expenses; a silver plan, 70 percent; a gold plan, 80 percent; and a platinum plan, 90 percent.

The average monthly premium for an individual in the 48 contiguous states will be $328 for a silver plan. According to analysis by the Kaiser Family Foundation, the range in costs for a silver plan for a single person will be from a low of $201 in Portland, Ore., to a high of $413 in Burlington, Vt.

These amounts reflect the premiums before providing tax credits to reduce the cost. The amount of the tax credit will depend on a person’s income, with credits available for those with income up to 400 percent of the poverty level. The ACA allows insurance companies to vary rates by the age and smoking habits of applicants. An older person can be charged up to three times the premium of a younger person for the same coverage, and smokers can be required to pay up to 50 percent more for premiums. States, however, can require that rates be uniform regardless of age and smoking habits. New York, for example, has such a regulation.

Adverse impact of low-cost plans
Those who choose low-cost plans may be in for unpleasant surprises. The premiums on a bronze or silver plan will be low compared to a gold or platinum plan, but the copay by the patient will be high. For example, if a patient incurs a $100,000 medical bill, the bronze plan will pay only $60,000, and the patient will be responsible for $40,000—perhaps even more if the patient received care out of network. This will have a ripple effect on providers who may have difficulty collecting the co pay from a patient who cannot afford it.

To determine eligibility for subsidies, insurance exchanges will rely on multiple sources, including the application forms, IRS records, Social Security data, and in some cases, other wage information that is available electronically, including through credit reporting firm Equifax. If an applicant for insurance claims a tax credit for which the applicant is not eligible, the IRS will require repayment the following year.

Physicians joining large groups or hospitals
Although physicians may have difficulty collecting large copayments from patients, they also are likely to find there are more patients coming through the door since the ACA is designed to provide insurance to people who currently do not have insurance. To gain access to the increased base of patients, physicians increasingly will join large physician groups or hospitals, particularly those that have contracts as preferred providers with multiple insurance companies or employers.

Private insurance companies will provide coverage through the exchanges. Plans affiliated with the Blue Cross and Blue Shield Association will be dominant players. Blue Cross is offering plans in 47 states and the District of Columbia. Under a contract with the federal government, Blue Cross’s offerings through the exchanges will include multi-state plans in 30 states. This will facilitate having additional health plans available, particularly in small states in which there otherwise might be fewer options for buying insurance.

Some companies—including UnitedHealthcare, Aetna and Cigna—are concerned about the profitability of selling products through insurance exchanges and have chosen to limit their participation by selling their products outside the exchanges or only through the exchanges of a few states.

The American Medical Association (AMA) has expressed concern about concentration in the health insurance market. In November, it issued a report entitled “Competition in Health Insurance: A Comprehensive Study of U.S. Markets.” AMA President Ardis Dee Hoven, M.D., said, “An absence of competition in health insurance markets places a particular strain on physicians in small practices who don’t have the leverage to be equal negotiating partners with large health insurers.”The AMA says the report “is intended to help researchers, lawmakers, policymakers and regulators identify markets where mergers and acquisitions among health insurers may cause competitive harm to patients, physicians and employers.”

The ACA seeks to balance competing interests. It wants to provide good quality coverage at an affordable cost. It seeks to give purchasers of insurance a choice, yet limit the range of choices to facilitate comparative shopping and promote price competition. Striking the best balance will be an ongoing challenge and adjustments can be expected in the years ahead.

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

 

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Erik Domingues, M.D.

Snapshot | Winter 2014

 

WORK: Southcoast Hospitals Group in Fall River, Mass. (Starts August 2014)
EDUCATION/TRAINING:
Medical school: Univ. of Mass. Medical School, 2010
Residency: Univ. of Mass. Memorial Health Care

Domingues, a dermatologist, enjoys traveling, playing basketball, and spending time with his fiancé, Kasia.

What’s your advice for residents beginning their job search?
My biggest piece of advice is to start early and be open to different possibilities. There may be opportunities in academics or private practice and it is important to get a feel for what each opportunity can offer you. Go with that gut feeling when meeting with a prospective employer. There will be places you have a good feeling about and others you do not.

What surprised you about your post-residency job search?
I was most surprised by the endless opportunities for graduating residents. I restricted myself geographically, but there were still plenty of opportunities. Having a wide variety of choices is a blessing, but sometimes also makes your ultimate decision a difficult one.

What do you wish they had taught in med school but didn’t?
Obtaining a world-class medical education at UMass Medical School, I felt prepared to transition into residency and ultimately into practice. However, I wish we had more training in the business of health care. With the current changes in health care, knowing the business side of medicine is of utmost importance.

Anything particularly unique about your job search?
The most unique aspect of my job search is that I started looking in my second to last year of residency, helping avoid the stress of making the right employment decision while applying for licenses and studying for my Dermatology board exam.

Any other advice?
Take your time and start early in the job search because when it is all said and done, you want to have made the best possible decision for you and your loved ones. Get to know a prospective employer well and ask questions of anything you are not sure of. Make sure that your employer’s values are in sync with yours. Don’t forget to get your loved one’s input because your future is dependent on you and your family being happy.

How did you use PracticeLink in your job search?
I signed on with Southcoast Hospitals Group in Massachusetts for a dermatology position. I learned about it from PracticeLink. I began receiving PracticeLink Magazine early in residency and found it very helpful for learning what to ask at interviews, what to look for at site visits, and what to look for in a job contract.

Through PracticeLink, I was able to learn more about the opportunity at Southcoast Hospitals Group, providing me with the opportunity to practice dermatology in my hometown. Thanks to PracticeLink, I was able to determine where I wanted to start my career upon graduating from residency.

 

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Can you recession-proof your career?

Seven resolutions that can help you build and protect your wealth no matter what the future has in store.

By Steven Abernathy and Brian Luster | Financial Fitness | Winter 2014

 

You’ve finished medical school, gone through the rigors of a tough residency, landed a plum job in your specialty. Now what?
Aside from working long hours, the demands of your office or hospital group, malpractice insurance, the EMR, Obamacare, business or school debt—and whatever future surprises will be thrown at the medical profession—your career is a stable one. But is it recession-proof?

Though joining the medical profession as a physician has long been considered a responsible and effective way to make a contribution to the greater good while earning a comfortable living, physicians today must plan ahead. Impulsive, risky financial choices are not an option.

Unfortunately, many physicians who will eventually become or are already members of the mass affluent all too often are investing like members of the middle class. This means not only mistaking salespeople for experts and failing to integrate advisors, but also not having a savvy eye to the future.

Though no one holds a crystal ball, there are known certainties ahead:

• Physicians are working more and retiring later. Do you have a set time to retire, or will you delay retirement and continue working? Remember, if you own your medical practice, like any business, many factors affect its value. A retiring physician cannot transfer managed care contracts, so this may depress the sale price, giving potential purchasers little incentive to buy. And because hospitals are choosing to pay through performance incentives rather than an upfront premium, this too lessens a practice’s salability.

• Despite a high monthly income, doctors seldom create and preserve generational wealth.  Medical doctors, as well as other professionals, fail to employ fiduciary stewards and instead rely on those bound by “suitability.” Only a fiduciary represents an investor’s interests 100 percent of the time and adheres to a coordinated plan designed exclusively for their family enterprise. An M.D. with a specialty or subspecialty averages $350,000 annually. If, over time, just 25 percent of that is saved, given the power of compounding, there should be, by age 60, $7 million available for retirement income. However, this is rarely the case! When wealth is properly looked after, its growth is prioritized over a “hot” fad. Professional investors, such as Warren Buffett, are praised for their temperance and patience. Not every horse is a winner—nor is every stock.  Professional investors are not incented to sell or promote products; their work constitutes making fiduciary decisions for clients.

More than $1.5 trillion in taxable money is invested at family offices, yet they’re still not something that successful physicians, businesspeople, and entrepreneurs learn about as a matter of course. According to Penta, published by Barron’s, the greatest wealth enterprise most people have never heard of continues to grow and thrive. Multi-family offices continue to spring up across the country and around the world. Yet their profile remains astonishingly low.

It’s not only about earning wealth; it’s about preserving wealth. And knowing the mechanisms to do this are what demarcate a successful family enterprise from the others.  Though there are no ways to determine exactly what will be ahead for medical doctors in the 21st century, it is possible to implement a thoughtful, strategic plan focusing on the goals of every doctor and his or her family.

We recommend committing to the following 7 fundamental rules:
1. Purchase products and services from established providers of wealth management services and advice rather than working with commissioned salespeople.

2. Employ up-to-date, accurate reporting that tracks progress and progression over time and offers a clear picture of the here and now.

3. Focus on sound decision-making, oversight and preparation for a strategic and clear succession plan.

4. Understand each individual’s role in managing both the family’s affairs and the roles of support staff.

5. Clarify and connect how all activities required to manage the affluence are connected, and identify effective providers to effectively achieve each action.

