Irina G. Trifonova, M.D.

Snapshot

Snapshot | Winter 2019

 

"Step by step, I simply used all the strategies recommended in PracticeLink Magazine." -Photo by Mojica Photography

“Step by step, I simply used all the strategies recommended in PracticeLink Magazine.” -Photo by Mojica Photography

Employer: New York Presbyterian, Queens, New York

Residency: Lincoln Medical Center (Bronx, New York), Weill Cornell Medical College, 2015

Fellowship: Pediatric hospital medicine fellowship, 2018

Trifonova enjoys reading and running. She has participated in a marathon, half marathons and a triathlon.

What’s your advice for residents beginning their job search? The most important thing is to know what you want. Take your time to think and write down what is important to you in your career.

Right after interviews, I made myself notes about what I liked and didn’t like about that particular site. It helped me later to make a final decision.

What was the most important factor in your search for a new job? Location—would it work for my family?

How did PracticeLink help you in your job search? One of my friends recommended PracticeLink Magazine to me and gave me his copy. I read it from the beginning to the end.

Step by step, I simply used all the strategies recommended in PracticeLink Magazine, from refining my résumé and applying for the positions, preparing for phone and onsite interviews to learning how to budget the interview process.

Even now, when I have my dream job (thanks to PracticeLink), I use the magazine to expand my knowledge on other aspects, such as financial fitness. I strongly recommend PracticeLink as a valuable tool and support in the exciting process of job search.

Any other advice? Be open-minded. Go for the interview even if you don’t think you’ll end up there. It helps to build confidence in interviewing, compare different practices and build new relationships. It is a small world. You might see people who you interviewed with at conferences, or work on multicenter research projects in the future. Never burn bridges.

 

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Family-friendly cities

Live & Practice

By Liz Funk | Live & Practice | Winter 2019

 

These family-friendly places have top schools, affordable housing, friendly neighborhoods—everything a physician with kids needs in a new place to practice. Plus, there are plenty of venues for play, from lakeshores to mountain bike trails to museums and film fests just for kids. With remarkable job opportunities for physicians in each location, these cities are worth exploring both for their renowned health care and their great livability.

Milwaukee, Wisconsin

Milwaukee, Wisconsin, sits on the shores of Lake Michigan and is one of the Midwest’s best-kept secrets. The people are friendly, the population is diverse, and the city is home to top medical institutions like Froedtert and the Medical College of Wisconsin. In a city made up of 191 neighborhoods, residents can choose to live in suburban, urban or rural communities, and can find family-friendly fun by exploring all this up-and-coming city has to offer.

Familiar with the German word gemütlichkeit? It means good cheer or friendliness, and it’s the spirit that embodies Milwaukee and the people who live there. The city has also been dubbed “Smallwaukee” by locals, because you can’t go long without seeing the face of someone you know on the street. For physicians seeking dynamic careers in a city with a small-town feel, Milwaukee is a perfect place to land.

Kristine Cooper, D.O., is an assistant professor of medicine at the Medical College of Wisconsin. "I love having access to all of the specialists on the cutting edge of medicine and research." -Photo by Joe Hang

Kristine Cooper, D.O., is an assistant professor of medicine at the Medical College of Wisconsin. “I love having access to all of the specialists on the cutting edge of medicine and research.” -Photo by Joe Hang

Kristine Cooper, D.O., is an assistant professor of medicine at the Medical College of Wisconsin. After attending medical school at Des Moines University College of Osteopathic Medicine in Iowa, Cooper began practicing in the greater Milwaukee area, where she stayed for 15 years until moving back to Iowa to be close to a family member who was ill. After her family member passed away, she knew she wanted to return to Milwaukee. When a recruiter reached out to her to see if she was interested in an opportunity at Medical College of Wisconsin, she took the job.

“I love being part of the academic medical team,” says Cooper of her current role. “I love having access to all of the specialists on the cutting edge of medicine and research.”

With over 1,200 students enrolled in the Medical College of Wisconsin’s medical school and graduate programs, the organization is the largest research institution in the Milwaukee metro area, according to Gabrielle Pollard, Medical College of Wisconsin physician recruiter.

“In 2016, faculty received more than $184 million in external support for research, teaching, training and related purposes,” says Pollard. “Annually, MCW faculty direct or collaborate on more than 3,100 research studies, including clinical trials.”

At the Medical College of Wisconsin, over 1,500 physicians provide care for more than half a million patients annually.

For Cooper, the combination of academia and practice allows her to flourish as a physician. She says, “I am constantly striving to be a better physician and always learning, as I have the opportunity to teach the next generation of physicians.”

According to Pollard, Medical College of Wisconsin is experiencing an exciting growth spurt which has opened up new opportunities for physicians. Froedtert, the college’s clinical partner, “is building a new neighborhood hospital to deliver academic quality medicine to the community where people live and work,” says Pollard. The organization seeks talented physicians in all specialties, but is particularly recruiting for emergency medicine and anesthesiologists.

Kristin Settle, director of communications at VISIT Milwaukee, notes that the city has no shortage of job opportunities. Milwaukee is home to the Children’s Hospital of Wisconsin (one of the nation’s top pediatric hospitals), Aurora Health Care (the state’s largest employer) and Wheaton Franciscan Healthcare (a not-for-profit health care system). On top of that, the city boasts eight Fortune 500 companies, adding to its reputation as a modern city that invests in itself.

“Milwaukee has something for everyone, and was ranked one of the top three up-and-coming places to live by U.S. News & World Report,” says Pollard. “It’s also a very family-friendly area with schools in the area being ranked as some of the top in the nation.”

“As a mom of three, I can tell you Milwaukee is extremely family-friendly,” adds Settle. Top attractions include the Milwaukee County Zoo, Betty Brinn Children’s Museum, Discovery World, the historic Mitchell Park Domes, three indoor botanical gardens, the Milwaukee Public Museum, the Milwaukee Art Museum and the Harley-Davidson Museum.

“We’ve even made our brewery tours and beer gardens kid-friendly,” Settle says. It seems only fair kids should be invited to the party, since beer and brewing is such an integral part of Milwaukee’s history.

It’s not just craft breweries that have exploded in Milwaukee; the arts are prominent too. “Milwaukee is home to 25 theaters and has one of the strongest performing arts communities in America,” says Settle. “And we have dozens of smaller, more intimate venues, giving us one of the best local music scenes around—take that, Nashville!”

When you want to get outside, Milwaukee has abundant opportunities for kayaking, biking, sailing, snowshoeing, tobogganing, skating, skiing and more.

“You have all the big city amenities with all the feel of small, friendly neighborhoods,” adds Cooper. “I would tell physicians considering relocating to Milwaukee—welcome home!”

Homewood, Alabama

Situated at the foothills of the Appalachian Mountains, Birmingham, Alabama, is a southern hub for health care. Newcomers to the greater Birmingham area, which includes the suburb of Homewood, are often struck by the natural beauty of the area, which also boasts a strong sense of community and hospitality, not to mention a low cost of living despite its cosmopolitan charm. Health care is the largest employment sector in Birmingham, and incoming physicians are welcomed with open arms into area hospitals and practices.

Jay Meythaler, M.D., did not want to retire from medicine. After working for over 30 years in public academic medical hospitals, including serving as chair of his department at Wayne State University for more than 12 years, he moved back to Birmingham. He’d practiced at the University of Alabama at Birmingham earlier in his career, and the city was a good fit again.

Though no one could fault Meythaler if he did want to retire, he says he simply wasn’t done taking care of patients.

In his current role as the medical director for Encompass Health Shelby County, Meythaler enjoys the opportunity to work with rehab patients, which is the hospital’s primary focus. The facility only opened in April of 2018, and Meythaler was a key player.

