Editorial
by David Stevens, M.D., M.A. (Ethics) – CMDA Executive Director
Keeping Your Balance
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knew Jody wasn’t going to be happy, but I raised my hand anyway. Before she could pull it down, surprisingly, I was selected from the large crowd. I took off my shoes, climbed the ladder and stood on a small platform while someone fitted a safety harness around my chest. The pole was long and so heavy it drooped at the ends, but with effort I picked it up, and as instructed stared toward my goal 75 feet away. Then I stepped out into space three stories off the ground. Wow! I was walking on a tightrope at Circus World! Though my style was nothing like the grace of “The Flying Wallendas,” believe it or not, I actually made it across without falling. (After 20 years, I still haven’t figured how to put this major accomplishment on my resumé!) Balancing our personal and professional lives is a much longer and less steady tightrope walk. Ninety percent of us get pulled off on the professional side and there is no safety net. Our life crashes. If we are lucky, we just bruise our happiness and find our spiritual walk has come up lame. Unfortunately, too many break their marriage, damage their children or treat their pain with drugs, sex, power or things. There is no safety harness on the tightrope of life. That is why we are devoting a whole issue to this crucial topic. With articles related to seeing your practice as your calling, improving your marriage, dealing with non-paying patients, restoring the joy, “opting out” of Medicare, avoiding prosperity mismanagement, and living with disability, we want to help you reach the other side in good shape. I’ve learned a few things that have helped me maintain my balance: First, I must remember that I can’t do it alone. I need the “heavy pole” of family, friends and colleagues who give me another perspective and hold me accountable. I have to give them permission and then seek their advice in maintaining my balance. I just don’t have the equilibrium to stay upright without the right help. Secondly, I’ve got to keep the most important goal clearly in focus. How does God want me to invest my life? At the end of life, what will I look back on and thank God for? Will I have been a good steward of the
time and energy I’ve given to my wife, kids and the kingdom? One member recently shared about his balancing act, “Dave, my life changed when I realized I wasn’t a Christian doctor but a doctor Christian.” He is still a great doctor, but that is no longer the definition of who he is. His most important goal is to please his Heavenly Father. With his eyes firmly on Jesus, the Author and Perfecter of our faith (Hebrews 12:2), I know he will safely reach the other side. Third, have total confidence in our loving heavenly Father. Anxiety or fear can distract and discourage anyone, but these can be deadly if you’re walking a tightrope. Perhaps you’ve heard of “The Wallenda Factor,” a principle based on the legend that the great Karl Wallenda fell to his death in 1978 after an extended period of worrying that he would fall. Tino Wallenda, Karl’s grandson and current leader of the troupe, told us, “Although I would agree with the gist of the principle, there is no truth in his being fearful. I was with him until the last week before he traveled to San Juan [where he fell].” In an article published in Decision magazine, Tino (who has walked cables that were higher than 100 feet in the air and cables that were longer than 600 feet across, over dens of lions and tigers, between buildings, across rivers, and over a pool containing more than 50 1 ‘man-eating’ sharks ) described how fear of falling is dispelled by confidence in our Father. “At one time or another,” he said, “I have taken each of my four children on my shoulders as I have walked across the wire. People have asked them, ‘Aren’t you scared?’ ‘No,’ they have said. And when they were asked, ‘Why?’ they have answered, ‘Because that’s my daddy.’ And I have confidence in my heavenly Father. I know that He will take me all the way across the chasm of life until I meet Him face to face.” This same confidence applies to all Christian tightrope walkers, including those who happen to be doctors. ✝ 1. See the Web site: http://www.wallenda.com. Used by permission.
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CONTENTS V OLUME X X X V , N O. 2
( O u r 5 4 t h Ye a r )
Summer 2004
The Christian Medical & Dental Associations ––changing hearts in healthcare—since 1931. SM
Features
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Ordained to Heal How a haircut changed a doctor’s perspective by Robert C. Wright, M.D., with Greg Wright
Strengthening Your Marriage Six ways to make your love grow stronger Jeanie Mirich, with Rod Mirich, M.D.
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A Collection Policy for Christian Doctors How to deal with non-payers while retaining your Christian witness by Gene Rudd, M.D.
From Prosperity to Financial Strength How to avoid “prosperity mismanagement” by Greg S. Gilbert
Now is the Time Is “opting out” of Medicare the best alternative? by Curtis E. Harris, M.S., M.D., J.D.
His Grace is Sufficient for Me How disability birthed deeper faith by Allison LaFrence, M.D.
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Departments 5 Progress Notes 32 Advertising Section
TODAY’S CHRISTIAN DOCTOR®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Summer 2004, Volume XXXV, No. 2. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations at 2604 Highway 421, Bristol, TN 37620. Copyright © 2004, Christian Medical & Dental Associations . All Rights Reserved. Distributed free to CMDA members. Non-member doctors may receive a complimentary six-month membership upon request or by referral by a patient or other healthcare professional. Non-doctors (U.S.) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tenn. Postmaster: Send address changes to Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Editor: David B. Biebel, D. Min. Editorial Committee: Gregg Albers, M.D., Ruth Bolton, M.D., Elizabeth Buchinski, M.D., John Crouch, M.D., William C. Forbes, D.D.S., Curtis E. Harris, M.D., J.D., Warren S. Heffron, M.D., Rebecca Klint, M.D., Samuel E. Molind, D.M.D., Robert D. Orr, M.D., Matthew L. Rice, Th.M., D.O., Richard A. Swenson, M.D. Director of Communications: Margie Shealy. Classified Ad Sales: Patti Kowalchuk (423) 844-1000. Display Ad Sales: Patti Kowalchuk (423) 844-1000. Design & Pre-press: B&B Printing. CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). SM
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Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction. Scripture references marked (NASB) are taken from the New American Standard Bible. Copyright © 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977 by the Lockman Foundation. Used by permission. Scripture references marked (KJV) are taken from King James Version. Undesignated biblical references are from the Holy Bible, New International Version ®. Copyright © 1973, 1978, 1984 by the International Bible Society. Used by permission. All rights reserved. For membership information or to request your first year's membership for half price, contact the Christian Medical & Dental Associations at PO Box 7500, Bristol, TN 37621-7500; telephone: (423) 844-1000 or toll free, (888) 231-2637; fax: (423) 844-1005; e-mail: main@cmdahome.org; Web site: http://www.cmdahome.org.
Media Training Workshop Held CMDA held its first “Voice of Christian Doctors” media training at the National Headquarters this spring. Thirteen members from across the U.S. participated in the 13-hour program. Jonathan Imbody, Senior Policy Analyst in CMDA’s Washington Bureau, directed a persuasive writing clinic that presented a simple five-step method for developing a powerful written message. The training also included radio and television personalities Josh Smith, Tom Taylor and Annemarie Dugan, who provided valuable information in getting our message to the media. Radio and television practicums were held in the recently equipped Digital Media Center, where each participate was interviewed, recorded and critiqued for radio and television broadcasts. A two-hour mini-session is planned during this year’s National Convention on Thursday, June 10, 2004, with Dr. David Stevens conducting the session and Jonathan Imbody presenting principles and practice related to writing editorials.
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Medical Education International (MEI)
A Teaching Mission to China Have you ever wanted to take the knowledge God has given you in your specialty and use it for the Lord Jesus Christ? If so, consider taking an MEI trip with us as we seek to use medical/dental education as a tool to reach others for the Lord. Our mission trips are different than the “traditional” medical mission. We go to various settings in developing countries and teach in the areas that we know best. While we’re there, we also take time to get to know our colleagues and learn from them as well. In the process, as we build relationships, we’re often able to share our faith with them. We will be taking a team and teaching in a variety of medical/dental specialties at a medical school in Shenyang, China from September 11-25, 2004. If you’ve ever thought about going to China and doing some short-term mission work, here’s your chance. It will be a wonderful adventure, and one that the Lord can also use to work in your life in many unexpected ways. If September doesn’t work for you, that’s fine because
Dr. Jonathan Saxe lectures a group of very interested surgeons in Mongolia.
we have plenty of other trips planned for the next year. Below is a listing for you to look over and pray about. If you have any questions about our work, please don’t hesitate to contact me via any of the means listed below.
Calendar—Medical Education International August 27-September 8, 2004: A team will be traveling to Afghanistan to work in a variety of hospitals. There is need for female Obstetricians to work and teach Obstetrics. In addition, there are teaching needs in many medical and surgical specialties.
September 11-25, 2004: A team will be traveling to Shenyang, China for two weeks to teach in a medical school setting. There was an early request for the following specialties: Emergency Medicine, Medical Oncology, Hand Surgery, Nurse educators and Molecular biology (and other basic science fields). October 2-16, 2004: A team will be traveling to Mongolia for two weeks for the purpose of teaching at the various specialty hospitals in Ulaanbaatar. There is a need for teaching in all specialties. There is specific request for a surgeon working in the field of biliary surgery as well as a Perinatologist. October 9-23, 2004: MEI will be participating in a joint venture with Medical Missions Response. A team will be traveling to China to teach in various medical school/hospital settings. There is a need for all specialties, especially neurology, surgical specialties, radiology, infectious disease and radiology. October 19-24, 2004: A team will be traveling to Pristina, Kosova to hold a surgical conference. Though the primary emphasis is surgical, all specialties are welcome.
October 22-November 1,2004: A team will be traveling to Albania to hold a medical/surgical conference. There is a need for teaching in all specialties. For more information, contact: Jeffrey J. Barrows D.O., F.A.C.O.O.G., Director, CMDA-MEI Phone: 937-599-3050 ◆ Cell: 937-414-0751 ◆ E-mail: jeffreybarrows@yahoo.com 6
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CMDA’s Medical Malpractice Ministry In today’s world, medical malpractice is unfortunately a reality for many doctors, the effects of which can be devastating for a doctor’s practice, family and career. If you’ve recently become involved in a malpractice suit, CMDA is here to help you. • The Medical Malpractice Ministry Resource Kit is free of charge and contains cassette tapes, brochures, and informational articles to assist physicians and their families during a lawsuit. • “The Malpractice Suit: A Survival Guide for Physicians and Their Families” is available for loan. This video and study guide assists in every aspect of a malpractice case. • CMDA’s Malpractice Commission is composed of doctors who have been through malpractice and are willing to give of their time to be an encouragement and prayer partner. The doctor seeking help is placed with someone far from his own area for protection. • Carefully selected CMDA members and staff provide Personal Counseling. These individuals are trained to provide confidential medical and spiritual counseling and general legal education. For more information about CMDA’s malpractice ministry, please contact Emma Carty at 423-844-1000 or log on to our Web site at: http://www.cmdahome.org - Networking.
