Med Monthly May 2014

Med Monthly MAY 2014

A Career with Many Hats:

Sharon Trahan, D.M.D. Dentist, Business Woman, Visionary pg. 42

PHYSICIAN SALARIES AND TRENDS AT A GLANCE pg. 51

the

n Physicia & Salaries Careers issue

An Overview of the Salaries, Bonuses, and Other Incentives pg. 46

A JOURNEY TO HOPE:

The Career of Dr. Stanislaw Burzynski pg. 48

contents

features

42 A CAREER WITH MANY HATS

48

A JOURNEY OF HOPE:

The Career of Dr. Stanislaw Burzynski

46 AN OVERVIEW OF THE SALARIES, BONUSES AND OTHER INCENTIVES 48 A JOURNEY OF HOPE: The Career of Dr. Stanislaw Burzynski 51 PHYSICIAN SALARIES AND TRENDS AT A GLANCE

insight 10 ADDICTION MEDICINE CONFERENCE 12 FIVE TRUTHS FOR YOUR SUCCESS 16 FOUR MYTHS ABOUT MINDFULNESS MEDITATION

research and technology 28 SEPSIS STUDY COMPARING THREE TREATMENT METHODS SHOWS SAME SURVIVAL RATE 30 POLARIS AWARDED $1.1 MILLION NIDA GRANT

practice tips

32 ANGEL CREATIVE SOLUTIONS CREATES DIABEGRAM: THE FIRST-EVER DIABETES AWARENESS MEAL PHOTO-SHARING APP

18 HAVE YOU CONSIDERED PODCAST CREATION?

legal

20 CHALLENGING PATIENTS OR CHALLENGING TIMES?

34 GUIDANCE ON MENTAL HEALTH & THE HIPAA PRIVACY RULE

24 WEBSITE BLOGGING

international 26 TWENTY YEARS AFTER GENOCIDE, LIFE EXPECTANCY DOUBLES IN RWANDA FOUR MYTHS ABOUT MINDFULNESS MEDITATION

16

36 NEW ENROLLMENT AND RE-VALIDATION REQUIREMENTS FOR PROVIDERS/SUPPLIERS FOR PARTICIPATION IN MEDICARE AND MEDICAID 38 SWEEPING CHANGES TO MEDICARE PAYMENT FOR CLINICAL LABORATORY SERVICES

the arts 52 MY CAREER IN MEDICAL ILLUSTRATION

healthy living 54 ASPARAGUS SOUP WITH HERBED GOAT CHEESE

in every issue 4 editor’s letter 8 news briefs

60 resource guide 80 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 The May edition of Med Monthly shines a spotlight on a few exceptional doctors’ careers as well as the salaries different specialties pull in. In “A Career with Many Hats” author and businessman Garrett Ludwig shares the evolution of Dr. Sharon Trahan’s profession, as both a dentist and entrepreneur.

Another physician we feature, Dr. Stanislaw Burzynski, has a career that takes him from his homeland of Poland to the States; his research and work with cancer patients are unprecedented, and author Barbra Phillips carries us on his “Journey to Hope”. Finally, the 2013 Merritt Hawkins Review of Physician Recruiting Incentives is summarized. It lists the demand for medical practitioners for the year and discusses percentage growth of salaries.

Dr. Trahan is a senior partner at Attleboro Falls Family Dentistry.

What makes her story so compelling is her goal driven method of building a practice and overseeing its operations without micro-managing. This is how Garrett and her thought process started, which is a telling reason why Dr. Trahan’s practice is so successful. Thinking like a business person is not always easy for doctors, but big picture ideas and a staff that you can trust is an excellent way to start.

Dr. Burzynski developed what he calls “antineoplaston therapy” which he believes offers “more successful and less damaging treatment options for patients who were facing the most hard to treat forms of cancer”. He has faced many challenges with his upbringing in a Communist country, and ironically his research and therapy has, after a period of excitement, caused quite a stir in the medical community. Dr. Burzynski is working with patients that have already been through the standard treatments of chemotherapy and radiation, and works with the sickest of the sick. Though his fight has been lengthy and troublesome, there are patients who did not have hope, who are now alive due to Dr. Burzynski’s efforts.

Quick - what type of doctor was most in demand in 2013? The Merritt Hawkins’ Review of Physician Recruiting Incentives says primary care doctors, for the seventh year in a row. The next growing area of recruitment in the medical profession is with physician assistants and nurse practitioners which have not happened in two decades. Other doctors that are being sought after are geriatricians and hospitalists.

The career paths of physicians can be very interesting – medicine is a complex field, notwithstanding creating your own business or conducting cutting edge research. Med Monthly has made a special effort to single out a few doctors who have been exemplary. Please stay tuned for next month’s issue on medical Specialties.