Both he and his wife are happy in Birmingham. “My hospital is on the back side of Oak Mountain. It has backpacking trails; I’m looking at the mountain right now from my desk,” says Meythaler. “My wife loves it. You’re close to Nashville, the coast, Atlanta.”

In addition to Encompass Health, the area also has health care organizations like the University of Alabama at Birmingham Hospital (which is among the 20 largest hospitals in the country) and St. Vincent’s Birmingham (which is operated by health network Ascension).

According to Meythaler, physicians often have privileges at more than one hospital, which contributes to a nice sense of familiarity among the medical community.

“I know physicians who do part-time at two different hospitals. That was very different from Detroit. [There,] it was as though all other hospital systems are the enemy,” he says. Not in Birmingham.

Jamie Boutin, Encompass Health Corporation associate director of physician recruitment, says southern hospitality has a lot to do with the collegial atmosphere among doctors. “Physicians connect with physicians coming in,” he says. “We’re built to be welcoming. All hospitals are kind and nice, but when there’s a community where [new hires] happen all the time for all varieties of specialties, that’s a big plus.”

At Encompass Health, an acute inpatient rehabilitation hospital, Boutin says they are recruiting doctors specializing in physical medicine and rehabilitation. Encompass Health operates 130 hospitals around the country, including Birmingham’s Lakeshore Rehabilitation Hospital.

According to Boutin, most candidates at Encompass Health locations in Birmingham are younger physicians who have families, in part because of the affordable cost of living and the availability of family-friendly activities. “It’s an hour to the mountains, less than an hour to a bunch of lakes and four hours to the beach,” he says. “Candidates tend to be struck—they’re surprised by how beautiful it is and how close they are to all sorts of activities.”

“Family-friendly events and activities are plentiful in Birmingham,” echoes Dilcy Windham Hilley, vice president of marketing communications at Greater Birmingham Convention and Visitors Bureau. “It is widely considered one of the most family-oriented cities in the Southeast.”

Annual events include the Sloss Music and Arts Festival, the Sidewalk Film Festival (one of the top independent film festivals in the U.S.), the Day of the Dead Festival and the Pride Parade, to name a few.

You can find beautiful white sand beaches, along with plenty of opportunities for fishing, hiking, golfing and camping, all in the state of Alabama. If you want a change of pace, you are close enough to Nashville, Atlanta and the Florida panhandle to get away for a weekend.

In a region characterized by southern hospitality, moderate year-round temperatures and a thriving health care system, it is no surprise physicians and their families are finding themselves in greater Birmingham. As Meythaler says, “this is a really nice circumstance to be in.”

Warwick, Rhode Island

In the greater Providence area, including picturesque cities like Warwick, locals can get outside to enjoy the natural beauty of the state and soak up city culture in the same day (and kids will delight in an afternoon spent at the zoo or watching minor league baseball).

When Therese Zink, M.D., explains why she chose family medicine as her specialty, she recognizes her reasoning is not uncommon for physicians in her field.

“My reason for choosing family medicine is one that you will hear from other family docs,” she says. “As a medical student, I fell in love with every specialty I rotated on. Family medicine allows us to do it all.”

Zink’s career has included teaching, research and administration in the academic setting.

Now a physician at Care New England, a health system that includes several hospitals in Rhode Island, Zink chose her current role because it allows her to work in academics while also seeing patients part-time.

According to Jean Butler, Medical Group COO at Care New England, the focus the health system places on teaching partnerships with Brown University and University of New England College of Osteopathic Medicine is a big draw for physicians who are considering a job with the network.

Butler says that Care New England’s physician-dominated board of directors has a positive impact on the organization. “It’s 80 percent physician participation, and they really do lead the group and where the group is going,” she says.

In addition to Care New England’s hospitals, other medical facilities in the region include Rhode Island Hospital (the state’s largest hospital), Hasbro Children’s Hospital, and Miriam Hospital (noted for cardiac care), among others. Plus, Brown University’s Warren Alpert Medical School is a leader in medical education and biomedical research.

As for why physicians might want to relocate to the greater Providence area, other than the jobs themselves, Butler says Providence’s status as a “mini Boston” is one good reason.

“It has all the elements of a major city,” says Butler. Despite being convenient to Boston and New York, locals don’t have to leave town for culture, great cuisine or exciting events.

Providence’s signature event is WaterFire, an award-winning fire sculpture installation situated in the heart of downtown on three of Providence’s rivers. Other cultural opportunities include exhibits at the Rhode Island School of Design Museum, gallery nights at venues across the city, and a restaurant week that features nearly 100 restaurants.

For kids, there is Roger Williams Park Zoo, which is the third oldest zoo in the country. There is also the Providence Children’s Museum, the Providence Children’s Film Festival, and the Pawtucket Red Sox. And of course, you can get outside. “Rhode Island sits on the coast, so people who live here like boating and swimming,” says Butler.

For Zink’s partner, in particular, being in Rhode Island was a perfect fit. “My partner is from the West Coast, so he was ready to see the ocean again,” says Zink. “We have loved walking the rocky beach with our dog, Conner, who is enjoying the seafood and learning not to drink the saltwater,” she adds. And, says Zink, her role at Care New England and the ability to work part-time in family medicine gives her time to pursue another passion—writing. She is writing a trilogy of international aid novels that feature a family physician.

"I don't know what you'd have to pay me to leave Bentonville," says Chad Jones, M.D. "It's wonderful here." -Photo by Stephen Ironside

“I don’t know what you’d have to pay me to leave Bentonville,” says Chad Jones, M.D. “It’s wonderful here.” -Photo by Stephen Ironside

Bentonville, Arkansas

The city of Bentonville, located in Northwest Arkansas, is one of the fastest growing regions in the nation. With a friendly and diverse population, great culinary experiences, affordable quality of life, good schools and expanding, state-of-the-art health care institutions, more and more people—physicians included—are deciding to call Bentonville and its neighboring communities home.

We have the whole world here,” says Chad Jones, M.D., an orthopedic spine surgeon at Mercy Hospital Northwest Arkansas. After graduating from Rhodes College in Memphis, Tennessee, Jones earned a master’s degree in biomedical engineering at Ohio State University. He also earned his medical degree at the Ohio State University before interning at Beaumont Hospital in Michigan.

Jones loves his specialty, specifically the fact that he can help make people better through surgery. “I don’t like taking care of sick people, but I love fixing broken people,” he says.

“We have a loud music selection that helps us when we’re operating. Here at Mercy Hospital, they have Bose sound systems for all the operating rooms, and the sound is fantastic.”

Physicians at the hospital treat patients from a huge variety of demographics, primarily due to the diverse population that is employed by Walmart’s Bentonville headquarters.

According to Raley O’Neill, Mercy Hospital Northwest Arkansas physician recruiter, the hospital—which is 10 years old this year—is expanding every single service it offers. Construction to the building, which is scheduled to be completed in the summer of 2019, will add 100 beds, significantly growing the current capacity of just over 200 beds. As part of the $227 million expansion, the hospital is also opening new clinics in the region.

With the significant population growth in the area, Mercy expects to add 1,000 jobs, including about 100 physicians. Currently, the greatest recruitment needs are in gastroenterology, urology and rheumatology, as well as for hospitalists and OB-GYN hospitalists. Pulmonologists specializing in electrophysiology are also in demand.

Other medical facilities in the community include Northwest Medical Center-Bentonville (a 128-bed acute care facility) and Washington Regional (a nonprofit, community-owned health care system with a hospital in Fayetteville and clinics across the region).

Kalene Griffith, president of Visit Bentonville, says that once people find employment and settle in the area, they tend to want to stick around. “We have people that change jobs rather than transfer out of the community,” she says.

In addition to the expanding health care options, the region offers affordable housing, top schools in the state, a budding music scene and cultural experiences for both children and adults. Cultural attractions include Crystal Bridges Museum of American Art, the Museum of Native American History, Bentonville Film Festival and Amazeum, a children’s museum with hands-on experiences.

