Med Monthly June 2014

Med Monthly June 2014

THE TOP

THE LANDSCAPE OF SPECIALTIES pg. 40

Medical Specialties

pg. 78

Family Practice Specialization in India

The Long Way Home pg. 46

Selecting a Medical Specialty pg. 42

the

Medical es Specialti issue

contents

features

THE LANDSCAPE OF SPECIALTIES

40

40 THE LANDSCAPE OF SPECIALTIES 42 SELECTING A MEDICAL SPECIALTY 46 FAMILY PRACTICE SPECIALIZATION IN INDIA: The Long Way Home

insight 10 3 PHASES TO HEAL CHRONIC STRESS 12 RX TO OTC: Is This the Next Big Thing?

16 2014 WORK/LIFE PROFILES OF TODAY’S U.S. PHYSICIAN

practice tips 18 ARE YOU MAKING THE #1 WEBSITE MISTAKE? 20 PROPOSED HEALTH IT STRATEGY 22 THE SIMPLE FORMULA FOR SUCCESSFUL MEDICAL PRACTICE MARKETING

research and technology 28 UP TO 40 PERCENT OF ANNUAL DEATHS FROM EACH OF THE FIVE LEADING US CAUSES ARE PREVENTABLE 30 FDA APPROVES AUTO-INJECTABLE NALOXONE FOR OUTPATIENTS TO REVERSE OPIOID OVERDOSE 32 NIH CENTER SETS NEW GOALS FOR GLOBAL HEALTH RESEARCH AND TRAINING

legal

international 24 DENTAL TOURISM FOR INDIAN MARKETS

34 NO MORE EXCUSES: Encrypt Your Laptop or Pay Big Money 36 HHS TO HOLD PUBLIC SESSION ON POTENTIAL UPDATES TO AODA CONFIDENTIALITY REGULATIONS 38 NEW DATA SHOWS HIGHER HEALTHCARE COSTS IN SECOND HALF OF 2013

the arts 48 QUINTESSENTIAL RENAISSANCE MAN

healthy living 50 ROASTED ASPARAGUS WITH PARMESAN RX TO OTC: Is This the Next Big Thing?

12

in every issue 4 editor’s letter 8 news briefs

56 resource guide 78 top 9 list

January 1, 2014 begins the attestation period for Stage 2 Meaningful Use. If you are a member of the North Carolina Medical Society, you have access to the resources provided for our members to help your practice achieve Meaningful Use in 2014.

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editor’s letter MedMonthly’s June edition puts the spotlight on medical specialties and how a provider should go about choosing one.

There are a variety of things to consider, and we hope to make that decision a little easier. SDN’s Specialty Selector is one way to match your personality with a specialty. Past that, let’s ask our experts.

“I want to make a lot of money.” “I don’t want to work an 80 hour week.” These are a couple obvious thoughts residents consider when deciding on a specialty. But medical careers are often long, and status alone is hard to carry you through. And though some specialties like emergency medicine generally have a 35-40 hour work week, the shifts are often nights and weekends. Just like in any other career, the sagest advice when contemplating a medical career is simply this: interest. In “Selecting a Medical Specialty” by Christopher Becker, MD, the factors that ought to be considered are discussed. Dr. Becker also gives us examples of specialties, including compensation, hours, procedures and call.

The editorial “The Landscape of Specialties” discusses another way to consider your options, by looking at demand for physicians, which is increasing everywhere in the United States.

But what is the area most in demand? Family medicine is at the top of the list, followed by internal medicine and geriatrics. Due to an aging population and influx of soldiers returning from war has put pain management has seen an almost 10% increase.

The article also points out that geographic location influences demand; for instance, dermatologists are needed more in the southern states because of exposure to sun.

Anuradha Katyal and Sahitya Reddy, in their feature “Family Practice in India”, remark on the troubled primary healthcare system in their country. They found that there was a lack of community based family practitioners, and therefore a substantial misuse of hospitalization. Because of the deficiency of primary care providers, people go to the hospital for unnecessary reasons, such as for infectious diseases easily curable at the primary care level. The cost of course is substantially more at a hospital, and a middle class family could easily slide into the poverty level with only one visit. In their study, Anuradha and Sahitya seek to “resuscitate primary healthcares, especially for the bottom of the pyramid.”

Next month MedMonthly focuses on what almost everyone has to worry about – dieting. See how your practice can increase its revenue through nutrition in July’s “Diet and Your Practice” issue.

Ashley Austin Managing Editor 4 | JUNE 2014

Med Monthly June 2014 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Christian Becker M.D. Nidhi Vats Behl Kimberly J. Gold Alexis Gopal M.D. Barbara Hales, M.D. Anuradha Katyal Eric A. Klein Audrey Christie McLaughlin R.N. Goran Medic Meghan O’Connor Sahitya Reddy Angela Savitri, OTR/L, RYT

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 medmonthly.com/writers-guidelines P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

contributors Alexis Gopal M.D. has years of clinical experience in Internal Medicine in NYC and CT, and has recently transitioned into a career of freelance medical communications. She has a special interest in regulatory affairs, and patient education.

Dr. Anuradha Katyal is a Program Associate with ACCESS Health Int, ISB, Hyderabad, India. She is a dentist and an MSc in Healthcare Management from University of Surrey. UK. She has practiced for two years and now works in the social sector with an inclination towards health financing.

Audrey McLaughlin, RN is a physicians practice expert, medical practice business strategist & marketing specialist. She uses her more than 12 years of diverse medical industry experience to help physicians, practice owners and managers to breathe new life into their practices.

Goran Medic, MPharm is a pharmacist specialized in health economics with more than 6 years of hands-on experience in market access and reimbursement across Europe. He has developed numerous budget-impact and cost-effectiveness models. He is writing documents to communicate health economics and other value messages, as well as performing systematic literature reviews and network meta-analysis. Website: www.mapi-consultancy. com

Angela Savitri, OTR/L, RYT helps high-achieving women be free of burnout and chronic stress.

She is an Integrative Health Coach and combines principles of behavioral science, mindfulness, and embodiment in her 90-Day Freedom from Chronic Stress Program. www.freedomfromchronicstress. com.

WWW.MEDMONTHLY.COM |5

designer's thoughts

From the Drawing Board In the “Research and Technology” section of the June issue of Med Monthly we report on new research by the CDC, approval by the Food and Drug Administration (FDA) on auto-injectable Naloxone, and NIH’s future goals for global health is research and training.

In the article “Up to 40 Percent of Annual Deaths From Each of Five Leading US Causes Are Preventable”, the CDC reports that up to two-fifths of fatalities could be prevented in the five leading causes of death in the United States. These include heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries. Many of these risks are avoidable by making changes in personal behaviors.

In the editorial “FDA Approves Auto-Injectable Naloxone for Outpatients to Reverse Opioid Overdose”, author Alexis Gopal M.D. informs readers that the U.S. FDA approved an easy to use form of the Opioid antidote Naloxone for physicians to prescribe to outpatients. Evzio delivers a single dose of Naloxone via a hand-held auto injector, either into the muscle (intramuscular) or under the skin (subcutaneous). She also explains it is crucial that family members and caregivers also be educated on how to use the device, since they may have to administer it to the patient.

Future goals of the National Institutes of Health (NIH) are reported in the article “NIH Center Sets New Goals for Global Health Research and Training”. “ As research discoveries and aid efforts have reduced deaths from HIV/AIDS, populations in the developing world are increasingly suffering from noncommunicable diseases such as heart disease, cancer, diabetes, and mental illness.” The NIH will address this concern through the use of e-learning, enabling physicians and health care professionals to gain access to the ever expanding knowledge base that can keep them current throughout their careers, no matter their location.

MedMonthly will continue to report on the latest medical research and technology. If there are topics or insights on advances in medical technology you would like to share with us for future issues, please contact us at medmedia9@gmail.com.

Thomas Hibbard Creative Director

6 | JUNE 2014

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news briefs

Predictive and Preventive Healthcare Propels Exponential Growth of Digital Pathology Market in China Finds Frost & Sullivan The advent of digital pathology is expected to revolutionize the healthcare industry in China and help overcome challenges in medical education, clinical practices and research. Favorable government healthcare reforms, such as initiatives on nationwide telepathology consultation and quality control programs, as well as the growing need for integration of healthcare delivery will usher in a wave of digital pathology adoption in the country.

New analysis from Frost & Sullivan, Analysis of the Digital Pathology Market in China, finds that the market earned revenues of $259.0 million in 2013 and estimates this to rocket up to $1,914.8 million in 2019.

A burgeoning elderly population cohort the number of people over 60 years is projected to increase 8 million annually and reach 243 million by 2020 has heightened the need for accurate and reliable pathological diagnosis. The issue is further aggravated by a rising incidence of cancer across the country.

“With the escalating growth of digital data, leveraging advancements in information technology and big data analytics will shift future healthcare deliveries towards personalized, evidence-based treatments,” said Frost & Sullivan Healthcare Research Analyst Raymond Chong. “Healthcare will revolve around collaboration among medical institutions with emphasis on predictive and preventive medicine, widening the potential of the Chinese digital pathology market.”

Unfortunately, high investment and maintenance costs, low sample volume, and limited returns are hurdles to the use of digital pathology, particularly in rural regions. With barely 20 percent of medical resources allocated to rural areas, healthcare institutions remain reluctant to purchase these solutions.

Digital pathology system vendors in China should identify and understand targeted end-user segments and deliver cost-effective, customized solutions to sustain business viability. Implementing unique pricing strategies in which products and services are priced in line with customer budgets and expectations will enable manufacturers to retain market share.

“Digital pathology system vendors should seek partnerships with various participants along the value chain, including software vendors and device manufacturers,” advised Chong. “Aligning investment plans with government and stakeholders’ agenda to build long-term partnerships will further bolster their position in the fastexpanding Chinese market.”

8 | JUNE 2014

If you are interested in more information on this study, please send an email to Julie Zheng, Corporate Communications, at julie.zheng[.]frost.com, with your full name, company name, job title, telephone number, company email address, company website, city, state and country.

Analysis of the Digital Pathology Market in China is part of the Connected Health (connectedhealth.frost.com) Growth Partnership Service program. Frost & Sullivan’s related studies include: China Healthcare Information Technology Solutions Market, Global Enterprise Content Management (ECM) Market for Healthcare, US Market for General Wellness and Early Intervention Technologies, and Western and Eastern European Image and Information Management Systems Market. All studies included in subscriptions provide detailed market opportunities and industry trends evaluated following extensive interviews with market participants.  Source: http://www.newswiretoday.com/news/142143/

SOON COMING NTHLY O IN MED M

coming In the up d issue, Me July 2014 l be theme wil Monthly’s e c ur Practi Diet & Yo

Students Raise Malaria Awareness With Flash Mobs Harvard’s Defeating Malaria initiative, spearheaded by Harvard School of Public Health, sponsored a student-led event called “Mob Malaria” in commemoration of World Malaria Day on April 25. Two hundred students gathered in the Science Center Plaza to participate in a synchronized flash mob designed to raise awareness of the need to eradicate malaria.

Dyann Wirth, director of the Defeating Malaria initiative and chair of HSPH’s Department of Immunology and Infectious Diseases, attended the event, along with the chief of staff for Ray Chambers, the UN Special Envoy for Malaria and a member of the HSPH Board of Dean’s Advisors.

The two Harvard College students who organized the event, Stephen Turban ’17 and Lily Zhang ’17, wanted it to be a global project and reached out to students in Beijing, China and Harare, Zimbabwe; a total of nearly 350 students participated in their own versions of Mob Malaria in the two cities.

In addition to the flash mob, the Defeating Malaria initiative supported a number of other student-led activities. HSPH students organized a photo exhibit called “Malaria Matters,” and a 5k fundraising run. Harvard College students ran a masquerade fundraising party called “Masquerade for Malaria.” All of the day’s activities were ideas submitted to the 2013 Harvard Malaria Competition, which sought innovative ideas for raising awareness to defeat the disease.  Source: http://www.pressreleasepoint.com/students-raise-malaria-awareness-flash-mobs

Findings Suggest Oral HPV Infection and Cancer Exposure Remains Low Many patients with throat cancer associated with oral human papillomavirus (HPV) have anxiety about transmitting the virus to their partners’ and increasing their cancer risk. However, a multi-center prospective study coled by researchers at Icahn School of Medicine at Mount Sinai suggests that cancer risk in partners remain low. The research is reported in the Journal of Clinical Oncology (JCO).

“The incidence of HPV-related cancer has increased dramatically over the past three decades, but we have limited understanding how the disease progresses of if it is transmitted to the partners of these patients,” said Marshall Posner, MD, Director of Head and Neck Medical Oncology and Office of Cancer Clinical Trials, Associate Director of the Center for Personalized Cancer Therapeutics, and Professor of Medicine in the Division of Hematology/Medical Oncology, Tisch Cancer Center at Mount Sinai. “Often, HPV infections that do become cancers often take years to develop. This is the first study to demonstrate that partners of HPV patients with cancer do not have any detectable cancer DNA, and that most partners are not exposed to any active infections.”

According to the Centers for Disease Control, 79 million Americans are currently infected with HPV with 14 million new cases each year. HPV is commonly spread through sexual contact. Most sexually-active men and women are diagnosed with one type of HPV at some point in their lives. In the United States, more than half of the cancers diagnosed in the oropharynx are linked to HPV. The study reviewed the histories of 164 patients with HPVpositive oropharyngeal cancer (HPV-ONC) and 93 of their spouses or long-term partners. The subjects were enrolled in head and neck cancer clinics at four study sites including Mount Sinai, Johns Hopkins Hospital, Dana Farber Cancer Institute and the Oregon Health and Science University.

Participants in the study were given an oral rinse where exfoliated cells were collected along with a base line blood sample and cancer history. A detailed risk factor survey was also collected at each visit, including questions on demographics, tobacco and alcohol use, and detailed sexual behaviors. Of the 164 enrolled patients with HPVONC, most had stage 4 cancers and oral HPV DNA in their tumors. Partners were primarily female, had performed oral sex, and were never smokers.

This study was funded by the Johns Hopkins Richard Gelb Prevention Award, and a research grant from the Early Detection Research Network.  Source: http://www.pressreleasepoint.com/findingssuggest-oral-hpv-infection-and-cancer-exposure-remainslow WWW.MEDMONTHLY.COM |9

insight

3 PHASES TO HEAL CHRONIC STRESS

By Angela Savitri, OTR/L, RYT

Certified Integrative Health Coach www.freedomfromchronicstress.com

S

tress often receives a bad reputation, but it is critical to distinguish the effects of acute stress and chronic stress.

Acute stress, stress that last for a short period of time, is normal and a necessary function of biological existence. There is nothing inherently harmful with experiencing acute stress. Some studies show acute stress can increase a healthy immune response1 and when people are informed that stress symptoms – a racing heart, butterflies in the stomach, feelings of nervousness - are working in their favor, perceived negative symptoms of stress decrease2.

The effects of chronic stress, however, are harmful. Chronic stress happens with the perceived demands of life outweigh one’s available resources for a period of months to years. It is chronic stress that wreaks havoc on the physical, mental, and emotional body, leaving those who experience it feelings of constant tension and susceptible to physical illness, insomnia, depression, anxiety, relationship problems, and career disruption.

10 | JUNE 2014

There are many external conditions that contribute to chronic stress, often identified as caring for someone who is ill or caring for a child with special needs, managing a chronic illness, experiencing long-term financial strain, and/or traumas.

Although these conditions contribute to chronic stress, there is another group of high-performing professional adults who experience chronic stress from a demanding career combined with competing personal demands, ambition, high expectations, perfectionist tendencies, and an overextended schedule.

In my work with high-achieving professional women, chronic stress symptoms show up as insomnia, a racing mind, exhaustion, reactivity, impatience, discontent, and feelings of disconnection from themselves and the ones they love. It is rarely their professional work that suffers, but symptoms first show up as a decrease in their own felt sense of well-being followed by relationship strain with a partner and/or children.

If the physical, emotional, and/or relationship problems get bad enough

after goal-setting cycles and traditional self-care measures fail to provide relief, high-achieving women may seek counsel from a healthcare provider, therapist, or health coach.

Providers may offer advice to take some time off, practice yoga, get a massage, or take warm baths. Although these are wonderful acts of self-care and temporarily reduce acute stress, these tactics do not resolve chronic stress. The belief that a vacation, taking a yoga class, or receiving a massage resolves chronic stress is a myth.