Ashley Austin Managing Editor 4 | MAY 2014

Med Monthly May 2014 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Liz Ferron, MSW, LICSW Rob Flewell Glenna M. Griffin Barbara Hales, M.D. Lisa English Hinkle Amanda Kanaan Garrett Ludwig Philip Miller Barbra Phillips Paul W. Radensky, M.D. Angela Savitri, OTR/L, RYT Christopher J. Shaughnessy John Warren Eric Zimmerman

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 Liz Ferron, MSW, LICSW is Vice President of Clinical Services at Physician Wellness Services in Minneapolis. She has been with the company for over 10 years, and has been in the employee assistance field for over 20 years. She has served three terms as President of the Minnesota Employee Assistance Program Administrators and Counselors (MEAPAC), and is a former adjunct faculty member at the College of St. Benedict. Liz has her MSW degree from the University of Minnesota and is a Licensed Independent Clinical Social Worker.

Glenna M. Griffin is a professional speaker, communications trainer & breast cancer survivor, Glenna encourages audiences to utilize the power of communication and collaboration to achieve personal and professional success! Connect with Glenna directly at www.glennagriffin.com.

Barbara Hales, M.D. is a skilled expert in promoting your health services. As seen on NBC, CBS,ABC and FOX network affiliates as well as Newsweek, Dr. Hales writes all the content you need to promote your medical services. Her latest book is on the best seller list and she can do the same for you. Check out her site at www.TheWriteTreatment.com

Garrett Ludwig is President of Diversified Design Technologies and specializes in health care office design. His design expertise is best summarized by his company slogan, “Profit By Design”. The slogan speaks to the purpose and intent of creating functional, efficient and fiscally sound design concepts. Contact: 800-622-5563, garrett@dentaldesign.pro, garrett@medicaldesign.pro

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 May Med Monthly we report on a new diabetes app that shares meal photos, improved cloud-based technology to increase the success rate of substance abuse treatment, and a sepsis study that for infected patients could raise their survival rates.

“Polaris Awarded $1.1 Million NIDA Grant to Improve Patient Engagement in Treatment for Addiction”, explains how more patients drop out of substance abuse treatment than complete it.

Polaris is implementing a cloud-based clinical system designed to predict and improve the likelihood of patient engagement in 12 addictions treatment programs of a large behavioral health system. Better engagement will mean better outcomes, including reduced relapse rates and the human and economic costs associated with it.

Angel Creative Solutions decided that by creating the app, Diabegram, they could utilize the ‘photo-sharing’ power of social media, making it the fastest way of raising awareness about diabetes. Using the Diabegram app, users take meal photos, add text and diabetes awareness digital ribbons, and share photos on social networking sites. As more people upload and share diabetes awareness meal photos, the more they will become aware about diabetes and its connection to nutrition and will in the long run make people revaluate their daily food choices.

The article “Sepsis Study Comparing Three Treatment Methods Shows Same Survival Rate” reports on a five-year, randomized clinical trial that indicated the survival of patients with septic shock was the same regardless of whether they received treatment based on specific protocols or the usual high-level standard of care. This new sepsis research effort will help improve treatment, speed recovery and increase survival rates for sepsis patients.

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 | MAY 2014

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news briefs

American Cancer Society Awards $42.9 Million The American Cancer Society, the largest nongovernment, not-for-profit funding source of cancer research in the United States, has awarded $42.9 million in national research and training grants to 103 scientists and health professionals in the first of two grant cycles in 2014. The grants will fund investigators at 68 institutions across the United States; 89 are new grants while 14 are renewals of previous grants. The grants go into effect July 1, 2014.

For more than 65 years, the American Cancer Society has funded research and training of health professionals to investigate the causes, prevention, and early detection of cancer, as well as new treatments, cancer survivorship, and end of life support for patients and their families. Since its founding in 1946, the American Cancer Society’s extramural research grants program has devoted more than $4 billion to cancer research and has funded 47 researchers who have gone on to win the Nobel Prize.

The American Cancer Society’s research and training program emphasizes investigator-initiated, peerreviewed proposals, and has supported groundbreaking research that has led to critical discoveries leading to a better understanding of cancer and cancer treatment.

Grant applications are ranked on the basis of merit by one of several discipline-specific Peer Review Committees, each of which includes 12 to 25 scientific advisors or expert reviewers. The Council for Extramural Grants, a committee of senior scientists, recommends funding based on the relative merit of the applications, the amount of available funds, and the Society’s objectives.

No member of the American Cancer Society’s Board of Directors or National Assembly may serve on a Peer Review Committee or as a voting member on the Council for Extramural Grants.