“Most important, the people are friendly and welcoming,” says Griffith.

“A year or two ago, I was talking with a fairly well-known person in medicine about a potential position for me in Little Rock,” says Jones. “I told him I appreciated that, but with all due respect, I don’t know what you’d have to pay me to leave Bentonville. It’s wonderful here.”

 

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Burned out

Recognizing and addressing burnout in you and your staff.

By Debbie L. Miller | Feature Articles | Winter 2019

 

Practicing medicine has never been an easy profession. But it’s also not getting any easier. Perhaps that’s what makes burnout not only a reality, but also on the rise—and rising fast. Tait Shanafelt, M.D., chief wellness officer of Stanford Medicine, has found that burnout rates among physicians are now twice as high as that of professionals in other fields.

In the most recent data from a national research study, Shanafelt found that nearly 49 percent of physicians reported burnout, as opposed to 28 percent for other professionals.

Although physicians of all ages and time in practice can and do suffer from burnout, it’s actually the younger physicians who seem to be particularly at risk.

“Residency is the peak time for burnout,” Shanafelt says. One factor is the long hours required of training.

Female physicians report burnout at higher rates than male physicians. In one survey from Medscape, 48 percent of female respondents reported burnout symptoms vs. 38 percent of male respondents.

Specialty can also play a role. One Medscape survey cites the following specialties have the highest reported rates of burnout: critical care, neurology, family medicine, Ob/Gyn, internal medicine, emergency medicine and radiology. Additional issues also contribute. For example, working emergency department shifts can contribute to “a distortion in circadian rhythm,” says David A. Farcy, M.D., who practices at Mount Sinai Medical Center in Miami Beach and is president of the American Academy of Emergency Medicine (AAEM).Likewise, “Emergency departments are the safety net of America, social issues are mounting and resources are getting less.”

The two factors most often cited in the Medscape survey as contributing to burnout are “too many bureaucratic tasks” (cited by 56 percent of survey respondents) and “spending too many hours at work” (cited by 39 percent of respondents).

Shanafelt notes another factor: complying with the demands of electronic health records. “About 37 percent of a physician’s time in an examination room is spent entering EHR data into a computer,” says Shanafelt—time that could be spent with the patient, and time that still often requires data entry on nights and weekends.

Bringing burnout to light

The first step to getting help with burnout? Acknowledging there's a problem, says Antonia Francis, M.D. -Photo by Lauren Listor

The first step to getting help with burnout? Acknowledging there’s a problem, says Antonia Francis, M.D. -Photo by Lauren Listor

As recently as the late 1990s and early 2000s, the idea of physician wellness was rarely addressed as part of med school curriculum. Instead, the focus was on strength and resiliency. The message was this: physicians should do whatever was necessary to deal with the challenges of a career in medicine. That mindset created even more stress.

It took an increase in physician suicides to bring the matter to the forefront.

In 2012, the suicides of two residents in New York City shone a light on the issue of physician suicide. “As a result, the emergency community as a whole came together in 2016 to form a coalition of all emergency medicine groups to address wellness,” says Farcy. Goals of the coalition included defining the problem of burnout and determining ways to identify and prevent it.

Benefitting from the focus

For Farcy, the topic was deeply personal.

“During my medical school, emergency medicine and critical care fellowship training, physician burnout and wellness was never addressed,” he says. “We were taught to just press on.”

But while in residency at Maimonides Medical Center in Brooklyn, Farcy was a first responder on 9/11—an experience with memories that he put “in a box” and didn’t speak about to others.

Then, during a moment of silence paying tribute on the one-year anniversary, Farcy’s experiences hit him hard.

Farcy’s program director took notice and invited him to her office to talk. She suggested he get help and referred him to a representative from the ACGME. From there, he visited a psychologist trained in PTSD and survivor guilt—and got the help he credits with changing his life.

“I am grateful that my institution had a program in place and a plan to address the issue without fear of repercussion,” Farcy says.

Antonia P. Francis, a maternal fetal medicine fellow at NYU Langone Health Center, reports that while she hasn’t personally known any physicians who have committed suicide, “I trained at an institution that experienced two suicides of house staff within a three-week period, yet I can honestly say that during my medical training, the topic of suicide was not heavily stressed.”

Francis, who works a fairly typical 80-hour a week, says, “I experienced depression and burnout during my residency training and first year of fellowship,” she says. The first step was recognizing she had a problem. Then, she took action.

“I visited counselors and a therapist who specifically works with physicians who had mental exhaustion,” she says. “I also learned to practice mindfulness, started journaling for stress relief, and exercised more.”

When help doesn’t come

Untreated burnout can lead to medical errors, substance abuse, depression and even death.

“About 300 to 400 physician suicides are reported each year,” Farcy says, “but suicide in doctors is under-reported and often hidden, because a physician can make a suicide look like an accident.”

The AMA and STEPS Forward module (stepsforward.org) on physician depression and suicide reports that female physicians commit suicide at a 130 percent higher rate, and males at 40 percent higher rate, than that of the general population for each gender. Those statistics alone make burnout a problem in dire need of fixing.

Fixing the problem

Alleviating physician burnout is a complex challenge. Survey respondents cited more pay, fewer hours and patients, and fewer government regulations as key.

Early detection can also help. Farcy, who has been supervising residents in emergency medicine for 12 years, has seen and addressed depression and burnout in others. The early signs, he says, are “less involvement, less caring, and negative comments in a person who used to be very positive.”

Addressing burnout, however, comes with its own land mines. Sometimes when a physician who is depressed or approaching burnout speaks to their supervisor about the issue, the physician is forced to stop working or see a psychiatrist in order to be cleared to go back to work.

“Too often, this adds to the stress by causing a new burden on the physician,” Farcy says.

And when a colleague has moved beyond burnout to something deeper, expressing concern may not be enough. “By the time a doctor is in the early stages of depression, it is harder to get them involved in resilience,” says Farcy. “Telling them you need to go work out, do yoga, drink less, spend more time with your loved ones, etc., too often falls on deaf ears. The physician may hear it but won’t change or do these things because of their underlying depressive state.”

David Farcy, M.D., has seen and addressed depression and burnout in others. The early signs, he says, are "less involvement, less caring, and negative comments in a person who used to be very positive." -Photo by Rodrigo Varela

David Farcy, M.D., has seen and addressed depression and burnout in others. The early signs, he says, are “less involvement, less caring, and negative comments in a person who used to be very positive.” -Photo by Rodrigo Varela

The best answer may be in fostering a community that’s open to discussing burnout. Farcy says physicians need to feel free to talk openly, in a safe place, without being labeled as weak. “We have a wellness program where I work, and I have an open-door policy for anyone to be able to talk and share, without risk or fear of repercussion,” Farcy says.

“Once the person begins speaking, most important is listening and creating a plan,” he says.

Clif Knight, M.D., is senior vice president for education for the American Academy of Family Physicians (AAFP). He’s worked in private practice, as a hospital administrator, and as director of a family medicine residency program. As a residency program director, he witnessed resident burnout and tried to help his physicians recognize their symptoms and consider counseling and coaching.

Knight stresses that burnout is not due to a lack of physician resiliency, as was once commonly thought.

“It’s important to recognize that the majority of burnout is related to problems in the health care system and outside the physician’s control most of the time,” he says. “We need to fix the system’s problems instead of addressing only the resiliency and coping skills of individual doctors.”

Francis agrees. “Physician wellness isn’t only about individual and personal efforts, but about change on a broader level.” She suggests that institutional support and a change in our medical culture would go a long way to support physician wellness.

The path ahead

Now, medical education institutions are addressing burnout head-on. And there appears to be more help for physicians in the throes of burnout.

“Cultural and environmental changes are necessary to combat physician burnout,” says David A. Rothenberger, M.D., who advises on physician burnout at the University of Minnesota. “At our institution, we have a multi-year, major commitment from the top of the organization to devote time, talent and treasure to take on this problem.”

