Jill Kruse, D.O.

Snapshot | Winter 2017

 

Jill Kruse, D.O.

Jill Kruse, D.O., found both her first and current jobs through PracticeLink! · Photo by Kate Heiberger

Specialty: Family medicine

Employer: Avera Medical Group Brookings in Brookings, S.D.

Education:Medical school: Des Moines University (2005)

Residency: University of Wisconsin – Rural Training Track (2008)

In practice since: 2008

Kruse enjoys community theater, reading, SCUBA diving, traveling, and spending time with her husband and two young kids.

What surprised you about your first post-residency job search? Getting into medical school and residency, there is so much pressure to want the program to “like you” or “want you” that you forget when you are searching for your first job that you have to interview them as much as they interview you. You need to make sure that this job is right for you, and you are under no obligation to accept the first job offer you are given.

What’s your advice for residents who are beginning their job search? Make a list of what you want and what is important to you in a job. Also make sure the community you are looking at is a good fit for your family. Can your spouse get a job? Do you want your kids (or future kids) going to school and growing up in the area?

What was the most important factor in your search for a new job? For me it was geography. We wanted to be near family for extra help and support with our small children.

Anything particularly unique about your job search? I grew up in this area, so I knew which hospital system I wanted to work for since I did lots of shadowing or medical school rotations with doctors who eventually became my colleagues or specialists I referred patients to see.

How did PracticeLink help you in your job search? I found both my first job and my current job on PracticeLink. It showed me options that I had not thought of.

Any other advice? Don’t feel like a failure if you move or change jobs. What may start off as the perfect job may change as you and your family change. We all have different needs at different stages in our lives and careers. What may be a great place to practice before you have kids may not work as well with a hard call schedule. You may find that you don’t want to be in a big city or a small town for the rest of your life. There is nothing wrong with changing your mind and moving on when you have changed and your practice has stayed the same.

 

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Skokie, Illinois

By Liz Funk | Live & Practice | Winter 2017

 

Skokie, Illinois, has the best of both worlds. It’s a suburb with top-ranked schools, but its public transportation makes it easy to travel to Chicago and all the attractions and excitement of the city. Skokie sits on the northern border of Chicago and is the first North Shore suburb north of city limits. Even so, living in Skokie doesn’t require a morning commute into the Windy City. Skokie Hospital and NorthShore University HealthSystem offer ample job opportunities.

Jonathan Pomerantz, M.D., grew up five blocks from Skokie Hospital, but he says the hospital has changed since his childhood. It was acquired by NorthShore University HealthSystem, and today Pomerantz works there as an ear, nose and throat doctor. “NorthShore really improved the quality, the safety and the prestige that Skokie Hospital had,” explains Pomerantz. “They took what I saw at the Skokie Hospital growing up, what used to be just one hospital, and made it a component of a really strong health system.”

Pomerantz was attracted to his specialty early in medical school. He says, “I thought it had a little something of everything. I like that you treat patients from birth to end of life. It’s a big quality-of-life field. Every time you fix a sinus infection or improve someone’s snoring or the quality of their sleep, you’re making their life better. It’s a feel-good field.”

With the exception of his undergraduate education at the University of Illinois Urbana-Champaign, Pomerantz has always lived in greater Chicago—a sure sign of his affection for the area.

For Pomerantz, his wife and their two children, Skokie has proved to be a family-centered place. “It’s excellent. The schools are top-ranked in the state. The neighborhoods are beautiful. The people are friendly and diverse,” he says.

Howard Meyer, executive director of the Skokie Chamber of Commerce and a Skokie native himself, echoes this. He says, “Skokie is a very dynamic community. …We have over 90 languages and dialects spoken in the school district.”

It’s also one of the strongest in the state, featuring more perfect ACT scores than any other Illinois school district.

Skokie’s entertainment and amenities have been created with families with kids in mind. “We have probably one of the largest park districts for any north suburban area. Our forest district is forest preserve land. We are just finishing the last leg of our bike trails.” These trails connect to Chicago bike trails and extend all the way to Green Bay.

Those interested in relocating to Skokie will find ample opportunities. The Illinois Science + Technology Park is located in the center of Skokie and employs 3,500 people. NorthShore University HealthSystem is also one of the large employers in Skokie and greater Chicago.

NorthShore University HealthSystem is an integrated system with four hospitals: Evanston, Glenbrook, Highland Park and Skokie. There are almost 800 beds across the system. NorthShore also has a 900-physician medical group with over 100 offices, a research institute, and a foundation.

NorthShore is currently most heavily recruiting for primary care, urgent care and surgical specialists.

One perk of working at Skokie Hospital is its state-of-the-art equipment, and the hospital is constantly upgrading its facilities. Pomerantz says, “We have all brand-new operating rooms. They built a brand-new surgical intensive care unit. Everything in the operating rooms is state-of-the-art. We can have video conferences with colleagues in operating rooms at other sites. Students can listen to their surgeon instructor explain what’s going on. We have state-of-the-art instrumentation and new types of surgical techniques. It’s a very exciting place to work. Sometimes I find myself strolling into the other surgical subspecialties. It’s so exciting to see what’s going on.”

“We’ve made a lot of interesting advances in sleep surgery, and we recently performed our first tongue implant for sleep apnea. It’s a new technology where you can implant an electrode into the tongue to keep from snoring. We were the first in the state to perform that procedure.”

Pomerantz says the strength of the hospital’s integrated sleep program made that procedure possible. “We have sleep medicine consultants from neurology and pulmonary medicine. We work in a nice, tight-knit center to have comprehensive care for sleep surgery patients.”

 

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Hartford, Connecticut

By Liz Funk | Live & Practice | Winter 2017

 

Connecticut is home to some of the best private schools in the country. The Hartford area also has magnet schools, charter schools and nationally ranked public schools. With two large local health systems in the area, it’s no wonder physicians relocate to raise their families in Hartford.

Although she was born and raised in Pennsylvania and did her medical training up and down the East Coast, Lisa Gronski, D.O., feels right at home in Connecticut. She chose to move to Hartford after observing the area and the workplace while in training.

Lisa Gronski, D.O.,

Sports medicine physician Lisa Gronski, D.O., returned to Connecticut after fellowship in Florida. The Hartford school system was a big draw for her family. · Photo by Jane Shauck

Gronski explains, “I rotated through the different hospitals and health care systems during my time there. And so I spent a lot of time at Hartford Hospital and in the outpatient offices with Hartford HealthCare.” Today, she practices sports medicine with Hartford HealthCare.

Hartford’s family friendliness attracted her back to the area. She says, “That was another reason why we wanted to move back up to Connecticut. Where we live is a very safe area. There are a lot of activities for families to do together.”