The Council also approved 133 research applications for funding totaling nearly $78 million that could not be funded due to budgetary constraints. These “pay-if” grants represent work that passed the Society’s multi-disciplinary review process and are beyond the Society’s current funding resources, so are available for funding by individual donors who wish to fund research that would not otherwise be funded. In 2013, additional donor funding totaling $8,866,115 covered 46 “pay-if” grants.  Source: http://www.pressreleasepoint.com/americancancer-society-awards-429-million-research-and-training-grants 8 | MAY 2014

New RSV Test Provides Healthcare Providers Objective Results in Minutes BD Diagnostics, a segment of BD (Becton, Dickinson and Company) (NYSE: BDX), a leading global medical technology company, announced today that it received 510(k) clearance and Clinical Laboratory Improvement Amendments (CLIA) waiver from the U.S. Food and Drug Administration (FDA) for nasopharyngeal swab specimens on the BD Veritor™ System for Rapid Detection of Respiratory Syncytial Virus (RSV). This is the first commercially available rapid CLIA-waived RSV test system that incorporates a digital result. The new assay is cleared for use in physician offices, hospitals, and other patient-care settings.

According to the U.S. Centers for Disease Control and Prevention, RSV is the most common cause of pneumonia and bronchiolitis in the United States in children under one year of age, leading to approximately 75,000 to 125,000 hospitalizations annually. Most children hospitalized for RSV infection are under six months of age. Almost all children have been infected with the virus by the time they are two years old.

“Early and reliable detection of RSV is critical among high-risk populations to treat and prevent the spread of this contagious virus and hospitalizations,” said Alberto Mas, President, BD Diagnostics Diagnostic Systems. “The CLIA-waived BD Veritor System for Rapid Detection of RSV has demonstrated good performance when compared to PCR, the highest reference lab based standard, while providing an objective test result in only 10 minutes.”

When used in conjunction with the BD Veritor System Reader, the RSV test utilizes Advanced Nano-particle and Adaptive Read technologies to obtain an accurate result while providing objective results on a hand held reader with an easy-to-read digital display. The Advanced Particle Technology along with improved chemistries helps improve the sensitivity of the test while the Adaptive Read Technology helps reduce false-positive results by examining and compensating for many of the effects of non-specific binding which improves specificity. This digital immunoassay (DIA) for Rapid Detection of RSV offers healthcare professionals a new option for RSV testing versus current visual read CLIA-waived assays.

The CLIA-waved BD Veritor System for Rapid Detection of RSV joins the previously FDA-cleared and CLIA-waived BD Veritor System for Rapid Detection of Flu A+B and Group A Strep. The BD Veritor System for Rapid Detection of RSV is the third CLIA-waived offering and BD plans to launch additional FDA-cleared assays on this platform.  Source: http://www.newswiretoday.com/news/140778/

NEW BOOK YOUR DOCTORS’ MANNERS MATTERS RELEASED Your Doctors’ Manners Matters: Better Health through Civility in the Doctor’s Office and in the Hospital (ISBN 978 -1-61005-447-8, BookLogix, 2014) by Dr. Barry Silverman and Dr. Saul Adler has been released. The book is a short and easy primer addressing what a patient should expect from their doctors in terms of service, respect, and human compassion. It also addresses what a patient should expect from hospitals in terms of behavior. The authors draw upon their extensive experience in the medical field. Using examples from their own practices and from those of their colleagues to illustrate their points, Your Doctors’ Manners Matters: Better Health through Civility in the Doctor’s Office and in the Hospital allows the patient to identify physicians and other medical professionals who practice medicine with compassion, empathy, and respect for the dignity of their patients.

“Dr. Adler and I have been physicians since the late 1960s. Lately we have heard patients discussing how displeased they are with their doctor’s manners and lack of empathy,” said Dr. Barry Silverman, co-author of Your Doctors’ Manners Matters: Better Health through Civility in the Doctor’s Office and in the Hospital. “In today’s world, patients put a great emphasis on the manners their doctors and other medical professionals display.

This book not only addresses what a patient should expect in terms of manners from their doctors but also what patients can do if they are not satisfied.”

Unlike other professions and industries that put an emphasis on customer service, the medical profession

doesn’t. A visit to a doctor who lacks civility and social graces will result in an unsuccessful medical outcome. .

For example, if doctors don’t spend time listening to their patients and interacting with them, patients may be less likely to follow the doctors’ advice. Despite the growing popularity of careers in the medical and health care industry, medical schools don’t offer courses in professional and social behavior. By educating patients on what to expect from the most effective and caring doctors, patients can influence their doctor’s manners.

