Med Monthly January 2012

Med Monthly January 2012

CLIMBING THE MEDICAL LADDER

the

n i s r e e r a c icine medsue is

A look at the “medical hierarchy”

Economics at the heart of

NEEDED:

MORE RESIDENCY SLOTS BUT WHO WILL PAY?

SEMI-RETIREMENT

Another option for aging doctors



CAREER DIRECTION FOR TODAY’S DOCTOR

contents features 24 WE NEED MORE RESIDENCY SLOTS

Artist feature

But who will pay for them?

26 THE DRUG SHORTAGE

And how economics play a role

28 PERSONAL CAREER INVENTORY A physicians worksheet

30 CLIMBING THE MEDICAL LADDER

42

research and technology 8 PULMONARY FIBROSIS CONFERENCE 10 ADVANCES IN PRENATAL CARE

An older doctor looks at “medical hierarchy”

practice tips

34 STANDING AT THE CROSSROADS

12 SUCCESSFUL PRACTICE MANAGEMENT

Career direction for today’s doctors

38 RETIREMENT OPTIONS FOR DOCTORS

14 PROFITABLE DENTISTS EARN MBAs

legal 22 OIG ONLINE SERVICE

26

Drug shortage

careers 16 CHOOSING A LOCUMS COMPANY 18 CAREERS IN MEDICAL CODING 20 NOTES FROM AN EXPERIENCED NURSE

the arts 42 THE ART OF SCIENCE

the kitchen 44 CRUMBLESS PUMPKIN PIE

in every issue 4 editor’s letter 6 news briefs

50 resource guide 62 top nine

COVER PHOTO COURTESY ISTOCKPHOTO

Our secret weapon against smoking?

Each other.

I first lit up a cigarette when I was 9. I started smoking at 16 and smoked for 15 years. When I wanted to quit, I found out the average person takes 3-4 efforts to quit because nicotine is so powerful. I learned that if you pick it up again, it’s part of a process. It’s not that you failed, that’s just how it works. When I finally quit, I had more weapons to help me — my pills, my support and my nurse practitioner to talk to. Now we have Tobacco Free Nurses to help, too.

Tobacco Free Nurses is a one-stop shop for all nurses, especially nurses who want to help their patients quit smoking and nurses who want to quit themselves. We are nurses who want to benefit nurses and patients, and promote a tobacco free society. Please visit our website or call for further information.

Toll Free: 877-203-4144 | www.tobaccofreenurses.org Support for the Initiative was provided by a grant from the Robert Wood Johnson Foundation in Princeton, New Jersey, to the School of Nursing, University of California, Los Angeles in partnership with American Association of Colleges of Nursing, American Nurses Foundation / American Nurses Association, and National Coalition of Ethnic Minority Nurse Associations.

Photo: Todd Pickering

— Maria, RN

editor’s letter

H

appy New Year medical professionals! 2012 promises a great deal of excitement and change for those of you working in health care, which is why we chose careers in medicine as our theme for January. This edition covers all aspects of the career path: from starting a residency to retirement and life after medicine – complimented with stories tackling the many steps in between. Our articles will provide useful tips on how to keep motivated and on track despite the many burdens carried by today’s health care professional. New career fields have emerged in recently established sectors of the industry brought by technological advances and creative efforts to increase patient satisfaction. January also delves into relevant topics affecting the field including costly drug shortages and the desperate need for additional residency slots.

At Med Monthly, we strive to be a required resource for all realms of health care – nurses, physicians, dentists – providing a little something for everyone. This month, we hear from Mary Pat Whaley on what it takes to be a successful practice administrator, Suzanne Leder shares specifics in coding techniques that allow the savvy physician and practice manager opportunities to increase their practice revenue while Tera Tuten provides aspiring nurses with insight from seasoned professionals regarding a career path in nursing and medical assistance. Charles Bankhead explains why the shortages that arise in the generic drug market are caused by their low profitability. Ed Logan details a business plan for success that applies to dentists as well as physicians.

Heather Fork, MD, is a physician wellness coach and a former dermatologist who has dedicated her career to helping doctors find fulfilling work and deal with the stress associated with practicing medicine. Dr. Fork’s company, The Doctor’s Crossing, helps physicians avoid dissatisfaction and rediscover their passion for life, leading them to find the happiness and balance that they deserve. In our cover story, “Standing at the Crossroads”, Dr. Fork explains why physicians are prone to dissatisfaction in their careers, and she offers suggestions and advice to those of you who may be considering career enhancements and options. And a perfect bookend to these topics on keeping satisfied with your career is Normal Morris’ motivating glimpse as a semi-retired physician who offers wise advice to senior doctors who cannot fathom retirement or cutting back from a practice.

To all of our loyal readers – regardless of the stage your career is at – thank you for making Med Monthly the most informative, resourceful and widely read publication in health care. My hope is that you will continue to turn to us for accurate industry coverage, encouragement and the occasional laugh when you need it. After all, we’ve heard laughter is the best medicine.

Enjoy our January issue: Careers in Medicine.

Thank you,

Leigh Ann Simpson Managing Editor

4 | JANUARY 2012

contributors

Med Monthly January 2012

Publisher Managing Editor Contributing Editor Creative Director Contributors

Marketing Manager

Philip Driver Leigh Ann Simpson Mollie Doll

Nancy Jo Reedy, RN, CNM, MPH, FACNM has been in continuous nurse-midwifery practice for more than 35 years and has served on the Board of Directors for the American College of Nurse-Midwives and the Board of Trustees for the ACNM Foundation.

Courtney Flaherty Mary Pat Whaley, FACMPE Kimberly Licata Edward Logan, DDS Ashley Acornley, MS, RD, LDN Suzanne Leder, BA, M. Phil., CPC, COBGC, Nancy Jo Reedy, RN, CNM, MPH, FACNM Tera Tuten Robert Centor, MD Charles Bankhead Norman Morris, MD Stella Fitzgibbons MD, FACP Steve Babitsky Daniel Rose, MD Will O’Neil

Med Monthly is a national monthly magazine committed to providing insights about the health care profession, current events, what’s working and what’s not in the health care industry, as well as practical advice for physicians and practices.

We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at medmontly.com/writers-guidelines P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

Norman Morris, MD is an Australian obstetrician and gynecologist who has led a varied professional life. After attending Medical School in Britain, he returned to his home town of Melbourne where he practiced privately and taught at Monash Medical Centre for many years. His semi-retirement has enabled him to work in several different settings, including tropical Australia and Nepal.

Mary Pat Whaley, FACMPE is board certified in health care management and a Fellow in the American College of Medical Practice Executives. She has worked in health care and health care management for 25 years. She can be contacted at marypatwhaley@gmail.com

Kimberly Licata is an attorney at Poyner Spruill, who practices health law and participates on the Firm’s Emerging Technologies and Privacy and Information Security teams. She may be reached at klicata@poynerspruill.com or 919783-2949.

Edward Logan, DDS is a general and cosmetic dentist practicing in O’Fallon, Mo. Dr. Logan graduated from the University of Washington School of Dentistry. After years of learning the business side of dentistry, Dr. Logan decided to write a book. “Dentistry’s Business Secrets”. You can read more articles by Dr. Logan at his website DentistrysBusinessSecrets.com MEDMONTHLY.COM |5

news briefs

Researchers Close to Making Brain Cancer Less Fatal Cancer researchers have found success in clinical trials that aim to find a vaccine for glioblastoma, a very aggressive type of brain cancer that is usually fatal. Researchers hope this vaccine will end the fatal reputation of this disease, not by curing or preventing it, but by converting it into a chronic condition that can be managed, allowing the patient to live the rest of their life normally — like diabetes or cardiovascular disease.

“This is the future of cancer therapy, says Richardo Kennedy, a neurooncologist at Sylvester Comprehensive Cancer

Center. “Radiation and chemotherapy fight the cancer but they also kill normal cells, and they’re toxic. This vaccine kills the cancer without harming normal tissue.”

The vaccine was developed at the University of California at San Francisco nearly five years ago. Phase I clinical trials were so promising that the FDA recently gave the go-ahead for researchers to begin Phase II trials. If their progress continues through Phase II and Phase III, the FDA could give its final approval within three or four years.

MEDICARE WILL COVER OBESITY SCREENING AND COUNSELING The Centers for Medicare & Medicaid Services (CMS) announced that in 2012 Medicare will begin paying for “preventive services” related to obesity. The obesity coverage program was initially proposed by CMS last September; it is expected that over 30 percent of Medicare beneficiaries will qualify.

During the announcement of the new coverage policy, CMS linked obesity to “many chronic diseases, including those that disproportionately affect racial and ethical minorities, such as cardiovascular disease and diabetes.

Addressing the prevention of obesityrelated disparities has the potential to reduce obesity prevalence while also closing the gap on health disparities among Medicare beneficiaries.”

6 | JANUARY 2012

The program will provide individual screening and counseling to Medicare recipients with a body mass index that is greater than or equal to 30, with no copayment required. During the first month patients begin weekly one on one sessions with a primary care provider followed by biweekly meetings for five months. These counseling visits will include dietary and exercise assessments as well as intensive behavioral counseling therapy to change habits and encourage participants to lose weight. Patients who lose at least 6.6 pounds (3 kilograms) of weight during the first six months of the program will then qualify to continue their counseling once a month for an additional six months in hopes of sustaining their progress.

Avatar International Expands Patient Experience Offerings Avatar International, a leading health care quality improvement firm, announced its acquisition of HR Solutions International, Inc., a human capital management consulting firm specializing in employee and physician engagement. The industry’s only thirdparty, HIPAA-certified patient experience vendor, Avatar provides clients with customized surveys and actionable data reports that track a patient’s journey from admission to discharge.

Chicago-based HR Solutions, which serves a wide range of industries, derives about half its revenue from health care customers. The firm designs surveys and administers them primarily through email and web-based channels. Customers access the data through an online reporting tool that provides detailed and customizable results as well as actionable recommendations.

“We are excited to join the Avatar team to offer our clients a leading-e��������������������� dge customer measurement tool. Through the acquisition, we will obtain the resources that will fund additional research to expand upon our service offerings and permit advancements to our online survey reporting and action planning technology,” said Kevin Sheridan, CEO and Founder, HR Solutions. “The forging of the two firms shifts the entire industry focus away from the world of satisfaction to a results-driven emphasis derived from employee and customer engagement.”

The acquisition furthers Avatar’s strategic position as a comprehensive provider of patient experience solutions to hospitals, health systems and other health care organizations.

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research & technology

National Scientific Conference to Drive New Research Pulmonary Fibrosis Foundation hosts summit to improve understanding and communicate new information

I

n order to advance education and awareness of idiopathic pulmonary fibrosis (IFP) in the medical and patient communities, the Pulmonary Fibrosis Foundation (PFF) recently hosted a national scientific conference the IPF Summit: From Bench to Bedside in Chicago, Dec. 1 - 3, 2011.

The Summit was established to meet the growing need to communicate the most up to date information on IPF. The conference featured a variety of presentations from distinguished experts and offered a unique continuing medical education (CME) curriculum for an audience of 250 physicians, researcher and allied health professionals. The Summit also hosted a one-day patient, family and caregiver symposium that was attended by more than 200 individuals. “As a growing national organization, the success of the Summit only reinforces our commitment to becoming a leading provider of programs and services that have a positive impact on IPF patients, their families and the medical professionals who treat them,� said Daniel M. Rose, MD,

8 | JANUARY 2012

Daniel M. Rose, MD

President and chief executive officer of the PFF. According to the National Institutes of Health (NIH), pulmonary fibrosis (PF) is a condition that over a period of time causes the lung tissue becomes thickened, stiff and scarred. As the lung tissue becomes more damaged, the lungs lose their ability to transfer oxygen. As a result, the brain and other organs may not receive

adequately oxygenated blood. In some cases, doctors can determine the cause of the fibrosis, but in many individuals, there is not a known cause.

When there is no known etiology for the fibrosis (and certain pathologic criteria are met) the disease is called idiopathic pulmonary fibrosis. IPF affects approximately 200,000 Americans and an estimated 40,000 Americans die from the disease each year.

“Despite two decades of progress in understanding IPF, the diagnosis and management of this disease remains challenging. It is critically important that we provide innovative CME programs for IPF as part of our collective efforts to help these patients,” said Kevin Brown, MD, Faculty Chairman for the IPF Summit and Vice Chair of the Department of Medicine and Professor of Medicine at National Jewish Health (Denver, Colo.).

Managing IPF patients has long

‘‘

clinical trials in progress.

• Basic science research and understanding of IPF has substantially increased with a significant amount of new information available.

• Recent genetic and blood biomarker research may have significant diagnostic, prognostic and ultimately therapeutic benefit.

To meet the complex educational needs of those who treat this difficult and complex disease, the IPF Summit

As a growing national organization, the success of the Summit only reinforces our commitment to becoming a leading provider of programs and services that have a positive impact on IPF patients, their families, and the medical professionals who treat them.”

- Daniel M. Rose, MD, President and CEO of the Pulmonary Fibrosis Foundation.

been a challenge for the medical community. Proper diagnosis involves the integration of clinical, radiographic and pathologic information. In addition, despite a recent consensus statement from the American Thoracic Society (ATS) and European Respiratory Society (ERS), which recommends using an iterative diagnostic approach involving clinical and diagnostic information, physician surveys have found that many individuals providing care to patients with IPF are not familiar with the new guidelines, and patients are often initially misdiagnosed.