In my practice, I guide highachieving professional women through three phases to heal chronic stress.

These phases, when approached with compassion and gentleness, create a restored nervous system, resiliency to prevent harm from future stressors, and self-awareness to regulate emotions and activities without guilt or exhausting one’s resources.

Phase 1: Stress Awareness “It came out of nowhere…I don’t know how this happened…I’ve been a little stressed but I feel fine.” These are

words commonly heard after someone has received a stress-related health crisis wake-up call.

In order to heal chronic stress, it is imperative to develop body awareness to discern and honor the body’s sensations. The body is constantly providing sensation and feedback from internal and external stimuli, most of which goes unnoticed, ignored, or denied.

With so much cultural identity and emphasis placed on scholastic knowledge and external achievement, few have mastered the art of embodiment. What is it like to live and be in the body instead of the head?

Developing stress awareness through embodiment practices allows one to observe and respond to fluctuations in body temperature, tempo of mental activity, and constriction of muscle and breath patterns that alert one to their current stress state. In order to change any pattern that is causing harm, awareness must precede action.

Phase 2: Stress Regulation Stress management is a popular term, but I prefer the term stress regulation. Stress management assumes that one needs to manage something – work, domestic responsibilities, relationship strain – outside of themself.

Healing from chronic stress is an inside job. Oftentimes, it is internal stressors like fear, guilt, perfectionism, high expectations, and/ or self-judgment that fuel the external circumstances high-achievers believe create their experience of stress.

By developing mindful awareness, the practice of paying attention to the present moment without judging it, high-achieving professionals learn to regulate their emotions, responses, and activities to maintain a personal well of energy that never runs on empty.

Stress regulation allows for ups and downs within safe parameters of enough activity for stimulation but not

so much activity to create overwhelm or exhaustion. Balance is never static.

Phase 3: Stress Shifting Managing stress as a consistent way of life is like managing misery. It sets the bar of what is possible very low and in turn, keeps one assuming that chronic stress is the norm.

Freedom from chronic stress happens when one shifts out of the ‘managing stress’ mindset and engages in activity and relationships that increase connection, love, and joy.

Love is humanity’s supreme emotion and governs the experience of contentment and peace needed to shift toward feeling light-hearted and connected. This is not romantic love, but rather a felt sense of warm connection with other humans, animals, and nature that evoke positive emotions.

Chronic stress is rooted in disconnection from the present moment, nature, and the experience of being alive. To heal chronic stress, one must decrease their stress muscle and flex their connection muscle. Slow down, pay attention, and connect.

It takes vulnerability, awareness, and self-reflection for high-achieving professionals to heal chronic stress. Approach the process with compassion; view it as a practice instead of a destination, and everyone can experience freedom from chronic stress.  1. Viswanathan, K. & Dhabhar, F. (2005) Stress-induced enhancement of leukocyte trafficking into sites of surgery or immune activation. Proceedings of the National Academy of Sciences of the United States of America, 102, 58085813. doi:10.1073/pnas.0501650102 2. Keller, A., Litzelman, K., Wisk, L.E., Maddox, T., Cheng, E.R., Creswell, P.D., & Witt W.P. (2012) Does the perception that stress affects health matter? The association with health and mortality. Health Psychology, 31(5), 677-684.

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insight

Rx to OTC SWITCH –

IS THIS THE NEXT BIG THING?

By Goran Medic, Eline Huisman, and Carla Vossen Mapi - HEOR & Strategic Market Access, The Netherlands Corresponding Author: Goran Medic

12

| JUNE 2014

Over-the-counter (OTC) drugs can be an important aspect of selfempowered decision-making by patients. Hence, patients are taking increased control of health care decisions, especially for non-life threatening chronic conditions. It also reduces costs for government and private insurers by limiting physician services for routine care and patients pay directly for consumer medicines.

The Food and Drug Administration (FDA) defines OTC drugs as safe and effective for use by the general public without a doctor’s prescription.

[1] OTC drugs are mostly used for “mild” diseases and patients can make a reasonable decision themselves on which OTC medication to use.

A prescription (Rx) drug requires a doctor’s authorization to purchase as these drugs are used for more “severe” diseases. [1] Switching patients from Rx-to-OTC is an interesting playing field for the pertinent stakeholders: patients, pharmaceutical companies and payers. Is Rx- to- OTC switch the next big thing?

The advantage of OTC drugs is that when a patient makes the right

self-diagnosis the OTC drug will likely provide a benefit if used according to instructions with a low risk of adverse events. However, problems arise in case of an incorrect self-diagnosis, which is delaying accurate diagnosis and treatment of serious illnesses by a healthcare professional, or when OTC drugs are used incorrectly or in combination with other drugs thereby increasing the risk of adverse events.

[2, 3] In addition, the easy access gives potential for misuse and abuse. [3] It can also increase or decrease costs of treatment depending on the health insurance and the country.

OTC drug retail is a growing market, with sales of $33.1 billion in 2013, compared to only $14.1 billion in 2004. [4] Currently, 35% of adult American citizens are using OTC medications on a regular basis and there is a trend towards increased use as more drugs move from prescription to OTC status. [5] In 2008, for the first time ever, growth in the sales of OTCs surged significantly ahead of growth in the sales of Rx medicines.

Now worth $98.5 billion globally, the OTC market continues to outgrow the

pharmaceutical sector by a clear and consistent margin (Figure 1).

We have recently seen an example of pharmaceutical companies trying to increase their revenues on OTC drugs. Novartis and GlaxoSmithKline, two of the world’s top drug makers, have struck a multi-billion-dollar deal to join forces and reshape their businesses. The deal involves swapping assets and combining their consumer health units which also include OTC drugs. Novartis will acquire GSK’s cancer drugs business and sell its vaccines division, excluding the flu unit, to GSK. [6,7] GSK and Novartis will create a new world-leading Consumer Healthcare business with 2013 pro forma revenues of $11 billion.

GSK will have majority control with an equity interest of 63.5%. [6] The goal of switching is the diversification of portfolios by expanding into consumer and OTC products, while addressing prescription market needs and simultaneously building stable and predictable revenue streams and managing the product lifecycle. continued on page 14

Figure 1. Year on year growth and OTC share of total pharma (Figure adapted from [8])

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continued from page 13

Rx vs. OTC drug There are over 80 therapeutic categories of OTC drugs which can be grouped in 12 broad therapeutic classes (Table 1). [9, 10] The recent strategic joint venture between GSK and Novartis points out those pharmaceutical companies are actively pursuing consumer health as an area of diversification and growth. In 2012, $33 billion of sales was reported to have been lost as a result of expired patents. [11] It has been suggested that for the period between 2012 and 2018, more than $290 billion of sales will be at risk from patent expirations, with 2015 being the most crucial year for pharmaceutical companies. [11] There are several ways to maximize an Rx product future potential as it approaches its patent expiration. Pursuing a generic strategy, monetizing the assets of a mature established product and of course performing a switch from Rx to OTC are all valid strategies which involve strategic analyses and thinking.

Regulatory bodies are nowadays also more favorable towards switching than they have been in the past. For example there are now more than 700 OTC drugs in the USA that

would have required a prescription only 20 years ago, according to the Consumer Healthcare Products Association (CHPA).

[12] The FDA believes that there is an important trend towards consumer participation in their health care. [12] Improvements in the regulation process by European Medicines Agency (EMA) and the adoption of the centralized regulations of Rx-to-OTC switching in Europe have fuelled further growth in Europe as well. [13] Rx-to OTC switching has a huge impact on the health care economy too. The greater availability of medicines over the counter saves payers approximately $20 billion each year, according to a 1997 study by the CHPA. [12] The $20 billion takes into account prescription drug costs, doctor visits, lost time from work, insurance costs, and travel. [12] In accordance, numerous economic studies investigating the effect of Rx-to-OTC switches have reported

Table 1. Twelve broad therapeutic classes of OTC medications Analgesics and antipyretics Cold, cough and allergy products Nighttime sleep-aids Gastrointestinal products Dermatological products

Ophthalmic products Oral health care products Menstrual products Nicotine replacement products Weight loss aids

Other topical products Vaginal contraceptives and (including dermal and emergency contraceptives vaginal antifungals, anorectal medications, head lice products, hair loss products and otics) 14 | JUNE 2014

cost savings to society or payers.

[14-29] For example, two studies suggested that the Rx-to-OTC switch of loratadine was cost effective for consumers, payers, and society as a whole. [27, 28] The study by Sullivan et al 2005 demonstrates that the Rxto-OTC switch of loratadine resulted in cost savings for payers (in terms of prescription utilization and cost only); consumers facing no change in their prescription benefits significantly decreased utilization of prescription drug after the OTC availability of loratadine. [29] In contrast, one study reporting consumer cost data and medical service utilization argues that Rx-to-OTC switches of cromolyn, tioconazole, ketoconazole and terbinafine did not benefit patients financially or medically. [26]

Conclusion Given the challenges that the pharmaceutical industry is facing in sustaining revenue streams, the consumer health care business is becoming a viable option for prolonging prescription product

lifecycles by switching to OTC. Competition is growing and the markets are definitely on the move.

OTC medications represent a diverse group of widely available drugs which are considered safe and effective when used appropriately. OTC use is expected to continuously increase in the coming years. Whether switching from Rx to OTC is the new big thing is hard to predict, but for sure it is already ongoing and major players are getting involved in the OTC market which will eventually diversify and expand the portfolio of OTC drugs.

This could eventually improve the quality and maybe even reduce the prices of existing OTC products.  REFERENCES: 1. http://www.fda.gov/drugs/ informationondrugs/ucm079436. htm#O Accessed May 8th, 2014 2. World Health Organization (WHO). Guidelines for Regulatory Assessment of Medicinal Products for Use in Self-Medication (Geneva 2000). http://apps.who.int/medicinedocs/ en/d/Js2218e/. Accessed May 9th, 2014 3. Brass EP. Changing the status of drugs from prescription to over-thecounter availability. N Engl J Med. 2001;345(11):810-16.

4. http://www.chpa.org/ OTCRetailSales.aspx Accessed May 8th, 2014.

5. Deloitte Center for Health Solutions. 2010 Survey of Health Care Consumers: Key findings, strategic implications. http://www.deloitte.com/ assets/Dcom-UnitedStates/Local%20 Assets/Documents/US_CHS_2010Sur veyofHealthCareConsumers_050610. pdf. Accessed May 8th, 2014.

6. http://www.gsk.com/media/pressreleases/2014/gsk-announces-majorthree-part-transaction-with-novartis. html Accessed May 8th,2014 7. http://www.novartis.com/ newsroom/media-releases/ en/2014/1778515.shtml Accessed May 8th, 2014 8. Tisman A. The Rising Tide of OTC in Europe. http://www.imshealth.

com/deployedfiles/imshealth/Global/ Content/Healthcare/Healthcare%20 Solutions/Consumers/The_Rising_ Tide_Of_OTC_Europe.pdf Accessed May 8th 2014.

9. Food and Drug Administration (FDA). Regulation of Nonprescription Products. http://www.fda. gov/aboutfda/centersoffices/ officeofmedicalproductsandtobacco/ cder/ucm093452.htm Accessed May 8th, 2014.

10. Schneider H and the Consumer Healthcare Products Association Clinical/Medical Committee.

Pharmacy Today. 2010 October; 68-79.

11. Harrison C. Patent watch.

Nature Reviews Drug Discovery. 12, 14-15 (2013).

12. http://www.fda.gov/drugs/ resourcesforyou/consumers/ ucm143547.htm Accessed May 8th, 2014 13. http://www.ema.europa.eu/ docs/en_GB/document_library/ Presentation/2011/06/WC500107874. pdf Accessed May 8th, 2014 14. Temin P. Realized benefits from switching drugs. J Law Econ.

1992;35:351-369.

15. Kline & Company, Inc. Economic Benefits of Self-medication: A Report to NDMA. Washington, DC: Nonprescription Drug Manufacturing Association; May 15, 1997.

16. Queen’s Health Policy. The Economics of Self-medication.

Kingston, Ontario: Queen’s University Kingston; June 1995.

17. Lundberg L, Isacson D.The impact of over-the-counter availability of nasal sprays on sales, prescribing, and physician visits. Scand J Prim Health Care. 1999;17: 41-45.

18. Andrade SE, Gurwitz JH, Fish LS. The effect of an Rx-to-OTC switch on medication prescribing patterns and utilization of physician services: the case of H2-receptor antagonists.

Med Care.1999;37: 424-430.

19. Andersson F, Hatziandreu E. The costs and benefits of switching a drug from prescription-only to over-the-counter status: a review of

methodological issues and current evidence. Pharmacoeconomics.1992;2: 388-396.

20. Oster G, Huse DM, Delea TE, Colditz GA, Richter JM. The risks and benefits of an Rx-to-OTC switch: the case of over-the-counter H2-blockers.

Med Care.1990; 28:834-852.

21. Gurwitz JH, McLaughlin TJ, Fish LS. The effect of an Rx-to-OTC switch on medication prescribing patterns and utilization of physician services: the case of vaginal antifungal products. Health Serv Res.1995; 30:672-685.

22. Kalish SC, Bohn RL, Avorn J. Policy analysis of the conversion of histamine 2-antagonists to over-thecounter use. Med Care.1997;35:32-48 23. McCarthy R.OTCs: the wild card in cost effectiveness. Business Health. 1999; 17:33-35.

24. Carlsten A, Wennberg M, Bergendal L. The influence of Rxto-OTC changes on drug sales: experiences from Sweden 1980-1994 [published correction appears in J Clin Pharm Ther. 1997;22:155-156]. J Clin Pharm Ther. 1996; 21:423-430.

25. Newton G, Popovich NG, Pray WS. Rx-to-OTC switches: from prescription to self-care. J Am Pharm Assoc (Wash). 1996;NS 36:488-495.

26. Gianfrancesco F, Manning B, Wang R. Effects of prescription to OTC switches on out-of-pocket health care costs and utilization. Drug Benefit Trends. 2002; 14:13-30, 44.

27. Sullivan PW, Follin SL, Nichol MB. Transitioning the secondgeneration antihistamines to overthe-counter status: a cost-effectiveness analysis. Med Care. 2003;41:1382-1395 28. Sullivan PW, Nichol MB.The economic impact of payer policies after the Rx-to-OTC switch of secondgeneration antihistamines. Value Health.2004;7:402-412 29. Sullivan PW, Nair KV, Patel BV. The effect of the Rx-to-OTC switch of loratadine and changes in prescription drug benefits on utilization and cost of therapy. Am J Manag Care. 2005 Jun; 11(6):374-82.

WWW.MEDMONTHLY.COM |15

insight

AMA Insurance’s New Report,

2014 WORK/LIFE PROFILES OF TODAY’S U.S. PHYSICIAN Delivers Insights From Finances and Marriage to Future Plans and Social Media Fifty-one (51) percent of physicians over age 60 graduated from medical school with debt. Now 73 percent of physicians under age 40 have student loan debt. And nearly half of these young physicians carry a debt of $150,000-200,000 – with 83 percent still paying off their loans. These statistics form a partial profile of physicians today. They also point up a difference by age, one of many that emerge in AMA Insurance’s newly released 2014 Work/Life Profiles of Today’s U.S. Physician ( http://bit. ly/1jvHwli ).

The in-depth report paints a highly dimensional picture 16 | JUNE 2014

of physicians’ work and lifestyles, and shows some distinct differences between physicians under age 40, ages 40-59, and 60-69. Report findings were compiled from a national survey conducted by AMA Insurance in October 2013.

An intriguing look at physicians at every stage of their career

“The enthusiastic response of nearly 5,000 physician participants helped us build a deep and very realistic portrait of physicians’ lives today,” said D.S. Friday CLU, Vice President of Sales and Marketing of AMA Insurance,

a wholly owned subsidiary of the American Medical Association (AMA). “We found that there is no ‘one’ profile for physicians when it comes to lifestyle, but rather a number of profiles related to different age groups, with some reflecting gender differences. Together, they offer an intriguing look at physicians at work and during leisure time, at every stage of their career.”

Report reveals current work/lifestyle insights

The 2014 Work/Life Profiles of Today’s U.S. Physician presents a wide range of insights spanning home and family life, activities and hobbies, work life, technology use, personal finances and financial concerns, and future personal and practice plans. Following are several findings; the full report is available at http://bit.ly/1jvHwli .