Gronski and her family love the area’s outdoor offerings. She has a 4.5-year-old son and a 7-month-old daughter. “We like to be outside as much as we can, whether it’s ice skating, hiking, biking or fishing. We also like to take our son to various events throughout the state. There are lots of festivals and carnivals. There are beautiful parks to walk through. There is Elizabeth Park, which has a rose garden that has a pond where you can feed ducks, which my son loves.”

It’s not surprising Gronski loves being active outdoors. She was an athlete in high school and college, and these experiences influenced her career path.

She chose the University of Connecticut for her residency, and she later became chief resident. She completed a fellowship in sports medicine in Florida and moved back to Hartford for a job with Hartford HealthCare right after.

Hartford HealthCare operates five hospitals in the area, including Hartford Hospital, a teaching hospital in partnership with the University of Connecticut School of Medicine. The hospital has 867 beds and a Level I trauma center. Hartford HealthCare Medical Group operates 56 outpatient locations, employing 196 physicians and 84 advanced practitioners, who perform primary care, urgent care, specialty medicine and outpatient surgery.

“Working in this area is nice because I can access all the specialists in the tertiary care center to refer our patients,” says Gronski.

Another major employer of physicians in the Hartford area is Saint Francis Hospital and Medical Center. Director of Physician Recruitment Christine Bourbeau says, “Saint Francis Hospital and Medical Center has 617 beds. The Saint Francis Emergency Department works out of a new state-of-the-art, 70-bed Level II trauma and tertiary referral center with 85,000 visits. Hartford is the capital of Connecticut, and we’re a Catholic hospital, so we do take care of the uninsured. That’s our mission statement—that we care for everyone.” Saint Francis Hospital and Medical Center is part of Trinity Health, which operates 93 hospitals, five of which are in New England.

Saint Francis Hospital and Medical Center operates nearly 60 outpatient clinics, some of which are on site at Saint Francis. Bourbeau says, “When you come in to Saint Francis Hospital, part of it is a whole medical office building. We have various clinics within our hospital setting.”

Bourbeau is currently recruiting for psychiatry, internal medicine, maternal-fetal medicine, neurology, occupational medicine and OB-GYN. “The list goes on and on and on,” says Bourbeau. “It’s usually because we’re building. We’re continually adding new talent. As big of a hospital as it is, when doctors come and visit us, they see that it’s not so big you get lost in the system. It’s not intimidating for physicians. It’s a warm, embracing place where there’s a collegial atmosphere.” Perhaps this atmosphere is why Bourbeau herself has been an employee of Saint Francis Hospital and Medical Center for 20 years.

When Bourbeau is recruiting physicians with families, Connecticut has a major selling point: education. “Connecticut has the best, best private schools. That’s what Connecticut is known for,” she raves. Some of the top private schools in Connecticut are Choate Rosemary Hall, the Hotchkiss School, Miss Porter’s School and the Taft School.

Connecticut’s public education also has locals singing its praises. Chip McCabe, director of marketing for the Hartford Business Improvement District, says, “The Capital Region Education Council (CREC) runs a lot of great of high schools in the Hartford region. Greater Hartford Academy of the Arts is world-renowned for arts disciplines. They have everything from creative writing to dance to music. There is a sports sciences high school and an aerospace and engineering high school,” says McCabe.

The schools were also a factor for drawing Gronski back to Connecticut. “The schools are top-notch and high-ranked throughout the country. That’s important because our son will be going into kindergarten soon.”

 

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Albuquerque, New Mexico

By Liz Funk | Live & Practice | Winter 2017

 

The Albuquerque International Balloon Fiesta draws visitors from all over the world and attracts plenty of media attention, but it’s just one of many activities for families in this outdoorsy part of the country. Families also enjoy a climate that’s pleasantly hot but not humid.

Christopher Calder, M.D., moved cross-country with his wife from New York to New Mexico mainly to escape the cold. “Long story short, I was in practice in upstate New York, and my adult daughter had moved to Albuquerque to do a master’s degree in public health,” Calder says. “We followed her here. A lot of people end up here relatively serendipitously like that. It’s not a place that most people think of going, which is something many of us like about it.”

Calder attended medical school in New Zealand, where he was born and raised. He completed his residency in neurology at the University of Rochester in Rochester, New York. He had a practice in Albany, New York, until 2012. Today, Calder is the neurology department vice chair at the University of New Mexico Health Sciences Center. “The job was an opportunity to move on and try an academic department instead of private practice. It was supposed to be a retirement job, and now I’m chair of the department.”

San Felipe de Neri church

San Felipe de Neri church was built in 1793 and is still home to an active parish in Albuquerque.

The University of New Mexico Health Sciences Center is the umbrella that connects the university’s academic programs, research programs and patient care. The University of New Mexico Hospitals operates five hospitals, including University of New Mexico Hospital, University of New Mexico Psychiatric Center, University of New Mexico Children’s Psychiatric Center, University of New Mexico Carrie Tingley Hospital and University of New Mexico Young Children’s Health Center. UNM Hospitals also operates clinics, including a women’s healthcare clinic, pediatric clinics and an ophthalmology clinic.

“We are the service area for 2 million plus people,” says Calder. “Albuquerque is the center of the state, so people come from long distances. We also see patients from southern Colorado and some from western Texas. Whatever field you’re in, there is usually a job. There is usually a good job. This is a good place to practice.”

Kelly Herrera, a physician recruiter for Presbyterian Healthcare Services, echoes this. Presbyterian Healthcare Services is a not-for-profit health system that operates eight hospitals in New Mexico and employs more than 700 physicians in 50 specialties. “You have a great team to refer patients to. There’s a robust medical group,” says Herrera.

Three of those eight hospitals are in the Albuquerque area. Presbyterian Hospital, the system’s flagship, is a 453-bed hospital that sees 70,000 ER visits a year. Kaseman Hospital has 55 beds and Rust Medical Center has 92 beds. Presbyterian Healthcare Services also operates outpatient clinics and urgent care clinics throughout Albuquerque. “We have been around for 106 years. The organization is very stable, and we continue to grow,” says Herrera.

As if job stability weren’t enough, Albuquerque also boasts 300 days of sunshine a year. “Our area is known for people who want to be outdoors. It is classified as a dry heat. You’re not going to get that moisture that you would in other parts of the U.S. What’s really cool is that you can go up to the mountains and play in the snow and then come back and golf,” says Herrera.

“There’s something for everyone. There is a lot of jazz and blues. There are a lot of playhouses here,” Calder says.