6. Decide to employ strategic, purposeful management of all assets and wealth.

7. Adhere to and honor a cohesive plan.

Former SEC Chief Arthur Levitt wrote: “65 million American households will probably fail to realize one or more of their major life goals because they have not developed a basic financial plan.” Avoid being one of those households. Make a plan with a professional money manager, adhere to it, and review it periodically.

Though the basic financial blueprint for every family will be different, honoring the ideas above will create awareness and lay the foundation for making intelligent decisions around your family’s wealth plan.

Steven Abernathy (sabernathy@abbygroup.com) is founder, principal and chairman of The Abernathy Group II where

Brian Luster (bluster@abbygroup.com) is a principal. They can be reached at (888) 422-2947.
The Abernathy Group II Family Office sells no products, and receives no commissions. It is independent, employee-owned, and governed by its Advisory Board comprised entirely of thought-leading physicians and professionals.

 

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Making a list, checking it twice

Start your job search by first evaluating your needs and wants.

By Patrice Streicher | Job Doctor | Winter 2014

 

During my tenure in health care, I have observed physicians who have delivered treatment to patients who had lost hope of ever improving their quality of life. And though medicine has never claimed to be a perfected science, practitioners’ decisions about a course of treatment are universally founded on the evolution of discovery and technology creating recognized practice protocols.

As a provider, your diagnostic and treatment strategies are guided by knowledge, experience, best practices, protocol standards, gut instinct and logic.

Most interesting to me is that, during their search for a new position, some incredibly intelligent and accomplished practitioners voluntarily paralyze themselves by casting such wide nets that they are faced with an unmanageable number of options.

Based on my experiences, I have come to conclude that this approach is derived from a need to tempt the unlikely, daunting curiosity about possibilities, a fear of missing out on the “perfect job” or an anxiety of making the wrong practice choice. And though some have taken an adventurous leap into an unexpected practice in a “now or never” location, the majority of job seekers lack the time or engery to stray from their recognized reality.

What’s your reality?
Last spring, I was assisting a Pediatric PGY3 who sought a position near her parents in North Carolina. Following our conversation about an opportunity near Raleigh, she expressed a sincere interest resulting in a site interview. Upon her return, we visited about her trip. She was highly enthusiastic about her prospective colleagues, the hospital and lovely community. Despite the practice’s interest to move forward with a formal offer, she shared that she was not ready to make a final decision. Throughout the next several months, the pediatrician interviewed with another practice in North Carolina, as well as opportunities in Washington, New York, Wisconsin, Ohio and Florida. More than six months post-interview, the group near her family in Raleigh and I received an email from her announcing her decision to move forward with their opportunity.

But as a result of her unresponsiveness to our calls and emails following her visit, she was unaware that the group had interpreted her silence to mean that she had no interest, and they signed another physician.

As a rule, practice searches are rarely a “one and done” proposition. For this pediatrician, her reality was that she was always going to choose a position in North Carolina. Her interviews in Washington, New York and Florida were an excerise in exploring possibilities. The Ohio interview was the outcome of falling prey to a persuasive recruiter who made unattainable promises. Wisconsin beckoned because of the potential of living near a friend from college.
Six months later, jet lagged, stressed, exhausted from juggling site interviews and difficult rotations, she discovered that in the end, her core practice decision had not changed since she began the process. Her final decision was to relocate to a practice near her parents in North Carolina. And though she did accept a position in North Carolina, to her dismay, it was not the job she most wanted.

As someone who has stood on the sidelines of hundreds (and at the risk of aging myself) even thousands of physicians’ practice searches, I have come to conclude that for most people, the reality of practicality and responsibility takes precedence over dreams of possibility.

For those inclined to heed the path less traveled, explore away. However, and at the risk of being a buzz kill, be aware that while you are on your expedition, the interview process halts for no one, and a desired position may close by the time you circle back.

Physicians searching for new positions should follow a similar structure as those they use in the practice of medicine. Diagnosis and treatment follows a structured process. Initially, information is obtained and the situation assessed. A plan is devised and strategies executed seeking a desired objective. This organized approach used in everyday practice is an optimal format when searching for a new practice opportunity. It will also help you streamline your search, have the support of a well-thought-out plan, and ease the stress that comes with making a major decision for you and your family.

Your job-search plan
As we embark on the initial step of your search, I suggest  creating categories vital to your search. Most commonly, that includes geographic location, practice preferences and community offerings. Next, revisit your thoughts about what you envisioned your career and life to be as you pushed through your academic training and residency. Oftentimes, this core truth will serve as the root of your final decision.

Talk it out
The next step is critical to your success: Devise a “needs vs. wants” list under each category. Make a list of both needs and wants that you will later merge with your significant other’s preferences. To that point, before applying for your first position, make sure you have had a face-to-face conversation with your spouse or significant other about their needs and wants. Stop. Read this again. Talk. Do not presume to know what is important to your significant other. Misunderstandings about “must have” versus “would be nice” items, whether yours or a loved one’s, serve as the greatest deal breakers.
Start the conversation with yourself and your loved ones with a common understanding that items listed as needs are essential for survival and wants would be nice but aren’t necessary. Rest assured that needs and wants have been known to migrate back and forth. When you have narrowed your practice choices to a final three, you can allow more flexibility in redefining the needs and wants on your list.

Start with your needs
A fundamental principle in physician recruitment states that physicians’ preferred geographic location almost always relates to some sort of personal tie to the region or state. Oftentimes, the location is within driving distance to family or friends. Additional considerations might include climate preferences or recreational offerings.

Practice considerations should include items such as practice environment (academia, private sector, government, public health service, federally qualified, underserved, hospital, university and/or clinical based); schedule (full time, part time, workdays per week, block scheduling, hours per day/shift); leadership opportunities; financial and benefit package offerings.

Your quality of life
When it comes to devising lists about community, tread cautiously. Your quality of life and overall happiness lie in the hands of the community in which you set roots for your family.

In my experience, one of the top reasons for practicing physicians to relocate is a result of a family member not being happy with where they are currently living. For the sake of conversation, this also applies to picking up roots and relocating to another city or state.

Selling a home, uprooting teenagers or moving away from an established life without the full support of all parties involved many times is a non-starter for a practice search. As a compromise, many physicians successfully secure a new position within 30 to 45 minutes of their home base. Should relocation be in your plan, make sure to include additional items like the proximity to places of worship, shopping, cultural venues and schools.

The interview
As you entered the interview stage, prepare to incorporate your needs list into the conversation in the form of questions. Also during your evaluation of an opportunity, feel free to explore items on your want list with the recruiter—but make sure to position them as such, to avoid misunderstandings about your priorities.

Decision time
After vetting a comfortable number of opportunities, I recommend narrowing down your choices to a final three. As a fan of HGTV, I like to refer to this as the House Hunter Decision phase. At the end of each show, the buyers discuss the pros and cons of each of their three options. They then exclude one, leaving two. For our purposes, this is the point in the process when items on your want list come in handy. Ask if one of the opportunities offers all your needs and more of your wants than the other. Or perhaps there are more wants and fewer needs for one compared to the other.

Whatever you decide, one thing is definite—your deliberate approach resulted in your well-deserved happy ending. Congratulations!

Patrice Streicher (patrice.streicher@vistastaff.com) has 26 years of experience in physician recruitment and patient care delivery systems. She is Associate Director at VISTA and has served on the National Association of Physician Recruiters (NAPR) Board of Directors since 1996.

 

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Hi Ho! Hi Ho! It’s off to work you go!

What Snow White’s Seven Dwarfs can teach us about achieving a work/life balance fit for a fairy tale.

By By Bruce D. Armon & Karilynn Bayus | Legal Matters | Winter 2014

 

No matter what your profession, it is increasingly challenging to find and maintain the perfect work/life balance. Physicians are no exception to this conundrum.

On the one hand, home/life pressure may come from a loving spouse, a naïve child or a doting parent who wants to make sure you’re happy and healthy.

On the other, every individual expects to be seen and treated by a physician for their malady in the most timely and comprehensive manner. A portion of the Hippocratic Oath states, “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability.” Physicians work with a sense of urgency and purpose and intense professional pressures.

We’re going to look at the key employment contract terms that can help physicians achieve the needed (but perhaps not perfect) work/life balance with the help of Snow White’s Seven Dwarfs: Grumpy, Happy, Sleepy, Bashful, Sneezy, Dopey and Doc.

Grumpy
The days of extremely long training hours in residency and fellowship have been moderated (a bit) by the change in ACGME Resident Duty Hour Guidelines. According to the ACGME standards, “Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting.” Working 80 hours in one week is a lot, let alone averaging that amount over a four-week period.