MARRIAGE: Nearly 40 percent likely to marry physician or healthcare professional; young physicians more likely to marry physicians than other age groups • The majority of physician respondents are married and nearly 40 percent are married to a physician or healthcare professional. Seventy-five (75) percent of physicians under age 40 are married; they are more likely to marry other physicians (26 percent) than those ages 40-59 (18 percent) and over age 60 (13 percent).

WORK: Most work 40-60 hours per week, but nearly 25% work 60 to more than 80 hours per week.

• 20% of female physicians under 40 with children at home work less than 40 hours per week.

• 70% of physicians work primarily days, about 30% work a combination of days and nights. Only 1% of all physicians work strictly nights.

PRACTICE PLANS: 23 percent under age 40 to change employers; 44 percent over age 60 to retire • In the next five years, most physicians plan to continue practicing, but 23 percent under age 40 plan to change employers – and 13 percent of physicians ages 40-59 also plan to make that change. Also in five years’ time, forty-four percent of physicians over age 60 plan to retire.

PERSONAL FINANCE: Retirement savings top concern; male physicians want more savings than female physicians; over age 60 physicians want $1,000,000+ more • Retirement savings is the top personal financial concern of physicians of all ages. The next top concerns are protecting estates from taxes (older physicians) and investment strategies and college fund savings (younger physicians).

• Asked about more retirement savings, physicians under age 40 (65 percent) said they would like to have $200,000-500,000 more in savings at this point in their life; physicians over age 60 would like to have

$1,000,000+ more. Males in all age groups were more likely to want $1,000,000+ in incremental savings than female physicians.

SOCIAL MEDIA: Facebook most used by female physicians; LinkedIn popular among young male physicians • Facebook is most popular with physicians under age 40 (71) percent and ages 40-59 (47 percent). About a quarter of physicians of all ages used LinkedIn. However, 38 percent of physicians ages 40-59, and almost half of physicians over age 60 do not use Facebook, Twitter, LinkedIn, Pinterest or Google+.

Pinterest is the least used by all age groups, followed by Twitter.

• Female physicians are more likely to use Facebook than males. For example, 76 percent of female physicians under age 40 use Facebook versus 66 percent of males. Male physicians, especially under age 40, are more likely to use Linked In than female counterparts.

ACTIVITIES: Physicians highly active outside of work, throughout their lives • Half of physicians under age 40 run and jog; 35 percent of age 40-59 bicycle, and 36 percent run and jog. Nearly one third of physicians ages 60-69 bicycle and 23 percent run and jog. Other top activities are camping/hiking, golf, aerobics and snow skiing.  About the Survey: The national survey was sent to 125,000 practicing U.S. physicians up to age 69 in October 2013. The respondent profile (N=4,950 physicians) showed almost equal representation across age segments (24 percent ages 30-39; 25 percent ages 40-49; 29 percent ages 50-59; 22 percent ages 60-69); a 62-38 percent male to female ratio; and 29 percent in family medicine and internal medicine, 11 percent in pediatrics, 7 percent in obstetrics/gynecology and 53 percent in other specialties and sub-specialties. Survey data was collected through Qualtrics®. There was an overall 95 percent confidence interval with a margin of error +/- 3 percent.

About AMA Insurance: Established in 1988 as a wholly owned subsidiary of the American Medical Association, AMA Insurance Agency, Inc. specializes in meeting the insurance and financial services needs of America’s 1,000,000 physicians, both AMA members and non-members. Authorized to conduct business in all 50 states, AMA Insurance offers a portfolio of physicianexclusive disability, life, health insurance, and retirement plans for individuals, medical group practices and other institutions. AMA Insurance’s national reach enables the agency to provide physicians with unique physician-focused coverage at competitive rates from top carriers. For more information, visit the AMA Insurance website at www. amainsure.com.

WWW.MEDMONTHLY.COM |17

practice tips

Are You Making the #1 Website Mistake?

By Barbara Hales, M.D. www.thewritetreatment.com

Hello, are you there? Is this medical practice still active or did the physicians retire?

These are not questions that you want your patients and clients to ask. Yet, it is precisely what they are thinking when healthcare facilities, throw a website together and then expect to get traffic from it without ever adding new information.

Without continually providing fresh content, you lose the opportunity to keep your patients coming back to view your site and attract prospective patients. Instead of attracting new clients, you become a virtual ghost and everyone “abandons ship” to go elsewhere …your competitors!

The #1 mistake of health sites and medical websites is to publish an online site and then ignore it.

Search engines can differentiate which sites are active and reward them accordingly by ratings. Having your website on page 28 of a search for your keywords means that you might as well not be there. People only contact the medical practices that show up on page one.

Most people are now searching for their health information online and finding their new doctors on the web. Can you afford to squander your most valuable assetyour website and your branding?

18 | JUNE 2014

Sure, you don’t have enough time. There’s barely enough time for yourself with patient consultations and charting that new EHR system you installed.

But, here are some reasons why tending to your anemic website is crucial: • New content that is both interesting and relevant to readers will attract prospective patients, bring referrals and maintain current patients • Establishes yourself as an authority in your field • Strengthens your branding and makes you stand out head and shoulders above your colleagues • Raises your search engine rankings with Google, Bing, Yahoo and others • Opens opportunities to inform patients about new techniques, new office hours, new staff members • Gives you the chance to explain procedures through videos so that patients understand, increasing compliance There is a flood of information available online nowadays, so to stand out, your content must be timely, unique and relevant.

How to Create Great Content for Your Medical Website There are 7 steps you can implement to have a successful and effective site:

1. Write about information that reflects your knowledge and what you represent.

Create content that you are well versed in and that reflects the specialty you are in. As these articles build, they help your branding and establish you as an authority in your field. Promote yourself, the practice and your services.

2. Make your content interesting but short and easy to understand.

Captivate your readers and engage them. Relate stories that make the point that you are trying to convey (using fictitious names). Write using simple, easy to understand words. Remember, you are communicating with the public, not your colleagues.

3. Include links that take the viewer to videos and audio files.

Incorporating videos and audio files allows the viewer to get a better grasp on new techniques, procedures and instructions that you would like to convey.

Remember, a picture is worth 1000 words. (And having them makes the search engines rank your site higher!)

4. Incorporate relevant long-tailed keywords.

Identify what phrases or groups of 3 words that patients or prospective clients will use to search for you or the type of healthcare that you provide. Having them on your site will ensure that your name pops up when they do the computer search.

7. Avoid banners and Adwords.

Besides banners becoming a distraction, you don’t want your viewers clicking on a link that takes them to a different website. You worked hard to get your readers. Don’t send them elsewhere!

Keep this in mind when creating your content:  Your viewers are quick on the delete button. If you make your content boring and dull, they will surely use it!  Write straight to the point and as short as possible to convey your ideas. If you drone on tediously, people will click out and not return to your site.  Have tabs on your navigation bar so that viewers know where to get the information they are seeking.  Have sidebars highlighting special content, events, articles or recent PR. Good luck with your website content. If you don’t have one of your own, now is the time to create one! Don’t rely on an insurance company to highlight you on their site.

I know that you will do well. To start you off, please send for your free copy of “15 Ways to Leverage Your Content for Successful Marketing” by emailing me at: Barbara@TheWriteTreatment.com. 

The Write Treatment

5. Make your site easy to scan.

Make your website pages uncluttered so that the eyes can focus on the areas of importance without getting lost. Have white spaces break up the content.

Format the text into short paragraphs and short pages.

If people see a mountain of information, it is unlikely that they will try to scale it.

“Entice them without giving away the complete show”. If you elicit interest and curiosity, the viewer is more likely to call for more information or return for another article.

6. Check and recheck your content.

Use the spell-checker tool and proofread several times to ensure that the grammar is correct. If there are many gross errors, it clearly reflects badly on you.

Patients will wonder what other mistakes you are making.

Ezines and NewslettersCost Effective Powerful Tools • Drive traffic to your business website • Build relationships between yourself and patients • Get new patients • Announce a new service or product • Give great impact Have you got a newsletter yet or want to spread a message?

Contact Barbara Hales, M.D. for a free consultation.

Barbara@TheWriteTreatment.com 516-647-3002

If writing is not your forte, seriously consider hiring a professional writer to create the content.

WWW.MEDMONTHLY.COM |19

practice tips

PROPOSED HEALTH IT STRATEGY AIMS TO PROMOTE INNOVATION, PROTECT PATIENTS, AND AVOID REGULATORY DUPLICATION

HHS released a draft report that includes a proposed strategy and recommendations for a health information technology (health IT) framework, which promotes product innovation while maintaining appropriate patient protections and avoiding regulatory duplication. The congressionally mandated report was developed in consultation with health IT experts and consumer representatives and proposes to clarify oversight of health IT products based on a product’s function and the potential risk to patients who use it.

The draft report can be found here.

The report was developed by the U.S. Food and Drug Administration (FDA) in consultation with two 20 | JUNE 2014

other federal agencies that oversee health IT: HHS’ Office of the National Coordinator for Health IT (ONC) and the Federal Communications Commission (FCC). The FDA seeks public comment on the draft document.

“The diverse and rapidly developing industry of health information technology requires a thoughtful, flexible approach,” said HHS Secretary Kathleen Sebelius. “This proposed strategy is designed to promote innovation and provide technology to consumers and health care providers while maintaining patient safety.”

Innovative health IT products present tremendous potential benefits, including: greater prevention

of medical errors; reductions in unnecessary tests; increased patient engagement; and faster identifications of and response to public health threats and emergencies.

However, if health IT products are not designed, implemented or maintained properly, they can pose varying degrees of risk to the patients who use them. The safety of health IT relies not only on how a product is designed and developed, but on how it is customized, implemented, integrated and used.

As proposed in the draft report, posted on the ONC, FDA and FCC websites, there would be three health IT categories, based on function and level of risk, that focus on what the

product does, not on the platform on which it operates (mobile medical device, PC, or cloud-based, for example).

The first category, products with administrative health IT functions, poses little or no risk to patient safety and as such requires no additional oversight. They include software for billing and claims processing, scheduling, and practice and inventory management.

The second category, products with health management heath IT functions, includes software for health information and data management, medication management, provider order entry, knowledge management, electronic access to clinical results and most clinical decision support software.

Products with health management health IT functions are of sufficiently low risk and thus, if they meet the statutory definition of a medical device, FDA does not intend to focus its oversight on them. Instead, the draft report proposes relying primarily on ONC-coordinated activities and private sector capabilities that highlight quality management principles, industry standards and best practices. The draft report also proposes to rely on tools for testing, certification and accreditation of this category of products.

“ONC welcomes comment on the draft report and stands ready to collaborate with stakeholders to ensure that health IT is designed and used with both innovation and patient safety in mind,” said Karen DeSalvo, M.D., M.P.H., M.Sc., national coordinator for Health IT. The third category, products with medical device health IT functions are a narrowly defined group that could potentially pose greater risks to patients if they do not perform as intended. The draft report proposes that FDA continue regulating these products, which include computeraided detection software, software for bedside monitor alarms, and radiation treatment software.

“This proposed strategy will facilitate innovation, protect patients and support FDA’s focused oversight on higher risk technology, similar to medical devices that are currently regulated,” said Jeffrey Shuren, M.D., director of the FDA’s Center for Devices and Radiological Health.

“FDA looks forward to additional stakeholder feedback on the proposed framework in this draft report.”

Included in the framework is a proposal for ONC to create a publicprivate Health IT Safety Center in collaboration with the FDA, the FCC, HHS’ Agency for Healthcare Research and Quality (AHRQ) and other stakeholders. The Health IT Safety Center would work on best practices and provide a forum for the exchange of ideas and information focused on patient safety.

“The draft report reflects FCC’s narrow but important role in encouraging new and innovative wireless medical technologies and ensuring that developers and users of these technologies are minimizing the potential for causing potentially harmful interference to radio services,” said Matt Quinn, director of healthcare initiatives at the FCC. “We look forward to future collaboration with all stakeholders to achieve the promise of health IT.” The three agencies also intend to announce a public meeting to solicit comments on the draft report and gather feedback on the outlined strategy and approach. A docket will be available soon for the public to submit any additional comments.

The Food and Drug Administration Safety and Innovation Act of 2012 directed the FDA, in consultation with ONC and FCC, to publish on their respective websites a report on an appropriate, risk-based regulatory framework for health IT that promotes innovation, protects patient safety, and avoids regulatory duplication.  Source: http://www.hhs.gov/news/ press/2014pres/04/20140403d.html

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WWW.MEDMONTHLY.COM | 21

practice tips

The Simple Formula for Successful Medical Practice Marketing

by Audrey Christie McLaughlin, RN www.physicianspracticeexpert.com

Description: The C.U.R.E.S method can help medical practices retain and attract more patients.

Recently I was asked to give a speech on practice growth and success, and in the preparation for that speech I developed a formula I call the C.U.R.E.S. Formula for Practice Growth and Success. This formula can help guide your practice to successful marketing.

The “C” stands for Cultivate.

The “R” stands for Revenue.

Revenue is the bottom line. You got into medicine to help people, so it may feel funny to think in terms of “the bottom line” but without revenue and profit, you have to close your doors, and then you can’t help anyone. You must be looking at new ways to provide excellent patient care and new revenue streams to survive and prosper in this market.

The “E” stands for Evolution.

Essentially in order to grow and sustain a successful practice, you must cultivate a community around it. This community is the pool in which you pull referrals from and attract new patients.

Medicine is evolving, from how practices must code and bill, to how patients are insured, to how physicians are paid. How you market your practice must evolve as well. If you fall behind, particularly in the area of attracting new patients, you will not create a sustainable practice.

The “U” stands for Unbelievable.

Finally, “S” is for Systemization.

You must provide each patient unbelievable service so that they want to come back to your practice and so that they talk about you and your phenomenal team to their friends, family, and even their community.

22 | JUNE 2014

This means you must have the systems in place to curate the conversation, cultivate the community, provide unbelievable service, and increase revenue. Success does not happen without a system to ensure everything and everyone is functioning properly. 

Physician Solutions is now hiring primary care MD’s and PA’s in North Carolina, Virginia and South Carolina

If you are a well informed physician or mid-level, we could use your services from 2 to 5 days per week. Find out why dozens of doctors choose Physician Solutions.

Short-term or long-term, Physician Solutions has you covered P.O. Box 98313, Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.

phone: 919.845.0054 fax: 919.845.1947 e-mail: physiciansolutions@gmail.com www.physiciansolutions.com

international

Dental Tourism for Indian Markets

By Nidhi Vats Behl Freelance Copy Writer

‘‘

Medical Tourism evolved into an Industry when travel & tourism and the healthcare Industry amalgamated themselves. “Dental Tourism” is among the various niche markets.

24 | JUNE 2014

“This is just going to hurt a little bit”

– Ogden Nash

You might remember this line from an Ogden Nash poem and it certainly comes to mind when the word “dental” is mentioned. “This is just going to hurt a little bit”.

When we get a tooth ache, we think of the dentist first and then the numbing fear associated with dental treatment.

And no matter how fearful we might be on the inside, the main focus still remains on where to go for treatment. The answer to this question used to depend on the location of the patient, but now the location can be anywhere in the

changed the functioning of healthcare. With the help of technology today, we can see the whole world as one country. When you have the internet, every task is just a click away. The same is applied to medical tourism with dental tourism being the budding branch on this strong and successful tree. Looking for treatment options for your dental procedures, your research on the internet is 60% of your task. Once you decide upon the tour organizer, then it’s their responsibility to take care of you.

Why people need to explore dental tourism as an option:

world. With “Dental Tourism”, it is easy to find answers and options these days. The world gets converted to one city when the term medical tourism comes into play.

Definitions:

1. Medical Tourism: Medical Tourism refers to the act of travelling to another country to seek specialized or economical medical care.

2. Dental Tourism: The act of travelling to another country for the purpose of obtaining dental treatment.

It is quite appreciable to see how medical tourism has

1. Budget: Very first and foremost is the budget. When people can get their treatment done at a lesser cost, without compromising on the expertise and quality, why not grab the opportunity. The patients who fall under this category are from countries including Australia, UK and other European countries, US, Canada and other developed countries 2. Long waiting period: Talking of these developed countries; some dental procedures take as long as few months to get the appointment for surgery/procedure to happen. Patients search for other alternatives to alleviate their pain and, being less expensive, it becomes all the more lucrative to opt for dental tourism.