“We provide information in the book that arms the patient on what type of manners they should reasonably expect from their doctors and other medical professionals,” said Dr. Saul Adler, co-author of Your Doctors’ Manners Matters: Better Health through Civility in the Doctor’s Office and in the Hospital. “If the doctor treats patients with compassion, understanding, and sympathy it reflects on their commitment to their profession. It is very disturbing for a sick patient, or a patient in pain and very vulnerable to visit the doctor and believe they have not been heard and treated well.”

Your Doctors’ Manners Matters: Better Health through Civility in the Doctor’s Office and in the Hospital is excellent for anyone seeking a doctor. Through the use of stories and examples, the book instructs patients on what to expect from a doctor and provides information on how to evaluate doctors’ ability and commitment to their patients’ health.  Source: http://www.newswiretoday.com/news/140852/

SOON COMING NTHLY O IN MED M

coming In the up ed 4 issue, M June 201 l be theme wil Monthly’s s Specialtie Medical WWW.MEDMONTHLY.COM |9

insight

2014 Addiction Medicine Conference

By Ashley Austin Managing Editor Med Monthly

S

everal hundred doctors converged at the Renaissance Hotel in beautiful Asheville, North Carolina for the 2014 Addiction Medicine Conference. The conference, organized by Sara McEwen, MD, and James Finch, MD, provided insightful workshops designed to strengthen fundamentals and lay the groundwork for the challenges that the future will bring for people with addiction issues. In addition to the educational side of the conference, physicians will be able to network with colleagues practicing all around the United States as well find new clinical materials.

The agenda of this 5th annual event started on March 21st with a registration at 7:00 in the morning and an overview of the weekend conference, including a breakfast sponsored by Millennium Laboratories. An hour later, the first speaker, Paul Martin, MD began his session entitled “Opening Plenary Session: A Year of Anticipated Changes” focusing on the new coding guidelines for DSM-5, ICD10, and ASAM. The field of addiction is vastly shifting with new research and protocols available for diagnosing, treating and paying for substance use disorder services.

10 | MAY 2014

The aforementioned resources help physicians stay aware of the changes to ensure the quality and access to addiction treatment. Dr. Martin is a family medicine doctor in Asheville. He received his medical degree for University of Arizona College of Medicine. He is a fellow of the American Society of Addiction Medicine and has been in practice for 38 years.

Some of major topics of the seminars had to do with changes such as the implementation of the ACA and the recently updated Guidelines for Using Opioids for Chronic Pain according to the co-directors of the conference, the emergence of the ACA as well as other developments will “significantly alter access to care, coding, and clinical guidelines.” These modifications were delineated for those participating in the seminars as well as insight into new drugs found on the streets and some innovative pharmacotherapies that are being worked on. Adam Zolotor, MD, was the speaker that discussed the impact of the ACA for North Carolina regarding substance abuse and mental health disorders. One of the largest expansions of coverage in a generation, the ACA will require insurance

plans to cover these services, on line with general care services. Previously, one third of those currently covered were not for substance abuse, one fifth for mental health.

Dr. Zolotor is the Vice President of the NC Institute of Medicine and an associate professor of family medicine at the University of North Carolina where he received his doctorate degree.

Dr. Finch, who is the Director of Physician Education at the Governor’s Institute and President of the NC Society of Addiction Medicine, followed this seminar with his speech on Chronic Pain and Opiods: Project Lazarus Part 1. He discussed how a doctor should choose patients who are suitable candidates for this type of management as well as assessing the risk factors before prescribing opiods. Stressing the necessity of drug screening, Dr. Finch delineated a correct code of conduct for therapy and safety issues. Dr. Finch was the recipient of the 2013 Frederick B. Glaser Award. The Glaser award is given to someone who has shown important contributions to the field of alcohol or other substance abuse. Dr. Finch did his fellowship at Duke University’s Division of Family Practice.

The conference also had seminars for medical professionals other than doctors. Physician Assistants, Nurse Practitioners and Practice Managers were able to attend a workshop that elaborated on more administrative and clinical work. The discussion concerned: Initial Patient Assessment, Engagement and Induction Monitoring, Physician to Physician Care Coordination, Drug-Drug Interactions, Updating Clinical Policy & Responses to Prescribed and Illicit Benzodiazepine Use in OTPs, and the Treatment of Pregnant and Post-Partum Women according to the literature. This type of knowledge is crucial for appropriate care given by the support staff at the clinics.

One of the largest sponsors of the event is the Governor’s Institute on Substance Abuse. SA4DOCS.org is a website that connects healthcare providers with up to date information and educational resources. Articles on the latest drugs and their affect on users are some of the topics discussed on their website. For instance Zohydro, a pure form of the painkiller hydrocondone, had been banned in Massachusetts, but a recent injunction lifted the ban. Another article describes a study on headaches, recommending that narcotics not be used as a first line of treatment.