Once a physician’s training is complete, most physicians realize they need a break or they will be grumpy to everyone they encounter, including patients, their family and colleagues. If taken to extremes, this may have professional consequences, as the vast majority of hospitals have rules allowing them to discipline a physician for displaying disruptive behavior. Moreover, this could violate standards in a private practice’s employee handbook relating to boorish behavior.

A physician’s contract may state the minimum number of hours a physician is expected to work on a weekly basis. The contract may not, however, state the maximum number of hours or shifts that a physician will work in a given time period. It is important that physicians confirm the expected schedule prior to signing an employment contract, or they may find that the “break” they were anticipating after training did not come to fruition. Striking the balance between minimum and maximum is very important.

Happy
There are lots of different things that can make a person happy or content. One of the most obvious elements that must be addressed or negotiated in an employment contract is salary. Be wary of a salary that seems too good to be true.

Though many physicians carry significant debt upon completion of training, taking the job that pays the highest salary or that provides the largest bonus may not be the best job fit for a physician in either the short or the long term.

There may be reasons why a prospective employer has to “over pay” to recruit a physician. Bonuses built into a contract may be illusory because the suggested thresholds can’t be realistically attained. Or it might take an excessive number of hours worked or improper billing techniques to achieve these goals. For instance, a contract that offers a physician-employee 25 percent of all revenue generated by the physician-employee in excess of three times the physician’s base salary may not be realistic if no other physicians in the employment setting generate more than two times their income.

In addition, other employers may offer non-salary terms that will ultimately amount to more value to the physician than a contract that simply includes a higher salary. Such items may include comprehensive family health insurance, CME reimbursements, board expenses reimbursed, technology stipends or reimbursement, and other business expenses.

Though a physician may decide that he would not be happy if poor (or in debt), if you’re measuring happiness by your monthly bank statement or investment portfolio, you’re sure to be disappointed. There will always be someone who makes more money and seemingly works less to reach that status. An unhappy physician should give careful thought to changing employment as soon as possible.

Sleepy
No one works well when they are tired. A tired physician can have life-or-death consequences for a patient. In addition to including language in the employment contract that describes a “typical” workweek, a physician is well-served to include language that specifies call frequency.

There is a substantive difference in quality of life for someone who has call every seventh day versus someone who has call every other day. Seasoned physicians may suggest that when they started in practice, they took call every night or every other night, and this is the way they built their practice. The expectation is that every physician needs to fulfill this legacy to achieve success and “earn their stripes.”

Instead, make sure that your employment contract specifies call frequency and call distribution. Confirm whether call is a week off or a week on. Confirm how weekends are handled and how weekends are measured. Does call go from Friday night to Monday morning or something else? Confirm distribution of holiday call. If “extra” call is taken by a physician, is additional remuneration provided? Though all professionals are expected to work hard and be proficient, a disproportionate call responsibility can have terrible consequences for the physician and the physician’s patients.

Bashful
Physicians are trained to learn and diagnose a lot of different things. No physician can know everything. In an employment setting, it is just as important to recognize what is not known as it is to understand core competencies of sound medical practice. If a physician is not comfortable treating children or adolescents, the physician should not be bashful about stating what is in the patient’s best interest. If a physician is not comfortable performing a certain surgical procedure, a physician should not be bashful in asking for assistance.

No professional enjoys telling others about a potential weakness in a practice setting or procedure. However, to be the best physician, constant learning and innovation is required. A physician should make sure the employment contract provides adequate CME reimbursement and a CME time allowance to ensure maintenance and enhancement of skills. Many specialty boards require physicians to undergo maintenance of certification processes to ensure clinical competence and public confidence in skill sets. A physician should not be bashful or afraid to want to be the best at his or her craft. To reach that standard and maintain that excellence requires time and effort and the ability to know that improvement is possible.

Sneezy
The lessons that may be derived from Sneezy extend beyond the allergy practice setting. You can’t afford to sneeze at the progress being made in online communication tools.

The electronic era is upon us. Connectivity is key. Smart phones and tablets are common in medical practices. EHR and e-prescribing incentives are available, and the cost of technology makes going paperless a viable and affordable option for health care providers.

A physician should ensure that the practice setting he or she joins is focused on technological improvements and e-communications. Paper is quickly becoming a relic of the past. Sleek office space is replacing cluttered, dusty desks stacked with reference books and journals. Smart phone and tablet apps are prevalent and useful. Patients are also getting smarter as they have instantaneous online access to medical journals and diagnostic tools.

Many practices are considering outsourcing basic functions to maintain economies of scale, ensure the best patient experience and protect decreasing profit margins. A physician should stay ahead of the proverbial curve or at least not fall so far behind that it is virtually impossible to maintain relevancy and the confidence of colleagues and patients.

Dopey
The temptation can be overwhelming to simply say “yes” when offered an employment contract, especially if it’s your first. But don’t be foolish about it—make sure you understand what may and may not be negotiable in your employment contract.

Be sure to understand every term in the contract. If drafted properly, every paragraph, sentence and word is meaningful. If something should be changed, make every effort to have the change made before signing.

After years of training in medical school, residency and fellowship, you should be an advocate for yourself or seek professional assistance to accomplish needed contract objectives. This philosophy applies to your first job, the next job and every job thereafter. A properly drafted contract protects the employer and the employee. The contract sets expectations for daily responsibilities and opportunities for advancement and maps an exit strategy when things do not go as anticipated.

Doc
And finally, Doc. Of any work title for an individual, “doctor” probably has the most honor and prestige. In the television and the movies, a doctor is often the hero and the savior. The doctor is intelligent, driven, compassionate and confident.

However, maintaining a medical license is a privilege, not a right. A state medical board has the authority to punish a physician for an inappropriate action. A hospital, ambulatory surgery center and third party payor can each restrict or revoke a physician’s privileges.

A successful physician is one who finds and maintains the appropriate work/life balance. The balance is different for each individual.

It is important for a physician to: not be grumpy; not think that happiness can be bought; be too sleepy and have lapses in judgment; be bashful to recognize boundaries of knowledge; sneeze at the chance to embrace technological change and advancement; or act dopey and not look to protect his or her interests in each employment contract executed.

The Hippocratic Oath states, “If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.” Working as a physician is not a fairy tale. It takes years of discipline and skill. Though it is unrealistic to think every physician will sing “Hi Ho! Hi Ho! It’s off to work I go!” in a blissful state each day, achieving and maintaining the “right” work/life balance will be music to a physician’s ears and bring added joy to a stressful professional life.

Bruce D. Armon (barmon@saul.com) is managing partner of Saul Ewing’s Philadelphia office.
Karilynn Bayus (kbayus@saul.com) is an associate in Saul Ewing LLP’s Health Practice.

 

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Physicians who write

Got an idea for a book? It’s possible to combine your medical experience with your creative side.

By By Marcia Travelstead | Career Move | Winter 2014

 

Looking to write? “Writing is a way to reach a lot of people. You are in control and have a greater capacity to protect the integrity of the message than in other media,” says David Katz, M.D., MPH, who has authored or co-authored 15 books and more than 1,000 articles.

NAME:  David L. Katz, M.D., MPH

WORK:  Founding Director of Yale University’s Prevention Research Center; Current Medical Director for The Integrative Medicine Center at Griffin Hospital in Derby, Conn.

EDUCATION:  Dartmouth College (BA); Albert Einstein College of Medicine (M.D.); Yale University School of Public Health (MPH)
Katz practiced internal medicine for more than 15 years and worked as an emergency medicine physician early in his career.

Katz is also editor in chief of the journal Childhood Obesity, president-elect of the American College of Lifestyle Medicine, and founder and president of the nonprofit Turn the Tide Foundation.

He has published nearly 200 scientific articles and textbook chapters, innumerable blogs and columns and nearly 1,000 newspaper articles. He has authored and co-authored 15 books, including multiple editions of textbooks in both nutrition and preventative medicine.

His extensive media portfolio includes being an on-air contributor for ABC/Good Morning America, a writer for The New York Times syndicate and a columnist for O, The Oprah Magazine. He’s also a blogger/medical review board member for The Huffington Post, a health contributor to U.S. News & World Report, one of the original 150 ‘thought leader’ influencer bloggers for LinkedIn; and a health writer for Everyday Health.

For more information about Katz, and his latest book, Disease Proof, visit davidkatzmd.com.

How did you get started writing?
I was invited by my residency director, who decided to do a book. For colleagues who want to get involved in writing and to establish a reputation, one tip I can offer is that when opportunity comes knocking, be sure to open the door.

It takes a tremendous amount of time to write a book. In fact, there was a stretch of time that I was on a three-book deadline simultaneously. There was a point where, for approximately three years, I had one day off a year—literally—because there was such a backlog of work. I would do my day job during the week, and that would leave my weekends for writing.