3. Non availability of Medical Facilities: It’s the patients who are living in under developed countries where proper healthcare is not accessible or the desired facilities or the latest technology is not available that lead them to consider dental tourism.

4. Insurance Coverage: Developed countries contribute huge revenue figures towards dental tourism in India because of the restrictions of their insurance coverage.

This concept of third party payment is great but generally it is not supported well when it comes to dental treatments. The policy covers a small portion of coverage related to dental care and associated procedures.

5. Employer sending their employees for treatment: It’s another increasing trend seen these days in the US where employers are sending their employees on dental vacations. It’s the new concept among the US corporations, where employees can relax and at the same time refresh their smiles too. Companies are able to save a lot and can receive huge discounts from the dental vacation planners.

What Dental vacationers are looking for?

People are coming to India, enjoying their vacation and getting their procedure done in between. Seems like a best deal for traveler patients who are on dental vacation. continued on page 26 WWW.MEDMONTHLY.COM | 25

continued from page 25

There are a lot of factors which come into the patient’s mind while deciding upon one out of the entire listed dental vacation destinations. The parameters which they are looking for while researching are: 1. Sterility & Hygiene: Health and infection free environment while getting procedure(s) done is the vital requirement. While talking in terms of the hospitals, many are JCI accredited since their aim is to seek medical tourism as a way of revenue generation.

2. Skilled work force: People seek experienced and renowned consultants in dental care, because they will give the best advice, be aware of various complex conditions and fully capable to treating them, and will have the least error probability. Interestingly, people from the US prefer to have a doctor who has worked in the US in past, as he/she will be aware of the US environment and working ways. Same goes with all the various nationals, seeking treatment in overseas countries.

3. Compassion & Care: The care after the procedures is equally important for assuring healing. While in pain, people seek professionals who can console them, who understand what they need and can be of great support while in distress. Combining care and compassion, the complete healing cycle can be accomplished in a minimal time period.

4. Infrastructure: This is a major criterion for the people looking at medical tourism, because the best infrastructure and the latest technology are not available to them. If it’s available, then it’s unaffordable.

So the patients want a combination where they can have the access to the best treatment within their budget by an established, proven infrastructure.

5. Medical and Travel itinerary: This part is equally important, because people want to stick by a timetable to meet their commitments. So when they have been told about the time duration for a procedure and a holiday, they appreciate the task being completed on time. Good coordination among the complete team is required here. The team includes the estimate providing doctor, the treating consultant, the care provider and the resort/accommodation providers inclusive of the sightseeing agents.

6. Accreditation(s)/ protocol(s) defined: Every procedure is well defined under a protocol. It includes everything from the product being used for dental procedures, the hygiene, qualification, complaint handling and, last not the least, infrastructure.

When the patient is looking for the dental vacation destinations, he appreciates being with someone who

26 | JUNE 2014

has defined protocols and systems in place. This will increase the level of confidence at the time of the initial research itself.

7. Budget: It is a well known fact that in developing countries, the cost for treatment is less. Due to this one reason in particular, the west is attracted towards India. It will always be of concern to the client that the figures which are quoted to them as an estimate should not be exceeded. It’s the word of commitment which is important.

8. Visa and document arrangements: It is the responsibility of the tour organizer to get all the paper work and other mandatory document work complete under the laws of both the countries, before the tour of the client starts.

9. Translators: Seeing to the comfort of the client is important and that includes the client easily communicating with their doctor. Translators fill the bridge quite efficiently for both the parties and the client level of satisfaction is greatly increased.

10. Mode of payments: Finally, this is all about money and its transactions. Everything should be made crystal clear to all the parties involved. Everything is written down in an agreement and duly signed by both parties.

Indeed, it’s a win-win situation, for the one who saved and for the other who gained.

During 2012, India treated 450,000 tourist patients from US alone, making them one of the most popular dental tourism destination hubs in the world. There are several other destinations competing with India including Costa Rica, Thailand, Mexico, Spain, Dubai, Singapore, Philippines, Poland, Hungary, Czech Republic and Turkey.

Medical tourism is an industry in itself, having employed more that 15% of world population in this profession. Over last few years it has become professional and ethical too. Dental tourism is a highly profitable niche to medical tourism. Dental tourism is accepted worldwide, and is the best offer one can ever think of by getting inexpensive, quality treatment done while on holiday oversees. 

Nidhi Vats Behl is an experienced professional with more than 6 years, in Healthcare industry with renowned organizations like: Fortis & Aditya Birla.

Currently she is working as a freelance copy writer.

research & technology

Up to 40 Percent of Annual Deaths From Each of Five Leading US Causes Are Preventable

Each year, nearly 900,000 Americans die prematurely from the five leading causes of death – yet 20 percent to 40 percent of the deaths from each cause could be prevented, according to a study from the Centers for Disease Control and Prevention.

The five leading causes of death in the United States are heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries. Together they accounted for 63 percent of all U.S. deaths in 2010, with rates for each cause varying greatly from state to state. The report, in this week’s issue of CDC’s weekly journal, Morbidity and Mortality Weekly Report, analyzed premature deaths (before age 80) from each cause for each state from 2008 to 2010. The authors then calculated the number of deaths from each cause that would have been prevented if all states had same death rate as the states with the lowest rates.

28 | JUNE 2014

The study suggests that, if all states had the lowest death rate observed for each cause, it would be possible to prevent: • 34 percent of premature deaths from heart diseases, prolonging about 92,000 lives • 21 percent of premature cancer deaths, prolonging about 84,500 lives • 39 percent of premature deaths from chronic lower respiratory diseases, prolonging about 29,000 lives • 33 percent of premature stroke deaths, prolonging about 17,000 lives • 39 percent of premature deaths from unintentional injuries, prolonging about 37,000 lives “As a doctor, it is heartbreaking to lose just one patient to a preventable disease or injury – and it is that much more poignant as the director of the nation’s public health agency to know that far more than a hundred thousand deaths each year are preventable,” said Tom Frieden, MD, MPH. “With programs such as the CDC’s Million Hearts initiative, we are working hard to prevent many of these premature deaths.”

The numbers of preventable deaths from each cause cannot be added together to get an overall total, the authors note. That’s because prevention of some premature deaths may push people to different causes of death. For example, a person who avoids early death from heart disease still may die prematurely from another preventable cause, such as an unintentional injury.

Modifiable risk factors are largely responsible for each of the leading causes of death: • Heart disease risks include tobacco use, high blood pressure, high cholesterol, type 2 diabetes, poor diet, overweight, and lack of physical activity.

• Cancer risks include tobacco use, poor diet, lack of physical activity, overweight, sun exposure, certain hormones, alcohol, some viruses and bacteria, ionizing radiation, and certain chemicals and other substances.

• Chronic respiratory disease risks include tobacco smoke, second-hand smoke exposure, other indoor air pollutants, outdoor air pollutants, allergens, and exposure to occupational agents.

• Stroke risks include high blood pressure, high cholesterol, heart disease, diabetes, overweight, previous stroke, tobacco use, alcohol use, and lack of physical activity.

• Unintentional injury risks include lack of seatbelt use, lack of motorcycle helmet use, unsafe consumer products, drug and alcohol use (including prescription drug misuse), exposure to occupational hazards, and unsafe home and community environments.

Many of these risks are avoidable by making changes in personal behaviors.

Others are due to disparities due to the social, demographic, environmental, economic, and geographic attributes of the neighborhoods in which people live and work. The study authors note that if health disparities were eliminated, as called for in Healthy People 2020 , all states would be closer to achieving the lowest possible death rates for the leading causes of death. ”We think that this report can help states set goals for preventing premature death from the conditions that account for the majority of deaths in the United States,” said Harold W. Jaffe, MD, the study’s senior author and CDC’s associate director for science. “Achieving these goals could prolong the lives of tens of thousands of Americans.”

Southeastern states had the highest number of preventable deaths for each of the five causes. The study authors suggest that states with higher rates can look to states with similar populations, but better outcomes, to see what they are doing differently to address leading causes of death.  Source: http://www.cdc.gov/media/releases/2014/p0501-preventable-deaths.html WWW.MEDMONTHLY.COM | 29

research & technology

FDA Approves Auto-Injectable Naloxone for Outpatients to Reverse Opioid Overdose

By Alexis Gopal M.D. In a decision that will hopefully lead to the reduction of the number of opioid overdose related deaths, the U.S. Food and Drug Administration (FDA) approved an easy to use form of the opioid antidote naloxone for physicians to prescribe to outpatients.

Evzio delivers a single dose of naloxone via a hand-held autoinjector, either into the muscle (intramuscular) or under the skin (subcutaneous).

When activated, the device gives verbal instructions on its use, similar to automated cardiac defibrillators. Like an Epi-Pen, Evzio can be stored for easy access, carried in a pocket, purse, or stored in a medicine cabinet.

Naloxone, an opioid antagonist, has long been used in the emergency setting to reverse symptoms from narcotics and anesthesia overdose, including respiratory depression, decreased heart rate, or loss of consciousness. Many opioid overdoses occur outside of the hospital setting.

In 2013, The Centers for Disease Control and Prevention reported that fatal drug overdoses increased for the 11th consecutive year. According to the FDA, there were 16,000 deaths from prescription opioid overdose in 2010, and 3000 heroin overdoses.

Drug overdose deaths are now the leading cause of injury death in the United States, surpassing motor 30 | JUNE 2014

vehicle crashes. This is largely due to prescription drug overdose, and the increased prevalence of heroin abuse. Heroin is now, more than ever, easily accessible, and cheaper to obtain than prescription opiates.

Heroin use has been rising since 2007, growing from 373,000 yearly users to 669,000 in 2012, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Heroin overdose deaths have also spiked, increasing 45% from 2006 to 2010, according to the most recently available data from the Drug Enforcement Administration. The geography of the drug’s users has also expanded. Once considered a largely urban problem, law enforcement and public health officials are seeing an uptick in suburban and rural users.

There are two key reasons for heroin’s resurgence: A larger, cheaper supply stemming from an increase in heroin importation by Latin American cartels, and a bigger market for opiates, driven by prescription painkillers.

It’s crucial that family members and caregivers also be educated on how to use the device, since they may have to administer it to the patient.

It is cautioned that because naloxone may not last as long as opioids, repeat doses may be needed. Also, the use of Evzio in opioid dependent

patients may precipitate severe withdrawal symptoms, including nausea, vomiting, sweating, elevated blood pressure, tachycardia, tremors, seizures and cardiac arrest. The person administering Evzio should seek immediate medical attention for the patient. Hopefully, more lives will be saved by earlier intervention in drug overdoses involving opioids. The Substance Abuse and Mental Health Services Administration (SAMHSA) recently advised that physicians prescribe naloxone alongside opioids in case of an overdose by the patient or another member of the household.

According to the FDA, Evzio is being approved ahead of schedule, after being given a fast-track designation. Original approval goal date was June 20, 2014. This underscores the unmet need filled by this drug.  Sources: http://www.fda.gov/NewsEvents/ Newsroom/PressAnnouncements/ ucm391465.htm https://jama.jamanetwork.com/article. aspx?articleid=1861793 http://time.com/4505/heroin-gainspopularity-as-cheap-doses-flood-theu-s/

research & technology

NIH Center Sets New Goals for Global Health Research and Training

G

lobal health research and training efforts should focus on combating the growing epidemic of noncommunicable diseases, better incorporating information technology into research and training, and more effectively converting scientific discoveries into practice in low-resource settings, according to the Fogarty International Center’s new strategic plan. Fogarty is the component of the National Institutes of Health solely focused on supporting global health research and training, and coordinating international research partnerships across the agency.

As research discoveries and aid efforts have reduced deaths from HIV/AIDS, populations in the developing world are increasingly suffering from noncommunicable diseases such as heart disease, cancer, diabetes, and mental illness.

“It is critical that we leverage the existing HIV research and care delivery platform to build the capacity needed to stem the tide of these new disease epidemics,” said Dr. Roger I. Glass, who leads Fogarty and serves as the NIH associate director for global health research. “We must focus our attention on these pressing problems, which also plague us in the United States, and discover new ways to prevent and treat them. Today, global health and local health are becoming one and the same and research

32 |JUNE 2014

anywhere can help people everywhere.”

Fogarty plans to reinvigorate its efforts to train more developing-country scientists in these new areas of global health, where the field is moving and where the most interesting discoveries are yet to be made, according to the plan.

“Our concept of investing in training outstanding young investigators, both U.S. and foreign, and linking them early in their careers in research partnerships between their institutions has been a winning strategy that has had a major impact on the research enterprise for global engagement,” said Glass.

Fogarty trainees have participated in research studies that have resulted in key discoveries to improve care and reduce the spread of HIV/AIDS. These include determining that populations in low-resource settings can adhere to complicated treatment regimens and that antiretroviral drugs and circumcision are effective at preventing disease transmission.

To capitalize on the upsurge of interest in global health on U.S. campuses, Fogarty intends to boost efforts to recruit investigators with diverse specialties including cardiology, oncology, bioengineering, neurology and mental health, and other topics that in the past were not considered in the realm of global health. To better address

‘‘

“E-learning is a powerful way to enable physicians and medical personnel at all levels to gain access to the everexpanding and changing knowledge base that can keep them up-to-date throughout their careers.”

today’s complex global health problems, the center will also support the development of multidisciplinary teams with skills not traditionally related to health, such as engineering, business, economics and law.

Another priority under the new plan is to intensify efforts to incorporate information and communication technology into the center’s research and training programs.

“E-learning is a powerful way to enable physicians and medical personnel at all levels to gain access to the everexpanding and changing knowledge base that can keep them up-to-date throughout their careers,” Glass explained.

The ubiquity of cellphones in the developing world has created opportunities to adapt mobile applications to improve access to populations for research and provision of care. However, it will be critical that these projects are carefully monitored and evaluated to ensure they are effectively integrated into the practice of medicine, public health and research.

Implementation science remains a high priority for the center under the new plan, so that proven interventions are quickly adapted for use in low-resource settings and scaled up effectively. Increased efforts are needed to catalyze partnerships and improve communication between the scientific community and program implementers and

decision-makers, so that science informs program and policy, and research is responsive to program and policy needs, according to the plan.

Fogarty’s new strategic vision is intended to advance the global health research agenda by building on past and current Fogarty investments and successes in a way that responds to the changed landscape in global health.

Specific goals and priorities are outlined in five main areas: • building research capacity to meet current and future global health challenges • stimulating innovation in the development and evaluation of technologies to address global health problems • supporting research and research training in implementation science • advancing research on prevention and control of communicable and noncommunicable diseases and disabilities • forming partnerships to advance global health research and research capacity “By taking science to where the problems are, and by supporting research and research training in areas where the burden of disease is greatest, Fogarty investments will continue to build the health research workforce of the future. This will ensure scientific methods are brought to bear on some of the world’s most complex health problems, which are affecting populations both at home and abroad,” Glass concluded.

Since it was founded in 1968, Fogarty has provided significant research training to more than 5,000 scientists worldwide. Today, the center funds some 400 research and training projects involving more than 100 U.S. and foreign universities for scientific collaborations on infectious diseases, chronic conditions, brain disorders, tobacco, biodiversity and natural products discovery, implementation science, mobile health and other topics.

The full text of Fogarty’s strategic plan is available at: http://bit.ly/FogartySP.  Fogarty, the international component of the NIH, addresses global health challenges through innovative and collaborative research and training programs and supports and advances the NIH mission through international partnerships. For more information, visit: http://www.fic.nih. gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Source: http://www.nih.gov/news/health/apr2014/fic-29.htm WWW.MEDMONTHLY.COM | 33

legal

NO MORE EXCUSES: Encrypt Your Laptops or Pay Big Money

By Kimberly J. Gold Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

34 | JUNE 2014

Two companies were hit with fines equaling a total of almost $2 million to settle alleged Health Insurance Portability and Accountability Act (HIPAA) violations involving stolen, unencrypted laptops, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced.

OCR conducted an investigation of Concentra Health Services (Concentra) after receiving a breach report that an unencrypted laptop was stolen from one of its facilities.