The Substance Abuse and Mental Health Services Administration was also a big presence and supporter of at the conference. SAMHSA is a leader of public health efforts to decrease the consequences of both substance abuse and mental illnesses in America through prevention, treatment and recovery programs. The site has contact information for these diseases, such as suicide prevention, substance abuse treatment facilities and mental health services.

SAMHSA contains articles pertaining to health reform, the Affordable Care Act, and the Mental Health Parity and Addiction Equity Act.

The Addiction Medicine 2014 conference was a big success. The organizers did a great job coordinating the speakers, and the speakers chose engaging and current topics to discuss. The sponsors were also knowledgeable giving insight into such services as billing and coding.

Please visit www.ncaddictionmedicineconference.org for more information. 

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Editorial Calendar: June - Medical Specialties

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July - Diet & Your Practice

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insight

FIVE TRUTHS FOR YOUR SUCCESS

By Glenna M. Griffin COO, Speak America

12 | MAY 2014

The recovery room was cold and stark. I sat on the gurney shivering slightly as I waited. These thin hospital gowns were not nearly warm enough. Still a little drowsy from the anesthesia my eyes adjusted to the bright lights. I wondered how much longer.

Two weeks ago I never imagined I would be sitting here. Two weeks ago I was in the midst of preparing for a large project at work. Two weeks ago I put my 6 year-old on the kindergarten bus for the first time and smiled at the image of him waving from the bus window. Two weeks ago I sat in my 2-year olds play circle at daycare singing with her class. Life was a constant juggle it seemed. Oh yes, and tomorrow would be my 33rd birthday.

As I sat and waited for the doctor to share the results of the biopsy of the lump he had just removed, I shuffled through my mind like an iPod playlist the schedule and what needed to be done. I remember thinking, “I don’t have time for this!” There is work to be done, children to pick up from school, family activities to plan and participate in...this was not a time to be taken out of the loop with a medical issue!

Finally, just as I was looking around for something else warm to wrap up in, the surgeon walked through the door at the opposite end of the recovery room. As he walked down the long corridor to my gurney, our eyes locked and I knew. I knew what he would have to say was not good news. With great compassion the doctor quickly informed me I had an advanced stage of an aggressive form of breast cancer. The recommendation for an immediate double mastectomy, chemotherapy, reconstruction and a complete hysterectomy followed. I sat, listened, and tried to process. Somewhere along the way as I listened to his words, the playlist of my ‘to-do list’ stopped.

Through the fog of hearing the diagnosis and initial treatment plan I recalled wondering how the doctor is able to deliver this kind of information every day…..to scared women and families….over and over again. I also realized I was grateful for the quick, direct, authentic communication of the news. It was evident that it was as difficult for him to tell me the news as it was for me to hear it. He cared.

That fateful day was almost 13 years ago. I’m one of the lucky ones. I was able to get through the surgeries and treatments and continue with my life. Many are not as fortunate and for each day I’ve been given I am grateful.

They say a cancer diagnosis changes you. Indeed it does. It changed my personal beliefs as to what is truly important in life. Spending an extra 10 minutes reading a story to my child was more important than washing the dirty dishes in the sink....those could wait….the time with my child could not. I realized in an instant what truly mattered in my life and it wasn’t the ‘things’ that I had acquired or the ‘title’ of my job at work.

While my personal perspective changed, my professional attitude about the critical nature of communication also became much more focused and value driven. I discovered that the key elements that allowed me to get through the medical crisis in my life are the same elements that have allowed me to succeed in business. Whether you are a medical practitioner, a patient, or a business person the elements for your success are the same.

The Five Truths I believe there are five truths that allow us to succeed in every aspect of our lives. They are not complicated or confusing. They do not need to be put into a spreadsheet and analyzed. The five truths simply need to be followed every day, in every situation, with every person you encounter.

1. Be authentic. The appreciation I felt for the way my diagnosis was delivered to me was due to the surgeon’s authenticity and genuine care for my well-being. An old friend of mine used to say, “You can smell fake a mile away!” How right she was! Over the years I’ve worked diligently to remain authentic in my professional and personal relationships. As they say, ‘People don’t care how much you know, until they know how much you care.’

2. Be clear. Every listener is different. Every patient has different needs. Every customer participates in communication differently. Take the time to understand how best to be clear with your listener. Avoid confusing jargon. Consider a visual diagram of what you are describing. A moment of clear communication prevents hours of confusion. Speak at a pace that the listener can follow. If you are giving the information, ask if the listener would like to take notes. Ask if they understand before moving onto the next thing. If you’re receiving the information, be prepared to write down what you hear! Nothing wastes more time than leaving an appointment or meeting or finishing a phone call and not having all of the information you need.