Another opportunity came along around 1996-97, when I was just starting my practice in internal medicine. The hospital that I was affiliated with thought we might grow the practice with a column in the New Haven Register. I wrote a weekly preventative medicine column. The column in the New Haven Register re-circulated in other Connecticut papers. For a number of years, it was farmed out to The New York Times syndicate. I did the column in the New Haven Register, and the next thing I knew, I had a monthly column in O, The Oprah Magazine for eight years.

What do you like best about being a physician author?
What I like best is making a difference in the world. I hope my epitaph will be that I made a difference. Writing is a way to reach a lot of people. You are in control and have a greater capacity to protect the integrity of the message than in other media, and the other media has certain inconveniences attached.

When I worked for Good Morning America, I had to get up at 4 a.m. to get into Times Square. For the most part, I can write in my pajamas and write when I want to write. With the increasing opportunities for online writing, I blog. I’m what LinkedIn calls an “influencer.”

It used to be that you’d write a blog or anything else and hope that people would find it or it would find them. I’ve got close to14,000 people following me on Twitter and about 93,000 on LinkedIn. If I write anything, I can tell them all. I can push a button and reach out to about 100,000 people. I like this medium because now we have a means to invite people to participate in the dialogue.

What’s challenging about being a writer?
You are never done. There’s never a complete escape. At any moment, if you are a writer, ideas pop into your head and you’ll feel obligated to try to capture them. In clinical care, as demanding as it can be, you’re either on or off. When you’re finished and you’re not on call, you’re done. If you’re a writer, there are always words. There’s no escape from words; they are always there. One can certainly relate to artists who went crazy. There is a certain poignant madness to it all.

What surprises you about being an author?
The field of writing, which you may think of as rudimentary, actually is a very special power. There is a widely respected, hugely influential power in writing. In some cases, it can influence life or death situations. That’s the happy surprise…the incredible impact. An unhappy surprise is that there is sort of a subculture in publishing that a lot of what prevails is predicated on what people think others want to read. It’s very hard to break through.

What advice would you give other physicians who want to write?
First of all, only write if you’ve got something to say. You shouldn’t write because you want to be a writer. You should write because words are percolating up in you and you’ve got to express them. Secondly, have somebody to say it to. Know who you are trying to reach. Third, what is the particular objective? There may be an expected action, something you want to change with your writing. The fourth would be consistency. If you really want this to be a significant part of your career, you have to make it part of your weekly routine. You cultivate an audience by consistently reaching out to them, becoming a voice they trust and turn to looking for guidance.

In terms of where to get started, there are all sorts of options to get published. You can try local newspapers or establish your own blog online. It used to be harder because the options were fewer. There are real advantages in cultivating social media to let people know about your writing.

 

NAME:  Joseph Shrand, M.D.

TITLE: Medical Director, CASTLE (Clean And Sober Teens Living Empowered), High Point Treatment Center, Mass.; Instructor of Psychiatry, Harvard Medical School

RESIDENCY: The Institute of Living, University of Connecticut, Hartford Hospital

FELLOWSHIP:  Massachusetts General Hospital, McLean Hospital

Shrand has served as Medical Director of the Child and Adolescent outpatient program at McLean Hospital, has run several inpatient psychiatric units, and was, until recently, the Medical Director of the Adult Inpatient Psychiatric Unit for High Point Treatment Centers in Plymouth. He serves on various boards involved in national mental health issues and global fair-trade concerns.

He helped design the Independence Academy, the first sober high school on the South Shore of Massachusetts.

For more about his books, including Outsmarting Anger: 7 Strategies for Defusing Our Most Dangerous Emotion and Manage Your Stress: Overcoming Stress in the Modern World, visit drshrand.com.

What do you like best about being an author?
I really enjoy having to formulate an idea to make it readable. The book I’m writing now is synthesizing state-of-the-art neuroscience and psychiatric science so that anyone can read it.

I like working with writers, and it’s really an education for me to be an author. I’m responsible for the content and the writer is responsible for the process. I work with a fantastic writer, Leigh Devine, who helps me stay focused. We have a great rhythm and have put my first two books together. There’s something wonderful about being able to express one’s self in writing.

What’s the most challenging part about being an author?
When I’m looking at my words in print, I’m always thinking I could have done it better. I don’t think it’s about being a perfectionist; it’s about striving for clarity. I feel my responsibility regarding writing in this genre is to be crystal clear so the person who is reading it can understand what I’m saying and apply it to their lives right then. If I’m writing something narrative, like my stories, then I want to make sure I take my readers through a whole range of emotions.

Any surprises?
When I started writing at this level, I had my own writer, editor, publisher—then another editor, a publicist and a copy editor. I had no idea how many people were involved in this. I didn’t own the book anymore, and that was fearful. However, what’s incredible is that so many people are invested in what you have to say that it becomes their book, too. I think that’s cool!

What advice do you have for other physicians who want to write?
Write! What I would recommend is to go to writer’s conferences and meet people. Write down new ideas, and document them by text or email. Don’t undermine your own creative process, because it’s amazing! Physicians have something to say. We’re into this very interesting time of our professional development. People will be interested in what physicians have to say whether or not it’s about medicine.

By Marcia Travelstead

 

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Court room not board room

Feature Articles | Winter 2014

 

Joseph Zajchowski, M.D., JD, medical director, Southwest Memorial Hospital Emergency Dept.

Joseph Zajchowski, M.D., JD, says he felt a little like a sheep in wolf’s clothing when he entered law school in 2007. He had been practicing emergency medicine for nine years and was employed with Mayo Clinic Hospital in Phoenix at the time he enrolled at Arizona State University to pursue a law degree. “I’d been taught to try to dodge lawyers,” says Zajchowski. Soon, however, he became comfortable in this unfamiliar educational venue and grew to enjoy the three years he spent attending school full time while also working full time. “My degree incorporated a certificate in health care law, which is unique to ASU and a few other programs around the country,” says Zajchowski. “Most of my classes, besides the core work that every lawyer has to have, were focused on health care law.”

“Law school is an amazing experience for anyone, and especially for someone a little older,” he says. “For so much of what they teach, I wouldn’t have had a point of reference when I was 20.” Having been in practice, Zajchowski was able to contribute real-world anecdotes during class, which he says both professors and fellow students seemed to appreciate. “There were things I was familiar with like making sure there was no malpractice or negligence and adhering to EMTALA laws,” says Zajchowski.

Managing a full load of classes while also practicing was relatively easy for Zajchowski, in large part because of the flexibility inherent in his specialty. If he had classes on Mondays, Wednesdays and Fridays, he’d schedule hospital shifts on the alternate days. That’s not to suggest it wasn’t a balancing act, especially given the fact that Zajchowski and his wife had no children when he entered law school and four by the time he finished three years later—one baby followed by a set of triplets. “I had to split my time but devoted enough to both. It was our intent to have a family, and we’re all doing well,” says Zajchowski. The children are now 3 and 2 years old, and Zajchowski’s wife, Kathryn, a naturopath, plans to resume her career once the little ones are in school.

Zajchowski is making good use of his law degree. He’s medical director of the emergency department at Southwest Memorial Hospital in Cortez, Colo., where his knowledge of the law is useful when it comes to risk management and quality assurance issues. He also recently started a medical-legal consulting business, QuantaMed, P.C. (mdjd.me). “I do medical-legal consultations, determine the merits of potential malpractice cases, and provide expert witness services,” says Zajchowski.

For physicians interested in expanding their horizons beyond providing direct patient care, Zajchowski says options are plentiful. “More universities are tailoring degrees now. Focus on your passion,” he says, “whether that’s a law degree, an MBA, an MPH, or some other post-graduate program.” Physicians considering an additional advanced degree should realize, however, that doors don’t automatically open upon graduation. “It’s just like medical school,” says Zajchowski. “You have to make an effort to apply it once you’re done.”

 

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Mission Medicine

Whether you’ve got your sights on international travel or a few hours of helping around home, there are plenty of medical missions to which physicians can donate their time and talent.

By Karen Edwards | Feature Articles | Winter 2014

 

Lucy Doyle, M.D., had never imagined that life after residency could be so hard. But as an internist working with the French-based Doctors Without Borders organization, she found herself the only physician in a small expedition party making its way to a village stricken by cholera. Although she was stationed at a nearby hospital, she and a team had set off through the jungle to help. “It was a two-day trek,” she recalls. “Walking through that jungle was the hardest thing I’ve ever had to do in my life.”

Midway on their journey, the expedition team ran into a couple carrying an infant son. The baby, a victim of the cholera outbreak, was unconscious and the desperate parents had decided to walk to the hospital for help. Fortunately, the hospital had come to them. “I took an IV from my bag and revived him enough so he could drink,” says Doyle. Extra fluids were given to the parents, along with instructions to keep their infant drinking as they walked. Then both parties continued on their respective ways.