Rothenberger is also helping to build a coalition of those who want to address the issue of physician burnout. Currently, close to 80 individuals belong to the coalition, including academic and clinical leaders and staff.

Though progress is being made, Rothenberger says it will take a decade or two to fully address the issue.

“Achieving the needed transformation of the workplace culture to overcome the current physician burnout epidemic will take many years, and sustaining physician wellbeing is dependent on continuous effort to meet the future needs of physicians and other health care professionals,” he says.

 

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The way back home

These physicians chose to practice where their roots were. Their stories can help you, too, decide if moving back is the right call.

By Anayat Durrani | Feature Articles | Winter 2019

 

The saying goes: “Home is where the heart is.” And for many physicians, this holds true when it comes to deciding where to practice. That was certainly the case for Amanda Mooneyham, M.D., MPH. No matter where school or work took her, she always planned to return to the Northern California town of Redding, where she grew up, to serve the medically underserved in her community.

“When I started medical school, a community health needs assessment showed that Shasta County, California, needed an additional 17 primary care physicians just to meet the existing needs of the community—and [that] didn’t account for those leaving the workforce through migration or retirement,” says Mooneyham.

This was in 2009, and Mooneyham says the needs of her community have not improved since—even though many more people in the area have been able to access care through the Affordable Care Act. In fact, this is the pattern nationwide. As residencies and high-paying specialties lure physicians to big cities, rural areas like Shasta County, which encompasses the city of Redding, are experiencing a shortage of health care providers.

Many states are trying to attract doctors to rural areas with financial incentives, such as federal- or state-funded student loan reimbursement or repayment programs. But among physicians who grew up in these areas, many need no convincing. Plenty of doctors return to their hometowns to join family practices, rural practices or the practices where they did their residencies.

Returning to your residency

Amanda Mooneyham's hometown was in need of physicians. She answered the call and moved back to practice. -Photo by Jack Vu

Amanda Mooneyham’s hometown was in need of physicians. She answered the call and moved back to practice. -Photo by Jack Vu

After graduating from UC Davis Medical School in 2014, Mooneyham returned to Redding with her husband, a civil engineer. She had done her residency in Redding and ended up taking a job there as a teaching faculty member at Shasta Community Health Center Family Medicine Program. She’s also one of four core providers in their Medically Assisted Therapy clinic. There, she practices full-spectrum family medicine, including obstetrics and addiction medicine.

Mooneyham enjoys filling the need for providers in a rural area, and she also enjoys the rural pace of life. “My commute to work is all of seven to eight minutes each way,” she says. “The hospital is less than 10 minutes from the clinic. Most of the providers at our FQHC work four days per week, which helps me maintain a healthy work/life balance.”

Brandon Allen, M.D., also chose to stick to his roots. Born in Fort Lauderdale, he attended medical school at Florida State University College of Medicine and residency at the University of Florida. He completed his residency and final year as chief resident in 2013 and joined the University of Florida as an assistant professor in the department of emergency medicine and the assistant medical director of the adult emergency department.

Allen says his transition from chief resident to assistant professor was mostly seamless because he was already familiar with the university. “I knew the environment, and I wouldn’t be starting over in a new place,” he says. “I had created strong relationships with nurses, staff and providers outside of the ED over my residency that would be hard to replace or recreate.”

However, he says he did face an initial challenge in figuring out new working relationships with residents who had previously been his peers. “One day I was a resident, and the next I was an attending physician and faculty member,” Allen says. “How would I be perceived by residents who I had shared a seat with in conference or the same shift schedule? Would they listen to me as an attending? Could I be effective?”

He also had to figure out new relationships with his staff, since he became an assistant medical director following his last day of residency.

Allen says he worked through these challenges by modeling the traits of an attending faculty member whom he had always appreciated and respected. He always tried to be the first to see patients, so he could take advantage of teachable moments. He also took the time to review charts and send regular feedback emails on performance.

“I made a conscious decision to be effective over being popular,” explains Allen. He adds that transitioning to his new role as medical director has taken time. Some faculty members embraced him with open arms while others waited for him to prove himself.

“One of the ways I did that was to focus on standardization of practice with evidence-based protocols and pathways,” says Allen. By working to improve provider satisfaction and patient care, he earned other faculty members’ respect.

Joining a family practice

The opportunity to join a family practice is what attracted Drew Schmucker, M.D., back to his hometown of Olney, Illinois. “I was attracted to the idea of practicing in a small town so that I could have the scope of practice I wanted,” says Schmucker. “I do both inpatient and outpatient medicine as well as OB.”

Schmucker graduated from Southern Illinois University School of Medicine and completed his residency at Memorial Hospital of South Bend in Indiana before joining Carle Richland Memorial Hospital in Olney as a family practitioner. Carle Richland is a not-for-profit facility, part of the Carle Health System, which serves eight southeastern Illinois counties with a population of over 109,000 individuals.

Schmucker says there were quite a few advantages to heading home. Being close to family and friends was a big one. “I spent a lot of time away from home, family and friends because of school and residency,” he recalls. “I missed some birthdays, weddings, family get-togethers, etc.” Now that he’s closer, he says it’s been great to be present at these special events. And it’s nice to have family around since he and his wife now have a 10-month-old.

As a family practitioner, Schmucker has patients ranging from newborns to adults, and he offers obstetrics services to expecting patients. Practicing medicine in a town as small as Olney has given him the chance to diversify his skills and connect with his patients. When he started his career there, one of his biggest concerns was getting too busy, since there was such a great need for primary care in the area. He says he was afraid of getting overrun with too many patients and too much call, especially because he wanted to have a broad scope of practice.

But those fears have been put to rest. “I’ve been really fortunate to have a great first year of practice so far,” Schmucker says. “The hospital system I work for keeps my office running smoothly, and there is a great group of doctors here to share call with.”

He says it helped that he knew some of his office staff before he began working with them. They have developed close-knit relationships and have a lot of fun while seeing patients. Schmucker has also noticed he has a lot of flexibility working for a small hospital in a small town. If there are ever any problems with workflow or patient care, he says it’s easy to find the right person to talk to and get the issue resolved.

“I love taking care of patients here,” he raves. “Oftentimes, people have been waiting to get in for appointments or driving out of town. It’s so rewarding to deliver good care in a place where it is really needed.”

Patients are very appreciative of his work, and Schmucker says in some cases, these patients are people he has known for years. He even went to school with some of them. Knowing a bit about patients before they visit helps him provide better care. “It also keeps me grounded as I practice,” he adds. “Patients aren’t just cases of pneumonia or diabetes here. They may be old classmates, family members of old classmates, former teachers, coaches, family friends, etc.”

Practicing solo rural medicine

Fifteen years ago, J. Scott Litton, Jr. M.D., returned to his hometown of Pennington Gap, Virginia-which has a population of just over 1,700-to open a family practice. -Photo by Andy Stacy

Fifteen years ago, J. Scott Litton, Jr. M.D., returned to his hometown of Pennington Gap, Virginia-which has a population of just over 1,700-to open a family practice. -Photo by Andy Stacy

While moving to a small rural town may not be a top choice for many physicians, others wouldn’t have it any other way. One month after finishing his residency, J. Scott Litton, Jr., M.D., returned to his hometown of Pennington Gap, Virginia—which has a population of just over 1,700—to open a solo family practice. This year marks the 15th anniversary of Litton Family Medicine, P.C.

“It was always my plan to practice in my hometown,” says Litton, who attended medical school at the University of Virginia, then completed his residency at the Spartanburg Family Medicine Residency Program in South Carolina. “I was very blessed to have exposure to wonderful mentors, both as a volunteer before medical school and with my attendings in medical school and in residency.”