“Family Fitness” Retreat Article Follow-up “Since the article about Family Fitness Retreats [FFR] appeared in Today’s Christian Doctor last summer,” said long-time CMDA member Robb Brandt, M.D., “we’ve had a number of medical/dental couples from across the country visit us at Twin Oaks, our Pennsylvania Christmas Tree farm. They’ve come to experience FFR firsthand, and with a boost from the Leaders’ Guide, they’ve learned to host their own retreats back home.” Dr. Brandt added, “Ruth and I see huge potential in this program to arouse a sleeping giant in medical/ dental families for outreach to communities everywhere. Contact us for a retreat schedule and availability at: www.familyfitnessretreats.com or: RIBrandtMD@aol.com.” See the ad, pg. 32. Twin Oaks
Sam Molind, D.M.D., Global Health Outreach (GHO) Director, led a medical mission team into a remote “unreached” region of Asia, an area without an established church or Christian witness. One evening during group devotions the team sang some worship songs in English. As they sang, someone pushed a note under the door. The note that was written in Chinese read, “Sing more songs.” Dr. Molind asked the translators, who were born-again Christians, to sing some songs in Mandarin so those outside could hear about the God that we were praising and worshiping. The next evening during devotions another note came under the door. This time the note said, “Open up the doors.” They opened the doors to see 50-60 people crowded outside listening. Although they could not let the crowd inside, the translators proceeded to present the devotion in Mandarin and read from the Word of God, so that those outside could hear and understand the gospel message. Six people gave their lives to Christ that week through a supernatural work of the Holy Spirit. Our national partners are now bringing them the Word of God and discipling them to maturity in their faith. GHO intends to take at least 25 percent of their teams into the “10/40 window,” bringing medical care and the gospel message to those without help or hope. These people need to know the Great Physician, the only One who can heal all their wounds.
Global Health Outreach
UPCOMING TRIPS:
❒ Ghana, July 29 – August 12 ❒ La Esperanza, Honduras September 25 – October 3 ❒ Cuenca, Ecuador November 6 - 20 Internet Web site:
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President’s Message
Restoring the Joy Unhappiness almost seems to be the norm in medicine these days. Physicians, and perhaps to a lesser extent dentists, are unhappy over what the professional liability issues through malpractice suits have done to damage the practice of medicine. Loss of control over medical management and practice are a reality of life. Huge corporations now dictate much of what we do and how we do it. Insurance plan changes cause huge turnovers in patients as they change plans sometimes yearly. A large segment of our population does not have medical coverage. They cannot pay for their care so they rely on the overburdened emergency departments, clinics and offices to provide discounted or free services. Expenses are up, and reimbursements are down . . . and so on goes the litany of unhappy events for most of us. However, in my travels this year and talks with our members, I find a difference between Christian doctors and dentists and the general medical/dental population. We may be unhappy with the world around us but we still have a joy about us, in our work and in the relationships we have with our patients. I think we are still experiencing the joy Jesus described to His disciples His last night on earth as He reminded us He had joy inside of Him and that our joy might be made full (John 15:11). Recently, I had a wonderful experience of sharing in that joy with about 300 medical missionaries at the Brakenhurst Baptist International Conference Center, 30 miles north of Nairobi, Kenya. Our CMDA Commission on Continuing
Medical and Dental Education sponsored a 10-day CME Conference so missionaries could maintain their medical and dental licenses in the U.S. while serving in Africa and the Middle East. Fifty-seven faculty, mostly from U.S. medical and dental schools, presented the update lectures, seminars and workshops. Missionaries sometimes have their own problems but it was interesting to see how the things that make for unhappiness here were non-existent in their lives. The daily preaching, Bible study, prayer and singing made the joy ring through the rafters and our lives. It was inspiring each night to hear medical mission reports from each country: ◆ The Pan African College of Christian Surgeons has a residency program utilizing several mission hospitals. The first graduate received his certificate at the conference. ◆ We enjoyed hearing a Family Practice residency program director in Jos, Nigeria report on how a residency functions in a mission hospital and how a medical education program adds to the witness and service of a mission hospital. ◆ The following evening we heard how one of the graduates of the Jos program was in Niger working to start a “daughter” residency in another mission hospital. The joy I find among our members in our mission fields here and abroad is wonderful.
With joy, Warren A. Heffron, M.D.
DID YOU KNOW? ✓ Progress Notes is a monthly e-mail newsletter providing up-to-date ministry and member information? Go to www.cmdahome.org >publications>progress notes and sign up for your update! ✓ CMDA’s reorganized Web site is much more user friendly. Check it out and give us your feedback. Go to http://www.cmdahome.org. ✓ Dental membership is steadily growing under Dr. Jack Shuler’s direction with 1,223 practitioners, students and friends. ✓ CMDA and Zondervan released four books in 2003 and have already released three books this year. For details, see www.cmdahome.org>shopping>product catalog. ✓ A recorded interview with Dr. Gene Rudd on “The Physical Suffering and Death of Christ” is available for download at http://www.cmdahome.org. ✓ CMDA members have been speaking out on Right of Conscience issues, RU-486, Morning-After Pill, and Homosexual Dangers. To see our news releases, go to http://www.cmdahome.org click on press > news releases. 8
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Washington Bureau Update Doctors Key to Terrorism CMA member Donald Thompson, M.D., M.P.H. & T.M. (Colonel, U.S. Air Force) describes upcoming U.S. Northern Command exercises to California Governor Arnold Schwarzenegger (at left) and Secretary of Health and Human Services Tommy Thompson and their staff in the Secretary’s Command Center in February 2004. U.S. Northern Command was formed after the September 11, 2001 tragedies to coordinate Defense Department activities in homeland defense, and to provide support to local, state and federal authorities for homeland security. Exercises in responding to terrorism incidents play a large role in improving the nation’s preparedness; the complex medical issues associated with managing biological, chemical and radiological casualties call for in-depth involvement of healthcare professionals.
Spreading the Word—CDA Update by Jack E. Shuler, D.D.S., F.A.G.D.—Director, Christian Dental Association When I began my duties as CDA Director over a year and a half ago, we faced a “chicken or the egg” quandary. CMDA needed more dental resources. Yet to obtain these resources, we needed more dentists! At the midpoint of my three-year commitment to this position, I can honestly say that we have been blessed: ◆ I have traveled the Midwest, the South and Southern California meeting with students and grads. ◆ We have exhibited our CDA booth, along with many new resources we have, at the ADA in San Francisco, as well as three state dental meetings. ◆ We have had 435 individuals join CDA during this time, representing almost a 40 percent increase in dental membership. ◆ And our resources have kept pace. However, we have ONE resource which needs to get into the hands of our Christian colleagues. We have a DENTAL CD which explains the dental ministry within CMDA quite clearly. This can be mailed, along with a brochure and membership application in a single envelope. Many of you know a dental colleague who might be
interested in CDA and the specifics of our ministry. Dentistry is growing. Please contact me via any means listed below. I will either send you a copy or copies to hand out or I’ll send them directly to the person you name. I need the help of ALL CMDA members—physicians and dentists—help in “spreading the word.” Remember, the Lord can take what may seem to be a small act of informing a colleague and turn it in to something great. Be a part of this! Jack E. Shuler, D.D.S., F.A.G.D. You can reach me by phone at: 603-437-8922, by mail at P.O. Box 7500, Bristol, TN 37621, or by e-mail at: jackcda@earthlink.net.
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by Robert C. Wright, M.D., with Greg Wright
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How a barber became God’s messenger to a surgeon ready to leave practice.
n the Old West, a man in need of a surgeon paid a call to the barber’s shop. Today, we’ve specialized a little bit more. Surgeons work out of facilities that are less—well, less hairy. And barbers know their place—behind the clippers, not the scalpel. Still, even doctors have need of a barber from time to time. Such was the case one Saturday morning not long ago as I accompanied my friend Barry to a barbershop in a strange town. Oddly, the barber looked more like a physician than we did—graying, physically fit and wearing a stylish pressed shirt—while we carried in the unmistakable aroma of an early morning workout. Barry apologized for his appearance, then remembered that he did not have any money with him. This was not just any Saturday morning, and his planned itinerary from the hotel had not included a visit to a barbershop. Barry said, “Hey, listen. I’m a doctor, my friend here is a surgeon, and we’re good for the money. Please cut my hair. My son is getting married today.” The barber laughed and said that the haircut was on him, in honor of the wedding. His own daughter had just gotten married two weeks earlier, and he knew full well what Barry must be going through. He introduced himself as Ari, and rattled off an unpronounceable, and plainly Greek, surname. We had a good laugh about “My Big Fat Greek Wedding,” and then asked why his hair salon was named “Agape”—a Greek word for love. Barry said we were Christians and guessed that Ari must be, also. The barber stopped clipping and addressed us soberly. “It is no coincidence that you are in my shop today,” he declared. “The Lord has led you here. You need to know that everything you do is important, and it means so much to other people.” I was dumbstruck. “You are ordained by God to heal,” he continued. “This is your ministry. It cannot be done by others. The pressures that you feel are great, but the fruit that you bear is resulting in eternal rewards.” Were these words actually being spoken to us by a barber?
“It is no coincidence,” he declared, “that you are in my shop today. The Lord has led you here.”