A month later, Doyle returned to the hospital in time to see the infant just before he was discharged. “The difference was remarkable,” says Doyle. “When I saw him, his eyes were sunken in and he was not responsive. Now, he was a typical child, looking well and playing.”

Just another life-saving day in the world of medical missions.

Mind you, this kind of work is not for the faint of heart. But if saving lives, making a difference and practicing medicine in order to help— really help—people, then mission work may be for you. There are plenty of opportunities out there for physicians who want to lend a hand. Whether you want to travel abroad, stay stateside or work close to home, the need is there, and it’s never been greater.

Here are four ways you can help, both domestically and internationally.

Remote Area Medical (RAM) Volunteer Corps
Learn more: ramusa.org

When Stan Brock was a teenager, he worked for a time as a cowboy on a Brazilian cattle ranch that butted up against the Amazon rain forest. As the newest—and youngest—employee, Brock was given a horse to ride that was so wild it had been named Kang, the devil.

Kang had already thrown two previous riders by the time Brock mounted the horse. He would be the third rider to go flying off, sustaining substantial injuries in the process. The nearest hospital, however, was 26 days away—on foot. The nearest doctor was a three-day walk away.

Brock was young and tough and he recovered, but he never forgot the experience of being days away from medical care. That’s why he founded the Remote Area Medical (RAM) Volunteer Corps, which brings health care to those who live in remote areas of the world, including the U.S.

When Brock brings his pop-up clinic to an area, it’s always advertised well in advance, and the news spreads quickly. By the first day of the weekend-long clinic, hundreds of people are lined up at the gates.

“I’ll stand at the gate and ask how many people are here to see a dentist, and nearly every hand goes up. Then I’ll ask who needs to see an eye doctor, and there will be another show of hands. Next, I’ll ask who’s here to see a doctor and a few hands go up, but not as many as for the first two,” he says. “Now, all of these people need to see a doctor, and we schedule as many as we can, but they see their dental and eye needs as more important because those are conditions that affect them every day.”

Diabetes, hypertension and other serious illnesses haven’t made the same impact on their lives—yet. But it’s just a matter of time, says Brock.

Volunteering for the Remote Area Medical (RAM) Volunteer Corps wasn’t enough for for pulmonologist Joseph Smiddy, M.D. So he bought an old tractor trailer and outfitted it with state-of-the-art X-ray machines. After 180 hours of driver’s training, he became licensed to drive the unit to RAM and other community health clinics.

Joseph Smiddy, M.D., would agree. As a pulmonologist, he has diagnosed emphysema, lung cancer, even black lung disease while working as a volunteer at RAM clinics.

“A lot of the areas we go into are coal-mining areas,” says Smiddy. But until recently, he and other colleagues had to depend on physical exams and stethoscopes to make their diagnoses. “I heard doctors say, ‘If only we could get a chest X-ray,” he recounts. So he decided to do something.

He bought an old tractor trailer and had it outfitted as a mobile X-ray unit, installing three state-of-the-art machines. “The clinics all use modern equipment, I want to emphasize that,” says Smiddy. “We don’t use old, hand-me-down equipment.” When the unit was road ready, Smiddy then carved 180 hours out of his busy practice time to obtain a tractor-trailer driver’s license so he could drive the unit himself to RAM clinics and other volunteer and community events.

Not every RAM volunteer rises to that level of dedication, of course, but a certain level of dedication is required of all RAM volunteers. For example, if you’re traveling to the clinic from out of state or elsewhere in the state, you’ll arrange for and pay your own transportation and lodging. And prepare to be at the clinic the whole day.

“We don’t do shifts,” says Brock. Everyone reports for work by 6:30 (the clinic opens at 5 a.m. for registration), and you’re likely to be there until 7 or 8 at night. All specialties are needed, although oral surgeons and ophthalmologists are most in demand.

If you decide to lend RAM a hand, you’ll need flexibility, endurance and a willingness to roll up your sleeves and pitch in for almost anything. You’ll also need a current medical license (and therein lays the rub for physicians who want to volunteer stateside).

“We need a federal law that allows doctors who volunteer in other states to do so without first obtaining a medical license in that state,” says Brock. He has testified before Congress on the matter, but although some states have passed “Good Samaritan” laws, as they’re known, not all states have and there has been no federal action on the issue. The American Medical Association has put together a state-by-state list of requirements for senior physicians who want to volunteer, and it’s probably the best of the resources out there. Visit ama-assn.org/resources/doc/spg/state-licensing.pdf to check to see what’s required in your state or the state where you wish to volunteer.

All in all, says Smiddy, the experience will be worth it. Yes, he admits, it comes with a level of frustration that you can’t do more, but you’ll meet real people with real needs, and experience the feeling of actually helping these individuals. “That’s the reason I went into medicine,” he says. RAM is a good entry into medical volunteerism, he adds, “and it’s personally rewarding.”

The National Association of
Free & Charitable Clinics (NAFC)
Learn more: nafcclinics.org, (703) 647-7427

Although the NAFC holds occasional pop-up clinics like RAM, “We have a very different model,” says Nicole Lamoureux Busby, NAFC executive director. “We use the one-day clinics to raise awareness of our freestanding clinics and to drive both patients and physicians to them.”

The NAFC is a loose consortium of 1,200 free and charitable clinics that have been set up in cities and towns across the U.S. The organization was founded in 2001 to advocate and serve as the voice for patients and physicians as well as other staff members who work there.

“The biggest problem we have is that many people don’t know these clinics exist,” says Lamoureux Busby.

Free clinics serve only patients who are uninsured, underinsured or who have no access to primary or specialty care. They operate much the way a doctor’s office operates, says Lamoureux Busby.

“The patient checks in, is triaged and is seen by a doctor,” she says. The physicians all serve on a volunteer basis.

NAFC is a good option for volunteering if you don’t want to travel or take a weekend off to travel away from home. You can work in your area, according to your schedule and for any amount of time—daily, weekly or monthly. Some volunteers may give five hours a week, some give 20 a month, and others may give 30 hours over three or four months, says Ariana Gordillo, NAFC’s outreach and operations manager.

All specialties are needed for both standing facilities and one-day clinics, though the greatest demand is for primary care physicians.

The experience will be rewarding, says Lamoureux Busby. “There are so many stories we could tell.” She recalls a mother who came to a clinic complaining she felt ill but didn’t know why. “She was diagnosed with stage 3 breast cancer,” Lamoureux Busby says. The woman was referred for treatment and has now recovered and is doing well.

Ed Weisbart, M.D., a family physician, has volunteered with NAFC for four years and recruits other physician-volunteers for NAFC in his spare time.

“When I volunteer out of state, they send me an application for a temporary license if it’s needed, and they purchase malpractice insurance for all of us who volunteer, whether a physician or not,” he says.

Some of the biggest problems, he says, occur because people have lost their jobs and their benefits, or their health care has been dropped by employers.It’s frustrating, he says, when people stop receiving life-improving or in some cases, life-saving drugs. He recalls an incident with a woman who came in with her mother. “She couldn’t put two sentences together,” says Weisbart. He learned she had lost her job, which meant she could no longer afford the medicine to control her epilepsy. “Her mother told me she has had epilepsy since she was a child and would have two to three seizures a day. With medication, she’d have two to three seizures a year,” says Weisbart. The woman was down to two to three weeks’ worth of medication and was so stressed about returning to more frequent seizures that she could no longer function normally. “We gave her a refill that was affordable, $40 for three months instead of the $1,200 pharmacy cost, and told her she could continue with that affordable prescription. The look on her face is one I’ll never forget,” he says.

Mercy Ships
Learn more: mercyships.org

For nearly 30 years, Mercy Ships, founded by Don Stephens, have focused on the plight of Africa, where nearly half the population has no access to a physician or to a hospital.

Stephens decided a ship was the best way to deliver health care for several reasons: At least 75 percent of the world’s population lives within 100 miles of a port city, so a ship could bring care to a vast amount of people. A ship could be maintained as a safe and clean environment, and it had its own infrastructure, its own water and electric supply. So Stephens set up his organization, acquired a ship, staffed it with volunteers and set it off on its task of delivering health care to those unable to access it.

“Mercy Ships’ current target area of service are the 17 countries on the West Coast of Africa between 15 degrees north and 15 degrees south latitude,” says Peter Linz, M.D., chief international medical officer. “These countries are among the poorest in the world and rank at the bottom of the United Nations Human Development Index.”

The Africa Mercy is the name of the ship currently in action. It serves as a specialized surgical hospital that offers direct patient care services as well as a variety of health education training to doctors and other health care workers in the area.

“The programs offered in any given country are tailored to the area’s specific needs,” says Linz. Care can include maxillofacial surgery, eye surgery, pediatric orthopedics, vesicovaginal fistula repair, general surgery and dental care. “There is much more demand for service than we can provide,” he adds.