These mentors gave Litton perspective on rural family care. He says, “I was able to see how a small-town family physician can connect with patients and truly have an impact on modifying their lifestyle behavior and medical outcomes.”

Litton believes one of the biggest benefits of practicing in your hometown is getting the chance to care for people you have known and loved for many years. Several of his childhood teachers, athletic coaches, church members and family now use his practice.

“My initial concern was that everyone in town has either known me since I was a kid or grew up with my parents,” he adds. “Everyone has always referred to me as ‘Scotty’ as a child, and ironically enough, many of my patients still call me Scotty, rather than Dr. Litton.”

He says that in a small town where everyone knows everyone, physicians have to politely and firmly draw certain lines about providing care. Whether he’s working as the varsity sideline doctor at a high school football game or simply attending church, people often expect him to answer their medical questions about anything at any time. Over the years, he’s learned how to handle people who get too pushy.

“I simply tell them that I practice medicine in the office, and I am happy to go over all their concerns or questions, but they must make an appointment and continue the discussion in a confidential setting,” says Litton. “Everyone has pretty much grown accustomed to it.”

He always finds it rewarding to help people but says it’s especially meaningful when you’re helping people with whom you have an emotional connection. The flipside of this is that people he cares about inevitably become sick or ill. “When I have to deliver bad news or comfort a grieving family, I just sit there and cry and pray with them,” says Litton.

A passion for his community also led David O. Barbe, M.D., MHA, to open a solo practice in his hometown. As he finished his residency in family medicine at the University of Kansas, Barbe says he and his wife had an easy decision in front of them. They had both grown up in the same small town of Mountain Grove, Missouri—with a population under 5,000—and as a nurse, she shared his conviction that the area needed more providers.

“We both knew that we wanted to return to our area of rural southern Missouri, and we saw it as a mission. That area has been underserved for as long as I can remember,” says Barbe, who attended the University of Missouri–Columbia School of Medicine.

Barbe had seen firsthand that the area never had enough physicians. He says the health care facilities there were few and far between, and there was no hospital. He knew he wanted to serve that population. “We went in eyes wide open,” he adds. “And although there were physicians in that community, joining with one of them wasn’t quite the right fit. So we opened a solo practice from scratch.”

Barbe established a solo practice in traditional family medicine, including obstetrics, endoscopy and minor surgery. “That was daunting, but we managed to pull together a simple one-physician office,” he says. “We opened our doors on August 1, 1983 and had essentially a full panel of patients the very first day. I have never regretted it or looked back.”

Over time, Barbe expanded his independent practice to two sites with several physicians. “I practiced solo for four years before I recruited my first partner,” he recalls. “She and I built that practice as an independent practice. In fact, we established a second office in a community about 25 miles away.”

After 15 years in independent practice, Barbe joined Mercy Clinic in Springfield, Missouri, a 650-physician multi-specialty integrated group. He saw merging as a way to bring more resources into his community and serve them better than he could as an individual physician.

Barbe is now vice president of regional operations for Mercy and oversees five hospitals, 90 clinics and more than 200 physicians and advanced practitioners. “But despite that growth and success, my practice eventually came full circle,” he says. “The physician who’d been with me for 22 years retired and another who’d been with me for 18 moved, leaving me as a solo practitioner, back to how I started.”

At first, he didn’t succeed in recruiting another physician to join him, but then his own son chose family medicine as a specialty and began seriously considering coming back home to practice. “He’s now decided to do just that,” says Barbe happily. “It wasn’t because of my pushing or encouragement. It was because he saw some of the merits of a rural practice that I experienced throughout my career.”

Advice for going home

Whether you’re excited about moving back home or just contemplating the idea, physicians who have done it have advice to share. They say it’s important to think carefully about the decision. Allen, who returned to work where he completed his residency, says a physician returning home should expect some people to struggle to embrace your new position.

“Having the self-awareness to understand your role and how your strengths and weaknesses may affect that will hopefully assist with prevention of burnout and/or dissatisfaction with your decision,” he says.

And Schmucker says physicians returning home to join an existing practice or hospital should talk with administrators about their expectations.

Let your employer know what you hope for in your role and address any concerns ahead of time. He also recommends talking with area doctors to see what the environment is really like. When he did this, Schmucker says, “I could tell they were happy and felt like the hospital was receptive to their concerns.”

Having this discussion ahead of time has allowed Schmucker to do all the things he wanted to do in practice while maintaining work/life balance.

He says one big help has been that the hospital arranged for some hospitalists to come in and share call on the weekends. “That gives me most weekends to spend more time with family, catch up on work at home and travel,” says Schmucker.

Litton, who opened a solo practice in his hometown, says no matter what specialty a physician chooses, he or she shouldn’t ignore the benefits of family medicine. “Sure, you won’t make as much money as a neurosurgeon, but if you start out and keep your practice small, then you can have a very good lifestyle with a very comfortable living,” he says.

The one mistake he says he made many years ago was not saying no enough. “Our practice is pretty much covered up on a daily basis,” he says. The heavy workload results in long hours and less free time than he would like, so now he’s trying to find balance by not accepting new patients for a time.

When Barbe opened his solo practice 35 years ago, he says he had to learn a lot on his own. Then, as now, medical students and residents weren’t taught about running a business as part of their training.

He says that’s something the American Medical Association—of which he’s president until June 2019—is trying to address. The AMA Accelerating Change in Medical Education Consortium is finding better ways to coach and prepare students for the future.

But whether physicians choose to pursue a solo practice or join a practice, Barbe says more physicians need to consider practicing in a smaller area.

“I want to debunk the myth of professional or social isolation in a rural community,” he adds. “Many physicians fear that in a rural community they’ll be too far from a good restaurant or sports or activities for their children.”

While it may take a little more effort to access some of those social amenities, most small communities are within driving distance of a larger community or metro area.

“I don’t think enough physicians give careful consideration to their opportunities in that regard,” Barbe says. “Rural America is a wonderful place to practice and raise a family.”

Mooneyham has found that to be true.

Her relocation to Redding—where her parents and brother still live—turned out to be a smooth move for her and her husband. The firm where her husband was working in Sacramento had a large corporate office in Redding. Now, her husband’s new office is only a quarter mile from her hospital.

Her advice for physicians considering moving home is simple: Do it. She believes it is especially important for those from underserved communities to return because they have insider knowledge of those areas and will be welcomed with open arms.

“There is a certain intimacy when working with other health care providers who have a connection to who I was before becoming a physician,” says Mooneyham. “It is likewise also rewarding providing care to those who know me as ‘Amanda,’ before I became ‘Dr. Mooneyham.’”

 

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To buy or not to buy…

Moving for work? Here are the options physicians consider.

By Karen Landry | Financial Fitness | Winter 2019

 

Cardboard boxes in room

Signing an employment contract doesn’t always come easy for physicians. The stress of a move, along with the decision of whether or not to purchase a home, can be daunting. Add to that the student debt held by today’s graduating medical students and new attending physicians, and many think the dream of home ownership is years away. Here are some of the options physicians face.

Buying a house

When comparing a purchase rather than a lease, it’s important to obtain information about the area based on sales trends. When a market is experiencing growth and an upswing in pricing, it’s a good time to buy. This is especially true if the physician plans to live in the property three or more years.

If the market is declining, the most important factor would be the net mortgage payment taking into consideration the tax advantage of home ownership. Communicate your purchase plans with a trusted financial adviser, local real estate agent or CPA to accurately determine net costs.

Deciding to rent

If renting is a consideration, consider the customary upfront fees in that particular area. Many times the costs can include first and last month’s rent, security deposit and one month’s rent for a broker’s fee. This can become a very expensive feat.