Concentra’s biggest mistake was its failure to remedy previously recognized security problems. The company had engaged in multiple risk analyses revealing that a lack of encryption on its laptops and other devices containing electronic protected health information (ePHI) was a critical risk. While Concentra had taken steps to begin encryption, OCR found that Concentra had insufficient security management processes in place to safeguard patient information. Concentra agreed to pay OCR $1,725,220 to settle potential violations and will adopt a corrective action plan.

The other organization, QCA Health Plan, Inc. (QCA), notified OCR of a breach in February 2012 involving the theft of an unencrypted laptop computer from a workforce member’s car that contained the ePHI of 148 individuals.

OCR reported that QCA encrypted its devices following discovery of the breach, but that it failed to comply with multiple HIPAA Privacy and Security Rule requirements between April 2005 and June 2012. In addition to a

$250,000 monetary settlement, QCA will provide HHS with an updated risk analysis and risk management plan, including specific security measures to reduce ePHI risks and vulnerabilities. QCA also agreed to retrain its workforce and document its ongoing compliance efforts.

The Resolution Agreements for Concentra and QCA can be found on the OCR website.

These settlements underscore the need for all entities to encrypt their laptops and other devices. Entities that fail to encrypt may not only be at risk of paying large fines to OCR for HIPAA violations, but they also may be slapped with fines for state law violations.

Other important takeaways: • Self-reported breaches do lead to investigations and penalties.

• Ongoing risk assessments are critical for HIPAA compliance, but so is acting on risk assessment findings.

• Encryption may be perceived as expensive and/or cumbersome, but it is much cheaper than a seven figure fine.

As we previously urged: “encrypt, encrypt, and encrypt again.” Even OCR stated: “Our message to [covered entities and business associates] is simple: encryption is your best defense against these incidents.”  Source: http://www.natlawreview.com/article/no-moreexcuses-encrypt-your-laptops-or-pay-big-money

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legal

Department of Health and Human Services (HHS) to Hold Public Session on Potential Updates to Alcohol and Drug Abuse (AODA) Confidentiality Regulations

By Meghan C. O’Connor von Briesen & Roper, S.C. While federal (and some state) privacy regulations permit sharing health information for a variety of treatment, payment, and operational purposes, strict federal regulations governing one category of health information prohibit such activity without patients’ written authorization.

A federal agency has opened the door to potential changes in those regulations.

The U.S. Department of Health 36 | JUNE 2014

and Human Services (HHS) Substance Abuse Mental Health Services Administration (SAMHSA) announced that it will hold a public listening session on June 11 to obtain input from stakeholders regarding potential changes to 42 CFR Part 2, the federal regulations governing the confidentiality of Alcohol and Drug Abuse (AODA) patient records.

HHS notes that over the last 25 years, significant changes have

occurred in the U.S. health care system that were not envisioned by 42 CFR Part 2, including: 1. New models of integrated care built on a foundation of information sharing to support coordination of patient care; 2. Development of electronic infrastructure for managing and exchanging patient data; 3. Development of prescription drug monitoring programs; and

4. A new focus on performance measurement within the health care system.

According to HHS, stakeholders, including health information exchanges (HIEs) and accountable care organizations (ACOs), are excluding AODA data due to the difficulty and expense of implementing functionality and workflow changes necessary to comply with current regulations; and patients are prevented from fully participating in integrated care efforts.

HHS reports that SAMHSA strives to facilitate information exchange while respecting the need for confidentiality protections that encourage patients to seek treatment without fear of compromising privacy. In order to address these concerns prior to the initiation of rulemaking, the listening session will address the following questions: 1. Applicability of 42 CFR Part 2, e.g., what entities and information should be covered under the regulations now that more AODA treatment is occurring in general health care and integrated care settings.

2. Consent requirements, e.g., difficulty in disclosing to programs like HIEs and ACOs and whether a more general consent would be appropriate rather than the current requirement that a 42 CFR Part 2 consent include the name of the organization to which the disclosure is to be made.

3. Difficulty with re-disclosure prohibitions, e.g., methods to address concerns related to required data segmentation and whether the prohibition should be limited to only that information that identifies an individual as a substance abuser.

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legal

New Data Shows Higher Healthcare Costs in Second Half of 2013 –

Is This a Result of the Affordable Care Act?

By Eric A. Klein Partner Sheppard, Mullin, Richter & Hampton LLP 38 | JUNE 2014

W

ill insurance expansion and industry consolidation result in higher healthcare costs, at least in the short term, and further stress the economy and the healthcare industry?

That highly political question is being asked now in light of preliminary analysis of 2013 healthcare spending data.

Healthcare spending grew broadly in 2013, and especially in the second half of 2013, according to The New York Times in its Saturday, April 19, 2014 article entitled “Health Care Spending’s Recent Surge Stirs Unease.”

According to government data, fourth quarter health care spending growth increased by 5.6 % in the fourth quarter of 2013, as compared to a 1.3 % increase in the first quarter of 2013. The 5.6 % increase was noted as the highest growth rate since 2004. Separately, the Altarum Institute, a nonprofit research group, reported that health spending started to climb in the summer of 2013, and that this February it reached a 7 year high.

According to some analysts, two trends are occurring concurrently. “Expanded coverage is happening simultaneously with the petering out of the recession’s dampening effect,” said Charles Roehrig, director of the Center for Sustainable Health Spending at the Altarum Institute. With expanded insurance coverage, it was expected that there would be a surge in short-term health spending, as previously unmet healthcare needs were addressed. The real question of interest, however, is whether that initial surge will be moderated or will continue and/or accelerate over time, as the new enrollees’ health status is assessed and treated and the costs of that fully enter the healthcare system.

The healthcare industry already is aware of the need to move toward population health management and value-based reimbursement systems, both for quality and for financial sustainability. We have noted a significant move in that direction in the past six months, as our law firm has seen a growing conviction on the part of payors and providers that healthcare reform is here to stay and that the current fee for service reimbursement systems no longer will be sustainable as the primary economic approach for the industry. We are seeing many interesting and innovative pilots, but also, more importantly, the beginning of true long-term movement toward lasting care delivery redesign. While pilots have their place, we have been warning of the danger of “aviation disease,” with too many pilots flying all over the place and buzzing around, resulting in a lot of motion without landing on an appropriate and meaningful commitment to large-scale healthcare delivery system redesign.

That view is shared by some commentators. The Affordable Care Act “was too heavy on insurance expansion and too light on delivery system reform,” according to Douglas Holtz-Eakin, former heard of the Congressional Budget Office and a prominent Republic

economist. He characterized the Affordable Care Act as having “tons of projects and demonstrations. But the road to hell is paved with projects and demonstrations.” (And we always thought it was good intentions…)

Keep in mind, however, that the above data is preliminary, and the federal government often revises its numbers (witness the GDP numbers that routinely are revised after the fact). The New York Times concluded its article by sharing the caution by Jason Furman, Chairman of the White House’s Council on Economic Advisers, against “reading too much into a small number of reports” and suggesting that there is a “wealth of other data showing that premiums and the price growth of medical goods and services remained low.”

Without relying on the numbers, we directionally are not surprised by the increase in healthcare spending, given the simultaneous drivers of insurance expansion and Baby Boomer aging. So, while we can rest assured that the data will continue to be analyzed and that the 2016 presidential election will focus heavily on healthcare issues, we also know that it is the responsibility of the health care industry to lead the necessary changes in healthcare delivery – otherwise someone else will mandate it for us.  Source: http://www.natlawreview.com/article/new-datashows-higher-healthcare-costs-second-half-2013-resultaffordable-care-act

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features

THE LANDSCAPE OF SPECIALTIES

By Med Monthly Staff Writers

40 | JUNE 2014

Physician jobs are on the rise in every region of the United States, but certain regions and specialties are more in demand than others.

The Association of American Medical Colleges has recently reported that by the year 2020, we will have a doctor deficit of almost 100,000 with primary care being the specialty most in demand.

Based on the research of some very insightful Med Monthly writers using statistics provided by the US Government, medical associations across America and statistics reported by several insurance delivery agencies, the following list may enlighten our readers as to the most demanded specialties.

1. Family medicine (14.9 % increases) 2. Internal medicine 3. Geriatric medicine 4. Pediatrics 5. Psychiatry (22.4% increase) 6. Hospitalist (15.8% increase) 7. Obstetrics and gynecology 8. General surgery (11.8 % increases) 9. Pain medicine or algiatry (9.5% increases) Other specialties that are in demand are; Orthopedic surgery, Dermatology, Neurology, Gastroenterology, Hematology/Oncology and Cardiology.

A specialty that has really increased in demand by most hospitals, veteran hospitals and agencies and private practices is pain management or algiatry practices. Certainly controversial and looked upon by several state medical boards as ‘high risk’ medicine; pain medicine practices have exploded in the past five or six years. With our population is getting much older and thousands of soldiers returning from service in pain, many doctors tend to write a prescription as the first option to treatment rather than using invasive techniques. This is a normal treatment path, but with more patients to treat and a quick fix being as close as the prescription pad, pain management specialists are certainly more in demand and this trend will certainly continue.

Pain management has become sophisticated in recent years offering may types of treatment.

Below you will find a sampling of treatments being offered by several hospitals and clinics throughout the country. l Trigger point injections l Epidural steroid injections l Facet blocks

l

Selective nerve root blocks l Blood patch l Implanted medication pumps l Radiofrequency denervation l Cryoablation l Disc decompression l Spinal cord stimulation l Medication management l Referrals as appropriate for physical therapy l Referrals as appropriate for behavioral pain management including: u Relaxation/Mediation therapy u Biofeedback u Smoking cessation u Individual and family counseling In an interview with Philip Driver, President of Physician Solutions, a regional primary care staffing company headquartered in Raleigh, he states that, “Physician assistants are becoming more and more in demand in most primary care settings. Especially facilities that are owned by hospitals, state and federal government clinics and practices located in rural settings. PA’s can certainly keep the delivery cost of medicine down while providing a high, dependable level of health care. We have noticed a 20% increase in the demand for physician assistants during the past two years alone. We are also observing a good amount of new nurse practitioners entering the primary care specialty, yet another indicator practice owners are more conscious about health care delivery cost.”

Geographic location becomes a large factor regarding demands on certain specialties. For instance, dermatologists demand has risen over 25% in the southern states for reasons related to the sun and exposure to the elements, as well as the increase in population. Psychiatrists have risen over 20% in the northern states due to recent hard winters and having to stay inside for long periods of time.

Driver adds that he sees most physician staffing agencies in all regions becoming more in demand as locum tenens positions are popular among doctors relocating and researching opportunities before starting their own practice or joining a group or hospital. Medicine has always evolved quickly and we should ready ourselves for more changes in health care during the coming years. More specialized practices are being opened by hospitals and we have more innovative doctors in medicine, dental and optical than ever before.  WWW.MEDMONTHLY.COM | 41

features

Selecting a Medical Specialty

By Dr. Christian Becker Previously published on the Student Doctor Network

42 | JUNE 2014

Overview So, how do you know what specialty is right for you?

Most medical students decide during their 3rd and 4th year clinical rotations which specialty training to pursue.

Students have to start applying to residency programs early 4th year and go on interviews during 4th year (usually December through February of their 4th year). The Residency Match occurs in the middle of March.

Many students already have ideas early during medical school about which specialty they may want to enter eventually. However, it has been found that about 70 to 80 percent of medical students change their minds while in medical school.

Use SDN’s Specialty Selector developed with residency expert Anita Taylor to find a residency matched to your personality.

Also, check out the list of specialties we have for more details on specific specialties and residency options.

Selection Factors When considering which specialty is the right one, there are many important factors to consider: 1. Does the specialty interest you?

2. Could you do this for a living, rather than just shadowing or spending a couple weeks on a rotation?

3. Is the lifestyle what you want for yourself?

4. Are you fine with the hours worked by physicians in this specialty?

5. Are you fine with the compensation offered in this specialty?

6. Are you fine with the length of training for this specialty?

7. Are you fine with the intensity of residency training for this specialty?

8. Are you interested in Academic Medicine?

9. Is this specialty going to change significantly within the near future?

10. Are you competitive for the specialty?

Probably the most important factor on this list is specialty interest (item 1). Make sure you are truly interested in the specialty. Don’t choose a specialty just because it pays well or is the most prestigious. Physicians who are miserable in their specialties most often made decisions due to those 2 factors, rather than focusing on what they would have most enjoyed to practice.

Your medical career will most likely last a long time and you don’t want to be stuck in a specialty you hate. At the same time, realize that you can still change specialties even if you have already begun or completed residency once. So, it’s never too late. But it’s painful to start over again.

Also, spending some time shadowing or rotating in a specialty may give you a false impression, depending on

where and who you rotate with. Often, your experience can be much better or worse than it should have been (what you would see if you were in practice yourself) and may influence your decision in the wrong direction, so keep that in mind.

Lifestyle, Compensation and Hours This is probably one of the most important factors for most people besides the factor of liking the specialty itself. It is generally known that surgeons have longer work days and more call than most other specialties. Also, dermatology, ophthalmology and a few other specialties are known as the “cush specialties”, with little call, very good compensation and relatively normal work weeks.

You have to decide which of these factors are most important to you. The surgical specialties are typically the most intense with the longest hours (60 - 80 hours per week is not uncommon), the most call, but also the highest compensation and the most prestige. Many specialties with great work hours and little call are also often the ones which are less well compensated and least prestigious.

Realize that medicine, in general, is an intense profession. So, most physicians in specialties which are considered to have better work weeks quite often still work 50 hours or more a week. Most employers require the physician to work 40 hours per week doing direct patient care. Any extra paperwork, charting, etc. is considered extra work, so realistically, most physicians don’t ever work just 40 hours per week, although you can find some exceptions. As one physician put it: “40 hours in medicine is part-time.”

Certain specialties are extremely competitive and hard to get into because the offer a favorable compromise between compensation (still fairly high), time spent each week (relatively low) and call schedule (not very intense).

These include Dermatology, Ophthalmology, Radiology, Radiation Oncology, Anesthesiology, Emergency Medicine, Pathology and some others for various reasons. These specialties (and a few more not listed here) offer a relatively decent lifestyle.

A rule of thumb for compensation is that the more procedures the physician does, the more he or she is paid.

So, a specialty that just sees patients in the office (internal medicine, family medicine, pediatrics), prescribing medications and is involved in thinking, etc. is not as well compensated as one that actually does probing, scoping, cutting, suturing, poking, stabbing and mutilating.

To pick out a few examples: Dermatology - virtually no call, fairly high compensation, nice work week Ophthalmology - virtually no call, very high compensation, nice work week continued on page 44 WWW.MEDMONTHLY.COM | 43

continued from page 43

Emergency Medicine - no call, decent compensation, shift work Pathology - virtually no call, fairly high compensation, nice work week General Surgery - extremely long work week, lots of call, higher compensation, surgical Otolaryngology - Head and Neck Surgery - longer work week, some call, very high compensation, surgical Cardiology - extremely long work week, lots of call, high compensation, procedural Anesthesiology - moderate to longer work week, some call, high compensation, procedural Family Medicine - nice to moderate work week, some call, lower compensation - few procedures Internal Medicine - moderate work week, some call, lower compensation - few procedures Averaging all specialties and all practice types, the average physician earns approximately $240,000 per year in the United States. Surgical sub-specialties and some other (highly procedural) specialties like Cardiology can reach $357,000 or so per year, whereas most office based medical specialties such as Family Medicine, Internal Medicine and Pediatrics are closer to $175,000 or slightly more. 1 There is some great variation in pay depending on whether or not physicians work for themselves in private practice, are employed by a physician group, hospital or other organization , or work in academic or military medicine.

You have to decide how much time you want to spend at work each week vs. spending time with your family or doing other things and balance this with your interests and compensation.

Length and Intensity of Training As is true for practicing medicine, the surgical specialties are also the ones which typically have the most intense and the longest residency training. Surgical residents have the longest work week and the most call, in most cases. Cardiology and some other specialties also have long hours and lots of call. Dermatology and a few others, again, have much less call and a much less intense schedule. General Surgery is notorious for having one of the worst and most intense residencies, but some of the other surgical subspecialties are not quite as intense.

Note that long hours and call schedules are not restricted to surgical specialties, however. Pediatrics, for example, and many other specialties, which do not have extremely long hours once in practice, can have long hours and lots of call during residency.