Volunteers aboard a Mercy Ship serve short-term missions, from one to nine months, or long-term missions serving two years or more. Shifts are from 8 a.m. to 5 p.m., though cases may run overtime. Most volunteers, however, will work a minimum of 40 hours a week. “It’s not unusual for more than 4,000 patients to show up for screening at the beginning of a field service,” Linz says. On the most recent trip to Guinea, more than 2,850 surgical procedures were performed.

Otolaryngologist Mark Shrime, M.D. (below), has served on six medical trips to Africa with Mercy Ships. “It seems like it’s just surgery, but it turns out to be more than that,” he says. “There’s often a social, economic, physical and sometimes spiritual transformation. Getting to know these patients is the most rewarding part of the work.”

Mark Shrime, M.D., an otolaryngologist trained in head and neck oncology as well as reconstructive surgery, has worked on Mercy Ships since 2008, serving first in Liberia for six months, then returning five additional times. The shortest stint he has worked was two weeks.

“The most rewarding part of the work is obvious,” he says “It’s the ability to change a life—not just physically, but socially and economically as well. It seems like it’s just surgery, but it turns out to be more than that. There’s often a social, economic, physical and sometimes spiritual transformation. Getting to know these patients is the most rewarding part of the work.”

He tells of a 22-year-old man he met on his Guinea trip who had a mass on his jaw. “The mass, as it turns out, was a benign bony tumor that had been growing for the prior eight years,” says Shrime. “He was anemic and malnourished and, importantly, ostracized from his community.” The surgery took all morning. The entire jaw was removed and reconstructed with a metal plate, onto which a bone was grafted three months later. But, says Shrime, “he left the ship with a new smile and the right to look human again.”

Beyond helping patients, Shrime says Mercy Ships is medicine in its purest form. “The profit motive is removed; the medico-legal overlay is removed—all you are left with is what you went into surgery to do,” he says.

Doctors Without Borders
Learn more: doctorswithoutborders.org

This Nobel Peace Prize-winning organization is French-based (also known as Médecins Sans Frontières, or MSF), but accepts physicians from all over the world who want to provide care to those in need.

Most projects are overseas, although the agency did come to the U.S. in response to the emergency created by Hurricane Sandy a couple of years ago, says Lauren Cohen, a field human resources officer with Doctors Without Borders.

“When a doctor is accepted on our team, there is a general work commitment expected of between nine and 12 months,” says Cohen, though some specialties, like surgery and OB/GYN, may serve just one to three months at a time. The physician will be assigned a location based on the agency’s current need, as well as their skills, background and availability.

Once on location, you’ll assume a supervisory or consulting role, working in close collaboration with local physicians and staff.

“About 90 percent of those working at a location will be local physicians and health care workers,” says Emily Bristle, another field officer and recruiter. “About 8 percent are international doctors, and they may come from a variety of countries.”

Though all specialties are needed, Cohen says doctors with experience in infectious diseases and tropical medicine are most in demand. If you do become part of a Doctors Without Borders team, you’ll be expected to work six days a week, morning to early evening, though hours may be longer depending on emergencies or on-call needs.

Unlike the other organizations mentioned here, Doctors Without Borders will cover your transportation and lodging expenses while working on the job, and it will pay you a stipend as well.

Accommodations depend on the location where you’re assigned.

“When I worked in Kenya on the Somali border, we lived in tents near the refugee camp where we worked,” says Lucy Doyle, M.D. Later, when she worked in a hospital in the Congo, the environment was more stable and she stayed in a home.

You should also be prepared to speak French, as French is the “language of work,” says Bristle. “There’s no language requirement,” she adds, “but we look for French speakers, even if they’re not perfect.” Spanish-speakers, however, are also becoming an asset, Bristle says. “And Arabic is becoming more important.”

Doyle says she learned French before reporting for work. “It was pretty basic, but after about a month I could understand and be understood pretty well,” she says. And though patients would often speak Swahili or the local dialect, the local physicians and staff would translate their responses for her—into French.

“Check out the field blogs written by some of our field members,” Cohen suggests. “You can learn a lot about the kind of work that’s needed, and what a physician’s average day is like.”

Doyle says she will go back as a field physician again when her schedule allows. “I’m glad I went right out of residency the first time,” she says. “It’s a natural break in your career, and it’s an easier time in your life to make it happen. Also, residents are used to being flexible and are used to changing environments.”

That flexibility served her well as a Doctors Without Borders physician, she says, and it gave her invaluable experience.

“I’ll definitely go back some day,” she says. “And I recommend it to others.”

These are just a few of the opportunities out there—in your community, in the country and in the world. There are many from which to choose, and a bit of research will reveal those to which you may feel more drawn. “While no one can guarantee any experience will be life-changing,” says Shrime, volunteering will improve the odds. “I would say, ‘Do it.’”

Karen Edwards contributes regularly to PracticeLink Magazine.

 

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Howdy, neighbor!

Some states seem to have patents on hospitality and friendliness. Narrow the scope to cities, and you can expect to find extra-welcoming handshakes for new arrivals. And then some.

By By Eileen Lockwood | Live & Practice | Winter 2014

 

In once wide-open spaces such as Texas, friendship was a necessity for survival. Today it’s a well-honored tradition, including in Houston, currently the fourth largest city in the U.S.

Farther north, pioneers worked together to face off foreboding mountains and freezing winters and created a welcoming ambience in cities like Colorado Springs, Colo., for those who came afterward. The outgoing Midwestern reputation lives on in Wichita, Kan., and about a thousand miles to the east, Southern hospitality takes over in Greenville, S.C.

Put it all together with state-of-the-art medical facilities, and the key words are “Come and join us, friends!”

Resort Town to Full-fledged City
Colorado Springs

The Blum family’s move to Colorado Springs, Colo., was a bit of a homecoming—thoracic surgeon Matthew Blum, M.D.’s, father was a general surgeon there. Blum, with his wife, pediatrician Valerie Beck, and their daughter, Marissa, also own a ranch about 60 miles out of town.

In, 1871 Gen. William Palmer decided to build a city in a scenic Colorado mountain area. He was a Medal of Honor winner in the Civil War and a highly successful railroad builder who established a line to the new town, Colorado Springs. Little did he know that another entrepreneur, Stephen Penrose, would turn Colorado Springs into a prime resort area.

“We have a lot of things around here named for Penrose and Palmer,” reports Allison Scott, director of communications at the The Broadmoor resort.

Neither man could have imagined how his memory would live on, for instance in Penrose-St. Francis Health Services, one of two major Colorado Springs hospitals, and Palmer High School, with its statue of the founder in front.

Nor could they dream of today’s mega-community of some 400,000, which includes an Olympic complex where some 15,000 athletes train for the world’s biggest athletic competition, the United States Air Force Academy, three military bases, branches of several aerospace corporations and other defense industry projects. All of this within shouting distance of natural wonders such as the Garden of the Gods, Pikes Peak, Seven Falls and Cave of the Winds.

For Matthew Blum, M.D., moving to “The Springs” was a homecoming. “My dad was a general surgeon here in town also, so I run into a lot of people I know, or knew, or who knew my dad or had been operated on by him. It’s kind of fun,” he says. But it wasn’t a foregone conclusion. A general thoracic surgeon, Blum was educated at the University of Denver, then moved east to The Johns Hopkins University School of Medicine, with additional training at Vanderbilt University, where he conducted research on heart and lung transplants. Moving to Chicago, he spent eight years leading the general thoracic surgery program at Northwestern Memorial Hospital.

“I wanted to move back to a western mountain state someplace, and there are only a handful of places in the west that would support the kind of surgery that I do, until you get out to California or Oregon or Washington,” he says. “As for Colorado Springs, it wasn’t so much that I was coming home. It just happened to be a good place, and it WAS my home.” That was three years ago. “At the time, they were interested in trying to get a thoracic program going at Penrose-St. Francis, so I thought that was a good opportunity, although it meant I was stepping out of academics, which was where I had been.”

As it has turned out, Blum is one of only six board-certified, dedicated general thoracic surgeons in the state, with three at the University of Colorado in Aurora and three in The Springs. When the University of Colorado acquired Memorial Hospital, the city’s other health care provider, he took the back-to-academe road and moved there, where a second surgeon soon came on board. Meanwhile, Penrose hired a replacement for him. “It really has elevated the level of chest surgery in the whole southern part of the state,” he says. “Places like Chicago and on the East Coast have many, many thoracic surgeons. It’s not because there isn’t a need. It’s because it’s hard to keep a thoracic surgeon busy in a town of 100,000 people. Colorado Springs is kind of on the cusp of that.”

He also cites the need for someone to help build a thoracic program at Memorial and to integrate that system into the University of Colorado system. “This is kind of an exciting thing for me,” he adds, “because there really are not that many people with my background in our community. People don’t move to Colorado to do academic medicine.”