And of course, there are hot air balloons. “We are the hot air ballooning capital of the world,” says Brenna Moore, communications specialist for Visit Albuquerque. “The Albuquerque International Balloon Fiesta happens every October. It’s nearly 600 hot air balloons going up all at once. You can walk on the field and walk between the balloons and talk to the pilots,” says Moore. Nearly 1 million visitors come to Albuquerque to enjoy the nine-day festival. The event is a widely anticipated annual activity for local families.

Another popular family activity in Albuquerque is visiting local Native American pueblos. “We have 19 Native American pueblos within the state. It’s like a glimpse back in history. The Native American culture has so much influence on our food and ways of life,” says Moore.

On feast days, families who live in pueblos across the state open their homes to the public and cook for visitors. Dancers perform for the crowds, and pueblo members wear traditional attire. Moore says another popular family destination is the Albuquerque BioPark, which comprises of an aquarium, zoo, botanical gardens, a small beach and a fishing lake for children. Moore adds, “Because the weather is so nice, many of our parks and outdoor activities are open sunrise to sunset every day.”

The warmer temperatures in New Mexico suit Calder, who sees the climate as conducive to a friendly culture. “People are very friendly. People here enjoy a very nice outdoor lifestyle. From mid-April to the end of October, we will often sit outside to have dinner,” he says.

Calder may not have raised his daughter in New Mexico, but now the state is home to them both. That’s not all they have in common. After pursuing graduate work in public health, Calder’s daughter decided she wanted to work more directly with patients. She became an EEG technician and works at the University of New Mexico Health Sciences Center.

 

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Charleston, South Carolina

By Liz Funk | Live & Practice | Winter 2017

 

It’s likely you’ve spotted Charleston lately on top 10 lists of “Best Cities for Millennials,” “Fastest Growing Cities” or “Best Places for Freelancers.” Charleston has experienced a recent publicity boom and an influx of new residents. They’re drawn to the area by its fusion of southern hospitality and local urban flavor. Charleston is known for its great food, vibrant arts scene and colorful architecture.

“Boy, we’re getting a lot of people moving in and a lot of new docs,” says John Rowe, M.D., a family physician with Roper St. Francis Hospital System in Charleston, South Carolina. “The city is coming into its own. It has a good feel to it with all these new people coming in. New doctors and people find friends very quickly and get to be part of the community.”

Charleston is known nationally for its friendliness, and it’s also a popular place for parents to raise families.

“For families, people like the depth and variety it has to offer,” says Rowe. “We’ve got the beach and the water. We have a great parks system. We do get a little bit of winter, and it may last six to eight weeks. By May, the beaches are great.”

Rowe comes from a long line of physicians, and he felt drawn to family medicine. “My personality has always been to know a little bit about everything, and my personality likes a diverse group of patients and people. So family medicine was really the job description written for me.”

John Rowe, M.D.,

“New doctors and people find friends very quickly and get to be part of the community,” says John Rowe, M.D., of living in Charleston, South Carolina. Rowe attended medical school in Charleston and has practiced at Roper St. Francis for 15 years. · Photo by Richard Bell Photography

Rowe has practiced at Roper St. Francis for the past 15 years. Roper St. Francis operates three hospitals: two in Charleston and one in nearby Mount Pleasant. The system’s namesake, Roper Hospital, has 368 beds. Founded in 1829, it was the first community hospital in South Carolina. Roper St. Francis also operates more than 90 outpatient clinics and primary care practices in the area.

Rowe attended medical school in Charleston at the Medical University of South Carolina. “We have a great medical community in Charleston because of the history of these two organizations [Roper and the Medical University]. They’re separate, but they’re right across the street from each other. That adds a little interesting dynamic to it.”

Rowe says his alma mater does more than educate physicians. It also instills an affection for Charleston in medical residents. “It does help having that residency program here. They fall in love. Physician retention at Roper is pretty amazing. For a lot of docs who come out of residency, they want to stay. They park it. They’re happy, and they don’t leave. There are a lot of doctors in our community that have been here a long time.”

MUSC is working to grow its reach outside the hospital. Its primary care network has 13 primary care sites in Charleston and is expanding to include specialists within that network.

Misty Daniels, director of physician recruitment there, is a native Kentuckian who is new to Charleston. “You have the natural beauty: the beaches, the weather, the marshes,” she says. “You have the man-made beauty: the beautiful architecture, the gorgeous bridges. It’s a really pretty city. Then there is a lot of inner beauty in terms of the personalities of the people you meet and who you work with. I never have a problem pulling into traffic. People are always willing to let you cut in. It was one of the things that I didn’t think about in making the move, but it’s been a really nice thing to discover about Charleston.”

Patrick Cawley, M.D., is CEO for MUSC Health. He’s a native Pennsylvanian who has been on what he calls a “25 year Southward trend”: Scranton to D.C. to Durham and, eventually, Charleston.

“I’ve worked here at MUSC for almost 15 years,” Cawley says. “We have a great viewpoint when it comes to physician work. We’re pretty flexible when it comes to alternative hours or reduced hours if you need that. We have a lot of part-time physicians. At the same time, if you’re working full time, just about every department from my perspective balances that out pretty well. That’s the culture at MUSC and in Charleston—to make sure physicians enjoy life.”

Cawley also credits the area’s medical community with helping make Charleston a great place for physicians to live and practice.

“This medical community as a group is always trying to make care better,” he says. “That’s just a great environment to live in.”

Forty-six new people move to Charleston every day. “That number comes to us from the Realtors association of Charleston,” says Daniel Blumenstock, chairman of the Charleston Area Convention Center & Visitors Bureau. “My family and I can’t go out to dinner without running into someone we know. So if you have a physician moving into town, if they don’t have a network already, they can easily grow a network of people they’ve met that have similar likes. One person connects to another person. That synergy is a positive thing.”

“I absolutely love this area for raising my family,” says Rowe, who has three school-aged children. “It’s a great environment. I think every city or area has its benefits, but I wouldn’t have my kids anywhere else. There are definitely parts that are super family-friendly and young-family-focused. Mount Pleasant is an area that has affordable housing and an incredible elementary school and high school. Summerville is another one of those areas. Our community planners have really seen, as we grow our community, that we need to couple new housing with excellent education.”

Blumenstock says Charleston has a variety of top-notch educational options for children. “We have a lot of charter schools and magnet schools. We have charter schools that have a specialized focus, like the arts or technology. We have magnet schools that students test into. And we have an excellent public school system.” Blumenstock has three children, ages 17, 14 and 12. He says, “I’m living proof that it’s great to raise a family in the Charleston area.”

 

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Protecting what you’ve built

You’ve worked hard for your money—both current and future. What steps should you take to protect it?