We are in a time of crisis in medicine. I practice in a state—like most— where malpractice litigation is a spreading quagmire. Physicians are losing autonomy. Patient outcome trends are institutionally pressured toward unattainable goals. In private practice, costs are increasing all the time. Just getting 10
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HIPAA implemented has been an ongoing headache. The problems we face continue to mount. All the pressures had been getting to me, so I took a vacation this past summer. Even in ordinary years I return to work thinking, “I just cannot believe I do this every day.” Vacation last year, though, was worse. During the course of one completely sleepless night, I rather fatalistically concluded that nobody really cares about the physician’s predicament. Politicians fail to act, and attorneys—even administrators—heap up unrealistic expectations. On top of it all, patients seem to be buying into the smokescreen of misinformation. My first day back on the job was crushing, confirming my pessimistic conclusions. As soon as I walked into the hospital, my partner informed me that one of my patients was doing poorly. Within 45 minutes the patient died—as I stood in the patient’s room, consulting with family members. We had a good discussion, but this unexpected turn for the worse was an outcome related to the surgery. I fully expect that the incident will result in a quality review. I no sooner had returned to my office than a valued receptionist resigned, walking out over petty office politics. I resignedly sat down to go through my mail, and found an invoice for $4,000 in cost overruns for a practice-related project. The next letter I opened was from a lawyer threatening malpractice. Though I had saved his client’s life twice in the prior five years, I was now being badgered with a delay-of-diagnosis accusation. Before I left the office that Friday afternoon, I unceremoniously dumped all these concerns in my office manager’s lap, telling her that I was not sure if I could continue practicing medicine. I wasn’t particularly concerned at that point what she did with the information. I left town that day to visit Barry. We had worked through a church breakup together, and he had shepherded me through some very difficult times three or four years earlier. He had recently left our state to practice medicine elsewhere, and my wife and I had been missing Barry’s family terribly. His son’s wedding was taking place only a few hours’ drive from our home, which afforded us the opportunity to get together again in the context of a joyous occasion.
At 7:00 A.M. the next day, we met at a local gym. Entering the club that morning, Barry noticed a barbershop nearby. As we worked out, Barry perceived the strain I was under. Soon I was doing the unthinkable—actually discussing my fear of malpractice suits, my dissatisfaction, my feeling that nobody cared and nobody understood. One of the frustrations of practicing medicine is that doctors cannot talk about such matters with just anyone. Casual comments have the most
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unpleasant habit of growing up into lawsuits. Physicians often feel like living, breathing targets; for me, this had become almost unbearable. I was seriously considering giving up medicine, and talked with Barry about pursuing a master’s in business administration—about literally walking away from my practice. I was naturally astounded, barely 15 minutes later, to have a barber telling me, “You are ordained by God to heal. This is your ministry. It cannot be done by others.” At the conclusion of our time together, the barber went to his door, locked the shop, drew the blinds, and in a moment in time that will live on with me . . . he laid hands on our shoulders, and prayed for us. I am aware that my story does not make me sound very spiritual; and that is undoubtedly one of the problems in my life—one reason things were turning into such a disaster for me. Disasters often precede wake-up calls. Ari told his own story as Barry’s haircut continued.
“You are ordained by God to heal. This is your ministry. It cannot be done by others.”
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Years ago, Ari had been in the middle of a 15round boxing match called divorce. Hurt by his wife, estranged from his children, he was then hit with a knockout blow—a major motor vehicle accident in which he suffered a fractured pelvis, among other injuries. Multiple operations, one colostomy and three months later, Ari had sat in despair in a hospital hallway, waiting to get his colostomy reversed. God had touched him in a meaningful way, giving him the strength to carry on. The ministry of his physicians had been instrumental in helping him through his ordeal. More than his colostomy had been reversed. His whole life had turned around. As time went by, he developed a relationship with Christ. He remarried, and the lies of his prior wife were uncovered. He was vindicated in the eyes of his family and reconciled with his children. His medical debts were finally repaid and he was rebuilding his life. He opened a barbershop and named it “Agape,” vowing to tell his story every chance he got.
This is precisely the kind of outcome for which I have striven in my practice as a general surgeon—saved lives, healed wounds and restored hope. Medicine and ministry. I began to believe that Ari was right. It was no coincidence that I was in his shop that day. It was providential. When Barry’s hair was nicely trimmed, Ari told me that my hair looked “like a rat’s nest,” too. He wasn’t done talking, either, so I “had better sit down” and get my hair cut. The monologue continued. But just as I thought Ari was going to explain more about his family, he stopped cutting, rested his hand on my shoulder and repeated, “It is no coincidence that you are here today in my shop. The Lord has led you here. You need to know that everything you do is important, and your work means so much to other people. You are ordained by God to heal, and this is your ministry. It cannot be done by others. The pressures you feel are great, but the fruits are great also.” By now I was in tears, sensing clearly the supernatural guidance behind his message. God knew that I desperately needed to hear—to really feel—these words. They were
words I would not heed from my wife, though she is my helpmate. They were words I would not heed from Barry, despite his wisdom and experience as a fellow physician and brother in Christ. These words had to come from a patient, though none of my patients had been able to get through to me. Ari—representing all the patients I have ever treated, a barber—was God’s messenger, in the right place at the right time, with just the right words. I shouldn’t have been surprised, I suppose. “Has not God chosen those who are poor in the eyes of the world to be rich in faith,” James asks, “and to inherit the kingdom He promised those who love Him? But you have insulted the poor. Is it not the rich who are exploiting you? Are they not the ones who are dragging you into court?”1 I had been hit by God before with a message from Scripture, “Be still and know that I am God,”2 and another verse, “I know the plans I have for you, plans for welfare and not for calamity.”3 I had always thought of gifts of healing as being charismatic, rather than the product of technical training such as I had obtained through medical school. Ari reminded me that all healing is a gift—a gift “ordained by God,”—no matter how God bestows it. All things considered, I rather imagine that I do need to make some changes in my life; but I also need to persevere— keep ministering, listening, dropping “faith flags,” praying with patients and modeling Christ as a good physician. And I need to remember that I’m not in this alone, as isolated as I sometimes feel. For when I returned to work the next Monday morning, I learned that, as my head was in Ari’s capable hands that fateful Saturday morning, my office manager was on her capable knees, praying that God would send me just such a messenger. In the Old West, when a man needed a surgeon he paid a call to the barber’s shop. Not long ago, when God needed a surgeon, He sent an ordinary man to a barber. Discouraged? Ready to throw in the scrubs? One step away from hanging up the scalpel? If you need a haircut—and even if you don’t—God has a barber who ministers to physicians. Would you like his phone number? ✝ References: 1. James 2: 5-6; 2. Psalm 46:10; 3. Jeremiah 29:11.
Robert C. Wright, M.D., lives in Puyallup, Washington. He and his wife, Sally, recently celebrated their nineteenth anniversary. They have four children. A graduate of the University of Washington, Dr. Wright practices general and laparoscopic surgery with C. Anthony Kim, M.D. Dr. Wright has been a member of CMDA since 1990, and has participated in two short-term mission trips. He was assisted in creating this article by his brother, Greg, Senior Editor for HollywoodJesus.com.
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by Jeanie Mirich (with Rod Mirich, M.D.)
Two members of CMDA’s Marriage Commission share six tips for keeping your marriage strong.
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ears have passed, love has grown, Christ is deeper in our hearts. The ups and downs of marriage are always a lesson to those who study the wonders of this unique, God-ordained relationship. With marriage being challenged in the courts, the love between a man and woman remains the most sacred of trusts, an open and transparent relationship that builds and trains the next generation. What have we learned? Here are a few thoughts, gleaned from our study of each other.
Spending Time Marriage is a living thing, pulsing with life, breathing and exhaling, growing, changing. It is the hardest yet most precious work we do because it reflects God’s love for us, His relationship to His Bride. A growing marriage takes commitment, energy and time. Energy expended on behalf of a loved one is never lost, for the effort converted to caring tenderizes hearts. We need to spend time wisely because it is a precious gift. God longs for us to take time to love one another. Time is an elusive element in a medical marriage. For
many years cherishing time together wasn’t a priority for us. We were married while Rod was in medical school and I was a college student. Internship arrived with the birth of our first child. The Air Force sent Rod to Thailand during the Vietnam War. The family grew to five during residency, then Rod was in solo OB-Gyn practice for six years. We excelled at postponement and discovered that not putting anything into our marriage meant not getting anything out of our marriage. My husband is my best friend, my confidant and lover, the person I reveal my heart to. Our time together is quality time. Focused time. Time to reconnect. There is no T.V. in our bedroom—nothing to distract us from intimately sharing with and listening to one another.
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Showing Love Unconditional love is often listed by both men and women and their most important need (see Dr. Gary and Barbara Rosberg: The 5 Love Needs of Men and Women). To show unconditional love we need to know our spouse’s daily struggles, dreams, joys and sorrows. So we began “couch time.” At the end of most days Rod comes home and we sit lengthwise on the couch facing one another and rubbing each others’ feet. It is a gentle reentry for Rod into the sanctuary of our home and a time for me to hear his prayer needs and share with him the experiences of my day. It also meets two of our love language needs. We both love touch and desire words of affirmation. Sometimes Rod expresses his love and devotion to our marriage by giving gifts. Recently he gifted me with a shopping trip. When I emerged from a clothing store with a pair of pants and sweater, he said he enjoyed watching me try on clothes because I had such a great figure. A lady nearby commented, “Well, you two must not be married.” I replied, “Thirty-six years this Christmas. I just have the greatest husband who understands how to show love.”
Obtaining CMEs Do you have a strategy for continuing education for your marriage? To attain CME (Creative Marriage Education) 16
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credits each year Dr. Patti Francis and her husband Ron study a book on marriage. They read separately and write notes in the margin, then take time to talk about what they learned. Other couples come to a CMDA Marriage Enrichment Weekend* as a gift to one another. Some take extra time to see the sights, nurture their relationship with a play, concert or walk on the beach. Family Life Conferences and Focus on the Family’s marriage conferences also provide tools to enhance your marriage. Rescue your relationship by covenanting and planning for time together. “If you don’t plan, it won’t happen,” Rod asserts.
Accountability — Get Yourself a “Wing Couple ” This one comes from our Air Force background: “Another way to strengthen your marriage is to have magnanimous, edifying, good-looking, above average friends,” our friend Doug Bennett offers. “You can’t do it by yourself. You must have a wing man or in this case a wing couple in your life.” What is a wing man’s purpose? To keep you from getting shot out of the air. To alert you to danger. To watch your back and to see you safely home. Every decade in your life you realize that change is the rule. You begin with courtship, then grow to marriage, careers, children, menopause, death of parents, perhaps
illness of a spouse. Rod and I have found it vital to have friends who share the covenant that we have made. It is also important to be honest about our struggles, to be accountable to others and to pray with them for a hedge of protection around our marriage. I call these relationships the “Fellowship of the Rings.” We have the joy of bearing with others through life’s struggles and sometimes carrying their burden when it becomes too great. Our friend Doug shared that he and his wife have three special couples in their life. One couple is a decade younger. The Bennetts share what they have learned to benefit the younger couple’s marriage. The second couple is contemporary (their wing couple) and there to help with unseen missiles and arrows of the evil one. The last are a decade ahead and can teach the grace of God and give hope because they have walked through difficult things. Do you have a wing couple or two in your life?