Robotic surgery, especially thoracic, at Penrose, as well as UC-Memorial, has taken a great leap forward in recent years. It’s been quite a step forward since the days when TB patients came to four or five big sanatoriums hoping to be cured with the help of clean, cool air. Today, robotic surgery in several areas has proliferated at Penrose, and, reports spokesman Christopher Valentine, “We have actually attracted a number of doctors, and we’re having people train here all the time.” Penrose is now part of the  Centura network, with 14 hospitals in the state and one in Kansas. Services at Penrose also include a hybrid suite. “If something goes wrong with a non-invasive procedure, such as heart surgery, the patient can go to a regular surgeon (on the premises),” Valentine says.

Just this year, according to Valentine, transaortic valve replacement (TAVR) has become part of the surgical regimen. Based on good outcomes for all surgeries, Penrose has been cited for six years in a row as one of the 50 best hospitals in the U.S.

Valentine says that the city “is totally family friendly,” with many opportunities for family activities, including “all sports.” Spectators can cheer at Air Force Academy football and Colorado College hockey games.

For dedicated pro-sports fans, Denver awaits just 45 miles away, the smallest city in America that has four major league teams: Broncos (football), Nuggets (basketball), Colorado Rockies (baseball) and Colorado Avalanche (hockey).

With the presence of the Olympic Training Center, plus the everyday outdoor activities of locals, it’s no surprise that sports medicine is a sizable part of the hospital scene. “With people out riding their bikes all over the place and running all over the place, training for triathlons and everything else, everybody’s breaking stuff and tearing stuff up and getting it fixed,” says Blum. That includes the medical community. He says with a chuckle, “The medical community isn’t wiped out by disease so much; they get wiped out by their own activities.”

In the meantime, his favorite relaxation opportunity awaits about 60 miles east on farmland he bought some time ago. “It was part of my escape-from-Chicago,” plan, he says. “If I spent my whole career in a big city, I could retire here and have a ranch. But then I figured I’d better learn something about ranching and farming. (Currently), friends of ours do all the crop planting and harvesting, but occasionally I’ll go out with them and drive a tractor around.”

With a job he enjoys and a farm for refuge, there’s not much likelihood that he’s developing an “escape-from-Colorado” plan any time soon.

Welcome to the new south
Greenville, S.C.

Proximity to the ocean, mountains and family in Pennsylvania motivated Thomas Sellner, D.O., and his family to look for a new practice in the east. They ended up finding a perfect match in Greenville, S.C., where Sellner and his wife, Sarita, and their children, Cali and Pearce, are enjoying the family-friendly environment—including their own backyard dock.

What does a medium-sized city in northwest South Carolina have in common with giant Houston? At least two things: It’s Forbes’ pick as number two in job opportunities. And a phenomenally energetic group of civic leaders has done a remake job in the last decade or so that seems almost magical.

“When we talk to people who have lived here 10 to 15 years, they say downtown was a place that you used to avoid,” reports Thomas Sellner, D.O., who arrived two years ago. “But now everyone flocks down here.”

It didn’t take long for him and his wife to join the enthusiastic crowd and add their own kudos. “Greenville is probably the first city where I’ve been where there was that growth, and it was amazing to see,” he says. “As soon as I finished the interview (with Carolina ENT, his current position), I called my parents, and I told them about the interview, but then I said, ‘I picked up the newspaper, and they’re hiring people down here.’ I just found that amazing. I’ve gotten to the point where I brag about Greenville constantly, because (the city is always) in Fortune magazine or some other magazine, saying, ‘This is an up-and-coming city.’ Or ‘This is the best of this or the best of that.’”

He also has some basis for comparison. He grew up in a town near Pittsburgh and spent several years in Erie, Pa., where he also graduated from college followed by the Lake Erie College of Osteopathic Medicine and a residency. Both cities were losing instead of gaining workers. While GE was moving a division to Greenville, it was cutting back in Erie. Today, Greenville hosts GE Power & Water, the world’s largest gas turbine manufacturer, as well as GE Aviation. And a supersized BMW manufacturing plant operates in the nearby town of Greer.

The Greenville “old-timers,” though, were recalling the early 1980s, when the face of downtown was empty storefronts, vacant lots and dying businesses, thanks in part to suburban development that had sapped the central city, but also because the factories that had made it the “textile capital of the world” had disappeared.

Today, downtown Greenville is a picture postcard of striking new buildings interspersed with green areas, fountains and even waterfalls descending over walls. A spectacular curved suspension bridge has replaced a feeble span over the Reedy River that divides the downtown area. Summarizing its progress from down-and-out to thriving is a statement from Visit Greenville SC, the city’s version of a convention and visitors bureau: “At a time when things were bad, and could have gotten worse, the community said, ‘Let’s do something remarkable!’” And they did that.

The “something remarkable” was almost a double reward for Sellner and his wife when he joined two other otolaryngology and facial plastic surgery specialists at Carolina ENT, affiliated with Bon Secours St. Francis Health System, which is one of two Greenville hospital systems. The other is Greenville Health System. There’s also a Shriners Hospital. St. Francis, now with three locations, dates to 1921 when it opened as America’s first Salvation Army hospital. It was acquired in 1932 by the Franciscan Sisters of the Poor and today is part of the Bon Secours Health System.

Besides adopting such state-of-the-art equipment as the “Absorb” heart stent, the hospital management recently initiated a reward program for employees who follow healthy diets, keep immunizations current and have physical exams. Those who do well, or even try, can receive as much as $900 in awards along the way. On the patient side, the hospital’s medical group introduced After Hours Care in 2011 to provide around-the-clock service.

Sellner is exhilarated by the city’s influx of younger, professional people. “You go downtown,” he says, “and all you see are young people and families—and everyone’s come from all over.” Not that he’s a stranger to large concentrations of contemporaries.

His last location in Surprise, Ariz., a Phoenix suburb, was anything but deserted. “We wanted to get away from cold weather,” he says. But there was a catch. “When we talked to our families, no one had any interest in moving out west whenever they retired.” But… “We also wanted to be close to the ocean and the mountains—and a major airport that will fly us back to Pittsburgh.” Greenville is at the foot of the Blue Ridge Mountains, and the ocean is three hours away. Then came the good news—a job opening in the perfect city. “We were just all smiles!”

Keeping pace with civic transformation is the school system, which actually covers 800 square miles to include the multi-county area. “Greenville is a very innovative place,” reports Oby Lyles, the system communications director. “Different people want certain things in schools.” To accommodate them, the mix includes several magnet schools, and about 15 percent of students attend schools of choice. In a construction binge, 70 new schools have been built recently, but—old or new—many in the system feature space-age equipment.

Road shows, symphony and ballet performances are held at the new downtown Peace Center. At least 50 artists have studios in various areas, including downtown.

Outdoor addicts can easily find activities, especially hiking or biking along a converted rail route, the 17.5-mile Swamp Rabbit Trail. Sellner goes in a different direction, to Fluor Field, to cheer on the Greenville Drive, a Boston Red Sox farm team. The field is a replica of Fenway Park.

The Sellners also plan to introduce their children to a truly full plate of special—and very diverse—activities.
As for special events, there’s something for everyone—and often. Taryn Scher of Visit Greenville SC, the visitors bureau, offers yet more proof of the city’s rejuvenation. “The biggest problem that Greenville has,” she says, “is that it’s hard to schedule a new event, because so many days are already booked.”

Deep in the Heart of…
Houston

Everything about America’s fourth largest city seems to come in Brobdingnagian proportions. The metro population is over 6 million—in a land area of 600 square miles.

Houstonians can claim the world’s largest concentration of health care and research institutions. So many, in fact, that no one seems able to cite the total number. According to the American Hospital Directory, the sum, including those in the suburbs, is 67.

Overshadowing all of the above is the city-sized complex cited by former First Lady Barbara Bush as Houston’s gift to the world, the Texas Medical Center. Started in 1945, TMC is indeed the world’s largest medical-related concentration: 290 buildings on 1,300 acres encompassing 21 “renowned” hospitals (seven acute care), plus schools of medicine, pharmacy, dentistry and nursing and eight research institutions.

It’s now spreading its services throughout the area and other parts of Texas and the world. (And, by the way, it hosts the largest air ambulance service.)
With that background, it’s no surprise to learn that more heart surgeries are performed at the various hospitals than anywhere else in the world.

Houston is the top U.S. market for exports, number-one port in international waterborne tonnage handled and has the greatest total area of parks and green space. The Houston Livestock Show and Rodeo is the world’s largest event of its kind.

Some local futurists hint that all of the above is part of a “conspiracy” to take over Chicago’s place as the  third largest city in the U.S.

Chris Langan, M.D., is hardly intimidated by the gigantic surroundings. His pre-Houston experience was in the New York City area. Before moving southwest in 2009, he earned a medical degree at New York University, plus a business degree at Columbia University. His other training and work experience was in nearby New Jersey. As an ER specialist and regional medical director for TeamHealth in the Memorial Hermann Healthcare System, he supervises facilities in eight locations.