By James M. Dahle, M.D., FACEP, WhiteCoatInvestor.com | Feature Articles | Winter 2017

 

Many physicians carry a profound fear of losing their personal assets due to a mistake at work. By understanding just how rarely this actually occurs, you can alleviate these fears—and make reasonable decisions about which steps to take to protect your assets. According to the National Practitioner Data Bank and health care cost writer David Belk, M.D., the number of paid claims against physicians between 2003 and 2014 dropped from 15,000 per year to 9,000 per year, with only about 2,000 of those paying out more than $500,000.

Plus, almost half of those claims occurred in just six states: New York, Pennsylvania, New Jersey, Massachusetts, Maryland and Illinois. In fact, the amount of money paid out per capita in New York is 2,969 percent higher than that of North Dakota and 39 percent higher than that of any other state.

According to a 2012 study published in the Archives of Internal Medicine, only about 55 percent of claims go on to become lawsuits, and the vast majority of those are resolved before going to trial, which means that less than 5 percent of claims end up going to trial. Of those that went to trial, 80 percent of them are decided in favor of the doctor. Of those that were not decided in favor of the doctor (about 1 percent of claims), the vast majority of awards from the jury are within the limits of the policy. Most of those that are above policy limits are then reduced to be within policy limits during the appeals process.

All that to say, the likelihood of your having to pay from your personal assets in any given year is less than one in 100,000, despite the astronomical awards often widely publicized. For example, in 2009’s Hugh v. Ofodile, a jury in New York famously awarded a plaintiff a $60 million verdict for pain and suffering following a thigh lift surgery. After two years of appeals, the verdict was reduced to $600,000, which was well within policy limits.

Tried and true techniques

Given the extremely low likelihood of having to pay out of personal assets, you needn’t lose any sleep over this issue. Rather, it is reasonable to limit the time, money and effort you spend protecting against this extraordinarily unlikely outcome. You should also consider the ethical dilemma involved in any asset protection plan—that if the plaintiff was legitimately damaged through your negligence, you have a legal and ethical duty to make it right financially, even if it involves the loss of your personal assets. Many would consider it unethical to engage in a scheme to prevent a plaintiff from collecting what is rightfully his.

Your first reasonable line of defense against any liability claim is an adequate insurance policy. Liability insurance policies not only pay any judgment that may come due, but just as importantly, pay for the cost of the defense, no matter how many years it may take.

Physicians tend to worry most about malpractice liability, which is defended using a professional liability policy, but they should also worry about their personal liability, which is defended using a homeowners, renters or auto liability policy. In addition, the wise physician adds an “umbrella” policy on top of these policies to provide liability coverage of $1–5 million. The good news about umbrella policies is that you can buy a great deal of insurance for a very low price. Several million dollars of coverage is typically available for less than $500 a year—dramatically less than a malpractice policy.

A malpractice policy needs to be both adequately sized and maintained for an adequate length of time. The general guideline for deciding how much coverage to carry is to match what’s typical for your state and specialty. For example, emergency physicians in Utah typically carry a policy with limits of $1 million per occurrence and $3 million per year.

Eric Tait, M.D.

In addition to proper insurance coverage, Eric Tait, M.D., recommends identifying an asset protection plan. · Photo by Kelli Durham

Eric Tait, M.D., an internist with Central Houston Medical Group in Texas, notes that his employer provides coverage of $200,000 per occurrence and $600,000 per year, so that is what he carries. Carrying less coverage could expose you to additional risk of paying out of pocket. More coverage, on the other hand, may make you more of a target due to “deep pockets.”

For insurance coverage to be adequate, it must remain in force until the statute of limitations runs out, which is typically two years from discovery of the error in question or two years from the time the plaintiff turn 18. You can get this length of coverage by purchasing either a “tail” policy in addition to your “claims-made” policy or by purchasing an “occurrence” policy (which includes tail coverage) from the get-go. When signing an employment contract, be sure it is very clear how your tail will be covered, because the cost of a tail is often two to three times the annual premium for a claims-made policy. Ideally, your employer will cover that cost under any circumstances, but this varies greatly among employers.

Sanghamitra Sadhu, M.D., a nephrologist with Renal Care Orlando in Florida, carries a claims-made policy. “If I change jobs, I hope to negotiate it as a sign-on bonus or part of my compensation package at the new job.”

Tait doesn’t advise relying solely on insurance. “For me it is equally important to have an asset protection plan in place as it is to have malpractice insurance,” says Tait.

Though this can greatly benefit you in the case of a lawsuit, it is important to realize there are no guarantees with asset protection. An attorney or insurance agent promising an iron-clad technique is usually overselling his favored technique. Any asset protection technique is designed to make it harder and more expensive both to find out what you own and to actually get it. The idea is to make it take more time, effort and money to get to your assets.

In addition, asset protection laws are always state-specific. What works in one state may not work in another. Not only do the likelihood of being sued, the likelihood of losing a trial and the expected payout vary by state, but so do the assets that creditors protect. The ultimate protection against your creditors is to declare bankruptcy. Then you keep whatever your state protects, and you lose what it does not. In practice, however, it is more typical for a defendant to settle for some amount rather than to go through bankruptcy. For example, a physician may have a lien placed on his home as a result of the judgment and may simply take out a second mortgage to pay off the lien.

Many states have a “homestead” law that protects a certain amount of your home equity from your creditors. The value protected varies dramatically, however. Florida, for example, protects property of unlimited value (up to 160 acres in rural areas and half an acre in urban areas), but Alabama protects only $5,000 of home equity ($10,000 if you’re married). Obviously, from an asset protection standpoint, it is better for a Florida physician to have his wealth in his home than it is for an Alabama doctor. Practically speaking, that might mean a Florida physician would buy a slightly larger house and pay off the mortgage faster. Sadhu, the nephrologist in Florida, admits buying a little more house than she otherwise would have due to this homestead law. “We have been hitting our mortgage aggressively with extra payments every year once we have met our retirement savings goal for the year. [The homestead law] did influence our decision with regard to how much house we bought. We decided we would buy the kind of house we dreamed of and save in other areas of our lives.”

John Odette, M.D.,

The homestead law in Texas, where John Odette, M.D., is an ophthalmologist, protects up to $1 million and mentions some very specific assets, such as two firearms and up to 120 chickens. · Photo by The Bird & The Bear

The homestead law in Texas is also interesting. Not only is up to $1 million protected, but $30,000–60,000-worth of very specific personal assets are also protected, including two firearms and up to 120 chickens. John Odette, M.D., an ophthalmologist at Austin Eye in Austin, doesn’t own 120 chickens but does say that he “plans to buy a little more house than I otherwise would as asset protection, although not too much more.”