Walking with His Mind “Smile on me, your servant; teach me the right way to live,” (Psalm 119:135, The Message). It is essential to know that your husband is the son of the Most High God or your wife is the daughter of the King. To minister to them you need to understand what their Designer created. There is a manual, Scripture, that reveals the process of learning how to serve your spouse. It begins with a deepening relationship with God—individually. We are directed to put on His mind, to see our beloved as He sees him or her and to pray as He directs. We can offer up time with God as a gift to our marriage.
Using His Gifts
* CMDA MARRIAGE ENRICHMENT CONFERENCES *
Rod and I are opposites. When “logic” marries “creativity,” the courtship is an adventure and the honeymoon and early years of marriage have a steep learning curve. Our personality differences were intially annoying until we began to respect the strengths and gifts in one another. Now our marriage has more resources because together we can combine “hands on” with “style and heart.” Rod’s ability to create furniture with his hands, rewire our basement, retool equipment on the mission field and fix an old wringer washer enable me to use my gifts of listening, nurturing and loving more freely.
CMDA understands that the effects of today’s medical and dental professions have taken their toll on marriages. Increasing time pressures, fiscal burdens, CE requirements, and countless demands have made building strong marriages more difficult. A Marriage Enrichment Conference will help you to: • Have a healthier marriage • Improve communication • • Develop spiritual intimacy • Achieve balanced priorities • • Rekindle romance • 2004 CMDA Marriage Enrichment Conferences Sept. 10-12 Lake Geneva, Wisconsin Oct. 1-3 Scottsdale, Arizona SEE THE CMDA WEB SITE FOR INFORMATION.
Final Words of Wisdom “When I humbly listen to Jeanie’s opinions, it is better for us,” Rod says. “I’ve learned to speak gently to her. Words of affirmation are important to her soul.” Rod has chosen to study me; to learn my likes and dislikes, and that shows me his love. As coach John Wooden says, “It’s what you learn after you know it all that counts.”As far as I can see that applies to marriage perhaps even more than anything else. ✝
Jeanie and Rod Mirich, M.D., have been married for 36 years, and have three children and seven grandchildren. Rob is an OB-Gyn. Jeanie is a free lance writer. They are former chairs of the Marriage Commission.
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Experienced doctor shares his principles for dealing with patients who don’t pay. by Gene Rudd, M.D.
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e have heard of the struggles of so many of our colleagues who deal with collection policies for patient accounts — whether the policy is authored by them or established by an employer. Too often, such policies are based on secular business practices that are not consistent with the compassion we wish to reflect in our profession or our call as Christians to serve the needy. The following policy grew out of my practice and has been refined through the years. Prayerfully consider if it should be adapted to your situation. The heart of the collection policy is its philosophy regarding how to deal with patients who do not respond to routine billing efforts. Our goal is to understand what is going on in the lives of these patients and why they have not fulfilled their responsibility, and then to respond as Christ would. (Note that this philosophy does not include anything about money.) The letter on the next page would be sent only after a series of “routine” collection attempts. Those attempts would include an invoice requesting the patient to contact the office if: a) there is an error, b) they
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Dear ________ ____: It is with sadne ss that I write becomes an is this letter. I am sue that affect only made aw s our relationsh are of a patient of your failure ip. Such is no ’s account stat to pay the deb w the case. M us when it t incurred from y office manag the care we pro er ha s vi no d tified me ed (you, your fam We take our re sponsibility to ily, or individu yo al). stand that the u seriously, an office staff has d are concerne tr d ie th d bill was correc at we have no to contact you t heard from yo t and that you , hoping to solv u. I underhad been pleas e any problem facing a probl s. We wanted ed with our se em that kept yo to rv be ic u es fr sure the interested in yo . We also wis om paying. In hed to know if u as a person— addition to ou yo r yo d we adjust our u were esire to give yo ur concerns an expectations. d needs. Only u excellent ca re, we are when we know about your situ ation can There may be other reasons we have not he fulfill your resp ard from you, onsi but we must as your name from bility in our relationship. T sume that you herefore, after our active pat do not intend (date four wee ient list and no time I would to ks in advance) advise that yo longer provid we will remov u seek to regist e (you-or fam from you, we e ily er member-care). with another (p will forward co During this hysician/denti pies of your re st). With writt cords to the d octor you sele en permission As for the deb ct. t you owe, we would like to None of us can follow the exam pay that debt. ple set by God But God cared While this forg . We all owe a enough for us iveness is offe that He forgav debt to Him. red to everyone it on His term e th , e debt through our relationsh s. Following th ip with Him is Jesus Christ. at example, w been broken, only restored e have forgiven and can only when we acce your debt to u be restored if relationship on pt s. However, ou you will come mutual trust an r relationship to us and let u d responsibilit ha s s d is cu ss a way to re y. -establish the If you are inte rested in re-est ablishing your number) to sc relationship w hedule a meeti ith our practic ng time. e, please call (p erson) at (pho ne With concern,
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were not pleased with the care they received, or c) they have a personal need that has interfered with paying the bill. The letter would be sent by registered mail with return receipt. Most patients who received the letter were not heard from again. A few contacted the practice to have their records transferred to another practice. Then there were those who offered to settle their account—perhaps out of guilt. However, staying true to the commitment in the letter, they were told that they no longer had an outstanding balance— it had been forgiven. Those who persisted in their desire to pay were advised to give a donation to a worthy charity that ministered to the poor. When during the process we discovered that non-payment was due to financial hardships, the account was written off and the patient continued in good standing. On a couple of occasions we learned of financial hardship significant enough that we not only canceled the debt, we provided financial assistance! The most meaningful responses were from those whose hearts were awakened to God’s forgiveness. One woman wept as she related how the letter reminded her of the joy of sins forgiven. She rededicated her life to Christ. Those who expressed regret for failing to respond were reinstated into the practice with the commitment for future mutual responsibility. There were very few occasions when a patient who was forgiven and reinstated took advantage of the policy the second time. This was deemed to be a small sacrifice to make for maintaining the policy. Yes, some people continued to act irresponsibly, perhaps intentionally. In cases where it seemed clear that there was intent to abuse the system, a report was filed with the credit bureau–not to be punitive, but to help protect others from the abusive person. Perhaps the greatest benefit of this policy was the change that took place in the office. Everyone sensed it was the right thing to do. The key was that the primary goal was not to collect money, but to understand what was going on in the patient’s life. That changed actions and attitudes. There were no frustrations over collection agencies or small claims court. A financial analysis was not done, but it seemed that God responded by opening the windows of heaven and 20
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pouring out a blessing on the practice beyond what we could have imagined. For sure the blessings included peace, joy and favor with our patients and the community. But a blessing was also seen financially! But what about the law? It is important for us to honor financial agreements and requirements of third-party payers. In most cases, it is illegal to accept an insurance payment without also collecting the patient portion of the payment. This requirement may handicap our charitable intents. One possible solution is to establish a benevolent fund though which patient financial assistance may flow. You contribute to the fund and ask a committee or someone else to manage the fund based on established guidelines. A local church may provide ideal administration. Whenever you have a patient you think needs financial assistance, you may refer her or him to the fund for consideration. The fund can be authorized to provide various forms of assistance including payment for non-covered care, co-pays or deductibles. Legal guidance is advised as you establish your own system. Is this policy for you? Discuss it with your partners and consultants. But most importantly, discuss it with God. ✝
Gene Rudd, M.D., is Associate Executive Director of CMDA. A specialist in obstetrics/gynecology, Dr. Rudd has extensive experience as a director of a maternal-fetal medicine training program and in rural healthcare practice. He is the recipient of several awards, including the Gorgas Medal, presented by the U.S. government for the most significant achievement in preventive medicine. As a spokesman for Christian doctors in America, Dr. Rudd has received national media coverage, including appearances on National Public Radio, American Family Radio and Salem Radio Network, as well as the Wall Street Journal, Christianity Today, The Washington Post and People.
Financial Estate, Tax, & Investment Counsel
From Prosperity to Financial Strength by Greg S. Gilbert
“If you make six figures and can’t make your ends meet, maybe your ends are a little too far apart.” Ron Barnes
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ow you deal with prosperity can make or break your financial situation. Whether in finances or otherwise, your prosperity-coping technique is critical. This is true for different reasons, but primarily because of the adversity you will most likely encounter. We have all been through lean times in different areas of our lives. Almost everyone was financially affected by the economic difficulties over the last few years. Most doctors and doctors’ practices have been impacted by recent legislation that has dramatically increased the cost of malpractice insurance. The problem of prosperity mismanagement often starts at the beginning of a career when a doctor increases spending at a rate equivalent to (or higher than) the increase in his or her income. At this point, the slippery slope has begun. A close friend taught me an important lesson in dealing with increase through his example. As income grew in his business, he was never careless with controlling his business costs. He never assumed that the prosperity he was experiencing would continue forever. As time went on, and even in the midst of criticism, he maintained his course and was able to redirect cost savings to the highest priorities of his business’s future. The end of the story is that his day did come, and continues to come, because he was rewarded for his discipline. Volatility and uncertainty are certain. The doctors’ practices that collapse are the ones that are not prepared for the unexpected. The same can be said about a person’s individual financial circumstances. Do not allow prosperous times to make you lazy or to prevent you from forging ahead with discipline. When prosperity comes, do not conclude that your time to coast has arrived.