The result is misinformation, additional time spent to clarify, or the wrong action being taken. Get it right the first time. Make it clear. Ask for clarification. Move forward knowing everyone is on the SAME PAGE, not in different chapters of the book! continued on page 14 WWW.MEDMONTHLY.COM |13

continued from page 13

3. Don’t put off to tomorrow what can be done today. You shouldn’t need a cancer diagnosis in your life to understand how precious every day becomes.

As a practitioner, if you have news to share with your patient call them……today! What may take 30 seconds of your time will prevent endless hours of heart wrenching worry for your patient. I recall waiting for days for a scan result and when I finally received the call I asked why it took so long for the results. The practitioner actually said to me, “As the report was negative I didn’t think it was a big deal.” Really? Who are we to say what someone else’s ‘big deal’ is in their life? It’s very simple, if something needs to be done, do it. In business, call on that prospect so you’ll be one step closer to that sale. Follow up on information or finish that proposal today, not tomorrow. Don’t fall into the trap of pushing things off as you’ll end up with not accomplishing anything. No matter what we intend to accomplish the next day, it can all change in an instant.

Finish what needs to be finished today.

4. Relationship is EVERYTHING! Every person we meet has something to share. Every patient has a story.

“Relationship” does not mean we become best friends with everyone. It means we take the time to know something about the other person. It means we take the time with social graces to connect with the other person. We are not robots…we are PEOPLE! People have a “desire, need, and want” to feel connected. I have learned more from other people than from any text book, webinar or class. People are interesting.

People have interesting experiences. People appreciate and will respond when they know you genuinely are interested in them! It does not take any extra effort to look someone in the eye when you’re speaking with them. Use their name. Invite them to participate in a conversation that means something and is not just a ‘data dump’ of information to get to the next task on your list. Build relationship and you will build trust.

5. Be present. This is sometimes more difficult then it seems. In our world of schedules and day-planners it’s easy to always be looking for the ‘next thing’ that has to be done. Yet if we focus too far on the future, we often miss the moment of ‘here and now’. Keep your eye on the end goal, yet remember to participate in the present. I discovered this truth during what seemed like the endless rounds of chemotherapy treatments.

The purpose of the chemotherapy treatments truly was to save my life….the big goal. Yet the meaningful moments were all along the way, with the other patients I sat next to in the treatment room, with the quiet moments with my children when I could do 14

| MAY 2014

more than barely lift my head and they would snuggle up next to me, and with the friends and neighbors who brought endless meals and cheer to our home.

The same ‘be present’ attitude applies to wherever we are and whoever we are with at any given moment.

We can be driving a business deal toward a long-range goal and be present in the moment of recognizing our teammates in the process, connecting with them so that we’re driving toward the goal together. It will be so much more meaningful once you get there!

While I’m not sure I can go so far as to say I am grateful I received the diagnosis of cancer all those years ago, I will say that I’m grateful for what I learned. I learned that life is indeed short……life is about making choices. I learned that each and every one of us makes choices every day on how we want to interact with others, how we want to impact the world around us, how we want to live our lives, and how we want to operate personally and professionally.

What choice are YOU making with your patients and customers? What choices are YOU making with yourself and your family? CHOOSE to be authentic! CHOOSE to be clear when you communicate! Don’t delay what you can do today! CHOOSE to build relationships and to be present in the moment! 

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If you would like to have another exciting tool to offer your practice clients, this could be the perfect fit that is financially rewarding. Call us today at our corporate offices in Raleigh, North Carolina to request more information on becoming a MedMedia9 Sales Associate. www.medmedia9.com 919-747-9031 medmedia9@gmail.com

Contact Tom Hibbard, Creative Director or Philip Driver, CEO for additional details.

WWW.MEDMONTHLY.COM |15

insight

Four Myths About

Mindfulness Meditation

By Angela Savitri, OTR/L, RYT Certified Integrative Health Coach www.freedomfromchronicstress.com

M

indfulness meditation has gone mainstream.

As more research is published about the benefits of mindfulness meditation, the general public, healthcare organizations, and corporations are seeking ways to incorporate this ancient practice into everyday life.

The Mindful Revolution was featured on the cover of the February 3, 2014 issue of TIME Magazine.

Corporations including Google, General Mills, Apple, and Aetna have introduced mindfulness programs for their employees. Mindfulness Based Stress Reduction (MBSR) training programs for healthcare professionals

16

| MAY 2014

offered by the Center for Mindfulness in Medicine, Health Care, and Society, part of the University of Massachusetts Medical School, have a waitlist.

Mindfulness meditation has shown multiple benefits to health and wellbeing. A sample range of benefits includes a decrease in stress, anxiety, depression, and pain. Additional benefits include an increase in immunity, concentration, weight loss, compassion, axonal density, and an overall felt sense of well-being.1 Mindfulness meditation is the practice of paying attention to the present moment without judging it. Seems simple enough, but the actual practice of learning to be fully

present in mind and body with open acceptance can be a challenge.