Other options

Many new residents choose to purchase a condo rather than a single-family home, allowing for a smaller mortgage, ease of maintenance and the potential to use the property for future rental income. In many areas, this is a more affordable option than renting. There are also unique health care provider lending services and loans specifically for practicing physicians, dentists, residents and fellows. Some of the benefits include up to 100 percent mortgage financing (varies by state and price range), waived private mortgage insurance, and fixed or adjustable rate mortgages to reduce monthly payments. Student loans that are deferred or in forbearance are not considered in the qualifying ratios, which allows for more purchase power.

Physicians have worked for years to join the ranks of an elite few and deserve to have the best financial resources available for one of the biggest decisions they will make.

Karen Landry is a licensed real estate agent and is the owner of Pulse Concierge Services for Providers. She specializes in physician relocation with in-depth resources for specialized physician loans.

 

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The case for a narrow job search

Being open to any location can send the wrong message to physician recruiters.

By Chris Scites | PracticeLink Tips | Winter 2019

 

Online job search.

At a recent physician specialty conference, a client stopped by the PracticeLink booth to say hi and offer some feedback. As PracticeLink is dedicated to constant improvement, I paid close attention so I could pass the idea along.

However, this particular client’s issue had less to do with PracticeLink and more to do with the physicians who use it—specifically, the way that physicians select the geographic areas in which they’re interested in working.

Curious, I informally surveyed more physician recruiters and found that most agreed: They hate it when physicians list their geographic preferences as “open U.S.”—meaning you’re open to a new job in any location, nationwide.

Why being too open can backfire

From your perspective, this might not entirely make sense. After all, there is a good chance that you’re just finishing training and are, in fact, pretty open to where you’ll go next. And you certainly don’t want to miss any opportunity that might be a good fit, no matter where it might be located.

But from the perspective of in-house physician recruiters, this openness is a signal that, when your contract is up in two or three years, you’ll be packing up and heading out somewhere new.

So what’s the answer?

Obviously, there are no guarantees that you are going to like the place you go, no matter how much research you do beforehand. And though nobody will expect you to stay beyond your contract if you’re miserable, some prep work can minimize that chance and help you identify locations where you’ll be more likely to stay long-term.

First, there might be some parts of the country to which you’re already attracted. Start there, and try to figure out why you like about those areas. Is there another part of the country that has those same attributes?

Next, think back to a time when you had free time. What were the things you enjoyed doing, and how important are they to you now? Will those opportunities be available in the locations you’re considering?

Are you interested in being close to family? If so, make sure you include those areas in your preferences, and determine how far you’d be willing to drive for a visit. Recruiters love when a candidate has roots in their area, and it may give you a leg up. Consider, too, the opportunities available for your spouse or partner and children.

Once you have some places identified, make those your geographic preferences. The next step is to visit those locations, ideally through the interview process. When you get there, make sure you try and take some time to explore the area, not just the employer.

You may find that you were wrong and those are not places you want to live. That’s fine—and better to find out before a contract is signed. Remove the location from your preferences and take it as a lesson learned.

Picking a location is as important as picking a practice. Employers know this and are going to be a lot more interested in candidates who have done their homework and know exactly where they want to live.

Chris Scites is PracticeLink’s physician relations manager. Reach his team for free job-search help at (800) 776-8383.

 

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Looking for that work/life balance?

Aren’t we all. Here’s how to find it.

By Charlene Plotycia & Terri Houchen | Job Doctor | Winter 2019

 

Work life balance

Yes, a healthy work/life balance is a critical component of your job-search strategy. But it’s also a complex issue with many personal nuances.

So before you get enticed by an opportunity that professes “work/life balance,” first consider what exactly that means to you and your family.

Figure out what you value most in your work and in your home, and how the interplay of those factors should be structured to result in your best overall health. Also consider what your life might look like a couple of years from now, and how your needs might change.

Once you have a grasp on what your best work and life activities look like, find the organization, the community and the practice that will support it.

Start by researching organizations and communities online. Check out websites of the company and the community’s visitors bureau and chamber of commerce.

After you have identified the organizations that may be a fit, create a list of questions that will further disclose an infrastructure that will support it.

These questions can include:

  • What benefits are offered that contribute to work/life balance?
  • What is your work culture like?
  • What are some ways that you set up employees for success?
  • How is the mission of the organization supported through your department?
  • How do you incorporate employee feedback into the day-to-day operations?
  • How is the department’s staffing level? What are the open positions?
  • Is it difficult to recruit to the organization? If so, what contributes to that?
  • Is there any flexibility in hours/shifts?

During the interview process, ask to meet with someone in a similar role or life stage. Learn how the organization or position fits their needs. Ask that person if there have been any big organizational changes, and how they were addressed.

Only you will know the right work/life formula for you and your family.

Charlene Plotycia and Terri Houchen are physician recruiters. Learn more about our contributors on page 20.

 

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Leveling up

How to prepare for a leadership role — even as you’re just starting out.

By Laurie Morgan | Feature Articles | Winter 2019

 

If you’re like most new physicians embarking on your career, you might not be thinking ahead to a management role. Your priorities are likely finding the right place to practice and, above all, helping patients.

But even if you don’t envision running a health system, hospital department or independent practice in the future, you should still be seeking out opportunities to develop leadership skills. These abilities will bolster your career as a physician—whether you see yourself in a corner office one day or feel certain you’ll always focus on patient care.

After all, some level of leadership is inherent in every physician role. Staff will look up to you and expect you to lead the way, and your employers will rely on you to guide new initiatives and solve problems. Learning to lead better can help you not only advance your career but also care for patients more effectively.

Filling a gap in your medical training

Mark Deshur, M.D., says it doesn't take a title to be a leader. "Even without a formal role, you can make a difference in how things are being done." -Photo by Colin Lyons

Mark Deshur, M.D., says it doesn’t take a title to be a leader. “Even without a formal role, you can make a difference in how things are being done.” -Photo by Colin Lyons

Despite their benefits, leadership skills rarely get attention in medical school and residency. With so many clinical priorities to cover, it’s hard to make room for non-clinical topics in the curriculum.

“Lots of physicians don’t want to accept that management skills are important,” says Maria Chandler, M.D., MBA, founder of the MD/MBA dual-degree program at University of California, Irvine and president of the Paul Merage School of Business Association of MD/MBA Programs. “But this is a disservice to medical students. We’re telling them [clinical education] is all you need, yet it’s not true.”

This focus on direct patient care is admirable, but it may be shortsighted. Chandler believes management training helps physicians care more effectively for patients. For example, physicians with business knowledge can be better advocates for clinical priorities. She explains, “If you’re interested in preventing chronic disease, you can learn to make the economic case for that.”

That’s one reason Chandler advises all physicians to learn some leadership basics. She says they should do so “as early in their careers as possible.” Once there’s an “M.D.” or “D.O.” after your name, people will expect you to guide them, regardless of your age. Many of these people—including the nurses, MAs and other staff you’ll work alongside—provide essential support for patient care. Working well with this team will require training you didn’t receive in medical school, and some of what you learned might even be counterproductive.

Unlearning the superhero myth

According to Dike Drummond, M.D., CEO of TheHappyMD.com, many physicians enter the workforce with misguided expectations. “In medical school and residency, there are no leadership courses. You learn by osmosis, and here’s how it works: you see patients, reach a diagnosis and write orders, and the rest of the care team waits on you,” explains Drummond. “You’re taught subconsciously that only you have the answers. But what kind of leadership style is that for team-based care?”

As a result, Drummond says that most doctors internalize a “Lone Ranger, workaholic, superhero, perfectionist ideal” in medical school. This mindset not only burdens physicians; it also makes it harder for staff to help. Nurses and others will follow your lead. If they’re always waiting for your orders, they’ll be underutilized and probably less motivated, too.

And when staff members don’t feel supported as part of the care team, patient safety can be affected. “It’s been proven in numerous studies that a lot of people feel too intimidated to say anything to a physician—even if it’s a life-threatening issue,” adds Chandler. “Leadership training can help physicians learn to create an atmosphere of teamwork.” In a culture where staff feel comfortable raising concerns, patient care improves.