Dr. Jones Income = $300,000 Saves Extra $20,000 Annually 9% Annual Return on Savings Does This Over 20 Years *Extra Savings = $1,023,202
Dr. Smith Income = $300,000 Spends Extra $20,000 Yearly Does This Over 20 Years *Extra Savings = $0
*Extra Savings is at the end of the 20 Years
The Bible discusses the natural phenomenon of changing situations and varying seasons: • Joseph - Under his leadership, Egypt used seven years of great abundance in order to prepare them for survival during the sevenyear famine. • Ecclesiastes - uses the phrase “a time for everything” for the first eight verses of Chapter 3. We will experience different seasons in our lives. If we are wise, we can allow prosperous times to help sustain us through adverse times. • Proverbs - Chapter 6:6-8 says that the ant gathers in the summer in order to provide for the winter. The three main pillars of financial strength are the amount of annual positive cash flow, the amount of cash/money markets and your overall investable net worth. Positive Cash Flow is the amount of money you have left over after expenses. Liquidity is determined by the amount of cash or money market funds you have on hand. Investable Net Worth is the amount of money that is not tied up in your home, cars, vacation home, personal property, etc. It is usually represented in investments such as mutual funds, stocks, income producing real estate, etc. At your practice or with your family, here’s where to begin making the most of your financial situation:
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your home (as it requires that the rooms be filled with furniture and the yard landscaped), a boat, a car, etc. A good example of contained costs would be a large dinner for the family. The amount of purchase is contained to the dinner itself and it does not require any more costs. Other examples would be a treadmill, a vacation, a charitable gift, etc. Take the time to understand the different types of costs in your spending plan and determine your minimum costs per month and per year. Once you have established your fixed foundation, you can decide on additional purchases (or investments) you would like to make with any available margin. Costs should trail income as much as possible for the strongest cash flow position. This method will provide you with amazing strength in your cash flow. 2. Determine Your Desired Level of Liquidity. Once the minimum annual living expense amount is established, determine the amount that needs to be saved for one year’s worth of living expenses and major purchases over the next one to five years. Major purchases might be your next car, landscaping your yard, a generous gift to a church/ministry, etc.
1. Create Consistent Positive Cash Flow. Begin by establishing a bare bones minimum annual living expense amount. This exercise can easily be thought of as being necessary only for those trying to gain their financial footing in life. However, the fact is that whether you make $100,000 a year or $1,000,000, the goal is to maximize the use of your income in the areas of highest importance to you. Determine your current annual necessities and priorities. Evaluate the importance of each expense. Is the expense ongoing or a one–time cost? Is the cost contained or does it require additional costs? Ongoing Costs vs. One-Time Costs: Not all costs are equal. Ongoing and one–time costs are as different as night and day. Many people increase living expenses with increasing income. Too often, the living expenses are increased too quickly. The largest ongoing cost is usually one’s residence. Often considered a great “investment,” a home can be quite the contrary. A home can require 15 to 30 years of fixed monthly payments. This purchase requires future income in order to provide for the same standard of living. Homes can be fantastic purchases, just be aware that they are not usually the most effective way to make your net worth grow. Contained Costs vs. Costs Requiring More Costs: An example of a one-time purchase that requires additional purchases is a DVD player. It is expected that individual DVDs will be purchased or rented after the player is bought. Therefore, the cost of the DVD player isn’t going to just be the player, but also all the costs that follow to make the DVD player worthwhile. Other examples are 22
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3. Maximize Investable Net Worth. Next, create a “capture account” that allows you to invest toward future priorities that are five years or more out. Examples might include your children’s or grandchildren’s education, your next residence, a business opportunity or financial independence. With every increase in income, there should be a quick analysis of how much you would like to “capture” for the long-term. The capture account is a practical way to help you save toward stated goals to a greater degree and with greater intention. The first definition for “wisdom” at dictionary.com is; “The ability to discern or judge what is true, right, or lasting” and the fourth is, “A wise outlook, plan, or course of action.” Regardless of the strength of your net worth, prepare for the future wisely. Know that losses do occur and the unexpected does happen. And when prosperity comes, be certain not to use all of it. ✝
Greg S. Gilbert is a Financial Advisor and Stewardship Coach at Ronald Blue & Co., L.L.C., a leading registered investment advisory firm with more than $2.5 billion assets under management with 14 offices across the country. Greg’s expertise is combining wealth management and biblical counsel to high net-worth individuals. Greg can be reached at: greg.gilbert@ronblue.com. TM
by Curtis E. Harris, M.S., M.D., J.D.
Introduction
In the best interests of your patients, it is time to opt out of Medicare.*
*Ed. note: This article represents the opinion of its author, and may not represent the official position of CMDA on this matter. Your interaction is invited: TCD-Editor; CMDA P.O Box 7500, Bristol, TN 37621-7500; or e-mail: main@cmdahome.org, Attn. TCD Editor.
“Therefore,
This article is not meant to make you I tell you, do not comfortable. You will probably disagree worry about your life, with several things I say. You may even decide that what I am suggesting does what you will eat, or about not apply to you, or that what I am suggesting is somehow self-rightyour body, what you will eous. But if it does apply to you, wear . . . But seek his kingdom and if you agree with my use of Scripture, then you need to at least and all these things will be given consider major changes in the way to you as well . . . For where you practice medicine.
your treasure is, there your heart will be also” Change is frightening. Christ knew that. (Luke 12: 22-34). He looked at the things of the world that
Change and Security
tempt us. One of them is security, or a reliance on things. The rich man said “I will tear down my barns and build bigger ones” and God answered “You fool” (Luke 12:16-20).1 Over the last 20 years, and certainly over the last decade, physicians as a group have traded their profession for security, compromising dearly held medical ethics. Physicians have bargained away professional autonomy for the security of Medicare, HMO captive groups, local hospital support . . . all of which increasingly require the rationing of necessary care. We seemingly have forgotten that it is our patients toward whom we owe our single-minded dedication—not to our government, not to society at large.2 At first, the limits imposed on the care we wanted to give seemed benign, but the cancer has grown. It is now apparent to most that we have traded freedom for security. How did we let that happen?
Truth and Consequences The greatest enemy of living a life based on truth is rationalization. We have rationalized doing what we now do every day by stateInternet Web site:
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ments like: “Medicare doesn’t pay for this, and I’ll get in trouble if I do it,” “You don’t need a specialist right now,” and “I can’t spend that much time on a follow-up visit.” We screen out uninsured and underinsured patients, Medicaid and (more often than ever before) Medicare patients because we cannot afford the overhead costs of the visit. In fact, the cost of malpractice insurance, unfunded mandates from the federal government (Medicare, CHAMPUS and Medicaid), and the combined paperwork requirements and openly fraudulent behavior of many HMO and PPO insurance plans have made caring for the poor and uninsured virtually impossible.3 We have no room for charity. The problem as I see it? We have forgotten how we got into this mess. I remember the words of the physician whose practice I took over in 1978, the year I began: “Medicare has ruined medicine.” I thought he was a bit “off” when I heard that. After all, Medicare paid for all of the medical expenses of older people, and some elderly got care when they would not have had anything. But I see now what he was saying. It goes back to an old saying: “He who pays the piper calls the tune.” Medicare came between a physician and a patient, and decreased the personal and financial accountability of 24
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both.4 Medicare set the stage for all managed care plans in 1984 by defining a “reasonable and customary charge” as what Congress said it was, not what was actually reasonable or customary. From that first, then-radical act has come all the definitions of what is “medically unnecessary” and “more than reasonable and customary.” Private managed care plans have followed the lead of Medicare, and have based their benefits on what Medicare allows.5 The recently expanded broad enforcement of Medicare Fraud and Abuse statutes against honest physicians who We cannot understand the nearly 170,000 have rationalized pages of Medidoing what we now do care code is also a prodevery day by statements uct of healthlike: “Medicare doesn’t pay care control measures.6 for this, and I’ll get in trouble if Rationing of care bedo it,” “You don’t need a gan slowly specialist right now,” and “I in 1984, but over the last can’t spend that much 20 years we time on a follow-up have created a multi-tiered sysvisit.” tem of medical care in the United States, divided along lines of reimbursement (rather than economic class). It is important to remember that the interference of private managed care organizations in the practice of medicine was not and is not possible without the leadership and support of the Congress and the federal government, through both legislation and the ever-increasing mandates of Medicare. Over 60 percent of all medical care dollars are now under federal control, with the number increasing each year.
What Do Good Doctors Try To Do? Dr. J. Willis Hurst recently published an important “Commentary” in Archives of Internal Medicine entitled “What Do Good Doctors Try To Do?”7 He first outlined a quality of care that every good physician should emulate, and then asked “So what is the problem? There are those who will say that what is described here as a good doctor is too idealistic for the new culture of the modern world.”8 The problem, he says, is that “the good doctor’s time is often controlled by corporate demands of a health management organization.” He added that “[d]octors may not be paid by third parties on a timely basis...[and that] this drives good doctors out of medicine.” Finally, the hassle factor of delivering medical care is increasing, and good doctors have a breaking point. They may or may not be able to cope with the frustrations that interfere with their desire to be good doctors.”9 So, what will it take to recapture the “good” doctor in all of us?