For most mindfulness meditation students, it is an unlearning process.

After decades of social conditioning, distraction, stimulation seeking, and striving to achieve, learning to be still through the practice of observing thoughts, emotions, and sensations without acting upon them takes a lot of patience and self-acceptance.

In fact, patience and acceptance are two of the seven pillars of mindfulness as outlined by MBSR founder, Jon Kabat-Zinn, PhD. The other mindfulness pillars are non-judging, trust, non-striving, beginner’s mind, and letting go.2

Embodying these seven pillars lead meditators to less reactive states and an increased sense of compassion and connection to themselves, others, and nature.

Mindfulness meditation takes practice and willingness. As healthcare practitioners increase the frequency of recommending mindfulness meditation to their clients, patients, and peers, it is important to address common myths that may arise about mindfulness meditation.

Myth #1: Mindfulness Meditation is a Form of Relaxation Mindfulness meditation is not a form of relaxation. Instead, mindfulness is the practice of waking up – learning to be fully alive and embracing the joy, sorrow, boredom, grief, and triumphs that life brings to every human being.

Relaxation is a sought after sense of relief. Mindfulness teaches to release the tight mental grasp that hopes for a specific outcome.

By constantly seeking relief and distraction from troubles, humans perpetuate suffering by not learning to be in compassionate relationship with what exists within and around us. If one learns to openly witness and accept negative symptoms and feelings, one has greater access to choice.

Turning away from discomfort may offer short-term relief but often leads to long-term dysfunction.

The stress reduction benefits of mindfulness meditation are not from relaxation. The benefits are from the freedom of the incessant identification of thought, feeling and sensation patterns that limit the openness of the heart.

Myth #2: Mindfulness Meditation Conflicts with Religious Beliefs One does not have to accept or deny any religion or creed to practice

mindfulness meditation.

It is true that the practice of mindfulness has roots in Buddhism, but it is commonplace for mindfulness meditation teachers and programs in the west to teach a secular approach.

Mindfulness meditation is safely available to people of any religion or no religion. My clients with religious faith often report mindfulness enhances their spiritual path by being able to slow down, pay attention, and live in harmony with their values.

The teachings of mindfulness welcome diversity and love. There is no request or need to adopt or change religious beliefs to practice mindfulness meditation.

Myth #3: Mindfulness Meditation Requires Thoughts to Stop Mindfulness meditation does not require one to stop thinking. One is not doing it right or wrong if one has less or more thoughts.

Instead of ceasing thought, mindfulness meditation asks the student to observe thoughts without judging them or labeling them as ‘good’ or ‘bad.’ It is this tendency to constantly label, attach to pleasure, and avert from pain that prevents humans from the experience of moment-tomoment presence.

Constantly seeking pleasure or avoiding pain limits one’s ability to connect with the present moment, and the present moment is where each of us experiences life. The present moment is the only time there is to embrace the opportunity to connect, choose, transform, or accept.

By learning to observe and be the neutral witness of one’s thought patterns, it increases the capacity for self-awareness and self-regulation.

With heightened awareness, there is a significant shift in the ability to choose - to respond thoughtfully in accordance with one’s values instead of on autopilot, and to connect with what is really happening in the present

moment in lieu of catastrophizing what may happen or ruminating over the past.

Myth #4: Mindfulness Meditation Takes Too Much Time Most people report being pressed for time. The last thing someone wants is another item to add to the to-do list, and approaching mindfulness as another task to check off this list is ill advised.

Mindfulness meditation does not have to take a lot of time. One can have a formal sitting or walking mindfulness meditation practice in as little as five minutes a day. The goal is to not achieve a certain length of time in meditation. The practice is to be comfortable without an end result, to be accepting in the space of not knowing, and to experience the presence of being.

Mindfulness teaches we are meant to be human beings, not human doings.

The experience of being trapped for time is an experience of constant doing. By taking both time and awareness to practice being present, my clients report a healthier relationship to time. The constant busyness fills a false sense of selfimportance and is a distraction to their core values.

One can take as much or as little time as desired to start a mindfulness practice; the peace is in the quality of the attention itself.  __________ 1 Scientific Papers from The Stress Reduction Clinic and The Center for Mindfulness in Medicine, Health Care, and Society. 2012-1982. (Editors Saki F. Santorelli, Ed.D., M.A. & Jon KabatZinn, Ph.D.) 2 Kabat-Zinn, Jon. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Pain, Stress, and Illness. New York: Bantam Dell.

WWW.MEDMONTHLY.COM |17

practice tips

Have You Considered Podcast Creation?