He, his psychiatrist wife and four children now live in Katy, an up-and-coming western suburb. But, he says, “I lived 25 minutes out of Manhattan, and now 25 minutes out of Houston, (and) it’s a little easier commuting here—without bridges.”

“Katy itself has really grown a lot,” he adds, joking, “When we bought our home we were pretty much the last home before San Antonio. Since then, thousands of homes have been built, and Katy itself has been expanding. We don’t really have to go into Houston to get to a good restaurant and so on.” However, he does mention “a lot of great restaurants downtown.”

Another example of Katy’s expansion is the school system. “The buildings are all brand new,” Langan reports. “When (our children) started, we were (practically) the first people to ever walk into their school. Down the road, they’re building high schools and junior highs.” But he was surprised at the size of school populations in other parts of the metro area. “Sometimes there are a thousand kids per grade,” he notes.

However, even in the newly expanding suburbs, there are many activities for the students. Langan’s three sons are all involved in sports, including the 7-year-old, who plays football. The other two have opted for gymnastics and tennis. His 12-year-old daughter’s main interest is art, but track and field is on her to-do list for next fall.

All in all, he’s concluded that Houston is indeed a very family-friendly city. Its prices are friendly, too. “The value of our home is so much greater out here—and much more affordable,” he reports, adding that the cost of living in general is lower.

Langan has developed his own theory on the number of hospitals in the city and metro area. There’s actually a lot of competition because there are so many, “but here there are smaller hospitals that feed into the bigger tertiary care centers downtown,” where more sophisticated care is available. “When I’m at a community hospital, I have a backup of a tertiary care center, so if someone is really sick or needs a specialized procedure, we have that transfer ability. And the same thing is true if you have a sick child. If I have to incubate a child for respiratory distress, I know a helicopter is coming to pick them up within 20 minutes to take them to the pediatric unit at (a well-equipped place).”

Besides overseeing ERs in the hospital group, his job includes doing regular shifts in various facilities and/or taking over whenever there’s a need in one of them. As a serendipity, he says, “One of my favorite places to work is Memorial Hermann NE, near the airport. We get all the patients who are sick from the airport, and I meet people from all over the country and the world. It’s really interesting.”

In a recent survey by Forbes, Houston was named number one in the U.S. for jobs. Bob Harvey, president and CEO of the Greater Houston Partnership, a chamber of commerce organization, picked up on the theme—and then some. “Houston is becoming synonymous with jobs,” he says, “not to mention quality of life and renowned educational institutions.” In fact, the city has made a 201.9 percent recovery from job losses during the recent recession.

Not surprisingly, six oil companies are among the major employers, although the aerospace industry accounts for a good number as well as technology corporations, shipping and, of course, health care. “There is a scramble for highly educated and skilled employees” says Jeannie Bollinger of the Houston West Chamber, one of a mind-boggling number of the area business organizations. There’s also a major reason for the corporate proliferation: “business-friendly climate and solid infrastructure.” For Texans, that’s elementary.

Still, in spite of the population and the bustling activity, Bollinger adds, “This is not a pretentious city; it’s the biggest small town you will ever live in.”

From Cattle Town to Air Capital
Wichita, Kan.

‘‘Expect the unexpected” is the catch phrase of Wichita’s Convention & Visitors Bureau. It’s hardly an exaggeration.
Who would expect even a big city deep in the Midwestern prairies to support so many aircraft manufacturers that it’s known as The Air Capital of the World? Or to be headquarters of two of America’s largest privately held companies? Or be home to what became the world’s largest pizza chain (Pizza Hut)? Or encompass at least 33 museums, one of them in a century-old former factory now showcasing worldwide exhibits donated by 140 different nationwide collectors? Not to mention 1,000-plus restaurants and 117 parks and greenways.

City promoters say that tourists—and residents—can leap 125 years in a single day by visiting museums chronicling Wichita’s progress from its years as the northern terminus of the celebrated Chisholm Trail to the amazing progress of science in its 21-century glory at the ultra-modern Exploration Place, one of six diverse museums along the Arkansas River, which borders the city.

Still, there was a different surprise for Kyle Vincent, M.D., who relocated from Orlando almost three years ago. It was what his patients consider heavy traffic. “I didn’t appreciate this until I started practicing and I had patients tell me they couldn’t come at certain times (for appointments) because it would be rush hour in the big city.” A robotics surgeon who specializes in gallbladders, hernias, upper GI work and the esophagus, Vincent was less surprised by other aspects of the city because he grew up in Ponca City, Okla., about 75 miles from Wichita, and had been to Wichita on shopping trips with his parents.

With his general surgery residency completed at Orlando Health, he began a job search. “We liked living in the Midwest and decided we’d like to come home,” he says. With a new child, proximity to grandparents was also an enticement. “I interviewed at several small towns around Oklahoma, and interviewed here. This was definitely the best fit for what we were looking for. My wife is Jewish, and her absolute requirement was that we had to live in a town big enough that they had a synagogue.”

Besides many activities with his family, plus attending an occasional Wichita State Shockers basketball game, Vincent has become a frequent user of area YMCA facilities, which he calls “amazing.” “A lot of people in other towns are looking to redo their facilities. They come to look at the facilities here,” he says.

“Coming from Orlando, everybody thought this was going to be a huge transition for us,” he says. “But it has the pace that we wanted to keep. We like the convenience of being able to get around easily. And we like that our kids can go to public schools.” With good reason. Besides traditional neighborhood schools, the city encompasses 28 magnet and 35 private and parochial schools.

The public schools have been keeping up with recent practices, too, and were among the first to incorporate workplace skill standards into curriculum and graduation requirements. Within an eight-year period, starting in 2000, voters approved two huge bond issues ($284 million, followed by $370 million) that resulted first in new buildings and enhanced computer facilities, then in 275 new classrooms, six more new schools and 60 storm shelters. (Kansas, after all, is the most tornado-prone state.)

Long before magnet schools, the soon-to-be-famous Jesse Chisholm set up a trading post in a prairie location destined to be Wichita. His half-Cherokee heritage eased his passage through Indian Territory. Cattle drovers began to follow his route, eventually named the Chisholm Trail, and by 1874, Wichita had become one of the major destinations for drovers who could use the railroad to transport some 5 million cattle to stockyards in Chicago. The city in Kansas became known as “Cowtown.”

Half a century later, Clyde Cessna built the city’s first airplane. By 1929, there were nine aircraft manufacturers. During World War II, about a fourth of the population (30,000) was employed in the industry. According to one city history buff, “Almost every pilot at some time during the war was in a Wichita-made plane.” And the city’s new unofficial title was “Air Capital of the World.” Today there are a few less industries, but the work force still edges around 25,000. There are also 6,000 military and civilian personnel at nearby McConnell Air Force Base.

With three hospitals and four specialty facilities on its roster, one of the other top employers is Via Christi Health, Vincent’s employer. Wichita’s largest and sole inpatient provider of behavioral health services, Via Christi also operates the state’s sole round-the-clock interventional primary stroke center outside the Kansas City metro area. A long-term goal is to provide an integrated system of care from cradle to grave.

The city’s other large health care group is Wesley Medical Center, with an acute care hospital and a heart hospital. Founded by a Methodist Church organization in 1912, it became an HCA facility in 1985 and was recently awarded the “Blue Distinction” for its spine surgery program by Blue Cross and Blue Shield of Kansas. In 2011, Wesley added the new O-Arm® surgical imaging technology, which provides three-dimensional images during spinal surgery. It has the area’s only Gamma Knife that non-invasively destroys brain tumors in one treatment. Another new acquisition is Trilogy, which can even treat inoperable tumors non-invasively, in any part of the body.

Medical technology is not the only field in which upgrading and modernization is part of the mix. Wichita itself has taken on a new ambience, from the rehabbed Old Town area to its downtown and riverfront. Today, the 44-foot high Keeper of the Plains, mounted on a 33-foot rock, keeps watch at the confluence of the Arkansas and Little Arkansas Rivers (pronounced Ar-KAN-sas), surrounded by the Ring of Fire, a set of flames rising from stone receptacles. A second spectacle is the Fountains at WaterWalk, a 150-foot-long choreographed display of music, lights and fountains.

Downtown has developed a revitalized face, too. Shops, restaurants and a farm and art market, plus a generous serving of outdoor art, keep company with the traditional symphony, ballet and theater mainstays. Not to be left out is the Old Town area, which has come alive with more shops and restaurants in revitalized warehouses.

For Vincent, the Wichita relocation couldn’t have been more rewarding. He summarizes, “It’s a good location for us.”

Eileen Lockwood is a frequent contributor to PracticeLink Magazine.

 

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