I
A Uniquely Christian Opportunity Christian physicians have an opportunity that is not generally shared. If in fact we are dedicated to the idea of building up “a treasure in heaven that will not be exhausted, where no thief comes near and no moth destroys” (Luke 12:33), then we are by nature risk-takers. If we in fact make decisions based on moral and ethical principles, then we are willing to pay the price of decisions that further those principles. If love is what consumes us, and a dedication to the welfare of others motivates us, then (as much as it depends on us) we need to practice within the biblical and Hippocratic traditions of both loving our neighbor and being an advocate for our patients only. For some who are able, that may mean leaving the traditional system that finances medicine. “Opting out” of Medicare is the first step. In 1997, Congress passed legislation that allowed physicians to “Opt Out” of Medicare, and sign separate agreements with their Medicareaged patients. I did that in 1998; let me tell you why and how.10 I realized that the overhead cost of complying with all the Medicare regulations was increasing, with no end in sight.11 I realized that the expense of complying with these regulations was seriously affecting my ability to see nonpaying and low-paying patients. I also realized that I could avoid all of these regulations and expenses, and all of the legal and financial risks associated with these regulations, by electing to “Opt Out.” In addition, when I calculated the overhead cost of a visit, I realized that the net amount of reimbursement I got from Medicare did not always pay the cost of filing and compliance.12 I knew that by deciding to “Opt Out” I Christian was taking the risk of being physicians have considered an opportunity that is greedy, and losing not generally shared. If in my fact we are dedicated to the both Christian idea of building up “a treasure w i t n e s s and my in heaven that will not be practice. But I also exhausted, where no thief knew that comes near and no moth I could no l o n g e r destroys,” then we are continue by nature riskseeing Medicare patients if I did not takers. make a change of some kind. To refuse new Medicare patients seemed exclusionary, and to sever my existing patients seemed unethical. I wanted to find a way to continue to see Medicare patients based on their need and not on their insurance. Therefore, I decided to ask my Medicare patients to pay just what their visit cost me—my overhead costs. Since I did
not have to file a claim, I saved that cost and passed it on to my patients. I sent all of them a letter more than four months prior to “Opting Out,” telling them what I would charge them and that in the future they would need to pay me for my services. I also told them that if they could not afford to pay me, I would see them at no cost, for as long as they needed care, even if that meant a lifetime of care. I also let them know that while Medicare would not pay my personal fees, it would continue to pay for all of the lab, radiology and hospital costs I might order. What was the reaction I got? Two very wealthy patients became angry, and left. The rest said things like: “Is that all you are going to charge? That’s less than my deductible,” and “I had no idea Medicare paid you so little.” A number of patients could not afford even my reduced fees. The greatest problem I faced was convincing these proud but poorer patients that I would treat them the same as anyone else, and that they were not receiving “charity care.” My Medicare practice continued to grow because I gave Medicare patients a level of comprehensive care they received nowhere else. I had the time to deliver the kind of care they needed, rather than what Medicare said I should do. I felt like I was once again their advocate for quality care in a system
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that often treated them like a statistic. By the end of the year, because I had decreased my overhead costs and increased my efficiency by shedding the administrative burden, my net income had increased. While it is important to remain solvent, my motive was not to make more money. Rather, it was to return to a place in medical care delivery that I did not think was possible, a place where I did not feel like someone was always looking over my shoulder, telling me what not to do. Since I had never joined an HMO (due to what I felt was an ethical conflict in the motive for reimbursement), I had no other immediate concerns. I did leave a PPO plan the following year, when it treated me dishonestly, but otherwise nothing changed. I started to extend low-cost, fee-for-service care to uninsured and under-insured patients. That was also very personally rewarding. They appreciated finding a caring physician who was willing to give full-service care at a reasonable cost, and I appreciated their loyalty. If I were starting practice today, I would start out simply. I would join no managed care plans. I would “Opt Out” of Medicare, and concentrate on providing quality, low-cost medical care to that large group of patients who have no or little insurance, and desperately need good preventative care.13 I would trust God to show me how to be a missionary at home, in the same spirit that I would serve in a mission field abroad. I would remember how I would want to be treated, and treat my patients the same way. I would always remember what it takes to be a “good doctor.” There is something contagious about a physician who loves his work and loves the Lord. Pass it on! ✝
By the end of the year, because I had decreased my overhead costs and increased my efficiency by shedding the administrative burden, my net income had increased.
Footnotes 1. For a secular look at the emotional entanglements and problems of a security-dedicated life, see Who Moved My Cheese? Spencer Johnson, M.D. (G.P. Putnam’s Sons, New York 1998). This little book should be mandatory reading for all senior medical students. 2. For a more scholarly look at this issue, see Peter Jacobson Strangers in the Night: Law and Medicine in the Managed Care Era (Oxford University Press, New York, 2002) and Colin Gordon Dead on Arrival: The Politics of Health Care in Twentieth-Century America (Princeton University Press, New Jersey, 2003). 3. Nine major health insurance carriers have been accused of insurance fraud and RICO violations in the reimbursement of physician claims, based on the testimony of several “whistleblower” employees. A national class action suit was filed in California in 1999 by the REPAIR Team, a group of attorneys who have previously won suits against the tobacco industry. To date, Aetna has settled. Blue Cross/Blue Shield has “vowed to fight to the death.” See also footnote 10, below. 4. Op cit, Jacobson (2002) and Gordon (2003). 5. It is important to note that Congress authorized all managed care in the United States in the 1973 Managed Care Act. In the absence of this legislation, current managed care operations would be in violation of the Sherman Anti26
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Trust Act and at least 11 other federal laws governing business. This led a well known national authority to quip: “If it [a decision concerning medical care delivery] makes good business sense, it is probably illegal.” AAPS News (October 2003). 6. For additional information, see Curtis Harris, M.D., “Physician Heal Thyself” (CMDA four CD-ROM set: “Medicare Fraud and Abuse Law.”) 7. Archives of Internal Medicine 163:2681-2686 (December 8/22, 2003). Christ defined the “good servant” as one who is “faithful with a few things.” Compared to the endless possibilities in all of creation for both good and evil, how small a thing is it to be faithful to our professional dedication to do the best for all our patients? 8. Hurst, op cit., 2685. 9. Ibid. 10. For more information see Harris, “Physician Heal Thyself”, op cit. 11. The average cost of filing a Medicare claim today is $22.00 (Based on data from AAPS, 2003). HIPAA Privacy and Coding laws are estimated (based on data from AAPS and The American College of Legal Medicine, 2003) to add expenses of over $25,000 per year to the average primary care medical practice, which will increase the cost of a claim (on the average) by $5.00 per claim, for a total current cost of $27.00 per claim. When I elected to “Opt Out” the average cost per claim was $16.00. 12. Based on a survey of similar practices I conducted in 2001, the average Family Practice physician in a middle-income practice area in my home state and city, Oklahoma City, Oklahoma, needs to generate over $58.00 per 15-minute visit. The average specialist in internal medicine must earn between $68.00-98.00 per 15-minute visit, based on the specialty. (It is important to note that these calculations include “no-shows” and unscheduled more extensive [time-consuming] appointments that are part of normal scheduling.) Medicare will typically pay 35-45 percent of that amount, when you consider the actual administrative and medical care time spent on any one individual patient. You can calculate your own overhead costs by looking at all of your annual expenses, excluding any money paid directly to you, and divide by the actual number of hours you spend seeing patients in a year. 13. This style of practice has a name: Curtis E. Harris, M.S., M.D., J.D., “Simple Care. “More information is is the Chief of Endocrinology for the available on the Internet, from the Chickasaw Nation, a Clinical Instructor Association of American Physicians and at the Oklahoma University College of Surgeons (AAPS) at www.aapson- Medicine, and an Adjunct Professor of line.org. I realize that not every Law at Oklahoma City University specialty or every practice situation is School of Law. He has been a Trustee conducive to this practice style. If you for CMDA since 1996. He lives in Ada, can opt out of mainline medical care Oklahoma with his beautiful wife Patty, financing, I would recommend you do and has three children and four grandso. It is a great way to recapture the joy. children.
One Doctor’s Story Robert S. Berry, M.D. Three years ago, I left ER medicine to establish a primary care clinic in a town of about 15,000 in northeast Tennessee– primarily for the uninsured, but also for anyone willing to pay me for my care at the time of service. I named the clinic PATMOS EmergiClinic–for the island where John was exiled and an acronym for “payment at the time of service.” I have no third party contracts . . . not commercial, not Medicare, TennCare or worker’s compensation. My practice today has over 4,000 patient charts. My patients are typically between 5-50 years old, but I do have a significant number of Medicare patients. A year ago, over 95 percent of the patients I saw had no insurance. Today, that figure may be 75 percent. But even those with insurance learn a simple lesson when they come to me: health insurance does not equal healthcare, at least not in my clinic. I clearly tell my patients how much a visit will cost. Everything is up front and honest. I will prepare a billing claim for my patients with insurance, for a small fee, but I expect them to pay me when I see them. Because I only need one employee in my office, my costs are low. For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges. I am the best bargain in town. My income last year was about average for an ER doc—not great—but I’m free and having fun. If I can do it, caring for the uninsured in a small rural town, any doctor can. As I see it, the real question is: Are we going to be Hippocratic doctors? What are we as physicians going to do about the uninsured? They are neither destitute nor derelict, and they pay their bills. They need our help, but they seem to be used only as pawns in a political attempt to garner public support for single payer healthcare. I hope Christian physicians will care for all people in need, to prevent the ever-increasing depersonalization of medicine. After all, we worship the ultimate Person and serve those made in His image. I encourage you to entrust your professional future to a faithful Creator in doing what is right.
Internet Web site:
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How disability birthed deeper trust in the ability of God
HIS GRACE IS SUFFICIENT FOR ME by Alison LaFrence, M.D.