Aside from a homestead in a few specific states, the best asset protection technique for most doctors is simply to maximize contributions to retirement accounts. In most states, 100 percent of your 401(k) and IRA balances are protected from creditors in bankruptcy. In some states, plans compliant with the Employee Retirement Income Security Act (ERISA), such as 401(k)s, receive more protection than IRAs. In other states, only an amount “reasonably necessary for support” is protected, so be sure to know the law in your state when fashioning an asset protection plan.

Some states also provide protection for the cash balance of insurance products like whole life insurance and annuities. Insurance fees result in a heavy drag on returns in these products, but for a physician who highly values asset protection benefits and actually lives in a state where these benefits exist, it can make sense to place some money into them. Odette, for instance, has strongly considered purchasing a whole life insurance policy primarily for the asset protection.

Another important asset protection technique involves titling assets correctly. In many states a married couple can title their home as “tenants by the entirety,” which means that both people own the entire house, rather than each owning half. In effect, this means that a suit against just one of them cannot take the house. Sadhu and her husband use this technique. “My home state of Florida recognizes tenants by the entirety, so this is the best way to title our house from an asset-protection standpoint, since it protects our homestead from a claim against either my spouse or me. This is vital for us, being a two-physician couple.”

Tenancy by the entirety is a much better option than a technique some physicians use—putting everything in the spouse’s name. You are far more likely to lose your assets in a divorce than in a malpractice lawsuit. That hasn’t stopped Tait from titling his primary residence in his wife’s name and his secondary residence in his own. He notes, however, the main reason for that was not asset protection, but to increase the ability to obtain leverage for his secondary profession as a real estate investor. Tenancy by the entirety isn’t available in Texas anyway.

Techniques to go above and beyond

Once you get beyond these well-known protected assets and titling techniques, asset protection strategies start becoming significantly more complicated and more expensive. At this point, a physician desiring more asset protection ought to take a look at reducing the risk in his life. That might mean moving to a state with fewer malpractice claims and lower payouts. An OB-GYN might drop obstetrics, and a general surgeon might drop trauma coverage. It might mean getting rid of the family dog, the pool and the trampoline in the backyard. It could mean not inviting your child’s friends on your boat and not serving alcohol when entertaining. But at a certain point, most reasonable people agree that you cannot eliminate all risk from your life.

Some physicians wonder whether they can reduce their risk by incorporating their practice. Unfortunately, malpractice is always personal, so having a shell corporation doesn’t provide any protection from professional liability, although it could have some usefulness from business-related liability (such as if an employee sued you for breach of contract).

Limited liability companies also have some useful asset protection possibilities, although the amount of protection they provide varies highly by state. Limited liability companies or LLCs are used to segregate “toxic” assets, such as rental properties, from “safe” assets, such as a portfolio of mutual funds. The idea is that if someone gets hurt on your rental property, the most he can receive is the value of that LLC, which contains only that particular property. LLCs can also make it more difficult to figure out exactly what you own. This was important to Tait following an incident at one of his investment properties. “At one of our apartment complexes, we experienced a violent crime early on in our ownership. News cameras were everywhere. The news agencies tried to find out who owned the property, but because of our structures, they could never find out. We were not negligent in any way, but we surely did not want any unwanted public exposure.”

Another use of LLCs occurs in states where creditors are limited to a “charging order” to get what they are due. A charging order basically says that if the LLC distributes income, the creditor gets their cut of it. Whether or not an LLC actually distributes income, however, is under the control of its owners. To make things even more interesting, an LLC is usually a pass-through entity from a tax perspective. So it is possible not only not to distribute income from the LLC, but also to send the creditor the tax bill for that income! Needless to say, in some states, this technique can be quite the incentive for a creditor to settle for less.

One of the best asset protection techniques is simply to give your money away. That which does not belong to you cannot be taken from you. This might mean establishing a charitable trust, funding 529 plans and Uniform Gift to Minors Act (UGMA) accounts for your children or putting money into an irrevocable trust. Like any asset protection technique, this needs to be done long before you are ever sued lest it be viewed as a fraudulent transfer. In fact, any technique done solely for the asset protection benefit is likely to be undone by a judge. It is always better to have a reason related to your business purposes or your estate planning to implement an asset protection technique.

There are more exotic asset protection techniques like family limited partnerships and off-shore accounts that can be useful in certain circumstances. Some of these are scams, many are overpriced, and all are usually unnecessary given the rarity of being successfully sued for an amount above your policy limits. If you are interested in these sorts of techniques, you should consult with a reputable asset protection attorney in your state.

Investing and saving as asset protection

Truthfully, most docs spend too much time worrying about asset protection and not enough time worrying about far more common causes of not reaching their financial goals. One common reason doctors and many others do not reach their goals is the death or disability of the breadwinner. Both of these issues are easily insured against. A doctor may earn $5–10 million during her career. Thus, her earning power is her most valuable asset. Disability insurance is expensive, but critical in the years prior to financial independence. A good individual disability policy typically costs 2–6 percent of the amount of income protected. So a policy that pays a monthly benefit of $10,000 in the event of disability would likely cost a healthy doctor in her 30s a few hundred dollars per month.

Premature death is also a risk worth protecting against. Luckily, term life insurance is much cheaper than disability insurance, so it is relatively inexpensive to purchase a policy of $1–5 million to provide for loved ones in the event of death. A healthy 30-year-old doctor can buy life insurance for as little as $280 per year per million dollars of coverage. Both types of insurance are best purchased from an independent agent who can sell you a policy from any company.

Another common reason doctors don’t reach their financial goals is inadequate savings rates. A doctor who wishes to maintain his lifestyle in retirement should be aiming to save 15–20 percent of his gross salary for retirement throughout his career. It doesn’t matter what your asset protection plan is if there are no assets to protect!

Inflation, taxes and investment fees are an investor’s chief enemies. Inflation is best protected against by taking an adequate amount of risk with the portfolio. A portfolio invested 100 percent in CDs, savings accounts and bonds is unlikely to grow adequately once the effects of inflation are taken into account. Most doctors will need to take on at least some risk with their investments by including risky assets like stocks and real estate in their portfolios. Your tax burden can be lowered by investing inside of tax-protected accounts such as 401(k)s, Roth IRAs, and even health savings accounts and 529 college savings accounts. Finally, investment fees can be minimized by reducing the frequency of your transactions (which is likely to boost returns anyway), by making sure you’re paying a fair price for any needed financial advice, and by using low-cost investments such as index funds.

Physicians spend more than a decade developing the knowledge and skills necessary to earn their high salaries. They continue to work hard throughout their careers. No wonder they are interested in protecting their assets from potential creditors as well as the corrosive effects of inflation, taxes and investing fees. Smart spending decisions combined with an intelligent investing plan and a reasonable asset protection plan will help you reach your financial goals.