To build team leadership skills as a physician, Drummond says the critical first step is learning to listen and ask questions. “Your staff can always help,” he explains. “They want to help. But they’re not going to elbow you out of the way.”

Once you start asking staff how they can assist, Drummond says they’ll likely respond with many useful ideas. When you enable them to take on more meaningful roles, they’ll be happier and more engaged, too. That means more support and less stress for you as a physician, more attention for your patients and higher career satisfaction for the entire team.

New clinical and economic approaches are making the ability to lead diverse teams more critical than ever. Patient-centered medical homes require high-performing care teams, and alternative reimbursement models—with evolving definitions of value and quality—require physicians to lead change, sometimes in tandem with administrators.

Chandler says physicians don’t always see these opportunities as being directly tied to patient care. “Many doctors think of taking on leadership responsibilities and roles like serving on committees as a chore,” she says. “All some of us want to do is see patients—like a surgeon who’s tied up in an OR 80 hours a week and inadvertently gives up their input.”

But she says by getting involved in leadership, physicians can impact more patients while helping hospitals and health care systems make better decisions and reduce costs.

Don’t wait for an official title

In the business world, budding leaders learn the art of managing up, down and across—or in other words, finding ways to influence the workplace even when they aren’t in charge. Physicians can benefit from learning to do the same. This starts with recognizing opportunities to help not only their patients and their subordinates but also colleagues at all levels.

Mark Deshur, M.D., MBA, vice chair of operations in the department of anesthesiology, critical care and pain medicine at NorthShore University HealthSystem in Chicago, has found this to be true in his own career. He says he knew from the beginning that he would eventually seek some sort of leadership role, explaining, “I knew I wanted to be part of the decision-making process, not just subject to others’ decisions.”

Deshur learned early on that you don’t have to wait until you have formal authority to contribute ideas to improve your workplace. “We have so many people in my practice who are leaders without titles,” he says. “Even without a formal role, you can make a difference in how things are being done. You see an opportunity to do something a little differently and a little better, and that improves things for everyone else.”

And making suggestions isn’t just good for others. It’s also good for you. “It creates more career satisfaction and better engagement in the practice because everyone wants to feel that when you’re going to work, you’re making the place better,” Deshur explains. He adds that phrasing a suggestion as a question is a good way to persuade others without putting peers and senior colleagues on the defensive. “For example, you could say, ‘Do you think if we tried X, it might be an improvement?’”

At practices that welcome this type of input, younger physicians get to develop their leadership potential and prepare for formal management responsibilities down the road, Deshur says. He recommends assessing prospective employers by asking recently hired doctors if they’ve been allowed and encouraged to suggest changes.

Managing upward can be especially challenging in the medical world. Physician training favors on-the-spot decision-making, and this tends to develop reactive management skills rather than proactive ones. As a result, some supervisors only communicate with their subordinates when there’s a problem, which can be discouraging for young physicians who want to do well. Scheduling a regular check-in with your boss can help you confirm you’re on track.

Mentors provide invaluable guidance

If you nurture relationships with your boss and other experienced physicians, you may find they become long-term mentors. These mentors can be invaluable as you navigate key career decisions. “I’ve been very fortunate to have several mentors I’ve leaned heavily on,” Deshur says. “Even though my career trajectory was different than theirs, they helped me take a step back and think about what my strengths and weaknesses are and what am I interested in.”

Deshur didn’t have to look far for his mentors. He found them in his direct managers. “I was lucky that I had them right in front of me,” he says. “But if you don’t have mentors readily available, seeking out one or two people who can give you feedback and advice is so important. So many people have tremendous experience to share that you can learn from.”

Finding mentors may require effort and creativity, but one easy way to start is to keep in touch with older physicians you admired during your training. If your job takes you to a different part of the country, ask them to introduce you to respected colleagues in the area.

Joining your local medical society can also help you form relationships with physicians from a range of specialties, especially since society leaders are often interested in becoming mentors. The nurses at your new hospital are another great resource as they undoubtedly have insights about which doctors are most admired.

To MBA or not to MBA?

Deshur says finding mentors helped him prepare for another major step in his leadership plans: pursuing an MBA. “It was in the very back of my mind, since I’d taken business classes in college. But I kind of forgot about it during the early years in my practice,” he says. “Then my boss, who was also a mentor, told me how he’d gotten an MBA mid-career and asked me if I was interested in it.”

Deshur’s mentor urged him to enroll in the executive MBA program at Northwestern’s Kellogg School of Management. Because the program was located nearby and designed for working professionals, Deshur could enroll without leaving his practice. He credits his employer and fellow anesthesiologists for helping him through.

“You can’t do it in a bubble. You need the support of your practice,” he says. “My boss was very supportive. He helped me get the time off that I needed and encouraged the other 50 people in the department to support me.” Deshur’s colleagues ensured he was able to attend required classes on Friday mornings and swapped call schedules with him as needed.

“As a department, we’d benefitted from the leadership of my boss, who had attended the same program,” Deshur recalls. “So I think people thought, ‘If we help Mark take on more, that can help our entire group.’”

Often, the entire organization benefits when a physician earns an MBA, so your employer may also help pay for it. This is especially true if you’re promoted to a role that requires advanced leadership or negotiating skills, such as heading up a department, says Gregg Bass, communication and marketing specialist at Auburn University’s Harbert College of Business. And when tuition assistance from your employer isn’t available, you might be eligible for financial aid.

Auburn’s Physicians Executive MBA Program is pioneering a new wave of MBA offerings tailored to busy physicians who go to school while working full time. “The majority of our program is distance learning,” Bass says. Physicians can access the curriculum online on their own schedule. Five short residencies on campus at Auburn are required, but students get these dates in advance so they can plan ahead.

Chandler believes a physician shouldn’t put off pursuing his or her MBA. She says, “It only took me two years of being out of training [and] seeing patients to realize there might be something more I’d want to do later, besides only seeing patients for my entire career. The worst case is you wait so long that you realize the opportunities you’ve missed.”

The growing number of flexible MBA programs makes it easier to pull the trigger, even while working as a full-time physician. “They make all different shapes and sizes of MBA programs now,” Chandler says. “There are fully online programs, one-year programs, hybrids, evening-weekend programs—all kinds of options to fit the needs of people.”

Another reason not to delay: the skills and professional connections you’ll develop in an MBA program can open new doors. If you’re facing a career change or just feel ready for one, an MBA can be a powerful catalyst.

“We’ve had physicians who are taking on leadership roles in hospitals, physicians who want to leave practice to work in pharma” says Bass. “Recently, we had a trauma surgeon with many years of experience who realized he wouldn’t be able to do that physically demanding work forever and wanted to prepare for something new.”

New opportunities might also come in the form of entrepreneurship. Bass says several physicians in the Auburn program turned their class projects into real-life business ventures. Similarly, Deshur says getting his MBA encouraged him to turn a software program he wrote as a resident into a product. Today, hospitals and practices all over the country use his on-call scheduling solution.

If you already have a great idea that can really make a difference in the industry, Chandler says you might need business training to make it a reality. “I knew a couple of intensive care docs,” she recalls. “They were five to 10 years out of school. They were trying to help save lives by bringing telemedicine to rural areas where intensive care resources were scarce. I said to them, ‘You need MBAs to take this thing and make it big.’ They both enrolled while still practicing and building their venture. It’s hard, but if you’re motivated enough, you can do it. Knowing why you’re doing it—to achieve a goal, to learn a new set of skills—can make it easier to stay focused.”