A longstanding need for the IPF Summit with a CME program is further reinforced by the following facts: • Pharmacologic and non-pharmacologic treatments for IPF are rapidly evolving with multiple

offered participants an exceptional curriculum designed to cover many aspects of IPF. The conference included symposia that discussed: Current research on the pathophysiology of IPF • • • • • • •

Genetic and peripheral blood biomarkers in IPF New and evolving therapies and regulatory issues A systematic approach to accurately diagnosing IPF Evidence-based treatments in the management of IPF Lifestyle management strategies to improve functional status Development of a comprehensive approach to the management of patients with IPF Indications and results for lung transplantation in IPF

“The ultimate goal of the Summit was to foster a collaborative environment of information sharing, so we can accelerate the process of identifying new approaches to treat, and ultimately find a cure for this devastating disease,” says Dr. Brown.

The Summit was hosted in accordance with the Essential Areas and Policies of the ACCME through the sponsorship of National Jewish Health. All scientific sessions, as well as the patient symposia, will be available for viewing online at the Pulmonary Fibrosis Foundation’s website, www.pulmonaryfibrosis.org in early 2012.

The Summit continues a year of progress for the PFF. Earlier in the year the Foundation announced the establishment of its Research Fund to Cure PF, with $200,000 in new research awards to be given in 2012.

Further details on the Fund, including investigator eligibility and application deadlines, are available on the Foundation’s website.

“With our funding of innovative medical education programs, and a renewed commitment to directly funding PF research, we hope to have a positive impact on improving future patient care and empowering the research community to identify new treatments for IPF,” says Dr. Rose.

Plans are already underway for the 2013 IPF Summit, scheduled for Dec. 5 - 7, 2013. For more information on the 2013 Summit, please visit ipfsummit.org The Pulmonary Fibrosis Foundation also offers patient education materials, patient support services and other resources for patients, caregivers and physicians. To learn more about the programs and services of the Pulmonary Fibrosis Foundation please visit pulmonaryfibrosis.org or call 888733-6741.

MEDMONTHLY.COM |9

research & technology

Prenatal Advances New technology helps nurse-midwives improve patient care

By Nancy Jo Reedy, RN, CNM, MPH, FACNM

I

’m pregnant! Who should I choose for my prenatal care – an obstetrician or a midwife?” More and more women are choosing to have midwives deliver their babies as about 8 percent of all births and 11 percent of vaginal births in the United States are now attended by midwives.

Certified nurse-midwives are registered nurses who have additional training and certification to provide nonsurgical obstetrics, gynecology and wellness care. Because of this, women can go to nurse-midwives for annual checkups, sick visits and prenatal care. This includes all the typical labs and other tests performed during pregnancy, the delivery of their babies in a hospital, birthing center or home, as well as postpartum care. The goal of a midwife is to get patients the right care at the right time. While expectant moms and babies are healthy and safe, they remain in the care of a midwife. But

10 | JANUARY 2012

for significant complications or for specialized care we cannot provide, midwives will consult or refer to an OB/GYN. Just as more women are choosing to go to midwives, the number of certified nurse-midwives in the U.S. is also on the rise. There are now 39 accredited midwifery education programs across the country. I can’t recommend this profession more highly for anyone who wants to experience the joy of caring for moms and babies.

The approach to midwifery is simple: pregnancy is a normal, healthy and wonderful event in a woman’s life. Nurse-midwives practice comprehensive medicine, going beyond clinical care to attend to many emotional and educational needs.

For example, we often help pregnant women prepare their older children for the new baby and work through other family transitions, even how best to deal with a dog when the baby comes home.

Nurse-midwives work with women

and their families in numerous settings. Some work in hospitals, staffing labor & delivery units 24/7.

Others work in private practices, either as a solo practitioner or with a group of midwives. Yet others staff clinics where women without health insurance can get prenatal care.

I started practicing more than 30 years ago and still love my job.

I work in a group practice in Fort Worth, Texas, where we deliver between 600 and 700 babies a year.

One thing that makes us unique is that our premature birth rate is less than half of the state average, even though we treat many low income women who are often at a high risk for prematurity. We are very proud of that and believe it pays tribute to the midwifery approach.

Prematurity is a worldwide public health epidemic and the leading cause of infant death. In the U.S., a baby is born too soon every minute – that’s over 545,000 babies every year. These “preemies” often face long hospitalizations and may suffer developmental delays or lifelong disabilities. I’ve seen the heavy emotional toll it takes on parents

and families. For the country, the economic toll of prematurity is $26.2 billion annually. In a profession dedicated to caring for pregnant women, these are the biggest challenges midwives face.

Until now, we have pretty much had to guess who would deliver early, but 2011 was a milestone year in obstetrics as we now have a powerful weapon in the fight prematurity.

Expectant mothers with a prematurely short cervix are at the highest risk for an early delivery. Recent research demonstrated that a vaginal progesterone gel can cut that risk nearly in half for women diagnosed mid-pregnancy with a short cervix.

This is a game changer, as the likelihood of premature birth can be lowered significantly with this treatment; we need to measure the cervical length of all pregnant women to find those who are at high risk and in need of this intervention.

Thankfully, there has also been an advance in technology that makes it possible for midwives – and obstetricians – to evaluate cervical length accurately during any prenatal visit.

The CerviLenz® device is used with a

speculum to directly measure cervical length.

This new device is my favorite addition to our practice in recent years. Now I don’t have to send as many patients out for a more expensive and complicated transvaginal ultrasound exam.

More often than not, a cervical length measurement reassures me and the mom-to-be that her cervix is long and she’s not at high risk of an early delivery. You can visit measure2besure.com to learn more.

With advances like cervical length measurements and vaginal progesterone to help us deliver more healthy babies, I can aid even more pregnant women in avoiding a potentially tragic premature birth.

I knew when I was six years old that I wanted to help deliver babies. I am passionate not only about caring for my patients but also for recruiting others to join this amazing profession through my work worldwide to offer and improve education for midwives. A great place to learn more about midwifery is the American College of NurseMidwives www.midwife.org.

9th Annual

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Also featuring recruiters and employers

practice tips

Finding Success in Practice Management

By Mary Pat Whaley, FACMPE

I

t’s not completely clear who the very first group practice administrator was, but most people attribute that honor to the inaugural administrator of Mayo Clinic, Harry Harwick, who was hired by Mayo in 1908 at the tender age of 19. He had come to Rochester, Minn., to work at the First National Bank of Rochester but was recruited

by Dr. William J. Mayo instead. Dr. Mayo and Harwick became the first documented physician-administrator team.

Despite this auspicious beginning, the profession of medical practice management has historically been unrecognized and largely misunderstood. Even the broadest definition of the field as “health services administration” has been translated by the general public into “hospital administration.” Today, health services administration, more commonly referred to as health care management,

12 | JANUARY 2012

includes professionals working in: • • • • • • • • • •

•

hospitals health systems physician organizations public health departments nursing homes home health agencies health insurance organizations health planning organizations healthcare regulatory bodies healthcare supply organizations (e.g., pharmaceutical, medical device and biotechnology companies) health care consulting organizations

The explosion of health care service organizations in the United States, the myth of the health care industry as “recession-proof ” and the well-publicized potential shortage of health care

workers at all levels, has led many people of all ages to seek first-time employment in the health care field.

Management of an independent medical practice has its perks Many people want to manage independent physician groups and take advantage of standard benefits – smaller work environments and work schedules conducive to being at home evenings, weekends and holidays.

Entry-level practice administrators need the basic skills of analytics and problem-solving, professionalism, collaboration and extremely good communication skills as a foundation to building a career. In addition, three key skills will make or break an administrator at any stage of their career:

1

Building relationships with physicians

I cannot over-emphasize how important it is to have a good grasp of what physicians have gone through to become physicians, and how to participate in the delicate dance that is co-managing with the people who own the business and produce the revenue.

2

Understanding technology

Technology advances will have significant impact on health care and your practice cannot be competitive without it. Managers must stay abreast of the changes and must understand how to implement and leverage technology.

3

Understanding reimbursement

It’s an unfortunate fact of health care that everything revolves around reimbursement – contracting, monitoring, coding, compliance, billing and more. Health care administrators must be able to understand and manage from a high-level strategy viewpoint as well as from a deep understanding of the details.

Many entry-level management jobs in healthcare are in small practices where the manager is required to be a Jack or Jill of all trades. This is superb training for an early-careerist manager who needs the hands-on experience to solidify knowledge and confidence. Basic knowledge in the following areas is required: • • • • •

human resources facility and equipment management supply and expense management legal accounting

• •

marketing strategic planning

People who are attracted to health care management are often missiondriven, and believe, as I do, that the manager’s expertise can positively impact both employees and patients’ lives. To be successful, you must enjoy the variety of tasks and projects that

To be successful, you must enjoy the variety of tasks and projects that cause a moment-to-moment shift of priorities and be willing to assume total accountability for everything in the practice except providing the medical care to the patient.

cause a moment-to-moment shift of priorities and be willing to assume total accountability for everything in the practice except providing the medical care to the patient.

How is the success of a practice administrator measured?

Practice management is a relatively young field and the programs that provide managers with education are still evolving. There is a complexity to practice management that involves a deep understanding of regulatory compliance, payer compliance and good business management. The success of the practice administrator can be measured as hallmarks of a wellmanaged practice:

•

•

•

• •

• • • •

•

•

The practice has foundation documents appropriate to the corporate structure and written agreements describing how income and expenses are shared by physicians and/or other providers and how partners enter and exit the practice. The owners of the practice and management meet monthly.

The practice has documents that set the guidelines for operations such as a compliance plan, disaster plan, personnel handbook, job descriptions and requirements for annual evaluations, raises, bonuses and progressive discipline. Management and staff meet monthly.

The net collection percentage is 95 percent or more. This means that of the expected collectible dollars, 95 percent is collected.

The practice has a budget and variances are addressed.

The unfilled appointment percentage is 5 percent or less. This is in retrospect, so it includes no-shows.

The practice has a marketing budget and a written marketing plan.

The practice has a line of credit or other means to draw upon in the case of unexpected cash flow drop.

A single commercial payer comprises no more than 50 percent of the practice business.

Employee turnover rate is 10 percent or less. New employees are onboarded with training, coaching and competency testing.

The practice has the ability to produce management reports to track and trend production, payments, adjustments and denials. Process Improvement (PI) is used to address negative trends.

Patient satisfaction is prioritized and measured. Improvement is valued.

MEDMONTHLY.COM |13

practice tips

The Profitable Dentist Earns an Honorary MBA

By Edward M. Logan, DDS

P

ractice management is an area of dentistry that is in great need of expertise; dentists need to learn strategies to improve the profitability and gratification of their businesses. Less than 2 percent of our graduate school education covered themes related to business, it seemed essential to make this limited exposure count. However,

14 | JANUARY 2012

most of the course time in these business related classes is spent learning how to work with a dental assistant performing four-handed dentistry.

Business start-up, growth and management were given cursory attention, yielding yet again to the dental school’s central imperative, training graduates for clinical excellence.

Dental schools are charged with the

unique responsibility of adequately preparing all of us to deliver standard of care dentistry to millions of people.

Their goal is to ensure that, clinically, we can all pass muster. Our well-meaning instructors hold hopes that all of us who choose to, will be successful in running a private practice; it is just not incumbent on them to assure that we will.

The profession of dentistry is vastly different from other occupations requiring the skills of business management. Those acquiring upper-level positions in corporate America receive training specifically in the acquisition of business knowledge and acumen.

Business is what these people do, it does not matter much what specifically the business does that makes the job pertinent.

Most well-trained business managers move from one position to another with the freedom and speed of an Indy car driver. They are neither tied to one company, nor committed to any particular product or service.

They are merely committed to the business of doing business.

Medical doctors are similar to

dentists in terms of their long-term occupational commitment. This is easily understood given their extensive training, heavy debt load and even greater requirement of deferred gratification than that of dental professionals. Medical doctors are, however, much less likely to become encumbered with practice loans, as they assume the role of business owner with much less regularity.

A friend and family physician early in his practice related to me the various ways in which MDs elect to practice. He explained that the most practiced form of medicine, which is within a small group, limits the upfront cost and serves as more of a blend between private practice and group practice. The next most popular form of practice is within a large organization, such as hospital, government or university employment. In this case, the individual doctor is shielded from the requirement to borrow money in order to start working.

The approach of starting a private practice alone is taken by less than one in six medical practitioners. Not only are a large percentage of medical doctors free from the burden of additional debt, they are also excused from the responsibility of running a business. The following data from the U.S. Department of Labor bear out these trends: • Physicians and surgeons held about 633,000 jobs in 2006.

•

Approximately 15 percent were self-employed.

• About half of wage and salary physicians worked in offices of physicians.

• 18 percent were employed by hospitals.

Others practiced in federal, state and local governments, including colleges, universities and professional schools; and outpatient care centers.

In contrast to the practice style numbers for MDs, the statistics for dental professionals are markedly different. According to the Bureau of Labor Statistics Occupational Outlook Handbook, 2006-07, there were 150,000 licensed dentists in the United States at the time of publication. The following is from an excerpt emphasizes the overwhelming propensity for dentists to work as solo practitioners: • About one third of dentists were self-employed and not incorporated.

• Almost all dentists work in private practice.

• According to the American Dental Association (ADA), 78 percent of dentists in private practice are sole proprietors • 14 percent of dentists belong to a partnership.

• A few salaried dentists work in hospitals and offices of physicians.

While there is a growing trend of dentists who start out working for

conglomerate practice management companies with multiple locations nationwide, the primary goal for most dentists is to eventually break out on their own. This typically means pocketing more of what you produce, but also imposes the responsibility to learn and put into practice the intricacies of running a business. Learning right the first time eliminates wasting time and money through trial and error in your own business.

As trained dentists, we tend to have only one shot at a career. Though some move on from this profession to others, most are committed to being dentists and doing dentistry. Accordingly, most dentists have accepted the commitment to running their own businesses. Investing sufficient time educating ourselves in the fundamentals of business administration is essential. We are owners, managers and administrators. If we do not know how to effectively manage those job descriptions, our businesses stand little chance of achieving maximum profitability. When we do invest the time and energy to acquire this business acumen, we position our practices for success, far beyond that of many or our peers. We have chosen a great profession, one that can reward us handsomely for our hard work.