James M. Dahle, M.D., FACEP, is the author of The White Coat Investor: A Doctor’s Guide to Personal Finance and Investing and blogs at whitecoatinvestor.com. He is not a licensed financial adviser, accountant, or attorney and recommends you consult with your own advisers prior to acting on any information you read here.

 

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A Moonlighter’s Guide to the Galaxy

Moonlighting during residency can be a boon to your professional skills and your wallet. The guide covers how to get a moonlighting gig and how to prepare for it.

By Derek Sawyer | Feature Articles | Winter 2017

 

Like ice cream on a hot day, moonlighting can be an epic idea or an epic mess, depending on your preparation for the situation. (A little luck never hurts either.)

Moonlighting, or having a secondary job in addition to your main employment, is a popular option among residents looking for additional income and experience. Having been a health care recruiter for more than 10 years, I’ve learned a thing or two about moonlighting to share with you, like where to find opportunities, how moonlighting can help you down the road and what newbies should know. Many moonlighting opportunities are available because they are in unpopular locations, but that doesn’t mean they can’t deliver your desired outcome—plus a little extra.

Why moonlight?

Erik Stamper, D.O.

Erik Stamper, D.O., had a rough first shift as a moonlighter during residency. Though his story isn’t the norm, it’s still an important warning to understand the total environment. · Photo by Wirken Photography

Speaking of outcomes, why is moonlighting a good idea? Simply put, it’s the best way to get out of your comfort zone and see medicine outside a controlled academic environment. Plus, it can help you get a head start on paying back those student loans. Since the monetary benefits are pretty self-explanatory, I would like to focus on a few other benefits of being exposed to a new setting at this point in your career. You may not be getting these benefits in your program’s curriculum, but they will complement the clinical skills established there.

Leadership experience. As a resident you have many chances to hone specific clinical skills (which, it goes without saying, are critically important), but in many situations throughout your career you will find yourself in situations that call for you to be more of a general than a foot soldier. Though it’s fantastic that you can intubate anyone while blindfolded, what happens when patients begin to stack up and you don’t have the time to properly handle each one? This is when it is critical to know your team and available resources, as well as how to best motivate them to achieve results in the quickest manner. As I will expand on later, your nursing support can make or break your shift, so having their buy-in is key. This doesn’t mean you need to order them pizza everyday (although that doesn’t hurt), but you do need to take the time to mesh well with the folks you will be counting on.

Political/relational experience (i.e. playing nice in the sandbox). No matter where you go, there will be folks who will be easy to get along with and there will be … the others. Unfortunately, as a resident you won’t usually receive the benefit of the doubt right away; you will have to earn it. This may take some time, but in the interim, moonlighting provides an excellent chance to learn how and when to push colleagues, specialists and others to get the help you need. Though I would not recommend being too blunt initially, you will need to be able to establish yourself if you want to care for your patients properly and get the requisite support. Speak with your current attendings; they have no doubt encountered similar situations and should be able to provide tips on handling difficult personalities while still getting what you need.

Steve Roberts, M.D.

When moonlighting, be sure to identify who can act as a second opinion. “Having backup that is only a phone call away helps me even in the most isolated locations,” says Steve Roberts, M.D. · Photo by That’s a Pretty Picture

Confidence. It is my belief that what separates pro athletes from amateurs is merely practice and a high level of confidence in their abilities (which pretty much comes from practice). It is one thing to conduct a complicated procedure with three techs, two attendings and a partridge in a pear tree, but what happens when it’s just you? Do you know what to do? Do you know whom to call to find out? Your confidence level will not only be blatantly obvious to all those around you but will also be infectious. If you know you can handle a situation, others will follow.

Perspective. To promote consistent clinical practice, most academic or residency environments are designed to be as controlled as possible. But part of learning is understanding multiple perspectives, and in many cases these perspectives can only be gained in the flesh. For this reason, emergency and internal medicine physician Sam Clemmons, M.D., emphasizes the importance of moonlighting as part of the educational process. Clemmons, who started in the military, has worked in both rural and urban settings. He is currently the president of Elite Emergency Service in Franklin, Tennessee, handling contract management on a large scale. The variety of his background has helped him gain a perspective on all aspects of medicine, which in turn helps him understand and contribute to it on a macro level.

How to find opportunities

Moonlighting opportunities usually aren’t hard to find, and there are often multiple options available, making you a chooser rather than a beggar. Moonlighting positions vary greatly depending on your geographic location and specialty, but in most cases they can be found in the same two ways—online and through word of mouth.

The internet is by far the best place to start; it will give you the ability to scour all opportunities available before making your decision. The more you know, the more leverage you have.

Talking to your attending, previous grads, local recruiters and others in your circle is another great way to find moonlighting jobs. Health care is a small community—take advantage of it. Out in the field, your CV will not take you nearly as far as a reference. The more contacts you have who will vouch for your clinical and leadership skills, the easier it will be to find a moonlighting position and, eventually, a permanent position.

Before your search, it is important to note that many residency programs have policies in place regarding moonlighting. Some will allow only third-year residents to moonlight, and others have geographic or clinical restrictions. Be sure to check with your supervisor or program director early on so that you fully understand those restrictions. One last thing to keep in mind is that the Accreditation Council for Graduate Medical Education (ACGME) has set an 80-hour cap on the total amount of combined educational and moonlighting time residents and fellows may work in any given week (including in-house call activities). Be sure you have a good grasp of any additional applicable rules in your area and specialty.

Moonlighting pitfalls

Now that I’ve highlighted the positive benefits of moonlighting, I need to take a moment to lay out some of the pitfalls you can run into. To get started along that road, I have included a short story from Erik Stamper, D.O., who is now assistant emergency medical director at Research Medical Center in Kansas City, Missouri:

My first shift moonlighting was during my third year of residency. I drove two hours to get some real-life ER experience [at a facility that] happened to be about a one-hour ambulance ride from the nearest larger facility.

We had no specialty backup coverage, but, hey, they were paying me a decent rate. I was told that I would only see one patient per hour and at most 12 total in a shift. There would also be double coverage, so I was told the other provider would help me with questions I may have about transfers, admissions, processes, etc.

The attending physician I was working with was board-certified in internal medicine, [and] half of my shift would also be covered by a moonlighter (whom I was told was board-certified in ophthalmology). After 15 minutes of conversation during my first shift, the attending physician said she was going to get some food to eat and take a break. She never came back.