Creating a healthier health care industry

Vidya Bansal, M.D., started a group for physicians of South Asian decent-a community that has helped her develop her own leadership skills. -Photo by Rachel Moore

Vidya Bansal, M.D., started a group for physicians of South Asian decent-a community that has helped her develop her own leadership skills. -Photo by Rachel Moore

Chandler believes pursuing an MBA is worthwhile not just for the career advancement but also for the personal development. It’s intellectually invigorating. “I found I missed school, missed learning,” she explains. “Doing the MBA while working was hard, but it filled the education void. If you’ve only studied medicine, it’s so intriguing to study something else.”

She adds that an MBA program is just one way to be a lifelong learner. Other development opportunities can also help physicians enjoy their careers. “I get emails from physicians who are many years into practice who are burned out,” she says. “I think one remedy to burnout is to give yourself additional skills so you have options. Your options can be in all different directions.”

Chandler believes today’s physicians can and must take on more leadership roles to improve the profession and make it appealing to the next generation of talent. “It’s like we’ve had blinders on,” she explains. “But we have to think about how to compete over the long-term with other employers who want smart, talented, young employees.”

Pediatrician Vidya Bansal, M.D., has found a way do just that—helping other physicians while developing her leadership skills. Early in her career as a pediatrician, Bansal wasn’t sure where to look for support. So she turned to Facebook and started a private group for physicians of South Asian descent: Desi Physician Moms. When Bansal first founded the group in 2015, it had only 14 members, but she’d struck a nerve. The group soon took off, and today more than 7,000 physicians are members.

“I started it for personal reasons, to find support,” Bansal explains. “I wanted a place where I could share and not feel alone.” What began as a hobby quickly became a lifeline for women physicians dealing with issues like domestic abuse and harassment at work. Over time, the group has evolved into a dynamic nationwide community with an annual conference, a subgroup to support single moms, and mentorship opportunities for medical students. Recently, it launched a foundation to help to women of all professions who are struggling with abusive relationships.

Along the way, Bansal has seen her leadership skills blossom. “To build the foundation, we had to build a team,” she explains. And in order to manage that team while building the foundation and keeping up with full-time clinical work, she’s had to learn to lead others and delegate tasks. Most of all, she says, she’s learned the value of speaking up for herself and for other women.

“What we don’t teach anywhere in medical school or residency is how to be your own advocate,” Bansal explains. “It comes down to being in control of yourself and what you will expect and accept. I feel great for the residents in our group who have a network of colleagues to tell them these things now. You have to find it from within. That’s what we’re trying to teach each other to do. It’s about unity and paying it forward and about fixing what we see that needs fixing in medicine and in women’s lives.”

Chandler emphasizes that everyone can find enrichment from learning at least a bit about leadership. It might not look the same for everyone, but whether you learn from an MBA program, a book, mentors or other activities, leadership training will benefit you professionally and personally.

“Developing a leadership mindset helps bring out some qualities you might not otherwise tap,” Chandler explains. “It allows you to express other talents. Learning about leadership and learning about business gave me a lot of personal satisfaction. You start to see the whole pie, not just the perspective of medicine.”

Laurie Morgan is a partner at Capko & Morgan, a boutique practice management consulting group. Learn more about our contributors on page 20.

 

 

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How tight is the job market in your specialty? Winter 2019 issue

Vital Stats | Winter 2019

 

List of Job Specialties

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

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

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

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

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.

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

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

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

 

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Changes in the market for health insurance

The employer-based insurance market has been stable for the last few years, but public exchanges less so. Physicians’ fees may be affected.

By Jeff Atkinson | Reform Recap | Winter 2019

 

Open Enrollment. Workplace of a doctor. Stethoscope on wooden desk.

Most Americans receive health insurance through employer-sponsored programs. That market has been stable in recent years. For the last six years, the increase in the cost of employer-sponsored insurance has been “relatively modest” according to the 2017 Employer Health Benefits Survey conducted by the Kaiser Family Foundation and the Health Research & Educational Trust.

In 2017, the typical annual premium increase was 3 percent, and the average premium for family coverage was $18,764. Although the total cost of insurance has remained stable, more of the cost has shifted to workers. In 2012, workers paid 14 percent of the cost of family coverage; in 2017, workers paid 32 percent of the cost.

Generally, people covered by small companies pay more to cover their families than people covered by large companies. The difference is $1,550 per year according to the Kaiser survey. The cost difference results from the proportion of premiums paid by employers and from the deductibles that are paid by employees and their families.

Insurance exchanges

President Trump did not succeed in repealing the Affordable Care Act (ACA), often referred to as “Obamacare.” President Trump and Republicans, however, have pursued multiple policies that undermine the ACA, including the insurance exchanges that offer health coverage for people who do not have access to health insurance through employers, Medicaid or Medicare.

Under the ACA, a penalty was assessed against people who didn’t acquire health insurance. President Trump has directed that penalties no longer will be assessed. The tax penalties, which were upheld by the U.S. Supreme Court in 2012, served as incentive for all people to obtain insurance. That broadened the risk pool and helped reduce the cost of insurance per person.

When people are no longer mandated to acquire insurance, some people will not—particularly if they view themselves as healthy and less likely to need insurance. That leaves sicker people in the insurance pool, and the cost of insurance per person goes up.

Increases in premiums

Health care premiums for policies on the exchanges are increasing. The Congressional Budget Office estimates average increases of 15 percent for 2019, and a Kaiser Foundation survey shows increases in a range of 7 to 36 percent, depending on the market.

Under the ACA, persons with income of less than 400 percent of the poverty level were partially protected from increases in the cost of health insurance by subsidies to help pay for insurance. (In 2018, 400 percent of the federal poverty level for a family of four in the 48 contiguous states was $100,400.)

Many Republicans would like to eliminate or reduce subsidies. If that were to happen, insurance would become more unaffordable for persons with moderate to middle income, and the number of people without insurance likely would increase.

Extension of short-term policies

Where Americans get their health insurance

The Trump administration says it can hold down insurance costs and promote choice in the health insurance market by encouraging use of short-term policies. The trouble is short-term policies often will not cover the care a patient needs.

Short-term policies traditionally were intended for short-term use, such as by people between jobs or early retirees waiting for Medicare coverage. Some in the Trump administration favor more open-ended use of short-term policies as well as reducing the requirements of what health insurance must cover. Gone would be the “essential health benefits” required under the ACA.

Many short-term policies, for example, do not cover prescription drugs, mental health, substance abuse, maternity care or preventive care. Short-term policies also may have dollar limits on the amount of coverage, including lifetime limits or limits during the period of the policy.

In addition, there are Republican proposals to eliminate the requirement (at least for some policies) that insurance companies cannot discriminate on the basis of preexisting conditions when issuing or pricing policies. A person with a preexisting condition may be excluded from the market or find that coverage is unaffordable.

The same could happen to people who work in occupations considered by an insurance company to be risky. Prior to the ACA, occupations that were considered by some insurers to be a basis for declining coverage included iron worker, professional athlete, meat packer, taxi cab driver and security guard. Recreational activities that could result in denial of coverage included scuba diving, rock climbing, skydiving and mountain biking.

Impact on fees for physicians

As the market for short-term or alternative policies grows, the impact is likely to be felt by physicians as well as patients. Physicians (as well as patients) may find that the insurance company is not willing to pay for a service, even if the service is medically necessary.

In addition, the same insurance companies that are trying to hold down costs by issuing discount insurance policies to patients also may try to squeeze physicians by having physicians sign network provider agreements at reimbursement rates that are much lower than those paid by other insurers, including Medicare.

Physicians and their billing companies should carefully examine proposed contracts to avoid entering into arrangements that turn out to be unacceptable.

Predictability in the market

The insurance exchanges had problems before Trump came along. Large insurers, including UnitedHealth, Humana and Aetna dropped out of most of the exchange markets, and that left fewer choices for people seeking insurance. For the companies that stayed, rates went up and the market became more predictable.

The Trump administration’s plans to alter subsidies, coverage requirements and rules for short-term policies will increase unpredictability again.

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

 

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