The dentist earning an honorary MBA is the one in charge of the profitable practice of the future.

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careers

are currently billing over $2 billion a year, and the need is expected to increase in the coming years.

Choosing a locum tenens company can be tricky. There are a number of factors to consider before making a decision that can have a direct effect on your future. As a healthcare professional, maintaining the integrity of your reputation is paramount and deserved or not, your reputation is tied to that of the locum tenens company you select. Here’s how to determine which locum tenens company is the right fit, both personally and professionally:

Identify Your Goals

Choosing a Locum Tenens Company What to look out for when you’re looking for temporary work from a locums company

By Tera Tuten

L

ocum tenens is a burgeoning business, a driving force in the economy and a practical approach to meeting the needs of a medical market that is

16 | JANUARY 2012

fast becoming overworked and understaffed. Staffing companies that specialize in temporary medical personnel placement at hospitals, clinics and other medical facilities

Before you look at agencies, determine your working goals and what type of experience will work best for you.

• Is your goal to sample different professional environments and settings?

• To explore different geographical areas for potential future relocation?

• Would you prefer working close to home within a limited area?

• Will you be traveling with a companion, a child or a pet?

• Determining an outline of your personal and professional goals will give you a place to start as you search for the right company to represent you.

Use the Internet Before contacting a locum tenens company, visit their website. Read

the information they provide and then search for the buzz – complaints or kudos from people in the know.

Look for independent confirmation that the company’s conduct reflects the image they project. Finding a reputable business is much easier than it once was now that every opinion is public.

Assess the Recruiter Once you’ve narrowed the field to a few top choices, contact the companies and speak to a recruiter. Pay attention to the pitch. Is the recruiter’s goal to sign you up or to find the right position to meet your needs? If it feels like a sales pitch, walk away. A good recruiter asks a lot of questions designed to match applicants with opportunities. Poor placement can end with either you or your temporary employer – or both – being unhappy; a situation that can spell disaster for a budding career.

Practical Considerations Compensation involves more than a simple paycheck. Once you’ve found the companies that fit your needs, it’s time to get down to brass tacks. Ask everything. Here’s a list to get you started: • How will I be paid?

• When will I be paid?

• Does the company offer paid vacations?

• Can I expect bonuses?

• Does the company offer health benefits?

• How long is a typical assignment?

• Is travel paid up front or reimbursed?

• Am I expected to make living ar-

rangements?

• Suppose I do not agree with the living arrangements?

• Can I terminate an assignment early if it is unacceptable?

• What additional support, education or credentials does the company offer?

A quality locum tenens agency will answer these questions and more without hesitation. Their compensation package should be clearly outlined, along with standard company policies and procedures. With the basics out of the way, look for the company offerings that really make a quality locum tenens company stand out from the rest. Traveling comes with a unique set of challenges, and the top locum tenens companies will help you overcome the obstacles. The most important things physicians must deal with are insurance and licensing.

Does the Company Provide Licensing Assistance?

A quality locum tenens operation will handle the arrangements for licensure to ensure that everything is in order before each assignment.

Liability Insurance Perhaps the stickiest issue any medical practitioner can face is that of liability insurance. Traveling doctors, working in a variety of unfamiliar settings, are often at even greater risk. Choose a company to represent you that covers you under its own.

This, incidentally, is one of the strongest arguments for doing locum tenens work. The cost of malpractice insurance has driven many doctors out of private business, and in some

cases, to different states. Before you accept the insurance offered by any locum tenens company, examine the offering carefully. All policies are not created equal.

Many companies offer a type of insurance known as a “claims-made” policy. This coverage alone is inadequate. Most malpractice suits are filed long after the incident and would not be covered under claimsmade policies without a rider, called a tail, which extends the coverage period.

There is also a more comprehensive type of insurance called an “occurrence” policy that covers the physician no matter when an incident is filed. This is the best insurance available and requires no tail for coverage after the fact. It is a far more expensive option, and most locum tenens agencies carry more affordable claims-made policies with tails.

The last thing to verify is the insurance carrier’s rating. There are a number of independent research companies that provide information on how insurance companies perform. You want to make sure that the carrier used by the locum tenens company you are considering is on solid financial footing and has a good reputation. If the insurance carrier has a Standard and Poor rating below an A-, pass.

Signing with a reliable company that meets your needs and preferences and offers a benefits package that includes comprehensive coverage with a quality insurer is the key to a long and satisfying career as a locum tenens physician.

Article originally published by Soliant Health, March 11, 2011 MEDMONTHLY.COM |17

careers

Medically Inclined? Consider a Career in Medical Coding “Being a coder is a lot like being a detective.”

By Suzanne Leder, BA, M. Phil., CPC, COBGC, certified AHIMA ICD-10 trainer, and executive editor at The Coding Institute

I

f you feel like you’re someone who can work miracles with a magnifying glass, trench coat and your coding manuals, then you have a lot in common with F. Tessa Bartels. She is a member of the medical coding world, a place where highly skilled professionals turn physician notes into both procedure and diagnosis codes for reimbursement purposes. This ever-changing field constantly keeps medical coders on their toes.

With Certified Professional Coder (CPC) and Certified Evaluation and Managment Coder (CEMC) credentials, Bartels is currently the reimbursement manager at the Medical College of Wisconsin in Milwaukee, Wis. Her career started there in 2000. She has also worked as a coder in pediatric critical care. She jumped into coding and never looked back.

Prior to working at Medical College, she had a career as a travel consultant but needed a change. She took a position as a transcriptionist at the Medical College — but only did that for about two days before being introduced to the world of coding.

“It was my second day on the job.

My supervisor told me she was going to have the person who did the coding cross train me, so that in the event of her absence, I could fill in,” explains Bartels. “Little did I know that this coder wasn’t just planning a short vacation, she was leaving her job. In any case, I jumped into her job and found that I absolutely loved it. I applied for and was granted a transfer.”

So, what do you enjoy about your job? “I really enjoy the variety

18| JANUARY 2012

Tessa Bartels

of work; the interaction between a wide range of professionals and the public; and the ’problem solving’ (it feels a little like detective work at times).”

How did the TCI training camp help you? “I had taken a basic coding course offered by the Medical Society of Wisconsin, but my experience was really limited to a highlyspecialized practice (pediatric critical care). When I applied for my current position, a requirement was that I had

to get my CPC within six months. The Coding Boot Camp was invaluable in preparing me for the exam because I learned specifics in areas where I had no experience (i.e., radiology, cardiology, OB/GYN); I passed the exam on the first try!”

Have any advice for people interested into going into this field? “Understand that this is an ever-changing field. No matter what your level of experience or expertise, there is always something new to

TIME MANAGEMENT TIPS FOR PASSING THE CPC EXAM

learn. Be open to challenging your ways of doing things. Also, you will need to interact with a wide range of people – physicians and other healthcare providers, managers, co-workers, insurance representatives, patients and more. Always be professional in your demeanor, work ethic, appearance and don’t forget to maintain your CEUs and certification.”

Tips for exam taking. “First – prepare by using practice exams. Don’t over think the responses. Pay close attention to guidelines. Answer all the questions that you feel confident about first, and then go back and tackle those that require more thought.” (For more test strategies, see “Medical Coders: Apply Time Management Tips to Tick Passing the CPC Exam Off Your List.”)

When Tessa isn’t coding, you will probably find her at one of her four (yes, four) in-person book discussion groups, or chatting online with one of three. She’s a voracious reader and an active community volunteer. She serves on two non-profit art boards and enjoys going to the theatre and musical events with her husband. She also loves to travel and to cook. “My husband and I will eat anything (at least once) that isn’t moving too fast,” she jokes.

We’ve all been there: the test, the paper, the ticking of that pesky clock. When it comes to the certified professional coder (CPC) exam, time management is of the utmost importance, because if you don’t allot your time appropriately then all that studying will go to waste.

Laureen Jandroep, OTR, CPC, CPCEMS, CPC-H, a CodeRyte coding analyst and senior instructor for New Jersey-based www.CodingCertification.org, has Advice for Timed Success I’ve been teaching medical coding since 1999 and many students that have come to my review class have said they took a course, attended a boot camp etc. and still did not pass the exam. For those students it is no longer a matter of studying – it is about how they take the test.

The CPC exam, sponsored by the American Academy of Professional Coders (AAPC), is divided in three sections. You need to pass each section to pass the entire exam. So you could go really slow in the beginning and ace the first section, pass the second section but due to running out of time fail the third section. The exam is pass/fail – not about getting an A. So you need to spread your success and pass each section.

One Hour – Two Hour Method When you open your exam you’ll find an answer grid with three columns containing 50 questions each.

Allow yourself an hour for each column – two hours for the one with the surgery questions. That will be four hours of the 5.5 hour exam. You can ask the proctor to announce as each hour elapses.

When hour one is over and the announcement is made, finish the question you are on and move to the next column – so question 51. Yes, you will have unanswered questions in column one – that is ok – you will go back. The idea is to spread your suc-

cess across each section. When four hours has elapsed take a deep breath and scan your answer grid – which column has the most unanswered questions? Spend time on that column first and spread your remaining time accordingly on you unanswered questions. This method will improve your chances of having enough correctly answered questions in each section.

One Dot – Two Dot Method Answering an easy medical terminology question carries as much weight as a time consuming surgical question. In addition to the above method you can rate questions you’ve started to answer but decided to leave them for later, and answer easier questions first. In the margin of your exam grid put two dots if you feel it is a very hard time consuming question; one dot for a medium difficulty one.

When you have your last hour and a half you can go right to the one dots – leaving to two dots for absolute last.

Don’t Leave Any Questions Unanswered Use the last 20 minutes to guess on any unanswered questions. You have a 25 percent chance of getting it right without even looking at the question.

If you’ve looked at the question and thrown out an answer or two, indicate that on your answer grid so now you may have a 50/50 chance of getting the answer right.

Career Coaching for Physicians *Career renewal *Non-clinical careers certified coach and physician Heather E. Fork, MD, CPCC www.doctorscrossing.com (512)517-8545 MEDMONTHLY.COM |19

careers

NOTES FROM AN EXPERIENCED NURSE TO A NEW GRAD Words of wisdom for your new career from a seasoned pro

By Tera Tuten

20| JANUARY 2012

Y

ou made it — you got through nursing school; and after celebrating your fantastic accomplishment, it’s time to start thinking about the future. As prepared as your education has made you, nothing is the same as actually working in the field. This article is full of advice from experienced nurses and even new nurses who have learned what’s necessary to survive the realm of nursing.

Choose Your First Job Wisely Don’t jump into any position out there. Your first job will have a huge impact on what you learn and the experience you get, so it’s not a choice to be taken lightly. When considering which job to choose, think of the following: • What kind of orientation do they offer?

• Will it be educational, thorough and flexible?

• What is the stance on continuing education?

• Is there any room for advancement?

• What is the scheduling like?

• What kind of shifts will you be working?

Talk to nurses already working at the hospital or office. Do they enjoy working there? What are the pros and cons? Hearing from someone already in the environment will give you amazing insight into the innerworkings and culture of the employer.

Extensively research your job options, but also make sure to keep an open mind. The position you’ve always dreamed of might not be your first, and if you want a job at the hospital you’re applying to, keep in mind that you might have to start doing something else and then work on switching positions. Being flexible will pay off in

the long-run. You can also consider a temporary or travel nurse position to test out different facilities and units beforecommiting to a permanent nursing position.

Find a Mentor When first starting out, you might have an image in your head of who you’d like to be and what work you’d like to be doing. However, it’s immensely beneficial to have a physical example of what you’re striving for.

A mentor can really help you focus on what you hope to achieve and will also give you a better means to achieve it. If you really respect and admire a nurse, then asking him or her for advice and feedback will only bring you one step closer to success.

When choosing a mentor, make sure it’s someone who’s very experienced and very knowledgeable about nursing. Don’t be afraid to get even more specific; if you have a certain specialty you’re interested in or a nursing job you’ve always dreamed of having, find someone who is an expert in your target area. Your mentor will be able to tell you how he or she got that position and can potentially help you get there yourself.

Once you have a mentor, make sure to ask questions and show that you have a lot of respect for what the person knows and has accomplished.

Avoid asking really general questions.

Instead of asking, “What’s that?” ask about the specific issue and explain why you’re confused. If you properly explain what you’re interested in learning, your mentor will be better able to educate you.

Take Care of Yourself You spend all day caring about your patients. Shifts can be long, and the problems can be plenty, so it’s easy to

become consumed in your work. It’s extremely admirable that you want to help others, but you must make sure that you take some time out for yourself. No one can function on a day-to-day basis without burning out unless they spend some time relaxing and doing things for themselves.

When you leave work, do something you love. If you neglect your own desires to have fun and relax, your dissatisfaction will spread to the workplace, and your demeanor will suffer overall. It may be difficult, but try to find the proper balance in your life. You’ll have to find time for your work, your family and yourself, and even though that may seem impossible, it’s definitely doable.

Try not to take too much overtime or overwork yourself. Even if you feel like you’re being productive at the time, you’ll start to stress and the tension can decrease your overall productivity. Exercise and eat healthy, because if your health is suffering, every aspect of your life will begin to suffer. Don’t spend all of your time at work — spend ample time for yourself to maintain your personal happiness and thus make your work experience even better, too.

Conclusion Now that you’re out of school, you’ll face new challenges, but you’ll also encounter new rewards. If you make good decisions, you’ll be able to learn all you can and advance in your career without letting stress overtake you. Focus on your goals, how you can accomplish them and how you can stay happy while you’re swamped with work. Always keep in mind why you love nursing, and remember to maintain a positive attitude.