44 | JUNE 2014

Academic Medicine vs. Private Practice About 50% of all physicians enter private practice, whereas the other half enters academic medicine or pursues other paths. Academic medicine involves teaching medical students and residents and doing research.

Typically, compensation of academic physicians is only about 50 - 60% of the compensation paid to physicians in private practice. This is also similar to what the military pays its physicians.

Many physicians particularly like or dislike academic medicine for some of the same reasons. Private practice compensation is substantially higher, but there are also differences in the work itself. Obviously, research and teaching involvement are not usually part of a private practice career.

Also, the types of patient cases seen on regular basis may vary quite a bit. Being in a major academic center can provide a different set of patients. Often, academic physicians can sub-specialize more in a specific area of interest within their specialty and become a “super-expert� if they wish to do so.

On the other hand, academic surgeons may also see more variety and more difficult cases in their academic practice and stay current on all the surgical skills needed to perform many different surgeries. Once in private practice, several of these surgeries may be so rarely encountered that they no longer feel adequately practiced in the surgery and refer all of these cases to a larger academic center from then on.

Similarly, in Internal Medicine, the academic practice can be almost or entirely inpatient, whereas most private practice settings are mostly outpatient settings. Also, in the academic world, physicians tend to see many more interesting and complicated cases on a regular basis (because they have been referred to the academic center), which are rarely seen in private practice.

How Competitive Are You? Certainly, your board scores, grades and a few more factors determine if you will be competitive for a specialty.

Some specialties are very competitive because there are very few residency training positions available and because the specialties provide a nice lifestyle, good hours, good pay and little call, as previously discussed.

The average USMLE1 score is between 220 and 240 each year. The average for accepted residency applicants in the very competitive specialties is 240 and above. Since this is an average, there are also people who get in with average board scores.2 Generally speaking, you should not give up on your dreams or ideas of becoming a particular specialist just

because you feel that you are not going to be competitive enough. Most students can get into the field they are interested in, but just like getting into medical school, they may have to make up for a lower board score and lower GPA with other activities to be competitive. Also they probably will have to apply to many more residency programs to get interview invitations.

SDN Specialty Selector Application

Aptitude Test and Evaluation During the 3rd and 4th year, most medical schools put together presentations and workshops to help students with the specialty decision making process. As part of these workshops, students work through various assessment tools which may help them focus on a list of potential specialties which may match their interests or personalities.

If you are interested in seeing which types of residencies you may want to consider or which ones may be a good fit for you now, you can visit the SDN Specialty Selector Application and take the online assessment quiz.  Physician Compensation Report 2013, http://www. startmedicine.com/app/specialtychoice.asp 2 USMLE (United States Medical Licensing Examination), http://www.usmle.org/bulletin/scores/ 1

Based on the book by Anita D. Taylor

Which specialty is best suited to your interests, abilities, and personality?

SDN and Anita Taylor, author of How to Choose a Medical Specialty, have partnered to provide this online overview of specialities. Learn more about each specialty and take the assessment quiz by clicking here to find out which specialties best match your values and personality.

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The Gross revenue is over $1,500.000 during 2012 with consistent high revenue numbers for the past several years. The average number of patients seen daily is between 26 and 32 with room for improvement. You will find this Med Spa to be in a highly visible location with upscale amenities. The building is leased and the lease can be assigned or restructured. Highly profitable and organized, this spa POISED FOR SUCCESS. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com

WWW.MEDMONTHLY.COM | 45

features

Family Practice Specialization in India The Long Way Home

By Anuradha Katyal and Sahitya Reddy

A few months ago we were a part of a very interesting study. It was a primary care design initiative for one of the states in India. It was an attempt to pilot an initiative with a creative as well as a curative approach to heal the ailing primary healthcare system in this state. The findings from the literature were rather startling. Most of the states are unable to deliver cost effective care, have a severe dearth of human resources, lack any standard regulatory mechanisms and grievance redressal. Information asymmetry causes lack of community engagement, accountability and voice.

To further our search for an ideal primary care model, our team 46 | JUNE 2014

started studying innovative practices attempting to resuscitate primary healthcare, especially for the bottom of the pyramid. We came across a few organizations who attempted to provide primary healthcare by reviving family medicine, especially in the era of super-specialization in medicine.

Most of these innovators mentioned about the vicious cycle these families have to undergo in the absence of family physicians (FP) and a good public system of primary healthcare.

Many studies have pointed out that a single episode of hospitalization can push a lower middle class family below poverty line. Most of the diseases that are a cause of

hospitalization in India like diarrhoea, complications of diabetes mellitus, malaria, typhoid and other infectious diseases like tuberculosis (unlike the western world, these still exist in India) are rather easily curable at the primary care level if the FP or even the health worker takes care of the early symptoms. It is also rather unfortunate that in the absence of a community based FPs, the lower quintiles of income resort to costly specialists (especially for the earning member for the fear of income loss and children). Over medicalization of healthcare, unnecessary hospitalization not just causes impoverishment but also the indiscriminate use of

antibiotics causing multiple drug resistance. It is estimated by the Medical Council of India (MCI), nearly 42,000 medical graduates are added yearly to the Indian pool of doctors. About 10,000 of them migrate abroad and 20,000 take up postgraduate courses in India, and nearly 2,000 MBBS graduates diversify to allied or unrelated fields. Eventually, only about 8,000-10,000 take up general medical practice as a profession. (Source – DNAINDIA).

A doctor examining a lady at Rural Healthacre Foundation in a village in Hence in a country which is West Bengal India obsessed with hospitalization, even for simple fevers and fees of INR 3000). The plan has four been historically centered on medical stomach upsets under the pretext that colleges, prioritizing clinical training they would “get well soon”, reviving the components. First, is a doctor which four family members can use for over social and preventive medicine. family practice seems to be the long unlimited advice over the phone. The The Medical Council of India (MCI) road ahead. second is a discount at empanelled does not regard primary care as a network providers for drugs, diagnosis specialty beyond the graduate level and Organizations We Visited and hospital care (MeraDoctor forgo there is no Masters degree for family Many private organizations have their cutback which may range from medicine (we thankfully have diplomas felt the need to encourage the general 10-60% depending on the network and now) leaving the doctors with minimal physicians, hence creating a family hence the patient receives a discount). career progression (Rao & Mant, practice in their area. Swasth India Third is a hospicash plan under which 2012). 1 Most of these organizations for example, targets the urban poor in case of hospitalization the patient which we had visited receive little or in Mumbai, India. A Swasth Health gets a cash back of INR 500 per day no support from the government and Center is located in low income areas, irrespective of the hospitalization to a work on the philanthropic zeal of the where the patients fight for both access maximum of INR 90000. And lastly, a owners. Yet it has to be acknowledged and affordability to good healthcare. personal accident cover under which a that the vision of achieving Universal The general physician specifically patient gets INR 3,00,000.

Healthcare is dependent on the works in that area and ensures that Rural healthcare foundation on strengthening of primary care via even drugs and diagnostics are the other hand has brought a general the family practitioners in India. available if necessary. They also practitioner in the most backward The concept of general practice is provide day care and dental treatment. areas of West Bengal, India. They lying dormant below the demons of They have ensured referral linkages have ensured provision of affordable globalization, quick fixes to health, for hospital care. Healthspring on medical care at INR 50 (less than a medical tourism, lack of accountability the other hand is a patient centric dollar) for consultation with either and regulation, which have all led to family medicine model in urban a qualified allopathic doctor or a specialized industry like hospitals. The settings. The focus is providing not qualified ISM (Indian system of government may consider the gold just primary healthcare, but also medicine) practitioner, including standard of primary care to achieve a diagnostics, referral linkages and medicines for a week. Cataract, cleft healthier nation.  emergency care at the level that the lip and cleft palate operations are clinic itself avoids patient distress. performed free of cost at various 1 Rao, M., Mant, D. (2012).

This organization is committed to charitable hospitals, to the patients Strengthening Primary Healthcare in reduce the abuse of specialist care referred from their Centres.

India: White Paper on Opportunities by treating the patients at the level for Partnership. BMJ, 344- e3151. Doi: of primary care itself. MeraDoctor’s http://dx.doi.org/10.1136/bmj.e3151 Long Way Home health plan under which the family gets a card (by paying one time annual India’s public health training has WWW.MEDMONTHLY.COM | 47

the arts

By Thomas Hibbard Creative Director

G

Quintessential Renaissance Man

ary Bodner is interested in everything from architecture to art and for the past thirty years, he has practiced medicine in Atlanta, specializing in Obstetrics and Gynecology. Reaching the pinnacle of achievement in all of his fields of interest is an ongoing, lifetime project. He is the quintessential renaissance man.

Bodner was a sophomore studying architecture at Miami University of Ohio when his father suggested that a career in medicine would allow more financial security.

He heeded his father’s advice and attended Chicago Medical School, but earned his medical degree from Emory University School of Medicine.

For the last 30 years, Bodner has been the first face seen by hundreds of newborn babies. He also has earned the respect and trust of the women for whom he cares.

Throughout his life, Bodner was attracted to art. He tried his hand at making pottery, as well as painting with watercolors and drawing with pen and ink, without much success.

But several years ago, he studied artistic techniques under Phil Carpenter in classes at the Atlanta College of

48 | JUNE 2014

Art and Chastain Arts Center. “Phil is a great teacher, and oil painting just works for me,” Bodner says. “It is very forgiving, and the more you fix your mistakes, the richer your painting gets.”

Bodner participated in workshops with nationally acclaimed artist Robert Johnson at the Sara Britt Arts Center in Tuscaloosa, Ala., and studied under Sandy Grow in Atlanta. But he credits his wife, Melanie, and Anne Irwin, owner of Atlanta gallery Anne Irwin Fine Arts (which represents Bodner’s artwork), with positively affecting his artwork.

“My wife has a great eye and can ‘fix’ a painting pretty quickly,” he says. “Anne Irwin has directed me to be a more expressionistic painter, almost an abstract painter. She has encouraged me to try different styles and take risks in the creative process.”

Anne Irwin recalls the first time she spoke with Gary, “He called me, indentified himself and asked if I would represent his work. He said he chose me because my name sounded familiar. “It should,” I replied, “You delivered my son.”

Due to his enormous energy and passion for his art, Bodner finds time to paint early in the morning, and late in the evening and on weekends. He describes his work as strong and colorful with an expressionistic style.

“The power of juxtaposing or placing one color on top of another to create an image is what drives my paintings,” he says. “It is a great way to relieve stress. I can paint for three hours straight, and it feels like only 30 minutes have passed. Painting for me is hard work, but the last hour of a painting when I feel it all comes together is so gratifying.”

Primarily Bodner considers himself a colorist and is constantly looking for the interplay of colors on his canvases. He says he has been inspired by works of Cézanne, Van Gogh and Philip Johnson, architect. He also admires artist Henri Matisse because of his color palette and his interior landscapes. And it seems to be all about color for Bodner as well.

“I love painting and color, and one simple stroke of yellow next to a purple vase can change the entire painting because they are complimentary colors,” he says.

Having practiced medicine for 30 years and art for over ten years, a common assumption might be that Bodner would retire from medicine soon and take up painting full-time. But he says he has found the perfect mix with art and medicine.

“I feel I have the best of two worlds, and I feel that medicine and my art, like my colors, complement each other,” he says.

Several of Dr. Bodner’s paintings were featured at the Anne Irwin Fine Art gallery in their “Best in Show 2013”. 

To see more of Gary’s work, please visit Anne Irwin Fine Art’s Web site at www.anneirwinfineart.com WWW.MEDMONTHLY.COM | 49

healthy living

Roasted Asparagus with Parmesan

By Ashley Acornley, MS, RD, LDN I know it’s officially Spring when asparagus appears at the state farmers’ market. Contrary to the canned variety, fresh asparagus is in a league of its own with its distinct grassy sweetness, which is especially pronounced when roasted. This recipe is both incredibly quick and delicious, not to mention loaded with great nutrients. The Parmesan adds just enough bite to make this side dish a favorite you’ll want to savor year-round.

Nutritional Facts: Makes 4 servings

Calories: 46 kcal Carbohydrate: 4.7 g Cholesterol: 4 mg Fat: 1.7 g Fiber: 2.3 g Protein: 4.4 g Sodium: 660 mg

Preparation: Ingredients: olive oil cooking spray 1 pound fresh asparagus, tough ends trimmed 1/4 cup shredded Parmesan cheese 1 teaspoon sea salt 1/4 teaspoon garlic powder, or to taste

• Preheat oven to 400 degrees F (200 degrees C).

• Spray the inside of a 9 x 13 casserole dish with olive oil cooking spray. Place asparagus in the dish and lightly spray spears with cooking spray.

• Sprinkle asparagus with Parmesan cheese, sea salt, and garlic powder.

• Roast in preheated oven until fork easily punctures thickest part of stem, about 12 minutes.

50 | JUNE 2014

U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.dced.state.ak.us/occ/pdop.htm

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 www2.state.id.us/dhw

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 www.obo.state.or.us

Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov

Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296 http://bod.ky.gov

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 http://1.usa.gov/zbJVt7

Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 http://sos.ri.gov/govdirectory/index.php? page=DetailDeptAgency&eid=260

California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 www.medbd.ca.gov Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.dph.state.ct.us/ Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 doh.state.fl.us Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 www.sos.state.ga.us Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 optician@dcca.hawaii.gov

Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/ New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 www.state.nh.us New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 http://www.njconsumeraffairs.gov/ ophth/ New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 http://www.op.nysed.gov/prof/od/ North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 http://www.ncoptometry.org/ Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707 http://optical.ohio.gov/

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://health.state.tn.us/boards/do/ Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 www.roatx.org Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 http://vtprofessionals.org/opr1/ opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 www.state.va.us/licenses Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission. aspx

WWW.MEDMONTHLY.COM | 51

U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 http://bit.ly/uaqEO8 Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 http://www.dora.state.co.us/dental/ Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI 52

| JUNE 2014

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 http://sos.georgia.gov/plb/dentistry/ Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://1.usa.gov/s5Ry9i Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://bit.ly/svi6Od Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/ Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.accesskansas.org/kdb/ Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/ Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://www.lsbd.org/

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd.

P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://bsd.dli.mt.gov/license/bsd_ boards/den_board/board_page.asp

Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://dhhs.ne.gov/publichealth/Pages/ crl_medical_dent_hygiene_board.aspx

Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/

Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044 http://www.nvdentalboard.nv.gov/

Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037 http://www.dentist.state.ok.us/

New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561 http://www.nh.gov/dental/

Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200 http://www.oregon.gov/Dentistry/

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://bit.ly/uO2tLg

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://www.rld.state.nm.us/boards/Dental_Health_Care.aspx

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/

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://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx 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://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp WWW.MEDMONTHLY.COM | 53

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov 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 54 | JUNE 2014

Florida 2585 Merchants Row Blvd.

Tallahassee, FL 32399 (850)245-4444 http://www.stateofflorida.com/Portal/ DesktopDefault.aspx?tabid=115

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820 http://www.lsbme.la.gov/

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913 http://bit.ly/vPJQyG

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601 http://bit.ly/hnrzp

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

Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000 http://bit.ly/orPmFU

Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200 http://www.mass.gov/eohhs/gov/departments/borim/

Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820 http://www.idfpr.com/profs/info/Physicians.asp

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27541-58914-,00.html

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

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/healingarts.asp

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bsd.dli.mt.gov/license/bsd_ boards/med_board/board_page.asp Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.mdpreferredservices.com/ state-licensing-boards/nebraska-boardof-medicine-and-surgery 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://bit.ly/w5rc8J 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/

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

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://bit.ly/rFyCEW

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

Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628 http://www.dopl.utah.gov/

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh

Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/

Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.state.pa.us/portal/server. pt/community/state_board_of_medicine/12512 Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://1.usa.gov/xgocXV South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/ South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/ Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://health.state.tn.us/boards/me/

Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.medlicense.com/washingtonmedicallicense.html West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 http://www.wvbom.wv.gov/ Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 http://drl.wi.gov/board_detail. asp?boardid=35&locid=0 Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

WWW.MEDMONTHLY.COM | 55

medical resource guide Urgent Care & Occupational Medicine Consultant

ACCOUNTING Boyle CPA, PLLC 3716 National Drive, Suite 206 Raleigh, NC 27612 (919) 720-4970 www.boyle-cpa.com

Lawrence Earl, MD COO/CMO ASAP Urgentcare Medical Director, NADME.org 908-635-4775 (m) 866-405-4770 (f ) http://www.asap-urgentcare.com/ UrgentCareMentor.com

EQUIPMENT APPRAISER Brumbaugh Appraisals 8601 Six Forks Road, Suite 400, Raleigh, NC 27615 (919) 870-8258 www.brumbaughappraisals.com

Utilization Solutions service@pushpa.biz (919) 289-9126

ADVERTISING

www.pushpa.biz

MedMedia9

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

DENTAL www.medmedia9.com

BILLING & COLLECTION

Biomet 3i

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

Dental Management Club Applied Medical Systems, Inc. Billing - Coding - Practice Solutions 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (800) 334-6606 www.ams-nc.com

CODING SPECIALISTS Place Your Ad Here

CONSULTING SERVICES, PRACTICE MANAGEMENT Physician Wellness Services 5000 West 36th Street, Suite 240 Minneapolis, MN 55416 888.892.3861 www.physicianwellnessservices.com

Urgent Care America

17595 S. Tamiami Trail Fort Meyers, FL 33908 (239)415-3222 www.urgentcareamerica.net

56 | JUNE 2014

EXECUTIVE ACCOUNTING & FINANCE RECRUITER Accounting Professionals Agency, LLC Adrienne Aldridge, CPA, CGMA, FLMI President 1204 Benoit Place Apex, NC 27502 (919) 924-4476 aaldridge@AccountingProfessioinals Agency.com

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

www.AccountingProfessionalsAgency.com

The Dental Box Company, Inc.