T
he year 2004 marks an anniversary for me. For ten years I have served as a crisis pregnancy center (CPC) volunteer. During that period of time, I have also been brought to my knees by the thorns of a life-changing disability. The Lord has used these things to teach me the sufficiency of HIS grace. That clinic day ten years ago, was like so many others. I was over-booked and running late. The teenager in the next room, however, was memorable. She was pregnant and abortion-minded. As I held her hand and the tears flowed freely down her face, she poured out the emotions she had struggled to keep at bay over the previous several weeks. The ten-minute appointment soon stretched into an hour, as I became aware of my lack of counseling skills in this area. I left the room and looked up the number of the nearest CPC. After talking with the director of the ministry about their services, I sent the young woman over to the center for assistance. I kept this patient in my prayers that entire week. I took care of this teenager throughout her pregnancy and delivered her baby. On her post-partum visit, I asked about her experi-
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ence with the CPC. Smiling, she shared with me examples of the physical, emotional and spiritual ways she had received support. For me, this experience opened the door to the life-saving world of pro-life ministries. After finding out how few physicians in this area were involved, I jumped in with both feet and have never looked back. A decade ago, my physician-husband and I had busy practices and an enjoyable life. We were healthy, financially stable and we were thinking of having children. As Christians, we had gone on several short-term medical missionary projects, and were planning on future trips. We were both content when the walls around us came tumbling down. In August 1995, I woke up in an ambulance. In an ER in Wisconsin, I was told that I had had a grand-mal seizure while attending my family reunion. Thankfully, the CT of my head was normal. After a night of observation, I was discharged home. Over the following nine days I became quite ill and was once again hospitalized, this time with the diagnosis of viral encephalitis. Except for the unremitting, intense pain in my head, I remember very little of that first month. My bout with viral encephalitis caused three separate thorns of affliction in my life and resulted in a chronic disability. One way or another, each thorn pricks at my flesh on a daily basis. My first thorn is my seizure disorder. I had numerous grand-mal seizures between 1995-1996. On multiple medications, I have remained seizure-free since that time. Migraine headaches are my most troublesome thorn. These headaches occur every two to three days, despite seeing multiple specialists and utilizing numerous treatment modalities. The third post-encephalitic thorn is the most devastating. I
cannot overstate the negative impact of this injury on my life. However, I am also eternally grateful for this weakness. For it was this thorn that led to the process of my spiritual healing. Soon after recovery, I noticed difficulty with my speech and language (i.e. short-term memory, word finding, math). I developed coping skills and, unless I had a headache or was tired, my deficits were not too obvious. When the headaches became a daily event, in late 1998, my impairments became more evident. I took a leave of absence from work and saw a pain specialist, who ordered a neuropsychological test after observing
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my problem with communication. Taking this exam brought tears to my eyes as I (who had previously graduated near the top of my medical school class) was now shown the full extent of my cognitive disability. The test showed mild diffuse brain damage due to the encephalitis. My previously bruised self-esteem took an incredible beating. I felt like a broken physician, unable to help others, because my problems were beyond fixing, even by God. I attended a brain injury clinic in the summer of 1999. One-on-one classes were personally designed to maximize my abilities. To accomplish this, I first had to acknowledge my deficits. I also needed to open the door again to the Lord’s grace and healing power. In 1999, I was asked to join the board of directors of one of the local CPC’s. As a Christian, I considered this offer both an incredible honor and an opportunity for service. However, my thorns were weighing me down like a mighty ball and chain. Instead of being filled with happiness, becoming a member overwhelmed me with a feeling of dread. That year, both my self-esteem and my communication
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skills were at the bottom of the barrel. I had just started new medications for my headaches and though feeling better, the side effect of significant fatigue was quite problematic. My first inclination was to decline the board’s offer. However, my speech pathologist encouraged me to reconsider. After prayer and discussion with my husband, I accepted their invitation. For the first several months I said only a few words per meeting, until my confidence improved. By the end of the first year, I was talking in sentences with this godly group of individuals, who had now become my friends. A remarkable event happened at the end of my second year (2001). The board president moved away and a new election of officers was held. I was elected vice president of the board. A physician, full of thorns, including difficulty with communication skills, was now the vice president of the board of a Crisis Pregnancy Center. I remember thinking at the time: I am so thankful that the role of vice president is a backup position on the board (only to fully function if the president was incapacitated or died.) Therefore, I will not have to do a lot of talking with this commitment.
I was quite mistaken, because our Lord had different plans in mind. During the past several years, my association with this CPC (and several others) has led to the recovery of most of my language skills. For the past 10 years, I have volunteered in multiple aspects of the pro-life ministry. I did this as my health allowed and most importantly, as led by our Lord to do. Ten years ago, I was a busy Christian physician who placed a high value on her intelligence (how else could I have gotten through medical school?). A disabling illness, the thorns of which wounded my most valued asset, brought me to my knees. Our loving Lord reached down and healed my soul by intertwining my life with that of the unborn. Through suffering, I have learned so much during this past decade. The most important lesson, however, is that HIS GRACE IS SUFFICENT FOR ME. �
Alison LaFrence, M.D., is a volunteer Family Physician. She currently is working as the Interim Executive Director of the Alpha Crisis Pregnancy Center and Maternity Home, Savage, Minnesota. She and her husband, John Edwards, M.D., travel to Cameroon, Africa for four to six weeks a year as medical missionaries.
Internet Web site:
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Advertising Section Pakistan - Christian physicians urgently needed for ST/LT in rural Shikarpur Christian Hospital: female (GP/FP, OB/GYN, GS) for OB/general; male/female pediatrician, OB/GYN for ST teaching GYN surgery. Contact Bill Bowman, MD; 714-963-2620; drbillbow@aol.com.
MISCELLANEOUS
Christian Dentist in a busy general practice is seeking a Christian Dentist as associate or partner. Great opportunity for the right person. Hope to achieve more balanced life with more time for family and 3rd world missions. Offers hiking, skiing, mountain biking, fishing, and other outdoor activities. Lilian Jaime, DMD; 505294-7016. 352/0647/2318
351/0361/2302
The Lord is at work at the mission hospital, Hospital Loma de Luz. We are in need of longterm (1 year or greater) missionary Family Practitioners or RN’s. If He is calling, please answer. Cornerstone Foundation 877-277-8663; cornerstone@ametro.net; www.crstone.org.
Johnson County, KS. Immediate opening for a Dentist 4 days a week Experience is necessary. Modernly equipped, excellent patient base, fulltime productive operation. Please contact Dr. Paul Mabe at 913-707-5337 or pmdds@comcast.net. 334/0617/2244 Group Practice - California. Seeks Christian general dentist and orthodontist to join partnership. New building and equipment, high technology, 10 chairs, surgery and ortho suite. Established community in central Orange County. Fax resume to 714-505-4503. 352/0649/2321 Our well-established group practice is seeking a caring, motivated Christian dentist wanting to locate in the beautiful Pacific Northwest (Yakima, Washington). Excellent opportunity leading to partnership. 509-965-0080. 352/0650/2322 Endodontist - Practices for Sale. Established practice in southern Colorado expressing Christ’s love through the practice of endodontics. Stellar community for family. Priced at one year’s net plus tangibles. Contact Dennis Ray Gimlin; 719351/0636/2306 544-7241; drgimlin@comcast.net. Excellent opportunity for competent dentist to join a practice in beautiful Williamsport located in central Pennsylvania. Associate status for a couple of years, then buy out retiring general dentist. Area needs dentists. Contact Dr. Boyd at 351/0569/2298 570-323-6116.
Certificate of Knowledge Exam in Clinical Tropical Medicine and Travelers’ Health
352/0311/2310
POSITIONS OPEN OVERSEAS MISSIONS Ghana - Year-round opportunites for medical service, most specialties, ST/LT. Baptist Medical Center in ‘brush’ of NE Ghana with 3 full time MDs on staff. Busy Clinic & Surgical service. Non-medical opportunities too. Email; hct@africaonline.com.gh; Danny Crawley, MD. 352/0645/2316
LAMB Hospital, Bangladesh, needs pediatrician December 04-May 05, obstetrician/gynecologist August - November 2004; short or long-term Internal Medicine/Family Practice physician with interest in hospital work. Contact InterServe USA at interserveusa@xc.org; 1-800-809-4440.
Mongolia: medical advisor needed for Christian umbrella organization (JCS International), with about 100 staff. Primary care physician, physician’s assistant or nurse practitioner acceptable. Term of service six months to long-term placement. Opportunities for ministry among local physicians as well. Please contact Berys at Berys@jcsintl.org or phone: 011-976-11-452465 or 352/0640/2311 fax: 011-976-11-452468.
The American Society of Tropical Medicine and Hygiene (ASTMH) will conduct its Examination Leading to a Certificate of Knowledge in Clinical Tropical Medicine and Travelers’ Health on November 6, 2004 at the Fontainebleau Hilton in Miami Beach, Florida. This exam assesses and recognizes individual excellence in training and knowledge in clinical tropical medicine and travelers’ health.
ASTMH is the principal organization in the United States representing scientists, clinicians and others with interests in the prevention and control of tropical diseases based on research and education.
T o d a y ’s C h r i s t i a n D o c t o r
MEDICINES
FOR MISSIONS
352/0646/2317
For a brochure with exam details and application form, visit http://www.astmh.org or send your request to ASTMH, 60 Revere Drive, Suite 500, Northbrook, IL 60062 USA, phone 847/480-9592, fax 847/480-9282, astmh@astmh.org.
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Dermatologist - Incredible opportunity for BC/BE dermatologists. Established opthalmology practice (60 years) with oculoplastic surgeons in brand new 33,000 sq. ft. facility seeks a BC/BE dermatologist for existing cosmetic practice. New Sciton and Candella lasers, two laser technicians with 30 years combined experience. Seeking energetic, friendly, well-trained dermatologists. Competitive salary with incentive and
Whether short-term or full-time,
Blessings International assists Medical Missions by being a source for: 1. Pharmaceuticals and medical supplies 2. Expertise in selecting needed medications 3. Guidance in building medical teams and operating short-term clinics For a pharmaceutical application and bulletin, contact:
Blessings International P.O. Box 35292, Tulsa, OK 74146-0292 918-250-8101; info@blessing.org www.blessing.org
Paid Advertisement
DENTAL
Advertising Section 352/0638/2308
Family Practice - Well established Christcentered, 6 Dr. FP Clinic in Bozeman, Montana seeking a colleague interested in doing OB. Start date is approx. Aug., 2004. Call is light approx. 3 weekdays per month, & every 8th weekend. Good compensation includes vacation, insurance, CME allow., production incentive, and partnership after initial employment. We provide an envirmonment in which to share the love of God through Christ with patients and staff. Short-term missions encouraged. Great family oriented community 90 mi. north of Yellowstone Park offering excellent Christian schools and many mountain recreation opportunities. For more info. contact Marsha Bolin, administrator; 406-587-4242; 344/0628/2245 fax CV 406-587-3507. FP or IM - 2-year old unashamedly Christian practice desiring two partners. Orlando, near ministries including Campus Crusade. Dan Goddard; fax 407-275-8775; e-mail hisquiver@bellsouth.net. 352/0644/2315 General Internist in multispecialty group interested in bringing half time general Internist to share job. Has been in practice at this location for 11 years and has a full practice. Group policy would allow overhead and call split. Call would be one in ten. Office hours would be 2 1/2 days per week. Initial salary possible as well as eventual group partnership. Excellent opportunity for physician wanting more time with family, service activities and Colorado recreation. If interested, please contact me at 970-635-9593 or e-mail at doul352/0639/2309 gaswebster@mindspring.com. Neurologist, Hospitalist - North Carolina. Sandhills Neurologists, PA is seeking BC/BE Hospital Neurologist. Fellowship in Stroke welcome, but not required. Busy practice of two neurologists interested in the physical and spiritual needs of the patient. Located in South Central NC. World renowned golfing resort, family-oriented community with large draw area. Approx 2.5 hrs from beaches and mountains. Contact Rose with Christian Medial Association. Phone 888-878-2133 or e-mail 352/0581/2319 rose@placedocs.com. Orthopedic Surgeon needed to join a six physician orthopedic practice committed to providing orthopedic care with compassion as well as excellence. Time off for short term missions supported. Kearney Orthopedic and Fracture Clinic would like to talk with general and subspecialty orthopedists about the possi-
bility of joining us in practice. The clinic has been in existence 30 years. Clinic owns an onsite, JCAHO accredited Surgery Center. The Clinic and Good Samaritan Hospital are cosponsors of the Nebraska Joint Replacement Center. Good Samaritan Hospital (207 beds) and its staff of 130 physicians provide tertiary care to a largely rural population in Central and Western Nebraska and Northern Kansas. Kearney, NE, is home to the University of Nebraska Kearney, the Museum of Nebraska Art, USHL hockey team, NIFL football team, the Great Platte River Road Archway Monument and Good Samaritan Health Systems. We can help with financial aspects of relocation, sub-specialty training and/or school loan repayment. Please contact our Medical Director, Dr. Steve Brestin at 308-8651407 or sbrestin@kofc.kearney.net. Our business manager, Vicki Aten, can be reached at 308-865-2512 or vaten@kofc.kearney.net. 342/0467/2119
Pathologist - NE Tennessee. Seeking Pathologist for growing practice with two Pathologists. Small city, beautiful Appalachian foothills, many lakes, near mountain hiking/skiing. Hospital-based with extensive outpatient practice. Send CV: RKnapp@pathgroup.com; 423-857-7156. 352/0642/2313 Paid Advertisement
partnership track (3 years). Opportunities unlimited. Contact Herby Pierce at 423-9292111.