Article originally published by Soliant Health, Oct. 11, 2011 MEDMONTHLY.COM |21

legal

OIG Approves an Online Service to Facilitate Information Exchange

By Kimberly Licata

I

ncreasingly, health care providers are turning to online services and vendors to provide them with electronic medical record software or management services. Many of these services and vendors have begun to expand offerings to include asynchronous messaging capabilities, geolocation tracking and information exchanging. For the second time in 2011, the Office of Inspector General (OIG) of

22| JANUARY 2012

the U.S. Department of Health and Human Services considered whether a proposed arrangement under which an online service would facilitate the exchange of information (and referrals) between and among health care providers, suppliers, and practitioners could violate federal fraud and abuse laws. The OIG concluded in Advisory Opinion 11-18 that while the proposal could potentially generate prohibited

remuneration, the OIG would not impose sanctions in connection with the proposal as described.

A publicly traded company who provides electronic health record (EHR) services and other online business services to physicians and physician practices requested the OIG’s opinion on its proposed new service.

The Company proposed new offering (in addition to its EHR services for practitioners for which they pay a monthly fee) a “Coordination Service� intended to facilitate information exchange and to help participants track patients and their service providers.

The Coordination Service involved two specific functions and associated information about providers, suppliers, and patients: making and receiving referrals.

Making referrals for services.

Practitioners or providers would be permitted to use an electronic database created by the Company to identify appropriate practitioners to refer patients to for services. There would be no charge for being included in this database, and the Company intended for the database to be as complete as possible. The database would include physicians, labs, pharmacies, durable medical equipment suppliers, and imaging providers, including those currently working with the Company and others from available information and resources.

Receiving referrals for services.

Health professionals could elect to become a Trading Partner with the company and be permitted to customize their database profile and to receive electronically transmitted, comprehensive referrals that include a formatted order with significant information about the referral and patient. Trading Partners may be an existing client of the Company using its services already (permitted greater communication opportunities) or one interested only in using the Coordination Services of the Company. Non-Trading Partner professionals would be able to receive referrals and basic information (insurance and demographic information, but would not be able to customize their profile nor receive a formatted order with comprehensive information.)

The Company would charge a fee to users of the Coordination Service based on the type of transaction used, including (i) a Transmission Fee ($1 or less), (ii) a Functionality Fee (assessment each time an ordering health professional uses the Coordination Service to make a referral to a Trading Partner), and (iii) a Service Fee (assessed when applicable, such as benefits verification or referral authorization service). All fees were asserted to be fair market value. The Functionality Fee and Service Fee would

always be paid by a Trading Partner; the Transmission Fee could be paid by either the Ordering Health Professional or the Trading Partner depending on certain factors. In addition, the Company would be offering discounts on monthly EHR Service subscription fees to those purchasing the Coordination Service Package.

The OIG considered whether the proposal implicated several federal laws (and regulations) frequently used to thwart fraud, abuse and waste in the health care system, including the Anti-Kickback Statute (AKS), Civil Monetary Penalties law (CMPs) or Exclusion Authority. Violations of these laws result in serious civil penalties and even criminal sanctions in severe cases. The OIG commends the Company’s goal of efficient exchange of health information as “laudable,” but considers whether the payments under the proposal could impermissibly influence referrals to Trading Partner (versus Non-Trading Partners). The OIG concluded that the proposal did not fit into a protective safe harbor, but the risks of the proposal were reduced to an acceptable level because of the following six factors: Inclusion in the Company’s comprehensive database of professionals was at no cost, and the Company would not control or influence the decision as to which professional a referral would be made; • All fees were certified both individually and in the aggregate to reflect the fair market value of the actual services provided, the services had a value unrelated to inducing referrals, and the fees would not vary on the value of items or services ultimately provided.

• While the fees were “per click,” this was reasonable under the circumstances and reflective of the services actually provided.

• The fee structure would be unlikely to influence the referral deci-

sions in a “material” way.

• The Coordination Service was intended to facilitate information exchange, not to limit the potential pool of professionals for referral.

• A Trading Partner’s payment of any fee would not provide that entity with enhanced access to a referral stream over Non-Trading Partners.

• The sixth and final factor sets the proposal in Advisory Option 1118 apart from Advisory Opinion 11-06, in which participants in an online referral services were not permitted to receive referral information unless they paid a fee putting them at a substantial competitive disadvantage.

What can you learn from this opinion? The OIG supports efficient information exchange, which often includes the electronic exchange of information. Further, the OIG will not blindly enforce its arsenal of laws against companies who develop creative solutions to information exchange, including online services charging reasonable per-click fees for services. The OIG considers the entire arrangement in determining whether fraud, abuse or waste are likely. Notice the words “privacy” and “security” are not mentioned in the advisory opinion. Don’t be fooled – these arrangements do implicate laws governing information privacy and security.

The OIG, however, does not have any responsibility for enforcing these laws or regulations. Companies considering solutions to facilitate information exchange have a great opportunity to grow their businesses exponentially with a well-designed product, but they must seek appropriate counsel to navigate the myriad of applicable laws.

Editor’s Note: These comments are not intended to establish an attorney-client relationship and are not intended to be legal advice.

MEDMONTHLY.COM |23

feature

We Need More Residency Slots but Who Will Pay?

By Robert Centor, MD

T

he growing physician shortage in the U.S. is becoming increasingly problematic as the population continues to age. Our ability to treat disease and prolong a high quality life has improved greatly, but we need more practicing physicians for these advances to actually benefit patients.

The Association of American Medical Colleges recently set a goal of increasing U.S. medical school enrollment by 30 percent. We are now producing many more MD and DO graduates and those numbers will continue to grow for at least the next five years. New medical schools and regional campuses have been established, and we have thousands of international medical students who come to the U.S. to train and practice, yet our physician numbers is static. Limiting the number of residents will not provide more physicians; it simply prohibits medical school graduates from continuing on their training path. So we have the paradox of increasing medical student production, while our residency production remains stagnant and if not corrected, this problem will cause the physician shortage to get worse.

Some critics have argued that organized medicine has conspired to constrain residency positions to improve physician income by limiting competition; obviously, they have not considered the consequences of their actions. This is not an American

24| JANUARY 2012

Medical Association or AAMC conspiracy; this is a monetary problem — where will the funding come from for more residency slots?

Most residency slots in this country are funded by the Center of Medicare & Medicaid Services (CMS). This CMS funding covers the salary of most residents as well as the cost of the administrative infrastructure necessary for excellent training. For the past 15 years, CMS has stopped funding new residency slots. This freeze has discouraged hospitals from adding new residencies positions and/ or expanding their current resident programs. Residents receive their pay from hospitals and if CMS does not provide more money, hospitals simply cannot continue to fund more residency slots. We could ameliorate this problem if all private insurers and outside payers were also required to contribute to residency training.

Residency positions are much less prevalent in hospitals that are not financially attached to a medical school. Many medical schools partner with hospitals to fund extra residency slots, but we cannot solve the physician shortage at medical school hospitals alone. We must expand residency programs into all hospitals across the county, especially in the areas of family medicine, internal medicine, general surgery and emergency medicine.

Residents cost around $80,000 per year, this number includes; salary, fringe

benefits, malpractice insurance, secretaries for residence, space and program directors. Considering these factors, it is obvious that the total cost of residencies must exceed the salaries of the residents. Unfortunately, while the AAMC recognizes this problem, they have not convinced Congress to take action.

What does this mean for patients? We have an increasing problem of providing adequate outpatient care. Many subspecialists see too many patients and even turn away patients. Some physicians no longer see Medicare patients because they do not have to and can fill their patient slots with private insurers. We have seen this problem manifest recently, our family medicine residents now get actively recruited and are given significant signing bonuses. Such activities only occur when you have a serious supply and demand mismatch. We also have a decreasing percentage of residency graduates choosing to go into private practice who are now instead accepting hospital employment. Cost reductions and any health care reform critically depend on better outpatient care.

The cost of not addressing this problem far exceeds the cost of solving it. We who train students and residents understand this, but apparently politicians don’t realize and need to learn that inadequate residency training will have an obvious negative impact on health care outcomes.

the Who will be t in this next residen out group? With ore funding for m ts it residency slo one. might be no

feature

Economics at Heart of Drug Shortage Low profitability makes generic drugs scarce in the U.S. market

By Charles Bankhead

T

he Obama administration’s plan to deal with current and future drug shortages got a lukewarm reception from several observers with knowledge of the problem.

President Obama issued an executive order instructing the Food and Drug Adminstration and U.S. Department of Justice to look into the causes of and potential solutions to the shortages. However, the regulatory approach did not jibe with the views of a consultant at an economic think tank, or those of two opinion pieces published online in the New England Journal of Medicine (NEJM).

“Essentially all of the drug shortages that occur in the U.S. arise in the generics market, where profitability is

26| JANUARY 2012

fairly low,” Greg Conko, of the Competitive Enterprise Institute in Washington, said by email in response to a request for comment from MedPage Today and ABC News.

“Compounding the problem is the fact that the ‘buyers’ of the drugs in question aren’t patients but third-party payers — insurance firms, pharma-

ceutical benefit managers and government health programs — all of which have a strong incentive to drive the prices paid for these products down as low as possible.

“So, for many of these drugs, the market can really only sustain a handful of manufacturers — sometimes just one or two. So, when supply dis-

ruptions occur — caused by a shortage of raw materials or more often a quality control problem in a manufacturing facility — there aren’t a lot of additional producers in the market to take up the slack,” Conko said.

Adding to the problem is Medicare’s “statutory price inflexibility,” which has established a 6 percent ceiling on price increases in any sixmonth period. The cap means that manufacturers have little incentive to bring new production online when shortfalls arise.

“What the executive order won’t do — can’t do — is address the problems with Medicare’s pricing rules or the fundamental underlying structure of the marketplace,” Conko continued.

“But by trying to prevent ‘price gouging,’ the executive order could actually serve to make drug shortages even worse.”

“When the demand for any product exceeds the supply, prices rise, sometimes sharply, that’s [Economics] 101,” he added.

Authors of two opinion pieces cited financial considerations as either a prominent factor or the driving force behind the shortages.

“The main cause of drug shortages is economic,” wrote Mandy L. Gatesman, PharmD, of Virginia Commonwealth University in Richmond, Va. and Thomas J. Smith, MD, of Johns Hopkins. “If manufacturers don’t make enough profit, they won’t make generic drugs. “ Oncologists’ decades-old practice of buying chemotherapeutic drugs directly from wholesalers is a second economic cause of drug shortages, they continued. Oncologists routinely “bought low” and “sold high” to patients and insurers, a difference that often determined the profitability of a practice.

Until 2003, Medicare paid 95 percent of the average wholesale price for injectable cancer drugs, whereas oncologists paid 66 percent to 88 percent of the price, turning a profit of $1.6 billion annually, Gatesman and Smith wrote.

As part of the Medicare Modernization Act, reimbursement was set at 6 percent above the average wholesale price of a drug.

“In some cases, the reimbursement is less than the cost of administration,” Gatesman and Smith continued.

As a consequence, oncologists have little incentive to continue buying and administering the drugs themselves, especially generic drugs. Because the problem involves market issues, nonmarket solutions have little chance of solving the shortage problem.

“To ensure a predictable supply of generic cancer drugs, manufacturers need reasonable markets and profits, and oncologists need incentives to use generics,” wrote Gatesman and Smith.

To achieve the predictability and provide financial incentives, they recommended use of standardized clinical pathways that base drug choices solely on effectiveness, in addition to reasonable salaries and disease-management fees for oncologists.

“The current system not only is unsustainable, but also puts oncologists in potential ethical conflict with patients, since it hides revenue information that might influence drug choices and thus affects costs and patients’ copayments,” Gatesman and Smith wrote in conclusion.

Increased financial incentives for manufacturers of generic drugs would help alleviate drug shortages but not by themselves, according to Bruce A. Chabner, MD, of Massachusetts General Hospital in Boston, author of the second NEJM perspective article.

Legislative and regulatory control is needed to ensure the predictability of manufacturing and supply, he continued.

One “carrot and stick” scenario would be to require generic manufacturers to submit projections for product demand and production capacity, and to build redundancy into their production capacity to accommodate generics. The requirements would be tied to new drug applications, and companies that performed well would get priority review, whereas companies with a poor track record could have their applications denied.

Granting an exclusive license to a generic manufacturer with a good production track record represents another potential incentive worth consideration.

Echoing the sentiments of Conko, Gatesman and Smith, Chabner wrote that manufacturers of generic oncologic drugs need more financial incentives.

Medicare’s 6 percent caps on price increases for injectables «affect price and reimbursement for all purchasers and providers, result in little profit for the manufacturer and the provider in the U.S. market, and greatly limit the ability of generic-drug manufacturers to increase their prices.

Meanwhile, generic drugs manufactured in the U.S. can be sold abroad for a greater profit. This differential will promote the leakage of the U.S. drugs to overseas markets, Chabner continued.

Although the U.S. can ill afford higher prices for drugs, raising the price of generics, which currently account for less than two percent of the cost of cancer drugs, would have minimal effect on the total cost of cancer care.

This article was developed

by MedPage Today and ABC News. Published by MedPage Today, Nov. 1, 2011.

feature

Physicians Personal Career Inventory Test your skills, you may find that you have more than you think

By Steven Babitsky

M

any physicians are reconsidering their career choices. As high as 20 percent of physicians have considered leaving clinical practice or making significant career changes. Physicians who are considering a career transition are best served by taking a personal career inventory.

This will force physicians to assess their current situation.

Physicians should consider the following: The Level of Support from Their Spouse/Significant Other Career experts agree that physicians who have the support of their spouse/ significant other are much more likely to make a successful career transition. This discussion may be complex: spouses may rightly be concerned about finances and how the family will replace the loss of income from practicing medicine. Sophisticated spouses who know the reality of declining income and longer hours are now asking a different question: how much money is the family losing by having the physician not leaving a practice?