FINANCIAL CONSULTANTS

PO Box 101430 Pittsburgh, PA 15237 (412)364-8712 www.thedentalbox.com

DIETICIAN Triangle Nutrition Therapy 4030 Wake Forest Road, Suite 300 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/

ELECTRONIC MED. RECORDS

Sigmon Daknis Wealth Management 701 Town Center Dr. , Ste. #104 Newport News, VA 23606 (757)223-5902 www.sigmondaknis.com

INSURANCE, MED. LIABILITY Jones Insurance 820 Benson Rd. Garner, North Carolina 27529 (919) 772-0233 www.Jones-insurance.com

AdvancedMD 10011 S. Centennial Pkwy Sandy, UT 84070 (800) 825-0224 www.advancedmd.com

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

LOCUM TENENS Physician Solutions

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

medical resource guide MEDICAL ARCHITECTS MMA Medical Architects

520 Sutter Street San Francisco, CA 94115 (415) 346-9990 http://www.mmamedarc.com

MEDICAL MARKETING

Bank of America

MedMedia9

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com

WhiteCoat Designs

Web, Print & Marketing Solutions for Doctors (919)714-9885 www.whitecoat-designs.com

MEDICAL ART

PRACTICE FINANCING

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com www.bankofamerica.com/practicesolutions

REAL ESTATE

Deborah Brenner

877 Island Ave #315 San Diego, CA 92101 (619)818-4714 www.deborahbrenner.com

MedImagery

Laura Maaske 262-308-1300 Laura@medimagery.com http://www.medimagery.com

MEDICAL EQUIPMENT Assured Pharmaceuticals Matthew Hall (704)419-3005 mhall@assuredpharma.com

MEDICAL PRACTICE SALES Medical Practice Listings

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

MEDICAL PRACTICE VALUATIONS

PO Box 99488 Raleigh, NC 27624 (919)846-4747 www.bizscorevaluation.com

Tarheel Physicians Supply 1934 Colwell Ave. Wilmington, NC 28403 (800)672-0441

MEDICAL PUBLISHING www.thetps.com

MEDICAL EQUIPMENT FINANCING Bank of America

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com www.bankofamerica.com/practicesolutions

Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350 Commercial Sales & Leasing (919) 821-7177 www.yorkproperties.com

STAFFING COMPANIES Additional Staffing Group, Inc. 8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601 Astaffinggroup.com

BizScore

www.assurepharma.com

York Properties, Inc.

MedMedia9

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com

MEDICAL RESEARCH

SUPPLIES, GENERAL CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077 www.cnfmedical.com

Gebauer Company

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

WEBSITE DESIGN

Scynexis, Inc.

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com WWW.MEDMONTHLY.COM | 57

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina GP Needed Immediately On-Going 3 Days Per Week at Occupational Clinic . General Practictioner needed on-going 3 days per week at occupational clinic in Greensboro, NC. Numerous available shifts for October.

Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com 3-5 days per week in Durham, NC . Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Disease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina. General Practitioner with a knowledge or interest in addictive disease. Needed in October on-going 1-3 times per week. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary Care Physician in Northwest NC (multiple locations). Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm.

Outpatient only. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

58 | JUNE 2014

Immediate need for full time GP/FP for urgent cares in eastern NC. Urgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent placement. Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com General Practitioner Needed in Greensboro. Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week. Adults only. 8 am-5 pm. No call required. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC. Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/on-going/full-time.

The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill this position immediately. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Occupational Clinic in Greensboro, NC seeks FP/GP for On-Going Shifts. Locum tenens position (4-5 days a week) available for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/ day. Excellent staff. Outpatient only. physiciansolutions@gmail.com Diabetic Clinic 1 hour from Charlotte seeks FP/GP/ IM for On-Going Shifts.Primary care physician needed immediately for outpatient diabetic clinic one hour outside Charlotte, NC On-going. Hours are 8 am -5 pm with no call. Approximately 15-20 patients a day. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing. A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. email: physiciansolutions@gmail.com

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Addictive Disease Clinic in Charlotte, NC and surrounding cities seeks GP/FP/IM for on-going shifts An addictive disease clinic with locations with locations in Charlotte, NC and surrounding cities seeks a GP with an interest in addictive medicine for on-going shifts. This clinic has 15-25 open shifts every month and we are looking to bring on a new doctor for consistent coverage. The average daily patient load is between 20 and 25 with shifts from 8 am - 5 pm and 6 am - 2 pm. If you are interested in this position please send us your CV and feel free to contact us via email or phone with questions or to learn about other positions.

Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com

Greensboro occupational health care clinic seeksgeneral practitioner for intermittent shifts. Primary care physicians needed for occupational medicine. Adults only. Hours are 8am-5pm. Large corporation, no call required. Please contact Physician Solutions at 919-8450054 or email: physiciansolutions@gmail.com.

IM/FP needed in Fayetteville clinic immediately. Fayetteville health department needs coverage March through June full or part time. Patients adult health and women’s health. Adults only. No call 8a-5p.

Please contact Physician Solutions at 919-845-0054 or email: physiciansolutions@gmail.com.

Geriatric physician needed immediately 2 to 5 days per week, on-going eastern NC. Nursing homes in Durham, Fayetteville and Rocky Mount seek GP/IM/ FP with geriatric experience to work full or part time.

Nursing home focuses on therapy and nursing after patients are released from the hospital. 8a-5p, no call.

Please contact Physician Solutions at 919-845-0054 or email: physiciansolutions@gmail.com.

Child Health Clinic in Statesville, NC seeks pediatrician or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Nursing home in Durham seeks PT/FT NP/PA for immediate ongoing scheduling. Durham nursing home seeks part time or full time mid-level for ongoing locums.

Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-8450054 or email: physiciansolutions@gmail.com.

Fayetteville occupational health care clinic seeks GP for May. Primary care physicians needed for occupational medicine. Adults only. 8-5p. Large corporation, no call required. Intermittent dates in the future and second office in Greensboro with ongoing scheduling.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Practice 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in March. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Nursing home in Durham seeks PT/FT Geriatrics doctor for immediate ongoing scheduling. Durham nursing home seeks part time or full time MD for ongoing locums. Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

FT/PT Mid-Level Provider needed for Wilmington practice immediately. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8:00-5:00.

Possible permanent placement. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Family Practice 1 h SE of Raleigh seeks coverage.

Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com. continued on page 61 WWW.MEDMONTHLY.COM | 59

PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually.

Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information.

The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well.

For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today.

List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

ROANOKE RAPIDS, NC In mid December, a pediatrician or family medicine doctor comfortable with seeing children is needed full time in Roanoke Rapids (1 hour north of Raleigh, NC) until a permanent doctor can be found.

Credentialing at the hospital is necessary.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com 60 | JUNE 2014

classified listings

Classified

continued from page 59

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Pediatric clinic near Greensboro needs 10 weeks of 3 day a week coverage beginning June 1. Burlington pediatric clinic seeks coverage June 1 3 days a week for 10 weeks. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Greenville Clinic seeks GP. GP/IM needed for intermittent shifts. Must have experience or be willing to do pain management and trigger point injections. 8-5p.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Raleigh practice seeks BC FP for permanent placement in new facility summer 2013. Board Certified Family Practitioner sought for FT permanent placement in new clinic in Raleigh to start summer of 2013.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing . A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Western North Carolina Clinic needs continuing physician coverage. Clinic seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call.

35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

IM/FP/Peds opportunity in Fayetteville clinic immediately. Fayetteville clinic needs immediate coverage for the following clinics: adult health, women’s health and STD. No call 8a-5p.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Pediatrician Needed MD June-Aug, Burlington NC 3x week for 10 wks starting June 1st, 8-5 Mon-Fri Burlington, NC: located 1 hour west of Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Pediatrician, IM & FP needed, Fayetteville NC Urgent Need for immediate MDs - Pediatrics, Family Practice or Internal Medicine - PT/FT, 8-5 Mon-Fri. Ongoing. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Locum & Permanent MD Needed , Kinston NC Urgent Need for immediate MD placement, 8-5 MonFri. Must be able to do family planning & light maternity, Kinston, NC: 1.5 hours outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

PT MD needed for Occupational practice, Greensboro NC. Urgent need for PT MD to do disability physicals 2-3 days weekly, 8-5, on-going scheduling.

Greensboro, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent PA or MD needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5, Goldsboro, NC: 1 hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practice MD needed 2-3x/week, Goldsboro intermittent dates, 8-5p,Goldsboro, NC 1h SE of Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

FULL TIME MD needed for Family Practice in Washington, N.C. Family Practitioner needed for FT MD June 15-Sept 1 on-going Mon- Fri 8-5, Washington, NC, 1 hour 45 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Geriatric Experienced Mid Level or MD, Durham NC Must have geriatric experience, PT/FT, Locations in Durham, Rocky Mount & Fayetteville, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practitioner opportunity available one hour east of Charlotte Monday through Friday. The hours will be 8:00am until 5:00pm either full time or part time.

You will be seeing 15-20 new patients a day. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

continued on page 62 WWW.MEDMONTHLY.COM | 61

classified listings

Classified

continued from page 61

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Immediate opportunity for a Primary Care Physician at a large practice located one hour south of Raleigh. The hours are from 8:00am until 5:00pm You will be treating generally 20-25 patients per day. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family MD opportunity at an Urgent Care facility that sees all ages in the Jacksonville, NC area. This will be an ongoing schedule from 8:00am until 6:00pm 1-2 days a week, including weekend dates. You will treating generally 30-35 patients a day. There is potential for permanent placement. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Primary care physician opportunity for busy occupational medicine practices near Greensboro/Fayetteville, NC. There are two locations with positions available within 15 minutes of Greensboro and Fayettteville. Your schedule will be from 8:00am until 5:00 pm either full time or part time, no call necessary. Patient treatment will consist of adults only in both facilities. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Exceptional Family Physician opportunity at a practice in the Raleigh, NC area. Schedule will be ongoing Monday through Friday from 8:00am until 5:00pm. Must be comfortable with treating all ages. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Immediate Pediatrician opportunity at a small outpatient hospital. Located between Fayetteville and Wilmington, this facility requires someone for intermittent shifts. Please contact Physician Solutions at 919845-0054 or email physiciansolutions@gmail.com.

continued on page 64

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business.

Family Physician opportunity for a leading medical practice in the Raleigh area. Must be able to start immediately and be comfortable with seeing all ages.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Primary Care Physician opportunity for a leading women’s practice in the Lenoir, NC area. Treating Physician must be comfortable with light OB and well women’s exams. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

General Practitioner/Internal Medicine Physician opportunity for intermittent shifts at a prominent practice in the Greenville, NC area. Treament schedule will be from 8:00am until 5:00pm. The practicing physician must have experience or be willing to perform pain management and trigger point injections. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

62 | JUNE 2014

l One

of the oldest Locums companies client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner l Large

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

NC OPPORTUNITIES

Woman’s Practice in Raleigh, North Carolina.

LOCUMS OR PERMANENT

Physician Solutions has immediate opportunities for psychiatrists throughout NC. Top wages, professional liability insurance and accommodations provided.

Call us today if you are available for a few days a month, on-going or for permanent placement.

Please contact Physican Solutions at 919-845-0054 or physiciansolutions@gmail.com For more information about Physician Solutions or to see all of our locums and permanent listings, please visit physiciansolutions.com

We have a established woman’s practice in the Raleigh North Carolina area that is available for purchase. Grossing a consistent $800,000.00 per year, the retained earnings are impressive to say the least. This is a two provider practice that see patients Monday through Friday from 8 till 6. This free standing practice is very visible and located in the heart of medical community. There are 7 well appointed exam rooms, recently upgraded computer (EMR), the carpet and paint have always been maintained. The all brick building can be leased or purchased.

Contact Cara or Philip for details regarding this very successful practice.

Medical Practice Listings; 919-848-4202

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients.

FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff.

Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

evaluation of patient on admission and development of a comprehensive treatment plan, serve on medical staff committees, complete court papers, documentation of patient progress in medical record, education of patients/families, provision of educational groups for patients.

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com WWW.MEDMONTHLY.COM | 63

classified listings

Classified

continued from page 62

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Pediatrics Opportunity - Roanoke Rapids Area Northeastern North Carolina Pediatric Practice seeks on-going physician for full time coverage beginning mid-October through the end of the year. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Primary Care Physician - Washington area Seeking a physician for a general primary care practice.

Treatment will include seeing 3-4 pediatric and about 10 adult patients per day. The hours are 8:00- 5:00pm M-F. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Physician –Williamston area Immediate opportunity at a developing family practice in the Williamston area. You will be treating 8-16 patients per day from 8:00-5:00 pm. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

MD Suboxone Duties Suboxone is a prescription medicine used for the maintence treatment of oproid dependence. Duties include opioid dependence recovery, rehabilitation, substance abuse and general Internal medicine. We have 4 practices to support with 3 to 5 day coverage. This means you have choices in the city you wish to practice. Slow to moderate patient pace with an exceptional staff and facility. Please contact Physician Solutions at; (919) 8450054 or Email; physiciansolutions@gmail.com Family Practice located in Winston Salem has an opening for a Family Practice MD. The hours are from 8 till 6 Monday through Friday with NO call duties. You will average seeing a dozen patients per day with a small experienced staff. This position starts in March and will last through the summer of 2014. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Family Practice Opportunity, treating patients of all ages, looking for a FP or well informed Pediatric MD to work a full schedule Monday through Friday in Raleigh NC. This job is available immediately and is on-going contracted assignment. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@ gmail.com 64 | JUNE 2014

Methadone Treatment facility in the Western part of North Carolina has an immediate opening for a dependable MD. This is a highly regulated facility and the nursing staff performs most of the routine duties. The physicians that currently work in this environment really enjoy the work environment. We are accepting applications for this position and we will consider 3 to 5 shifts per weekly. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Physician Assistant to work primary care settings in North Carolina. We have 5 or 6 primary care practices that are looking for permanent or locum to perm PA’s.

Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Fayetteville area practice on-going physician for full time coverage. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Pediatrician needed for permanent placement at Fayetteville area practice. Board Certified or Board Eligible. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Winston Salem clinic seeks PA for FT ongoing locums position immediately. Average daily patient load is 25.

Primary care services as well as some pain management. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Chiropractic Clinic seeks mid-level provider in Greenville, NC for Monday and Tuesdays shifts beginning in April. No call required, 8-5. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Cardiology practice has immediate opportunity for full time mid-level or physician in Fayetteville area to provide primary care assistance for the practice. The position has the potential for permanent placement. No call required, 8-5 M-F. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com

continued on page 67

WWW.MEDMONTHLY.COM | 65

What’s your practice worth?

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

Doctors can tell you what their practices made or lost last year, but few actually know what it’s worth.

In today’s world, expenses are rising and profits are being squeezed. A BizScore Performance Review will provide details regarding liquidity, profits & profit margins, sales, borrowing and assets.

Our three signature sections include:  Performance review  Valuation  Projections

Scan this QR code with your smart phone to learn more.