Pediatrician - Join 2 other pediatricians in this thriving rural practice. Candidate should be a well-trained pediatrician with a passion for Jesus, a compassion for the poor, and an urgency to redeem a generation of children for Christ. Our facilities are new and our medical records are computerized. Our support staff is excellent. Hospital is rated among the top 20 small hospitals in the country. Call is 1:3 with no C-sections. Keith Tolar, M.D.; The Children’s Clinic, 183 Prosser Road, Lawrenceburg, TN 38464; 931-762-5988; 351/0632/2299 www.drtolar.yourmd.com. Pediatrician & Internal Medicine physicians needed in a growing Northwestern Arizona community. Excellent opportunity. Within easy reach of large metropolitan cities. Fax CV to Linda at 928-692-1911; phone 928-6921424. E-mail; rickvu@yahoo.com. Please, no J-1 visa applicants. 352/0643/2314
POSITIONS WANTED Wanted to buy. A Christian Physician is interested in buying a family, general, internal medicine, or urgent care practice in Los Angeles or Orange county California. If you are selling your practice, please contact: 323846-4509; fax 562-869-9547. 352/0651/2323 Internet Web site:
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Advertising Section GENERAL SURGERY Alabama (MS-226). Solo Practice, very flexible schedule and hours. Colorado (SG-227). Single-specialty group. Kansas (SG-237). Independent practice; single specialty group. Inpatient & Outpatient. Louisiana (SG-240). Single specialty group with call schedule 2 days per week; weekends 1:3/1:4. Michigan (SG-210). Providing gastrointestinal endoscopy and broad-spectrum non-vascular general surgery including laparoscopy. Call schedule 1:3. (MS-244). Multi-Specialty, independent practice, required Endoscopy abilities. Call schedule 1:4. (SG-236). Independent practice; single specialty group. Ohio 6 opportunities. (MS-150), (SG-206), (SG159), (SG-225), (MS-259), (SG-239). Texas ( SG-216). Independent, single-specialty group, inpatient-outpatient, Call schedule 1:3.
North Carolina (SG-120). Single-specialty group. Call schedule is 1:5.
Contact Cathy Morefield, CMDA Placement Service at 888-690-9054, fax CV to 423-844-1005; or e-mail: cathy@cmdahome.org
UROLOGY
Openings in GA, IL, KY, MI, MN, NC, PA, OH, TN, WA
Illinois (UR-112). Established Christian SS group. Earn in top 10% of all urology incomes.
MID-LEVELS
Additional Opportunities in Every Specialty! Contact Aaron Paulus at 888-690-9054, or e-mail: ajpaulus@cmdahome.org
Openings in AZ, CA, FL, GA, OH, OR, TN, TX, WA, WI
OB/GYN Openings in CA, CO, FL, GA, IA, IL, IN, KY, MD, MN, MO, NV, NC, OH, OK, PA, TN, VA, VT, WA, WI
PEDIATRICS Openings in Bermuda, CA, FL, GA, IL, IN, NM, NC, OH, PA, SC, TN, VA
PSYCHIATRY Openings in AR, FL, ID, IL, MN, NE, TX, WI
ANESTHESIA
Openings in AL, MO, NC, OH, TN
Illinois (AN-139). Single-specialty group of 18 physicians. Call schedule rotates.
ORTHOPAEDICS Arizona (OS-188). Independent practice, single specialty group, Call currently 1:2. California (OS-191). Independent, singlespecialty group. Inpatient & outpatient. Call schedule 1:11. Colorado (OS-192). Independent, singlespecialty group. Inpatient & outpatient. South Carolina (OS-172). Independent Christian practice. Excellent benefits and compensation. Texas 2 opportunities. (OS-193), (MS-143). Washington (OS-163). Independent, single specialty. Orthopaedic Spine and/or Orthopaedic Hand. Call schedule 1:5 & 1:4.
VASCULAR Minnesota (SG-221). Vascular Surgery opportunity in central MN. Call schedule 1:5.
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INTERNAL MEDICINE Tennessee (IM-245). Established, Christian, SS group located in Knoxville. New offices. Busy practice. Ideal area to raise a family.
MED/PEDS
Washington 6 opportunities. (SG-202), MS-207). (SG-205), (SG-238), (SG-243), (Sg-195).
Southern California (AN-138). Independent, single specialty group. 4 physicians. Call currently is 1:3.
Pennsylvania (ON-108). Established Christian practice. Spiritual emphasis with patients. Ideal place to raise a family.
NEUROLOGY OPHTHALMOLOGY Openings in MI, SC, TX, WV
NEONATOLOGY Kentucky (NEO-102). Independent, hospital owned practice seeking 2 full-time Neonatologists in order to cover the services 24 hours a day, 7 days a week. This hospital has the largest delivery service in the region and is able to handle many high-risk pregnancies locally with the daily average increasing.
Contact Rose Courtney: 888-878-2133; fax CV to 423-844-1005; or e-mail rose@placedocs.com.
GASTROENTEROLOGY Florida (GI-133). Family oriented coastal town. Call 1:4. Established Christian practice.
CARDIOLOGY
EMERGENCY MEDICINE South Carolina (MS-267). Primary/Urgent care clinic seeks Christian EM or FP physician. Free to witness and share faith. Only 15 minutes from Charleston.
PHYSICAL MEDICINE & REHAB Iowa (PR-107). BC/BE physiatrist needed to join another Christian physiatrist in a multi-specialty group in south central Iowa.
Contact Gloria Gentry, CMDA Placement Service at 888-690-9054, fax CV to 423-844-1005; or e-mail: gloriag@cmdahome.org
FAMILY PRACTICE Central Arizona (FP-919). Outpatient only practice located near Phoenix area seeking FP, no OB. West Central Florida (FP-564). FPs, no OB, needed for single specialty group that desires to expand and become more mission oriented. Inpatient/Outpatient required. Eastern Pennsylvania (FP-908). Practice located northwest of Harrisburg searching for FP, no OB. Inpatient/Outpatient. Call: 1:4. Northern Minnesota (FP-928). Independent multi-specialty practice consisting of 24 physicians is seeking to add 1-2 full-time Family Practice physicians, OB optional.
Chicago (CD-124). Interventional or invasive cardiology. Established patient base. Familyfriendly suburb.
Hawaii (MS-243). Community Health Clinic searching for FP to join medical director and nurse practitioner on beautiful rural island.
California (ON-114). Solo opportunity. Beautiful area & Hospital. Christian environment.
Contact Allen Vicars for more information: 888-690-9054; fax CV to 423-844-1005; or e-mail: allen@cmdahome.org.
HEMATOLOGY/ONCOLOGY
REQUEST YOUR FREE SAMPLER
to help new parents raise spiritually healthy babies. Your expert advice helps parents provide for their baby’s physical growth. Now you can help first-time moms nurture their baby’s spiritual growth too! Offer them a FREE sampler of the Top 20 Tips for New Moms. It’s taken directly from the new book First-Time Mom, written by respected family psychologist, Dr. Kevin Leman. First-Time Mom is a comprehensive handbook that helps new parents create a nurturing home while establishing a spiritual foundation. They’ll get answers to their non-medical questions about the essentials of child rearing written in Dr. Leman’s witty, common-sense style.
Dr. Kevin Leman An internationally-known family psychologist and best-selling author, Dr. Kevin Leman has been a guest on numerous radio and television programs including Oprah, Today, The View, and Good Morning, America. His guest appearance on Focus on the Family with James Dobson has become the third most-requested taped program in their history, and his parenting books include the best-selling The New Birth Order Book.
Order your FREE First-Time Mom samplers for your waiting room or to distribute to your patients. To order, call Jacki Vietmeier at 1-800-323-9400 ext. 5465 or e-mail firsttimemom@tyndale.com. (Limit 100 free samplers per physician.)
Internet Web site:
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addition to spiritual growth, In His Image Family Practice “ InResidency has given me indepth medical training. We have traditional teaching rounds at the hospital and one-on-one clinical precepting. One afternoon each week is devoted to medical lectures, morbidity and mortality presentations, journal club and board review. I've been well prepared in the sorts of procedures that are needed in the U.S. as well as overseas. We get a variety of hands-on experiences and training from Family Practitioners and numerous subspecialists. Frequently in our Family Practice clinic I do exercise treadmill tests, colposcopies, and flexible sigmoidoscopies. In the hospital I've done multiple central lines, delivered numerous babies, and performed various other in-patient procedures. Residents have the option to do elective rotations and receive extra training in various fields and procedures of personal interest like C-sections. In His Image has given me the ability to learn and the encouragement to do so.
�
- Rodney Burrow, M.D.
CHRISTIAN MEDICAL P.O. Box 7500 Bristol, TN 37621-7500
& DENTAL ASSOCIATIONS
Nonprofit Org. U.S. Postage
PAID Bristol, TN Permit No. 1000