28| JANUARY 2012

These physicians have left clinical practice and have succeeded in business exponentially: • Drew Senyei, MD, left clinical medicine, obtained patents, and started Enterprise Partners Venture Capital which has built 155 companies and has over $750 million in capital under management.

• Dr. Michael J. McLauglin, MD, was a plastic surgeon and attended a course designed to help physicians with the transition process. Dr. McLaughlin started and is chief scientific officer of Peleton Advantage, a highly successful medical communications company.

Physicians who have made the transition do so in large part for their families and lifestyle. In their new positions they can spend more time with their spouse and children without the fear of constant interruption.

limitations does the family have? Are there children to consider? Their ages and current schooling situation may impact the degree of geographic flexibility.

Desire to Relocate?

Additional Training

The physician and his/her family will have to decide how much flexibility they have with regard to possible relocation. What, if any geographic

Financial Situation The physician considering a career transition should take a long hard look at the family financial situation. Before changing anything, review finances and determine what is required. Ask yourself these questions: • • • •

What is your current financial situation?

How long can you go without income?

How much money will you need to make you happy in a new position?

Is your spouse willing and able to help during this transition period?

Physicians should consider the additional training, certifications or degrees necessary to obtain their goals. The decision is a significant one;

WHAT ARE YOUR STRENGTHS, SKILLS AND ABILITIES?

obtaining this training can be expensive and time consuming. Before you sign up for anything ask yourself the following questions: • • •

How much time are you willing to devote to obtaining this additional education?

What additional training is required for the career path you are considering?

How does your spouse/significant other feel about the situation?

What is your passion?

Physicians in career transition will often be advised to follow a passion. When one moves towards a passion instead of running away from a bad situation, they are much more likely to succeed and be happy with their choice. Physicians should consider five careers/jobs that they would enjoy and feel passionate about, to help narrow the many possibilities available.

What makes you unique?

Physicians in career transition will have to decide and be able to explain what makes them unique. What are you really good at? What transferable skills do you bring to a new position/career? Doctors should be able to confidently articulate and answer one question, “Why should we hire you?”

The Final Word Physicians who are considering a career transition should take a critical look at their current situation, and be prepared to take a personal career inventory. Physicians who start their transition with an honest look at their current situation, abilities, talents and passions will be on the way to a successful career transition.

Steven Babitsky, Esq. is the President of SEAK, Inc. He is the seminar leader for the SEAK NonClinical Careers for Physicians Conference. Steven himself made a successful career transition and is a recovering attorney. You can find out more about SEAK, Inc. and their upcoming Non-Clinical Careers for Physicians Conference, Oct. 21-22, 2012 at seak.com

Take a moment to critically and honestly rate yourselves on a scale of one to 10, with 10 being the highest. Review your scores and search for patterns; this will help you realize your strengths as well as areas that you need improvement.

Ability to deal with complex situations Ability to motivate people Ability to multi-task Ability to prioritize Ability to work independently Analytical abilities Attention to detail Calm under fire Commitment to job Communication skills Computer literacy Computer skills Deal successfully with adversity Deal well with stress/pressure Dependable Driven by excellence Driven and dedicated Excellent interpersonal skills Excellent judgment Excellent presentation skills Excellent project management skills Excellent written skills Flexibility Good active listener Handle fast paced work environment Hard worker High level of integrity and honesty Intelligence Leadership skills Love new challenges Manage functional groups Management experience Meet or exceed time deadlines Negotiation skills Passion for learning Pragmatic Provide leadership Provide solutions Public speaking Quick study Record of success Teacher Team player Tenacity and perseverance Work in matrixed environment Works well as part of a team Works well in time sensitive environment

____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____

feature

Climbing the Medical Ladder An older doctor looks back—and ahead—at the “medical hierarchy”

By Stella Fitzgibbons, MD, FACP

30 32||JANUARY JANUARY2012 2012

“That poor youngster has such a long way to go.”

You probably heard that when you got accepted to med school: the common idea that you are starting a long struggle up a steep ladder until you arrive at where you want. As you take classes and start interacting with actual patients, though, you are starting to realize that this is not always a struggle. In fact, it’s often fun. The subject is fascinating. Making sick people better is a thrill. Even in the tragedies there’s a chance to do some good. But still there’s that ladder. How are you going to fit in? Which parts are the hardest? Don’t you have to worry about falling off?

Looking back over the years since I started med school in 1977, let me describe the stages you’ll go through, with some ideas on how to handle the adjustment.

Out on the Wards Well, we don’t have many actual wards anymore, but your first clinical rotation is still a milestone. Most of your teaching will come not from faculty but from the residents and nurses who teach you the rules of the hospital, from hygiene to etiquette.

Try to learn from everybody: the guy who mops your patient’s floor may have had an aunt with a similar illness and be able to explain what the family is going through better than the attending oncologist. And every doctor I know learned how to scrub for the OR from a nurse who was more interested in doing it right than in our lofty ideas about the “big picture” or our differential diagnosis.

You’ve spent most of your life on the honor roll or dean’s list and been pretty sure that if you work hard enough, you’ll get the A. Your first patient tragedy will hit you hard, whether it’s a death, a late miscarriage or a young person with permanent disability. As a med student I found that it helped more to talk about it with residents, for whom it was still a relatively new experience, than with older teachers. Sharing our memories of what happened over a cup of hospital coffee and knowing that somebody else had recently gone through the same thing didn’t change what had happened, but at least we felt less alone.

Residency and Fellowship If the first year out of med school doesn’t scare you, maybe you should be in a different line of work. Having people call you “doctor” and mean it reaches into childhood memories— usually of Mom telling you that the doctor was there to keep you healthy and fix all the bad things. It makes you wonder if anybody realizes that you’re just you, not some miracle worker. Even the top member of your class gets a little sweaty at having to make actual decisions and write orders that nobody has to cosign, and if your internship is in a new place it’s even harder.

Carry that therapeutics manual with you everywhere. Ask for help when you need it. Remember that you have backup: nurses who will question orders with an extra zero, senior residents you can call for advice and in private hospitals the attending physician who checks what you do even

when you don’t realize it. The attending was an intern once too, and probably carries the memory of blunders as bad as any of your nightmares.

Thanks to limits on residency hours and patient loads, sleep deprivation won’t be the problem it once was. Follow the old rule anyway: eat when you can, sleep when you can and for the love of sanity, spend time with your family when you can. Residency is the period when your life is most likely to be swallowed up by the practice of medicine, and spending time with normal people will help to keep your humanity intact.

Respect your teachers, but don’t be intimidated by them—even senior professors put their socks on one at a time. Talk to older doctors who are not academics about what their practices are like, and look ahead to where you want to be when you get out of residency or fellowship. If your attending takes you to lunch in the doctors’ lounge, eavesdrop shamelessly and ask questions about the relationships among medical staff members. It will help you understand the ecology you’ll be living in a few years from now.

Stepping into the senior resident role is an easier adjustment since you’ve had plenty of role models and by then you will probably already have some ideas as to how to handle the job. Start looking ahead your next to last year, to actual practice, when you won’t have limits on how many patients you can see or the number of hours you work. Develop good timemanagement skills, because you won’t have nearly as much time per patient once you join a busy group. Learning MEDMONTHLY.COM |31

to prioritize and be efficient will save you sleep, time and frustration in the years ahead.

“Hey! Where’d My Ladder Go?” After being a trainee all your life it’s a shock to realize that you are now a “staff physician”, regardless of the practice setting. And even more of one when a doctor 20 years older than you asks your opinion on something.

If you’re in an academic setting you still have a ladder with instructors on the bottom and full professors on top.

But when you’re taking care of patients you can no longer look to somebody else to handle tough situations: you are the person in charge of care, and while consultants may advise you they, don’t make final decisions.

As a very junior attending at a Houston teaching hospital I ran into one of those situations, in which the

32| JANUARY 2012

patient had both bleeding and clotting problems. If we gave anticoagulants she might bleed to death, but if we stopped them she would have a pulmonary embolus or stroke. I turned to the senior (and very wise) critical care specialist who ruled the MICU and asked him what our next step was. “Wrong question,” he answered.

“What is YOUR next step? Your name is on the chart, you are the attending physician, and I can make suggestions but I’m not the one making decisions here.” This is two lessons in one: not only are you the primary doctor on the case, other doctors are not, no matter how senior they are or what comments they may make. The ladder disappears when it’s your patient and your responsibility.

Gray Hair Isn’t All Bad Keep your resume up-to-date and

all your paperwork where you can assemble it for job hunting. Odds are you won’t settle into a single medical practice and stay there your entire career: the group that looks like a good setting when you’re fresh out of training may change, or it may no longer be a fit once you’ve had more experience and looked at other options. In signing your first contract, watch for clauses that mean you’ll have to leave town to find a second practice or pay the “tail” on malpractice insurance yourself.

Whatever you do, don’t get too comfortable. The best practice for you is one that allows you not only to keep learning but to keep meeting challenges, and the confidence you gain from those will gain the respect of whatever medical community you enter. And by the time you have enough gray hairs to notice, you (and others) will know that you earned them.

What’s your practice worth?

When most doctors are asked what their practice is worth, the answer is usually, “I don’t know.”

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feature

STANDING AT THE

CROSSROADS Career Direction for Today’s Doctor

By Leigh Ann Simpson

34| JANUARY 2012

E

very physician embarks on their career filled with an overwhelming desire to save the world, never dreaming that one day they might not absolutely love their job. After many years of dealing with the stress of practicing medicine, especially in today’s health care industry, what once starting as an overwhelming passion sometimes becomes simply overwhelming. Many find themselves standing at a crossroads, having to choose between providing quality care and enjoying a reasonable quality of life.

Tait Shanafelt, MD, director of Mayo Clinic’s Physician Well-Being Program, has reported that at any given time, one out of three physicians are experiencing burnout. Their dissatisfaction is often made worse because physicians won’t seek guidance or support—asking for help is perceived as weakness. Doctors are trained to ignore their own needs for the sake of patient care, causing many to suffer in silence for years.

Heather Fork, MD, is a physician life coach and says that she understands physician burnout far too well. After owning a successful dermatology practice for nine years, like so many physicians, she became discontent with her career and finally made the difficult decision to leave.

“I simply wasn’t happy and I no longer looked forward to going to work,” Dr. Fork says. “There were the usual frustrations of a medical practice; it had its stresses and challenges, but it was more

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of a feeling that there was something else I was supposed to be doing to help people.”

Throughout her career she developed an interest in personality types and personal development, she even did some complimentary coaching for friends before becoming a certified coach in 2009.

“When I first started coaching, I didn’t know what my niche was going to be but one of my first clients was a very bright physician who was experiencing some challenges,” she says. “My heart went out to him and I knew right away I needed to help other doctors.”

In 2010 she started her own life coaching company, The Doctor’s Crossing, to help physicians who are unhappy with their clinical career discover other options so they may avoid or overcome burnout.

The possibilities beyond straight patient care career are literally infinite, so it can be daunting and to figure out how to proceed. Asking the question, “What would you most want to do if you knew you couldn’t fail?” helps to uncover the client’s true passion and this is so important when Heather E. Fork , MD CPCC

considering career direction, Dr. Fork says.

The life coaching program offered at The Doctor’s Crossing is structured and custom-made to help physicians decide if a clinical, non-clinical or a blended career is right for them.

Through a series of assessments these physicians are able to identify their values, interests, abilities and work preferences. Then, they take a look at their current situation, evaluating the pros and cons and what can be done to improve the situation. Dr. Fork says her clients have expressed that they feel comfortable seeking help from another physician who understands where they are coming from.

What are the Causes of Physician Burnout?

The majority of Dr. Fork’s clients still have the desire to practice medicine in some capacity but they’ve grown unhappy with the way that they have to practice. Despite many working long hours and bringing their work home with them, they feel they’re unable to provide the level of care that they would like to give their patients. They are also dissatisfied because there are so many factors that adversely affect the doctor-patient relationship; too little time to provide quality care, hassles of electronic medical records, excessive paper work, declining reimbursement, third party intrusions and the ever present risk of malpractice. Essentially, they are extremely stressed but stagnating at the same time.

Some of the physicians that Dr. Fork works with don’t want to leave clinical practice and are merely seeking more satisfaction in their life in general or just need some sort of change. This could range from a new specialty, developing a new niche practice, integrative medicine or having a concierge practice.

Why Do They Stay?

The biggest fear of a physician who is unhappy and considering a change is what others will think if they leave medicine or switch to a non-clinical career.

“When a doctor wants to do something even slightly different from the mainstream, it seems like it unsettles people, and they don’t understand it,” says Dr. Fork. “I think there is still this perception that doctoring is like being Marcus Welby, MD, and why on earth would anyone want to do anything else?”

Another concern that causes doctors to hesitate making a career change is because they often have an enormous amount of debt. With the average medical school debt around $185,000, they think that they can’t afford to lose their income. However, taking a non-clinical career path doesn’t necessarily mean taking a pay cut. Depending on what salary level a physician is at currently, a nonclinical job could mean an increase or decrease in salary. For example, if the primary care physician who makes around $75.00 an hour wants to make a non-clinical career move, it is likely to be financially beneficial. It is a little more of a challenge for highly paid specialist to find a non-clinical career

making their same level of income initially; however, with hard work and determination it is certainly possible, says Dr. Fork.

How Does a Doctor Know When They’ve Had Enough?

The decision to leave medicine entirely is extremely drastic. Dr. Fork advises her clients to thoroughly evaluate all options and explore all possible remedies of dissatisfaction before electing to do so. One might even consider taking a sabbatical with the hope of returning to practice with a renewed spirit.