919.846.4747 bizscorevaluation.com

classified listings

Classified

continued from page 64

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

North Charlotte area practice has immediate opportunity for mid-level provider. Position is 2-3 days per week (flexible) beginning in March 2014. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Clinic seeks PA immediately 3 days per week ongoing in Rocky Mount. Small clinic in Rocky Mount seeks 2-3 days coverage a week immediately. Few peds, 8-5pm M-F days flexible. Temp to perm. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Occupational Therapist (OT) - 3 positions available in Eastern, NC. We have opportunities for 3 on-going Occupational Therapists. These positions are 40 hour per week temp status to permanent positions. Contact Ashley or Cara at; physiciansolutions@gmail.com or PH: (919) 845-0054 for more details.

Immediate opportunity for a Family or Internal Medicine MD to practice 3 to 5 days per week in Charlotte.

Light patient volume along with top wage make this a very attractive position. If you have 3 to 5 hour shifts you can work from Monday through Friday, we would like to discuss this upscale practice opportunity.

Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com Primary care practice in North Raleigh has an immediate opening for a well rounded Medical Doctor in Raleigh, NC. 3 to 5 days per week seeing 16 to 22 patients between the hours of 8-5. This is an on-going opportunity with some flexibility as there are two other providers as co-workers. Outpatient with no hospital duties makes this a very desirable locum’s job. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Family practice in Wake Forest, NC seeks 2 to 3 shifts per week from a Board Certified FP. There is one doctor and 2 PA’s already practicing here and the growth requires another provider. No call, no hospital and great colleagues and facility. Contact Ashley or Cara at; physiciansolutions@gmail.com or PH: (919) 845-0054 for more details.

Addictive medicine practice would like FP or IM physician to see 8 to 15 patients per day in Charlotte, NC. This position requires a solid level of Administrative writing skills for outlining patient protocol. The ideal doctor will have 2 to 4 shifts per week. Providers with Suboxone credentials can start within days. If you would like to obtain Suboxone certification, the process time is one to two weeks (on-line course). Call (919) 845-0054 or Email us at physiciansolutions@gmail.com Wilson, NC Urgent care treating 25 to 35 patients per day has an opportunity for a well qualified MD. The shifts are 10 hour days during the week and 6 to 8 hour shifts on the weekend. This allows you to work 3 to 4 days per week comfortably. You must be comfortable seeing children to geriatrics and basic suturing skills are required. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com Walk-in primary care practice in Wilmington, NC would like to add 1 to 3 shifts per week for a primary care doctor. Heavy population of female patients and young adults are seen between 8 and 5 M-F. This is an ongoing locum opportunity. Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com On-going contract with an Assistive Living and Nursing Home organization in Raleigh, Durham, Greensboro, Charlotte, Wilmington, High Point, Greenville, Wilson, Asheboro, Rocky Mount, Asheville and Hillsboro. The mentioned cities are the major cities we need Geriatric MD’s to see patients. 6 to 8 doctors are required as this a long term locum opportunity. You will be paid hourly (no commissions or fee splits) plus mileage and lodging when necessary. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com PA opportunity in Raleigh, NC for long term locum opportunity. This large primary care practice would like to add one, possible two physician assistants. If you can provide 3 to 5 shifts per week, we would like to introduce you to this up-scale practice. No call, no hospital and no pain management. This job starts May and is on-going. Call (919) 845-0054 or Email us at physiciansolutions@gmail.com

continued on page 68 WWW.MEDMONTHLY.COM | 67

classified listings

Classified

continued from page 67

To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina (cont.)

South Carolina

Asheville, NC needs long term PA opportunity in this beautiful mountain city. This is a 40 hours per week on-going positions that can develop into permanent.

No call or hospital. This is a locum assignment for the serious PA to work with 3 MD’s and several other PA’s.

Primary care medicine at its best in this modern facility.

Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com

A family and urgent care in Little River, SC seeks an FP/EM physician for 1 to 2 days per week, on-going shifts. The practice is a one-physician facility and is looking for a physician to come in regularly. The practice is small and does not have a large patient load.

The qualified physician will have experience in Family or Emergency medicine. If you have any availability and a SC medical license contact us today and we will do our best to work around your schedule. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Charlotte area pediatric practice seeks on-going mid-level for immediate coverage, 1-2 shifts per week.

Hours are 8:00-5:00 with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com Vascular Surgeon needed for multi-practice specialty group located in Greensboro area to cover weekend shifts. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Family practice with Sports Medicine focus in Greensboro, NC seeks physician assistant, practice sees all ages. Must be familiar with electronic records. Practice sees 20-25 patients a day, hours are 8:00-5:00. Contact Ashley or Cara; (919) 845-0054 or Email us at physiciansolutions@gmail.com Family practice with busy allergy clinic in Rocky Mount, NC seeks full time physician assistant to join their practice. Clinic hours 8-5 with no call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com Immediate opportunity for Physician Assistant with Fayetteville area family practice and Heart clinic. Practice is conveniently located with excellent support staff. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Immediate opportunity for Geriatrics or Family Physician with statewide practice. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

68 | JUNE 2014

Physicians needed Virginia 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, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.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, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Classified To place a classified ad, call 919.747.9031

Nurse Practitioners needed

Medical Marketing & Sales needed

North Carolina

North Carolina

Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte.

8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte.

8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Medical Marketing & Sales needed North Carolina Accounts Manager; Physician Solutions has an immediate opportunity for a professional to work from our North Raleigh corporate offices. Duties include; calling on developed practice accounts while developing new accounts. Recruiting physicians and overseeing all marketing and sales duties. Please contact Physician Solutions at; (919) 845-0054 or Email; physiciansolutions@gmail.com

WebSite Development and Hosting Sales; MedMedia9 is accepting applications for Sales Associates in all parts of North Carolina. We are looking for Independent Medical Sales Reps that are looking for a really solid product that is needed by 6 out of 10 practices, cost effective and will enhance their practice income while attracting new patients. Easy sales delivery by a confident professional. Please send your resume and contact information to; medmedia9@gmail.com or go to www.medmedia9.com the About Us tab and view the Reseller Application. We pay exceptional commissions and offer the best back office support. We welcome the opportunity to discuss our program with you. continued on page 70

Internal Medicine Practice for Sale Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments.

The average patients per day is 20-25+, and the gross yearly income is $555,000.

Listing Price: $430,000

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com WWW.MEDMONTHLY.COM | 69

classified listings

Classified

continued from page 69

To place a classified ad, call 919.747.9031

Practice wanted North Carolina Pediatric Practice Wanted in Raleigh, NC 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 US. When you list with us, your practice receives exceptional national, regional and local exposure.

Contact us today at (919) 848-4202.

Practice for sale North Carolina Primary Care Practice Only Minutes East of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. The Gross revenue is about $235,000 yearly. Contact Cara or Philip at 919 848 4202 or email: medlistings@gmail.com to receive details.

Family Practice located in Hickory, NC. 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, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com Impressive Internal Medicine Practice in Durham, NC: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four wellequipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing

70 | JUNE 2014

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 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, NC 27624. PH: (919) 848-4202 or send an email to medlistings@gmail.com Internal Medicine Practice located just outside Fayetteville, NC 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 that 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, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com Modern Vein Care Practice located in the mountains of NC. 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

Classified To place a classified ad, call 919.747.9031

Practice for sale 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 you

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

want. Physician will to stay on for a 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, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

Practice for sale Washington Family Practice located in Bainbridge Island, WA 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 for Sale in Raleigh, NC Primary care practice specializing in women’s care Raleigh, North Carolina The owning 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 profit 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 and beautifully decorated throughout. New computers and medical management software add to this modern front desk environment.

Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com

List price: $435,000

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

WWW.MEDMONTHLY.COM | 71

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

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients.

Contact one of our advertising agents and find out how inexpensive yet powerful your ad in Med Monthly can be.

medmonthly.com | 919.747.9031

3 OCCUPATIONAL THERAPISTS POSITIONS IN JACKSONVILLE, NC These positions are 40 hour per week temp status to permanent positions with the following qualifications required: l Have graduated from an accredited Occupational Therapist program with a Masters Degree and 1 year experience or a Bachelors Degree with 3 years experience in Occupational Therapy. Program must be accredited by the Accreditation Council for Occupational Therapy Education (ACOTE). l Possess and maintain a valid license or certificate to practice as an Occupational Therapist in any of the 50 states, District of Columbia, the Commonwealth of Puerto Rico, Guam or the US Virgin Islands. l Possess and Occupational Therapist Registered (OTR) certification by the National Board for Certification of Occupational Therapy (NBCOT). l Possess a minimum of one year experience as an Occupational Therapist, preferably working in the neurological based practice setting and with a familiarity of TBI specific patient care practice needs.

HOW TO APPLY: Send us your Resume/CV along with the following: available date to start, salary history, cover letter, eight hour shifts available per week. We will contact you by Email or phone to discuss our program. Make sure you provide your phone numbers and Email address.

Contact Ashley or Cara at: physiciansolutions@gmail.com or phone (919) 845-0054 for details

Internal Medicine Practice Wilmington, North Carolina Newly listed Internal Medicine practice in the beautiful city of Wilmington, NC. With Gross revenues over $400,000, 18 to 22 patients per day, this practice is ready for the physician that enjoys beach life. The medical office is located in a brick wrapped condo and is highly visible. This well appointed practice has a solid patient base and is offered for $85,000.

Medical Practice Listings l 919-848-4202 l medlisting@gmail.com l medicalpracticelistings.com

NC MedSpa For Sale MedSpa Located in North Carolina

Primary Care Practice For Sale

We have recently listed a MedSpa in NC

Wilmington, NC

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.

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 today to discuss the practice details.

Contact Medical Practice Listings for more information.

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

www.medicalpracticelistings.com

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

PRIMARY CARE PRACTICE East of Raleigh, North Carolina We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day.

Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly.

We are offering this practice for $130,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased.

Contact Cara or Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202

Adult & pediAtric integrAtive medicine prActice for sAle

Women’s Health Practice in Morehead City, NC

This Adult and Pediatric Integrative Medicine practice, located in Cary, NC, incorporates the latest conventional and natural therapies for the treatment and prevention of health problems not requiring surgical intervention. It currently provides the following therapeutic modalities: • • • • •

Conventional Medicine Natural and Holistic Medicine Natural Hormone Replacement Therapy Functional Medicine Nutritional Therapy

• • • • • •

Mind-Body Medicine Detoxification Supplements Optimal Weigh Program Preventive Care Wellness Program Diagnostic Testing

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20 Gross Yearly Income: $335,000+ | List Price: $125,000

Newly listed Primary Care specializing in Women’s care located in the beautiful coastal city of Morehead City. This spacious practice has 5 exam rooms with one electronic tilting exam table and 4 other Ritter exam tables. Excellent visibility and parking make this an ideal location to market and expand. This practice is fully equipped and is ready for a new owner that is ready to hit the ground running. The owning MD is retiring and will be accommodating during the transition period. This medical building is owned and is offered for sale, lease or lease to own. The gross receipts for the past 3 years exceed $540,000 per year. If you are looking to purchase an excellent practice located in a picturesque setting, please contact us today.

Medical Practice Listings Buying and selling made easy

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

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

Primary Care Specializing in Women’s Health

Located on NC’s Beautiful Coast, Morehead City

Practice established in 2005, averaging over $540,000 the past 3 years. Free standing practice building for sale or lease. This practice has 5 well equipped exam rooms and is offered for $38,000.

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

WWW.MEDMONTHLY.COM | 79

Pediatrics Practice Wanted Pediatrics practice wanted in NC 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.

Contact us today to discuss your options confidentially.

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 that are 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

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

To view more listings visit us online at medicalpracticelistings.com

FAMILY PRACTICE FOR SALE A beautiful practice located in Seattle, Washington This upscale primary care practice has a boutique look and feel while realizing consistent revenues and patient flow. You will be impressed with the well appointed layout, functionality as well as the organization of this true gem of a practice. Currently accepting over 20 insurance carriers including Aetna, Blue Cross and Blue Shield, Cigna, City of Seattle, Great West and United Healthcare. The astute physician considering this practice will be impressed with the comprehensive collection of computers, office furniture and medical equipment such as Welch Allyn Otoscope, Ritter Autoclave, Spirometer and Moore Medical Exam table.

Physician compensation is consistently in the $200,000 range with upside as you wish. Do not procrastinate; this practice will not be available for long.

List price: $255,000 | Year Established: 2007 | Gross Yearly Income: $380,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

Eastern North Carolina Family Practice Available Well-appointed Eastern North Carolina Family Practice established in 2000 is for sale in Williamston, NC. This organized practice boasts a wide array of diagnostic equipment including a GE DEXA scanner with a new tube, GE case 8000 stress testing treadmill and controller and back up treadmill, Autoclave and full set of operating equipment, EKG-Ez EKG and much more.

The average number of patients seen daily is between 12 to 22.

The building is owned by MD and can be purchased or leased.

The owning physician is retiring and will assist as needed during the transition period. The gross receipts for the past three years are $650,000 and the list price was just reduced to $240,000.

If you are looking to purchase a well equipped primary care practice, please contact us today.

Contact: Cara or Philip at 919-848-4202

medlisting@gmail.com medicalpracticelistings.com

the to Thanks to the growing doctor shortage (a deficit of 63,000 by 2015 and 91,500 by 2020, current and new physicians should find it relatively easy to secure positions within our nation’s hospitals, practices and other health care facilities. We’ve listed here the top 9 best medical career specialties.

Bear in mind that the salary ranges noted here are averages.

1

ORTHODONTIST

The median income for an orthodontist working in the United States is $140,850 per year. Employment opportunities for orthodontists are expected to grow by 9 percent, from 9,200 to 10,000 by 2016. It can be a stressful job, but not really much more stressful than any other job in the medical field.

2

RADIOLOGIST

Salaries average about $349,000. A career in radiologic technology offers a promising future, job stability, minimum stress, and a good salary. As technology advances and the American population ages, the demand for radiologic exams and procedures has grown. The country needs qualified professionals to provide medical imaging and radiation therapy.

78

| JUNE 2014

op 3

Medical Specialties DERMATOLOGIST

The median annual salary for a dermatologist is around $302,000 and has the option for flexible hours. Dermatologists are in high demand with an ever growing income base. This is considered one of the least stressful specialties and is ranked very high in job satisfaction.

4

6

Along with pediatrics, this specialty is considered least desirable from a financial standpoint and because you have poor control over your hours.

The demand for family physicians continues to surpass the demand for other specialties and subspecialties. This demand played a role in fueling a 6 percent increase in family physician salaries during the past year, to an average of $189,000 a year.

7

ANESTHESIOLOGIST

Average salary is $220,000. Pros of a career in anesthesiology are job security (expected 22% job growth through 2018) and it’s among the better work-life balances in the medical profession with lots of flexibility with job location.

5

OPHTHALMOLOGIST

FAMILY PRACTICE

The average median ophthalmologist salary in the United States is reported to be about $257,000 per year. This specialty has good control over working hours with very little stress and is ranked high in job satisfaction. Overall, from a manpower perspective, ophthalmology continues to be an attractive field of medicine with great opportunities.

PEDIATRICS

Pediatricians were the second lowest ranked specialty, with a mean income of $173,000. Being a pediatrician is one of the most emotionally-satisfying medical specialties for those who enjoy working with children. The job opportunities are promising, as the expected employment growth from 2010 to 2020 is 24 percent.

8

PSYCHIATRIST

Salaries average $186,000 annually. Psychiatry is in high demand and there is a serious shortage of doctors, especially in child/adolescent psychiatry. As a result there is more freedom in the type of practice and level of specialty a doctor can have (working exclusively with certain groups like addicts, people with mood disorders, or psychotic disorders).

9

SURGEON

Depending on your exact specialty, salaries average $214,000 to $321,000. Working hours are uncontrollable and the job is considered very stressful, but it’s ranked high in job satisfaction. Employment of surgeons is projected to grow 18 percent from 2012 to 2022.

WWW.MEDMONTHLY.COM | 79

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Our website packages are custom designed and affordable.

Scan this QR code with your smartphone to learn more.

Increase your patient volume and profitability with a website from

MedMedia9.

Visit us today at medmedia9.com to find out how we can make your practice grow. Click on the “Web Design” tab for more details and view the sample website.

Call MedMedia9 today at 919-747-9031.

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