So, in short, after 15 minutes I was the only physician available in a facility [with] which I had very little orientation (if you count the 15 minutes), and an ambulance was bringing in a stroke patient. The first patient I saw was a stroke [whom] I gave TPA after a negative CT head for hemorrhage (thankfully they had an off-site radiology service to read CTs). My shift was hell, and those 12 patients promised to me quickly became 25 with five transfers to larger facilities. By the way, the second-half moonlighter, the ophthalmologist, never showed up for his shift. I survived that shift only because the nurses were great and realized I was left for dead by the other physicians. A nurse at this facility told me that when the other doctors realized an EM resident was working, they typically left or took very long breaks. After my shift, I got in my car and drove back home two hours at 2 a.m. Did I mention the odd shift schedule availability? I never went back to the facility and ended up moonlighting at a facility that was farther away but had more specialty backup coverage and double coverage that was also staffed and was run by a national EM group.

Phew! Though Stamper’s situation isn’t the norm, it is still a scenario you could find yourself in if you don’t know what to look for before you step foot on-site. To ensure your shift goes as smoothly as possible, take the time up front to review the following clinical and logistical suggestions.

These will not prevent all possible curveballs but should minimize your chances of getting caught off-guard with a preventable situation.

Clinical suggestions

EMRs. Since the days of the ol’ paper T-sheets, EMRs have been evolving at a rapid pace—with many companies adding their own variations to make their systems unique. This means that while some things are similar or common sense, others can be completely counterintuitive depending on the system you were trained on. Fortunately, most systems are accessible remotely, so you can spend some time familiarizing yourself with the ins and outs even if you aren’t on-site. Stamper noted that if you are unable or too tired to finish all of your charts post-shift, you can do charting at home and play around with the system so you will be more efficient during your next shift.

Orientation. The term “orientation” can mean different things to different folks. Some hospitals consider orientation to be as simple as giving you a badge, a few passwords and a map to the restroom, while others provide entire shadowing shifts to get you acclimated. Regardless, find out what the orientation process will entail and whether you are comfortable with it. Ask who will be conducting the orientation and, if possible, be sure it’s the medical director or a long-time attending at that specific location. Though it’s not always possible, it is a good idea to ask for a shadow shift prior to starting a shift on your own. You will be extra help, so you should not be pushed to work outside your comfort zone the first time you are working independently.

Emergency Medical Treatment and Labor Act. The regulations under EMTALA regarding transfers and admissions can vary by location, and it is your responsibility to be in the know. As you can see from Stamper’s story, a variety of scenarios can pop up unexpectedly. Knowing your way around patient transport laws and hospital subspecialty coverage can help you avert a potential disaster. It’s important to realize that you will be the physician responsible for the care of any patient during transport, and you may need to write orders for the paramedic or flight crew. Think through potential problematic scenarios and determine what you would do if a woman in labor shows up when you have no OB coverage and the nearest accepting facility is 30 minutes away. If you are uncomfortable or don’t know what you would do in cases covered under the EMTALA laws, you are increasing your chances for a lawsuit. “Don’t assume risk or think that you will be able to figure it out because learning on the fly is how you get sued,” Stamper says.

Lifeline. This is simple but important: Be sure to have the phone number of another attending whom you trust and can call during your shift. (Also be sure to warn him or her before your shift—you might be calling for help at 3 a.m.) Steve Roberts, M.D., a traveling emergency medicine physician who floats at facilities throughout the Midwest and Southeast with EmCare, pointed out that having a second opinion can make all the difference in the world, especially when you find yourself in a unique situation. “The longer I do this, the more I realize what I do not know. Having backup that is only a phone call away helps me even in the most isolated locations,” says Roberts. It is always difficult to be prepared for all possible scenarios, so having resources identified just in case is a prudent idea.

Last but not least, do your homework on the facility and your specific unit. Have a strong grasp of the coverage and specialty backup available. Look for information regarding mid-level providers and nurse-patient ratios. If there’s anything you can’t find on your own, be sure to ask the director!

Logistical suggestions

Contracts. Handshake deals have their place in friendly competitions and Super Bowl wagers, but in employment scenarios, get everything on paper—ideally in contract form. That being said, not every single detail may be listed in the main contract itself, so keep all written correspondence for backup on any promises made.

While not the most important aspect of moonlighting, rate is obviously an important piece of the puzzle. Rates will vary in amount and structure depending on location and specialty, so make sure you understand your pay rate up front. If you are being paid based on RVUs, ask about the average RVUs per hour at that location. If you have metrics, bonuses or other incentives, make it a point to understand the ins and outs. Roberts recommends speaking with one of the attendings already working there (offline if possible). Pick his brain to see what other folks are currently making, as well as his thoughts on it.

Reimbursements. Additionally, dig into any expense/travel reimbursement options with the company. Since many moonlighting opportunities are in rural settings, there is a good chance the company will offer to pay travel or reimburse for it (if not, remember to write it off on your taxes), so be sure to ask. Also, inquire about the specifics, such as what kind of hotels they’ll cover (there’s a big difference between a Super 8 and a Homewood Suite with a kitchenette), whether you can get the travel points, how long it takes to be reimbursed, what the mileage rate is, whether can you fly instead of drive, whether per diems are offered, etc. After a long, stressful night shift, the last thing you’ll want to deal with is a hotel issue that prevents you from getting to your bed. Getting this hammered out in the beginning will not only save you from some gray hairs, but may also earn you some travel perks along the way.

Insurance. Confirm that malpractice coverage is provided and that it is high enough to cover any potential issues per the state guidelines. Malpractice varies quite drastically from state to state, but most states make it easy to obtain the insurance guidelines as well as recommended coverage levels. If you are unsure what you have, just ask the company to provide you a copy of the certificate of insurance (COI). That is probably a good idea in either case.

Lastly, trust the organization you are working for. Whether it be a large company with the resources to back you up in case of any issues or a smaller company that can react very quickly, know whom to contact with potential travel or clinical issues—and make sure you can count on them to help. Roberts points out that it is critical to find someone in the organization to trust. This may be the head of the program, a recruiter or a scheduler. An ideal scenario is to get the security of a large company but the relationship associated with a small group—trust people not institutions. Oh, and I’ve said it before but I’ll say it again: Get everything in writing!

Moonlighting can be immensely rewarding on both a clinical and personal level in addition to providing some extra money while you’re in residency. I can’t overstate, however, how important it is to be prepared when you arrive. Following these simple steps and doing your homework can make all the difference in the galaxy.

Derek Sawyer is a physician recruiter for American Physician Partners.

 

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How tight is the job market in your specialty? Winter 2017 issue

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

PracticeLink Physician Recruitment Index | Winter 2017

 

What’s your competition like?

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

Challenging

Most-Challenging-to-Recruit Specialties

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

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

The change in rank reflects the specialty’s movement since last quarter.