Severe burnout can be such a heavy cloud that it may be hard to see the possibility of ever wanting to practice again, but a lot can change when a doctor is no longer constantly running on fumes and not getting any of their personal needs met, says Dr. Fork. However, when a doctor has examined all options and still feels the need to leave medicine, it may be time. In this situation, Dr. Fork suggests not to burn any bridges, maintain licensure and even consider doing some part-time clinical work to keep skills current.

The sooner a doctor who is feeling unhappy in their work can talk to someone and gain an outside per-

spective, the better. When physicians wait too long to seek help, they tend to isolate themselves. This is one of the symptoms in the later stages of burnout and is extremely detrimental because once they’ve reached this point they’re more resistant to getting help. When feelings of dissatisfaction are addressed early the solutions are easier to find and there are more options to choose from. Early detection also decreases the risk of adverse consequences such as poor financial management, substance abuse and boundary violations.

Final Words of Advice When evaluating various career options, it is important that the direction fits with your interests and personality. Talk to people who are doing what you are considering and ask a lot of questions. This is the best way to get accurate information and make an informed decision about any potential changes. It’s important for physicians to remember that there are no guarantees of continued employment in any field. Whatever direction you want to pursue, make sure that it excites and energizes you. If it doesn’t, it will likely be a mistake. Passion is the fuel that will sustain you in the work it takes to implement significant changes.

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MEDMONTHLY.COM |37

feature

38| JANUARY 2012

A LIFE AFTER MEDICINE Retirement Options for Doctors

Norman Morris, an Australian obstetrician and gynecologist, made the decision to semi-retire from his career in private practice to work in several exotic settings, including tropical Australia and Nepal. Through the accounts of his travels he provides words of wisdom to physicians who may be contemplating or avoiding retirement.

By Norman Morris, MD

In order to make a living as a young specialist obstetrician, I performed casual work for many senior colleagues. Some were still leading very busy lives well into their 70s and I remember being fascinated by the concept of retirement, even then.

Alas, the issue is no longer only of theoretical interest to me!

Why would somebody presumably wealthy enough to afford to retire, want to keep working indefinitely? I was appalled by a common reluctance to retire — especially when the work, often very stressful, frequently involved long and inconvenient hours.

When asked, they gave me a variety of explanations, the most common being:

alternative care, however reluctantly.

In my opinion, this is the most valid of these reasons, even if we often have an inflated view of our value!

There is a great diversity of individual objectives when it comes to looking at options for the autumn of our lives. In general, I believe that most of us have a need to be intellectually and socially occupied. In addition, we mostly want to do something worthwhile. Many of us want to take a serious interest in a subject or subjects outside our chosen career.

Given these factors, let us look at our options:

As already indicated, this option indicates a sad lack of zest for aspects of life other than work.

I Can’t Afford to Retire

Traditional Retirement

This is risky, probably irreversible and usually involves leaving one’s comfort zone. Then again, it may enable the fulfilment of a long-cherished ambition and provide great satisfaction. Some years ago, a colleague of mine, well into her 70s, was talked into retirement by her family after she suffered a heart attack. After recovery

Senior doctors – usually no longer having fully dependent children – are generally in a financially secure situation. Surely, the vast majority of doctors can afford to retire at or before the conventional age for retirement – in Australia, 65 – even if this necessitates leading a slightly more frugal existence.

It Would Be a Waste of My Skills, Knowledge and Experience

For me, spending large amounts of time fishing or playing golf would be unfulfilling, pointless and largely boring. No doubt, others see these pursuits very differently. Spending more time with family, in particularly with grandchildren, seems perfectly

laudable, although not necessarily full-time!

Work Until We Drop

Work Until We are Forced To Stop Perhaps, even sadder and no doubt very frustrating; the possibility that an illness or disability may curtail any plans for other post-retirement activities is unfortunately always there. We can never be sure what lies around the corner.

A New Career

I Wouldn’t Know How to Occupy My Time Personally, I feel great pity for an educated person who, despite six decades or so on the planet, has insufficient other interests or hobbies. I assert that there should be more to life than work, however fulfilling that work.

My Patients Need Me! Although most doctors derive much satisfaction from their professional relationship with their patients, and many patients value highly the care they receive, it is sad that doctors feel so indispensable. Such doctors must be aware that their patients will find 40| JANUARY 2012

Grampians, Australia

from her illness, she resumed studies in music and ultimately worked for several extremely gratifying years as a music therapist!

Semi-Retirement Essentially, semi-retirement allows one to do the same work but with a significant reduction in the number of hours. This may take several forms: • An alteration in the type of professional work, still within one’s area of expertise.

• Changing from private practice to salaried government work.

• Re-location to a remote area where your expertise will be highly valued by the local community.

• Voluntary work of some sort.

For me, semi-retirement has provided a varied, fulfilling and enjoyable lifestyle. At the age of 50, I reassessed my options. I had been working in metropolitan Melbourne, partly in private practice, partly salaried at a teaching hospital. Although not unhappy with my work, the idea of spending the rest of my career doing the same work was not appealing, I needed a change.

I took a full-time salaried position in a government hospital in the tropical city of Cairns in far north Queensland. I spent seven enjoyable years in that job, with a totally different lifestyle. The work included the opportunity to provide outreach clinics for remote communities, as well as other more “normal” aspects of teaching hospital-based work. However, after seven years, it was time for another change.

It seems self-evident that specialist obstetric skills are needed much more in developing countries than in western countries like Australia. I looked for a suitable opportunity and,

Milford Track, New Zealand

after nearly two frustrating years not working, found a position on the faculty of a teaching hospital in Nepal.

This proved remarkably rewarding, although it was very challenging at times. Fortunately, I was still young and fit enough to take on these challenges. However, three years in Nepal was enough. I might have stayed longer if I had been able to find a suitable (and much-needed) job coordinating obstetric care in remote areas of that country where obstetric services are primitive and maternal mortality is an international disgrace. After much fruitless effort to find such a position, I decided to return to Australia.

Back home, I found myself still energetic enough to look for other professional opportunities, preferably allowing time for pursuit of travel and other hobbies. For the last five years, I have been doing remarkably well-paid work in Australia, provid-

ing locum obstetric services in the generally underserviced rural and regional areas. This has allowed me to go to places that I had previously not visited — while still doing something “worthwhile”.

My current conundrum is whether to fulfil the requirements needed for me to continue working as a specialist for another three years after my current certification expires in late 2012. I am still in good health, and I believe that my version of semi-retirement will allow me to continue doing something worthwhile and enable me to keep utilizing my clinical skills and experience for a few more years, without limiting significantly the time that I choose to spend with my family, travelling or pursuing my other interests. I acknowledge that each of us has our own objectives and priorities in life. For me, full retirement is not yet a real option.

MEDMONTHLY.COM |41

the arts

THE ART OF SCIENCE

By Leigh Ann Simpson

42| JANUARY 2012

The Sky Was Broken and I Tossed the Pieces Into My Dreams V

T

raditionally art and science have been thought of as complete opposites. One would never expect to paint in a science class or conduct experiments in an art class. However, are they truly complete antithesis? Scientists and artists, particularly abstract artists, are closely linked by the way they often blindly approach their work. While their tools are different, neither the artist nor the scientist knows what the end result of their efforts will be; they are conducting an experiment.

Eduardo Lapetina has proven that there is truth to this theory. During his extensive career as a brilliant medical scientist, he spent countless hours in labs conducting research. Today, as an artist, he applies the same experimental approach used in his research to his extraordinary abstract paintings. The transition from science to art came naturally to Lapetina.

“The creation of abstract paintings is not much different than what I did in science. When you are immersed in an experiment, you don’t know what the final answer will be, and you are often surprised by the outcome,” says Lapetina.

Lapetina was born in Buenos Aires, Argentina, and after attending medical school there he left for a fellowship in London. Eventually he was recruited to the University of North Carolina at Chapel Hill where he conducted cardiovascular research in thrombosis and arteriosclerosis that led to groundbreaking discoveries. For 35 years he regularly travelled internationally to present his research and give lectures. Through his travels he was able to visit some of the world’s most renowned art museums and during this time he developed his love for abstract art. Over the years, Lapetina has acquired an impressive collection of abstract paintings that he now displays in his home.

Ten years ago, his battle with multiple sclerosis forced him to retire early from medical research, a career move that he says was not easy to make.

“At first I thought, ‘What am I going to do with my life?’”Lapetina recalls. “Then one afternoon, as I was reading the paper I saw an ad for a painting class on campus that was

scheduled to start in an hour. Without hesitation I left my house, went to the class and I never looked back.”

Since that first painting class he has gone on to develop a one of a kind technique, unprecedented by other artists. His paintings have a unique textured appearance that is created by applying layers upon layers of different colored paints. To construct these layers he employs several methods of application that can vary from pouring, splashing and dipping sometimes entire tubes of acrylic paint to his canvas. Then, using only a palette knife, he begins to manipulate the layers, allowing some colors to be revealed while others remain hidden. Remarkably, Lapetina approaches all of his paintings without any premeditated ideas or imagery. As he applies more layers and more colors are revealed, the concept of the painting begins to emerge, essentially allowing the paint to guide him. His work and unusual artistry is hailed by his instructors and has fascinated local art enthusiasts.

Lapetina’s paintings are frequently showcased in art galleries and regional exhibitions throughout N.C., S.C. and Va. Lapetina says that he never saw himself becoming an artist. Even though he had a deep appreciation for abstract art, he thought he would never have any artistic talent.

Today, he is very happy for the opportunity to have a career that he is equally, if not more passionate about than medicine “As an artist, I feel free,” Lapetina says. “There are no reports to turn in on time, no hierarchy or pressure. I am able to work completely at my own pace; I simply paint when I feel like it.”

He admits that he often misses his research; once a week he dreams that he is back in the lab experimenting again, which assures him that his passion for discovery will never fade.

To find out more information about Eduardo Lapetina please visit http://eduardolapetina.com/index.shtml.

the kitchen

Winter Delights

By Ashley Acornley, MS, RD, LDN

P

umpkin is a classic winter food; pumpkin pie, pumpkin soup, pumpkin cookies… you name it! The good news is that pumpkin is chock full ‘o goodness.

You can tell by its bright color that it’s full of vitamins, minerals and antioxidants! Not only is pumpkin loaded with vitamin A and antioxidant carotenoids, particularly alpha and beta-carotenes, it’s a good source of vitamins C, K and E, and lots of minerals, including magnesium, potassium and iron. Pumpkin is also full of complex carbohydrates and fiber. For instance, half a cup of canned pumpkin has 6.5 grams of complex carbohydrates and 3.5 grams of fiber.

This recipe is for a classic crustless pumpkin pie. When you are in the process of losing or maintaining weight, it is best not to deprive yourself of anything that you enjoy. The only catch is to enjoy your favorite foods in moderation or using the correct portion size.

Therefore, enjoy the healthiest part of the piethe filling! Skip all the sugar, saturated fat and calories in the crust. This winter treat is less than 100 calories per slice, has 2 grams of fiber and is low in sodium! This recipe is diabetic friendly and tastes just as delicious with sugar substitutes.

BASIC CRUSTLESS PUMPKIN PIE Serves 8 Ingredients: 1 15-ounce can pumpkin 1/3 cup sugar or sugar substitute 2 Tbsp honey 1 ½ tsp pumpkin pie spice

½ cup refrigerated egg product, or 2 eggs lightly beaten 1 tsp. vanilla ¾ cup evaporated fat-free milk

Preparation: Preheat oven to 350 degrees Fahrenheit. Lightly grease an 8-inch springform pan . In a medium bowl, combine pumpkin, sugar, hon ey and pie spice. Add eggs and vanilla. Beat lightly unti l just combined.

Gradually stir in evaporated milk . Pour into prepared pan and place on a foil-lined baking sheet.

Bake for 45-50 minutes or until center is set. Cool for 1 hour on a wire rack. Cover and chill for at least 2 hours before serving.

NUTRITION FACTS PER SLICE

44| JANUARY 2012

95 calories 4g protein 20g CHO 2g fiber 59 mg sodium

needs.

MEDMONTHLY.COM |43

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Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://bit.ly/s5oYiS

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://bit.ly/vCnCP4

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB

New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/

North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/

South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/

North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/ Ohio Riffe Center 77 S. High St. 17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/

Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://health.state.tn.us/boards/dentistry/ Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/

Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://www.dopl.utah.gov/licensing/ dentistry.html Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://www.vtprofessionals.org/opr1/ dentists/ Virginia Perimeter Center 9960 Maryland Dr. Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.state.va.us/dentistry/ default.htm Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://1.usa.gov/tKBFHT West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-(877)914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1-(877)617-1565 http://bit.ly/sEhr0Q Wyoming 1800 Carey Ave. 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index. asp

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (344)242-4116 http://www.albme.org/

Florida 2585 Merchants Row Blvd.

Tallahassee, FL 32399 (850)245-4444 http://www.doh.state.fl.us/

Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://www.commerce.state.ak.us/occ/ pmed.htm

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913 http://medicalboard.georgia.gov/portal/ site/GCMB/

Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov

Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 (808)587-3295 http://hawaii.gov/dcca/pvl/boards/medical/

Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://www.dchealth.dc.gov/doh 46| JANUARY 2012

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, ID 83720 (208)327-7000 http://bit.ly/orPmFU Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820 http://www.idfpr.com/ Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 http://www.in.gov/pla/ Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 http://medicalboard.iowa.gov/ Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 http://www.ksbha.org/ Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY 40222 (502)429-7150 http://kbml.ky.gov/default.htm

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820 http://www.lsbme.la.gov/ Maine 161 Capitol St. 137 State House Station Augusta, ME 04333 (207)287-3601 http://www.docboard.org/me/me_ home.htm Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/ Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200 http://www.mass.gov Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://www.michigan.gov/lara Minnesota University Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd.