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

Demand

Most-In-Demand Specialties

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

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

This PracticeLink Physician Recruitment Index was pulled October 1. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.

 

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Creating your desired first impression

Looking to move forward as a candidate? Improve your chances with these tips.

By Jeff Hinds, MHA | Job Doctor | Winter 2017

 

In the absence of any pre-established relationship, the content of your CV and other application materials are all an employer knows about you before deciding whether to consider you as a candidate for their job opening. The reality is that you may be filtered out as a viable candidate for your dream job before you even have the opportunity to sell yourself via a phone interview or on-site visit.

There will likely be competition for any position you decide to pursue, so how you market yourself as a candidate should not be taken lightly. Though the content of your CV and other application materials may appear very basic on the surface, it is the minor details that can set you apart and differentiate you from the competition when all else is equal.

Create a strong CV

The first document that will be required by all employers is your curriculum vitae (CV). Employers use the CV as a screening mechanism to filter out candidates who don’t seem like the right fit before proceeding to phone interviews.

To determine fit and qualification, they look for obvious items like medical training and education, work history, certifications, licensure, professional associations, honors and awards, research and publications. Your goal is to include all the pertinent information that will set you apart as a candidate.

Conversely, do not add what could be construed as irrelevant content just to make your CV longer. The length of your CV is not indicative of your quality as a candidate. Simply adding content to increase length will dilute the meaningful substance of your CV and make it more difficult for potential employers to navigate.

Employers need to be able to navigate through your CV quickly to find the information they are looking for. Beyond the content itself, you can also help accomplish this through proper formatting, consistent spacing and listing activities in reverse chronological order. Employers are most interested in what you are doing now and shouldn’t have to dig too far to find that information.

Again, a strong CV will not win you the job necessarily, but one that is disorganized and difficult to navigate can certainly eliminate you from consideration earlier in the process.

Sell yourself in your cover letter

It is to your advantage to submit a cover letter along with your CV. Your CV may show how you’re qualified, but your cover letter will show why you’re a great fit.

If there is a job posting or advertisement for the opening, take the specific qualifications, skills or attributes being sought and elaborate further in the letter on how you are a match. In addition, indicate any pre-existing relationships you have in the organization or area to show that your commitment to the opportunity will be long-lasting.

Line up references and letters of recommendation

Request letters of recommendation or contact information for your references before or at the onset of your search. Be sure to notify your references if you believe a potential employer will be reaching out to them.

By devoting the necessary time and attention to ensure your application materials reflect your strength as a candidate, your chances of moving forward in the process are only increased. You have worked hard to get this far in your career and do not want to miss out on your dream job for reasons within your control.

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

 

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Integrative medicine evaluates a person’s many facets

By Marcia Travelstead Marcia Travelstead | Career Move | Winter 2017

 

Practicelink molly roberts sf 037

Through probing questions and integrative medicine, Molly Roberts, M.D., aims to get to the root of patients’ issues. “If more attention was placed on dealing with the underlying problem, then we’d have fewer people dealing with the serious health issues they have now,” she says. · Photo by Drew Bird Photography, LLC

Name: Molly Roberts, M.D., MS

Work: CEO and president of LightHearted Medicine, San Francisco

Undergraduate: St. John Fisher College, Rochester, N.Y.

Med School: University of Arizona, Tucson

Residency: University of Arizona

Molly Roberts, M.D., known as “Dr. Molly,” is on the board of directors for the Academy of Integrative Health and Medicine and is chairman of the Academy’s Association Leadership Counsel. She is past president of the American Holistic Medical Association and the past chairman of the Board for the Integrative Medicine Consortium. She is a psychotherapist with a master’s in rehabilitation counseling and vocational evaluation with Ph.D. work in rehabilitation psychology. Dr. Molly has published a number of books and has contributed to numerous articles and publications. She has been a volunteer faculty member at the University of Arizona College of Medicine and continues to serve as a mentor. Her business partner and husband Bruce Roberts, M.D., brings his vast experience and expertise to LightHearted Medicine as well.

What do you like best about practicing integrative medicine? I get to spend time with my patients. I think it’s important to get to the root cause of their symptoms. Instead of treating one symptom after another, you can delve into all of the clues of what’s going on physically, emotionally and spiritually. We can look at it together to figure out what is the next step in their life journey.

I tell my patients that “I follow the energy.” So, if they’re talking about their physical symptoms, we head in that direction. If they’re talking about their relationship with their spouse or how much they hate their job, we head in those directions. I was a psychotherapist for 15 years before I became a medical doctor, so we can cover both the physical and emotional aspects of their life and health.

Is there anything you don’t like about your work? What I don’t like is that the current health care system doesn’t do enough to address prevention and proactive health care. It’s really focused on crisis management. For example, it doesn’t work on nutrition until the person has diabetes. If more attention was placed on dealing with the underlying problem, then we’d have fewer people dealing with the serious health issues they have now.

Was there anything that surprised you about practicing integrative medicine? It was when I really started looking at the spiritual aspect of my patients’ health and well-being. I first started probing into spiritual health when I had my own personal injury. That’s when I realized how important it was to ask those big-picture questions: What am I doing here? Where do I want to go? What’s my meaning and purpose in life? To what and whom do I feel connected?

I thought that if I asked those questions of my patients, I would be put on the sidelines with my medical colleagues.

However, my medical colleagues instead said they knew these questions were important, they just didn’t have the time to explore them with their patients. What happened was those doctors started referring to me instead of isolating me. I think it’s important to say that I don’t have a religion I am pushing on anyone. It’s more about asking those big questions in order to discover what patients feel connected to.

What advice would you give a physician who wants to practice integrative medicine? I would suggest reaching out to physicians who are already practicing it. I think that’s really helpful. Integrative medicine has actually been around a long time (it used to be called holistic medicine), and now there are formal fellowship training programs in integrative medicine.

Physicians who practice integrative medicine are doing different things. For example, there may be an integrative medicine specialist who added acupuncture to the list of tools in their toolbox. Another practitioner might have added nutritional or herbal remedies. Someone else might be using bodywork, health coaching, sophisticated biochemical testing and treatment, or some other modality to help their patients.

The other thing is to have an open mind regarding science and research. We know so much more than we did five years ago, but what we know now was a mystery back then. I think it’s helpful to stay humble about how you think health and medicine work, as the research will inevitably shift your understanding as time goes on.

Anything else you’d like to add? Integrative medicine is a mixture of what you bring to the world and what you explore about yourself. If a physician is looking to make a difference in their patients’ health while at the same time honoring the quest for their own best life path, this is the type of medicine he or she would want to work in. Most of us go into medicine to help others on a deeper level, and this is a great opportunity to do just that.

 

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