P.O. Box 1335 Jefferson City, MO 65102 (573)751-0293 http://pr.mo.gov/

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bit.ly/obJm7J p

North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 (701)328-6500 http://www.ndbomex.com/

Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.hhs.state.ne.us/

Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 (614)466-3934 http://med.ohio.gov/

Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://www.state.nj.us/lps/ca/bme/index. html New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/ Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/ Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://bit.ly/havKVj

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://www.tmb.state.tx.us/agency/ contact.php Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628 http://www.dopl.utah.gov/ Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://healthvermont.gov/hc/med_ board/bmp.aspx Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://www.dhp.virginia.gov/About/ contact.htm

Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://www.health.ri.gov/partners/ boards/medicallicensureanddiscipline/

Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.doh.wa.gov/PHIP/default.htm

South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/

West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 http://www.wvbom.wv.gov/

South Dakota 101 N. Main Ave., Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/

Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 http://drl.wi.gov/section. asp?linkid=6&locid=0

Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://health.state.tn.us/

Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

medical resource guide ADVERTISING 1-800-Urgent-Care

6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)819-6838 www.ringringllc.com

Find Urgent Care

PO Box 15130 Scottsdale, AZ 85267 (602)370-0303 www.findurgentcare.com

MedMedia9

PO Box 98313 Raleigh, NC 27624 (919)747-9031

Axiom Business Solutions

4704 E. Trindle Rd. Mechanicsburg, PA 17050 (866)517-0466 www.axiom-biz.com

4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545 http://doctorscrossing.com/

Frost Arnett

480 James Robertson Pkwy Nashville, TN 37219 (800)264-7156 www.frostarnett.com

Gold Key Credit, Inc.

PO Box 15670 Brooksville, FL 34604 (888)717-9615 www.goldkeycreditinc.com

CODING SPECIALISTS The Coding Institute LLC 2222 Sedwick Dr. Durham, NC 27713 (800)508-2582 http://www.codinginstitute.com/

Horizon Billing Specialists www.medmedia9.com

Ring Ring LLC

6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)-819-6838 www.ringringllc.com

ANSWERING SERVICES Corridor Medical Answering Service

3088 Route 27, Suite 7 Kendall Park, NJ 08824 (866)447-5154 www.corridoranswering.net

Docs on Hold

14849 West 95th St. Lenexa, KS 66285 (913)559-3666 www.soundproductsinc.com

BILLING & COLLECTION Advanced Physician Billing, LLC

PO Box 730 Fishers, IN 46038 (866)459-4579 www.advancedphysicianbillingllc.com

4635 44th St., Suite C150 Kentwood, MI 49512 (800)378-9991 www.horizonbilling.com

Marina Medical Billing Service 18000 Studebaker Rd. 4th Floor Cerritos, CA 90703 (800)287-8166

CDWG

www.cdwg.com/

www.marinabilling.com

Instant Medical History

Mediserv

6451 Brentwood Stair Rd. Ft. Worth, TX 76112 (800)378-4134 www.mediservltd.com

4840 Forest Drive #349 Columbia, SC 29206 (803)796-7980 www.medicalhistory.com

Practice Velocity 1673 Belvidere Rd. Belvidere, IL 61008 (888)357-4209

www.practicevelocity.com

CONSULTING SERVICES, PRACTICE MANAGEMENT

Sweans Technologies 501 Silverside Rd. Wilmington, DE 19809 (302)351-3690

Manage My Practice www.medisweans.com

VIP Billing

PO Box 1350 Forney, TX 75126 (214)499-3440

103 Carpenter Brook Dr. Cary, NC 27519 (919)370-0504 www.managemypractice.com

myEMRchoice.com www.vipbilling.com

3562 Habersham at Northlake, Bldg J Tucker, GA 30084 (866)473-0011 www.ajishra.com

CAREER CONSULTING

Applied Medical Services

SEAK Non-Clinical Careers Conference

4220 NC Hwy 55, Suite 130B Durham, NC 27713 (919)477-5152 www.ams-nc.com

COMPUTER, SOFTWARE

300 N. Milwaukee Ave. Vernon Hills, IL 60061 (866)782-4239

Ajishra Technology Support

50| JANUARY 2012

Doctor’s Crossing

Oct. 21-22, 2012 in Chicago, IL (508)457-1111 www.nonclinicalcareers.com

24 Cherry Lane Doylestown, PA 18901 (888)348-1170 www.myemrchoice.com

Urgent Care America 17595 S. Tamiami Trail Fort Meyers, FL 33908 (239)415-3222 www.urgentcareamerica.com

medical resource guide

Medical Practice Listings 8317 Six Forks Rd. Suite 205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com

Laboratory Management Resources 3729 Greene’s Crossing Greensboro, NC 27410 (336)288-9823 www.managemypractice.com

NextGen 200 Welsh Rd. Horsham, PA 19044 (215)657-7010 www.nextgen.com

Synapse Medical Management 18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143 www.synapsemgmt.com

ELECTRONIC MED. RECORDS

Medical Protective

ABELSoft 1207 Delaware Ave. #433 Buffalo, NY 14209 (800)267-2235 www.abelmedicalsoftware.com

Acentec, Inc 17815 Sky Park Circle , Suite J Irvine, CA 92614 (949)474-7774 www.acentec.com

AdvanceMD 10011 S. Centennial Pkwy.

Sandy, UT 84070 (800)825-0224 www.amdsoftware.com

CollaborateMD 201 E. Pine St. #1310 Orlando, FL 32801 (888)348-8457 www.collaboratemd.com

DENTAL Biomet 3i 4555 Riverside Dr. Palm Beach Gardens, FL 33410 (800)342-5454 www.biomet3i.com

Dental Management Club 4924 Balboa Blvd. #460 Encino, CA 91316 www.dentalmanagementclub.com

The Dental Box Company, Inc. P.O. Box 101430 Pittsburgh, PA 15237 (412)364-8712

4701 W. Research Dr. #102 Sioux Falls, SD 57107-1312 (877)697-4696 www.docutap.com

Integritas, Inc. 2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486 www.integritas.com

www.thedentalbox.com

9016 Phoenix Pkwy O’Fallon, MO 63368 (636)561-5445 www.dentrysbusinesssecrets.com

Modern Dental Marketing Practices 504 N. Oak St. #6 Roanoke, TX 76262 (940)395-5115 www.moderndentalmarketing.com

5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776

MGIS, Inc.

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447 www.mgis.com

Professional Medical Insurance Services

16800 Greenspoint Park Dr. Houston, TX 77060 (877)583-5510 www.promedins.com

Wood Insurance Group

4835 East Cactus Rd. #440 Scottsdale, AZ 85254-3544 (602)230-8200 www.woodinsurancegroup.com

LOCUM TENENS

DocuTAP

FINANCIAL CONSULTANTS

Dentistry’s Business Secrets

INSURANCE, MED. LIABILITY

Sigmon Daknis Wealth Management 701 Town Center Dr. Suite 104 Newport News, VA 23606 (757)223-5902 www.sigmondaknis.com Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063 http://www.sigmondaknis.com/

Simply Locums, Inc. Your direct, simple & comprehensive source for locum tenens and permanent positions for physicians and other healthcare professionals. Simply Locums was developed to provide a source for both healthcare providers and health care facilities to efficiently and directly manage and negotiate their locum tenens and permanent assignments. We’ve streamlined the process, eliminated the costly middleman, and directly link highly qualified healthcare professionals to healthcare facilities. By prohibiting third party recruiter access to our site, we provide cost savings to health care facilities and maximize your income.

3949 Hester Lane Salem, IL 62881 liz@simplylocums.net www.simplylocums.com

MEDMONTHLY.COM |51

medical resource guide LOCUM TENENS (CONT.) Physician Solutions

P.O. Box 98313 Raleigh, NC 27624 (919)845-0054 www.physiciansolutions.com

MEDICAL ART

Cryopen

800 Shoreline, #900 Corpus Christi, TX 78401 (888)246-3928

Peters Medical Research

www.cryopen.com

Carolina Liquid Chemistries, Inc.

391 Technology Way Winston Salem, NC 27101 (336)722-8910 www.carolinachemistries.com

Dicom Solutions

Deborah Brenner 877 Island Ave. #315 San Diego, CA 92101 (619)818-4714 www.deborahbrenner.com Martha Petty 316 Burlage Circle Chapel Hill, NC 27514 (919)933-4920

548 Wald Irvine, CA 92618 (800)377-2617

www.dicomsolutions.com

Radical Radiology

524 Huffman Rd. Birmingham, AL 35215 (866)324-9700 www.radicalradiology.com

Roche Diagnostics www.marthapetty.com

Julie Jennings (678)772-0889 juliejenn@silksynergy.com http://silksynergy.com/ http://www.coroflot.com/naddie09 Eduardo Lapetina 318 North Estes Dr. Chapel Hill, NC 27514 (919)960-3400 eduardolapetina.com/index.shtml

MEDICAL EQUIPMENT

9115 Hague Rd. P.O. Box 50457 Indianapolis, IN 46250-0457 (317)521-2000 www.roche-diagnostics.us

MEDICAL PRACTICE SALES Medical Practice Listings

8317 Six Forks Rd. Suite 205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com

MEDICAL PRACTICE VALUATIONS

Abaxis

3240 Whipple Rd. Union City, CA 94587 (800)822-2947

BizScore www.piccoloxpress.com

ALLPRO Imaging

www.bizscorevaluation.com

MEDICAL RESEARCH

Biosite, Inc

Arup Laboratories

www.biosite.com

Brymill Cryogenic Systems 105 Windermere Ave. Ellington, CT 06029 (860)875-2460

52| JANUARY 2012

www.brymill.com

NUTRITION THERAPIST Triangle Nutrition Therapy 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/

SUPPLIES, GENERAL BSN Medical 5825 Carnegie Blvd.

Charlotte, NC 28209 (800)552-1157 www.bsnmedical.us CNF Medical 1100 Patterson Ave. Winston Salem, NC 27101 (877)631-3077 www.cnfmedical.com Dermabond Ethicon Route 22 West Somerville, NJ 08876 (877)984-4266 www.dermabond.com DJO 1430 Decision St. Vista, CA 92081 (760)727-1280 www.djoglobal.com

P.O. Box 99488 Raleigh, NC 27624 (919)846-4747

1295 Walt Whitman Rd. Melville, NY 11747 (888)862-4050 www.allproimaging.com 9975 Summers Ridge Rd. San Diego, CA 92121 (858)805-8378

507 N. Lindsay St. 2nd Floor High Point, NC 27262 www.Petersmedicalresearch.com

ExpertMed 31778 Enterprise Dr. Livonia, MI 48150 (800)447-5050 www.expertmed.com

Gebauer Company 500 Chipeta Way Salt Lake City, UT 84108 (800)242-2787

www.aruplab.com

Clinical Reference Laboratory 8433 Quivira Rd. Lenexa, KS 66215 (800)445-6917

www.crlcorp.com

4444 East 153rd St. Cleveland, OH 44128-2955 (216)581-3030 www.gebauerspainease.com

Scarguard 15 Barstow Rd. Great Neck, NY 11021 (877)566-5935 www.scarguard.com

Buying or selling? We can help!

Listing Benefits • • • • •

Buying Benefits

Maintain confidentiality Professional representation National and regional marketing Maximize your practice value BizScore Valuation assessment

• Accurate practice pricing • Detailed reports and financials • Largest selection of health care facilities • Work one-on-one with an experienced team of qualified professionals

Medical Practice Listings Scan this QR code with your smartphone to learn more

A Philip Driver Company

medicalpracticelistings.com

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

Occupation Health Care Practice located in Greensboro, N.C., has an immediate opening for a primary care physician. This is 40 hours per week opportunity with a base salary of $135,000 plus incentives, professional liability insurance and an excellent CME, vacation and sick leave package. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, (919) 8450054, E-mail: physiciansolutions@gmail.com

call or invasive procedures. Look into joining this three physician facility and live the good live in one of North Carolina’s most beautiful cities. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, (919) 845-0054, E-mail: physiciansolutions@ gmail.com

Family Practice physician opportunity in Raleigh, N.C. This is a locum’s position with three to four shifts per week requirement that will last for several months. You must be BC/BE and comfortable treating patients from one year of age to geriatrics. You will be surrounded by an exceptional, experienced staff with beautiful offices and accommodations. No call or hospital rounds. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, (919) 845-0054, E-mail: physiciansolutions@gmail.com Methadone Treatment Center located near Charlotte, N.C., has an opening for an experienced physician.

You must be comfortable in the evaluation and treatment within the guidelines of a highly regulated environment. Practice operating hours are 6 a.m. till 3 p.m., Monday through Friday. Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Family Practice physician is needed to cover several shifts per week in Rocky Mount, N.C. This high profile practice treats pediatrics, women’s health and primary care patients of all ages. If you are available for 30 plus hours per week. This could be the perfect opportunity.

Send copies of your CV, N.C. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Cardiology practice located in High Point, N.C. has an opening for a board certified cardiovascular physician.

This established and beautiful facility offers the ideal setting for an enhanced lifestyle. There is no hospital 54| JANUARY 2012

Board Certified Internal Medicine Physician position is available in the Greensboro, N.C. area. This is an outpatient opportunity within a large established practice.

The employment package contains salary plus incentives. Please send a copy of your current CV, N.C. medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624. Email: physiciansolutions@ gmail.com or phone with any questions, (919) 845-0054.

Locum Tenens opportunity for Primary Care MD in N.C.’s Triad area This is a 40 hour per week on-going assignment in a fast pace established practice. You must be comfortable treating pediatrics to geriatrics. We pay top wage, provide professional liability insurance, lodging when necessary, mileage and exceptional opportunities. Please send a copy of your current CV, N.C. medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624. E-mail: physiciansolutions@ gmail.com or phone with any questions, (919) 845-0054.

Internal Medicine practice located in High Point, N.C., has two full time positions available. This well-established practice treats private pay as well as Medicare/ Medicaid patients. There is no call or rounds associated with this opportunity. If you consider yourself a wellrounded IM physician and enjoy a team environment, this could be your job. You would be required to live in or around High Point and if relocating is required, a moving package will be extended as part of your salary and incentive package. BC/BE MD should forward your CV, and copy of your N.C. medical license to physiciansolutions@gmail.com. View this and other exceptional physician opportunities at www.physiciansolutions.com or call (919) 845-0054 to discuss your availability and options.

Locum Tenens Primary Care Physicians Needed If you would like the flexibility and exceptional pay associated

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Careers Customer Service

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Visit ManageMyPractice.com. Today!

Unfortunately, its motor is inside playing video games.

Kids spend several hours a day playing video games and less than 15 minutes in P.E. Most can’t do two push-ups.

Many are obese, and nearly half exhibit risk factors of heart disease. The American Council on Exercise and major medical organizations consider this situation a national health risk. Continuing budget cutbacks have forced many schools to drop P.E.—in fact, 49 states no longer even require it daily.

You can help. Dust off that bike. Get out the skates.

Swim with your kids. Play catch. Show them exercise is fun and promotes a long, healthy life. And call ACE. Find out more on how you can get these young engines fired up. Then maybe the video games will get dusty.

A Public Service Message brought to you by the American Council on Exercise, a not-for-profit organization committed to the promotion of safe and effective exercise

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A M E R I C A’ S A U T H O R I T Y O N F I T N E S S

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Hospice Practice Wanted Hospice Practice wanted in Raleigh/ Durham area of North Carolina.

Hospi

To find out more information call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

EXCELLENT FAMILY PRACTICE FOR SALE North Carolina family practice located about 30 minutes from Lake Norman has everything going for it.

For more information call (919) 848-4202. To view other practice listings visit medicalpracticelistings.com

Gross revenues in 2010 were 1.5 million, and there is even more upside. The retiring physician is willing to continue to practice for several months while the new owner gets established.

Excellent medical equipment, staff and hospital near-by, you will be hard pressed to find a family practice turning out these numbers.

Listing price is $625,000.

56| JANUARY 2012

e in Dall ce Practic

as, TX

We have a qualified buyer that is looking for an established hospice practice in the Dallas,Texas area.

To review your hospice practice options confidentially, contact Medical Practice Listings at 919-848-4202 or e-mail us at medlistings@gmail.com.

Medical Practice Listings has a qualified physician buyer that is ready to purchase. If you are considering your hospice practice options, contact us for a confidential discussion regarding your practice.

Medical Practice Listings

: d e t Wan

To view our national listings visit www.medicalpracticelistings.com

Wanted: Urgent Care Practice Urgent Care Practice wanted in North Carolina.

Qualified physician is seeking to purchase an established urgent care within 100 miles of Raleigh, North Carolina.

If you are considering retiring, relocations or closing your practice for personal reasons, contact us for a confidential discussion regarding your urgent care. You will receive cash at closing and not be required to carry a note.

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Classified To place a classified ad, call 919.747.9031

Physicians needed

Practice sales

North Carolina (cont.)

North Carolina

Virginia

Impressive Internal Medicine Practice in Durham, N.C.: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four well equipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com.

with locums, we have immediate opportunities in family, urgent care, pediatric, occupational health and county health departments in N.C. and Va. Call today to discuss your options and see why Physician Solutions has been the premier physician staffing company on the Eastern seaboard. Call (919)845-0054 or review our corporate capabilities at www.physiciansolutions.com.

Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from Pediatrics to Geriatrics, we welcome your inquires. Send copies of your CV, Va. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, and PH: (919) 8450054, E-mail: physiciansolutions@gmail.com.

Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, Va. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, Va. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, N.C. 27624, (919) 845-0054, E-mail: physiciansolutions@ gmail.com. Call (919)845-0054 or review our corporate capabilities at www.physiciansolutions.com.

Modern Vein Care Practice located in the mountains of N.C. Booking seven to 10 procedures per day, you will find this impressive vein practice attractive in many ways.

Housed in the same practice building with an Internal Medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at www.medicalpracticelistings.com.

Family Practice located in Hickory, N.C. Well-established and a solid 40 to 55 patients split between an MD and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues average $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, N.C. 27624. (919) 848-4202 or email: medlistings@gmail.com.

MEDICAL PRACTICE LISTINGS Are you looking to sell or buy a practice? We can help you!

View national practice listings by visiting our website or contact us for a confidential discussion regarding your practice options. We are always ready to assist you.

919.848.4202 medlistings@gmail.com | medicalpracticelistings.com We have in-house practice experts and an attorney ready to assist.

MEDMONTHLY.COM | 57

Classified To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina (cont.)

South Carolina (cont.)

Internal Medicine Practice located just outside Fayetteville, N.C. is now being offered. The owning physician is retiring and is willing to continue working for the new owner for a month or two assisting with a smooth transaction.

The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice, it is modern, tastefully decorated and well appointed with vibrant art work. The practice, patient charts, equipment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, N.C. 27624. (919) 848-4202 or E-mail: medlistings@gmail.com.

Primary Care practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider.

Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several wellappointed exam rooms throughout. New computers and medical management software add to this modern front desk environment. This practice is being offered for $435,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, N.C. 27624. (919) 848-4202 or E-mail: medlistings@ gmail.com.

South Carolina Lucrative ENT practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/ thyroid surgery. Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when 58| JANUARY 2012

you want. Physician will to stay on for smooth transition.

Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, N.C. 27624. (919) 848-4202 or E-mail: medlistings@gmail.com.

Washington Family Practice located in Bainbridge Island, Wash. has recently been listed. Solid patient following and cash flow makes this 17 year old practice very attractive.

Contact Medical Practice Listings for more details.

Email: medlistings@gmail.com or (919) 848-4202.

Practice wanted North Carolina Pediatric Practice wanted in Raleigh, N.C. Medical Practice Listings has a qualified buyer for a Pediatric Practice in Raleigh, Cary or surrounding area. If you are retiring, relocating or considering your options as a pediatric practice owner, contact us and review your options. Medical Practice Listings is the leading seller of practices in the U.S. When you list with us, your practice receives exceptional national, regional and local exposure. Contact us today at (919) 848-4202.

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Pediatrics Practice For Sale Minneapolis, Minn.

Pediatrics Practice Wanted Pediatrics Practice wanted in N.C.

Located in the beautiful suburbs of Minneapolis, Minn., this two year old pediatric practice is successful and growing steadily. Averaging 14 patients per day and projected numbers top 35 per day within a short few months. Contracts have been established with Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, PreferredOne, UCare, Minnesota Medicaid, and America’s PTO. Providers include one MD, one LPN and two CMAs.

Considering your options regarding your Pediatric Practice? We can help.

Medical Practice Listings has a well qualified buyer for a Pediatric Practice anywhere in central North Carolina.

Fully equipped with modern computer networking in this 3,370 sq. foot leased medical space. Contact Medical Practice Listings for more information.

Medical Practice Listings 919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

MD STAFFING AGENCY FOR SALE Great opportunity for anyone who wants to purchase an established business.  One of the oldest Locums companies  Large client list  Dozens of MDs under contract  Executive office setting  Modern computers and equipment  Revenue over a million per year  Owner retiring  List price is over $2 million

Please direct all correspondence to mdstaffingforsale@gmail.com.

Only serious, qualified inquirers.

Contact us today to discuss your options confidentially.

Medical Practice Listings Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com PRACTICE FOR SALE

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina Well-established practice serving the Greensboro and High Point areas for over 15 years. Five exam rooms fully equipped, plus digital X-Ray. Extensive corporate accounts as well as walk-in traffic. Lab equipment includes CBC. The owning MD is retiring, creating an excellent opportunity for a MD to take over an existing patient base and treat 25 plus patients per day from day one. The practice space is 2,375 sq. feet. This is an exceptionally opportunity. Leased equipment includes: X-Ray $835 per month, copier $127 per month, and CBC $200 per month. Call Medical Practice Listings at (919) 848-4202 for more information.

Asking price: $385,000

To view more listings visit us online at medicalpracticelistings.com

MEDMONTHLY.COM |59

Primary Care Practice For Sale

Exceptional North Carolina Primary Care Practice for Sale

Medical Practice Listings

Established North Carolina Primary Care practice only 15 minutes from Fayetteville, 30 minutes from Pinehurst, 1 hour from Raleigh, 15 minutes from Lumberton and about an hour from Wilmington. The population within 1 hour of this beautiful practice is over one million. The owning physician is retiring and the new owner will benefit from his exceptional health care, loyal patient following, professional decorating, beautiful and modern free standing medical building with experienced staff. The gross revenue for 2010 is $856,000, and the practice is very profitable.

We have this practice listed for $415,000. Call today for more details and information regarding the medical building.

Our Services: • Primary Health • Well Child Health Exams • Sport Physical • Adult Health Exams • Women’s Health Exams • Management of Contraception • DOT Health Exam • Treatment & Management of Medical Conditions • Counseling on Prevention of Preventable Diseases • Counseling on Mental Health • Minor surgical Procedures

919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

For more information call Medical Practice Listing at (919) 848-4202.

To view our other listings, visit medicalpracticelistings.com.

Wilmington, N.C. Established primary care on the coast of North Carolina’s beautiful beaches.

Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients.

Excellent exam room layout, equipment and visibility.

Contact Medical Practice Listings for more information.

Private Medical and Mental Health Care Practice for Sale Coastal North Carolina, Minutes from Atlantic Beach

Established private internal medicine practice treating general as well as adolescent patients and licensed clinical psychologist’s combine for a high profile multi-disciplinary practice. The staff includes a medical doctor, physician assistant, three licensed clinical psychologists, and a complement of nurses and administrators. The internal medicine practice also uses locum physicians to treat primary care patients as needed.

Excellent gross income with solid profits are enjoyed in this evergrowing practice located in a bustling community with handsome demographics. Two all brick condominiums house these practices which are offered for lease or purchase.

This expanded services private health care facility has a solid following and all the tools necessary for enhanced services, income and expansion.

For more details which include a BizScore Practice Valuation, financial statements, patient demographics and furniture and equipment details, contact one of our professionals.

Medical Practice Listings PH: (919) 848-4202 Email: medlistings@gmail.com www.medicalpracticelistings.com 60| JANUARY 2012

N.C. MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in N.C. This established practice has staff MDs, PAs and Nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, Fractional Laser Resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process.

Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail medlistings@gmail.com.

Practice for Sale in Raleigh, NC Primary Care practice specializing in Women’s care Raleigh, North Carolina The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider. Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice.

Spacious practice with several well-appointed exam rooms, tactful and well appointed throughout. New computers and medical management software add to this modern front desk environment.

List price: $435,000.

Call Medical Practice Listings at (919) 848-4202 for details and view our other listings at www.medicalpracticelistings.com

www.medicalpracticelistings.com

Med Monthly Practice at the beach Plastic Surgery practice for sale with lucrative ENT specialty

Med Monthly is the premier health care magazine for medical professionals.

By placing an ad in Med Monthly you’ll reach: family medicine, internal medicine, physician assistants and more!

Myrtle Beach, South Carolina Practice for sale with room for growth and located only three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, Mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of Otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery. Room for establishing Allergy, Cosmetics, Laryngology & Trans-nasal Esophagoscopy. All the organization is done, walk into a ready made practice as your own boss and make the changes you want, when you want. Physician will to stay on for smooth transition. Hospital support also an option for up to a year. The listing price is $395,000.

For more information call Medical Practice Listing at (919) 848-4202. To view our other listings, visit medicalpracticelistings.com.

Call us today to place your classified!

919.747.9031

Also available online 24/7

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MEDMONTHLY.COM |61

the top If you are a doctor considering a specialty, a nurse looking to re-train, seeking a change of pace or just looking for a minor side project, below are 9 medical certifications you may consider:

Medical Career Options

NUTRITIONIST If you have a nursing background, a PhD or other medical training, certification in nutrition can be a high-reward, low-stress option.

8

HEALTH CARE IT PROFESSIONAL As the importance of meaningful use grows, an increasing number of practices are hiring health care IT professionals, especially those with medical experience, to optimize their electronic medical records system.

Compiled by Leigh Ann Simpson

TEACHING PROFESSOR Educating at a teaching hospital or med-school can be a natural part of a physician’s career, but specific courses and certifications can make you more marketable.

2

MEDICAL WRITER If you want to explore your options outside of clinical practice that allow you to still make a significant impact, why not consider becoming a medical writer? This is a fulfilling career you can enjoy full or part-time while expanding your knowledge into new arenas!

3

RESEARCHER Are you sick of dealing with people, or at least patients?

Apply your medical experience to the world of academic research and continue to make a difference, perhaps on an even greater scale.

62| JANUARY 2012

7

MEDICAL CODER If you are a nurse, administrative or support professional, there is a great demand for medical office staff who are certified and up-tospeed on codes and other short forms for conditions, treatments, procedures and drugs.

5

SPORTS MEDICINE TRAINING A total switch to working in sports medicine can help keep you and your patients healthier.

HEALTH CARE CONSULTANT Consultants are vital to today’s industry as so many healthcare providers are seeking strategic insight and actionable advice during the process of implementing changes in their practices.

9

PROFESSIONAL PUBLIC SPEAKER Public speakers with a proven track record of great success in the corporate/medical field can earn $50,000 per engagement and up. Why not cash in and present on what services, research and success stories you can uniquely speak on?

GROW YOUR PRACTICE

Let MedMedia9’s expert designers create a website for your practce. Need more? We can also create print collateral to help your practice grow.

Scan this QR code with your smartphone to learn more.

MEDMEDIA9.COM | 919-747-9031

IMAGINE THAT!