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

Podcast publication takes medical marketing to the next level.

After mastering article and newsletter publication along with blogging and social media, the next step is podcasting.

This tool complements your other marketing strategies and reaches a vast new market that you may not have reached for new patients and clients. What’s more, you don’t have to compete for attention as much as with other modalities yet.

According to Edison Research, almost 50% of Americans over the age of 12 (70 million) have listened to or watched a minimum of one podcast over the last year.

Benefits of Podcasts There are several benefits that podcasts offer for healthcare providers, which include:

• Strengthening Brand Recognition

The more places that people see your logo, message, voice, name or practice, the stronger your brand becomes.

Simply put, brand recognition is the level at which the public can identify a company by its features or intellectual property. When the general public can recall a brand simply by hearing or seeing associated 18 | MAY 2014

characters like logos, taglines, slogans, colors, voices and programs, then the brand increases strength and revenue.

By having podcast programs on a regular basis, your message is spread and you stay in the minds of your current contacts while attracting a new audience and new prospective patients.

• Increasing Online Traffic

Podcasts link to your website, increasing search engine ranking while simultaneously creating fresh material on your site. With discussed topics laden with your targeted keywords, you further improve the association of these keywords with you and enhance your search engine optimization (SEO).

• Enabling a modality for instruction

Podcasts provide a way that you can explain techniques, preoperative and postoperative instruction or new medical breakthroughs.

How to Create a Podcast Start by answering these questions:

• Objective

What is the goal of your podcast?

• Theme

What is the motif of your podcast? Will it be education? Does it reflect your practice? Will you be able to recycle it to your website?

• Regularity

How frequent will the podcast be aired? Make sure that you are consistent here. If a fan wants to hear the program through a live streaming mode, don’t disappoint this fan and essentially turn away interested individuals, unlikely to return.

• Format

What format you might distribute your podcast in?

This just depends on which theme you select and the technology you use.

• Hardware

If you don’t already have the necessary gear to begin a podcast, you either need to invest in the basic gear - a computer with Internet access, a microphone, and headphones - or invest in a computer that already contains these items. Keep in mind that these are the basic tools. If you want to include video, you’ll need the proper equipment for that as well.

Structure of an Effective Podcast Consider the “4 Ps”.

1) Plan

Planning out the podcast will help you focus on your goals, prevent babbling, and create a much better podcast that will attract more listeners.

Consider: • Topic • Format of the podcast • Length of each episode • Frequency that new shows will be released Select a topic that both reflect your medical practice and your passion. Write an outline that keeps you on track without losing focus during recording. The outline will also help listeners know what they expect to hear.

2) Production

Consider giving interviews. This is a great way to demonstrate your authority while having someone else do the talking, helping to relieve the pressure of being the sole content creator.

Engage your listeners. Have them call in and ask questions, which creates content, not only for the specific show, but also as a basis for a future show. This also lures listeners into tuning into a new show to hear a continuation of a program that was of interest to them.

3) Podcast Publication

• Find/Buy Web Hosting (this is to help store your blog and or site and your audio files onto the internet) • Start a Blog (this is your personal website for posting your show notes, links, and anything else) • Create an RSS Feed (this is the feed that your listeners will subscribe to so they can automatically download new episodes of your podcast straight to there mp3’s) If you can tie the podcast into your website, or linked to a tab on your website, it will promote additional traffic to you.

4) Podcast Promotion

The first step in promoting your podcast is the description itself. It should be clear and give an accurate representation of the contents.

The next step is to get it out there; there are tons of sites that list podcasts. There are podcast directories, forums that discuss podcasts and then there are the search engines also.

The last step is growth management. This is where you will have an ever increasing number of listeners and may even attain cult status for your podcast.

If you need help with your podcast creation or would like to kick around a few ideas, contact me for a free consultation at Barbara@TheWriteTreatment.com.

I would be happy to help you get started. 

The Write Treatment

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

To publish your podcast to the Internet: • Register a Web Address (this is also called a domain name) WWW.MEDMONTHLY.COM |19

practice tips

Challenging Patients or Challenging Times?

Exploring the Changing Nature of Doctor/ Patient Encounters

By Liz Ferron, MSW, LICSW Physician Wellness Services

20 | MAY 2014

There are certain types of patients few physicians look forward to seeing, most commonly: • Patients who demand a laundry list of tests they’ve read about on the Internet • Uncooperative patients who won’t follow treatment plans and complain about the outcome • Patients who seem aggressive, angry or hostile • Patients whose issues are complicated by aging or lifestyle • Patients who appear to be drug seeking or exploiting the healthcare system Studies over the past two decades have consistently shown that clinicians experience up to 15% of patient encounters as “difficult.”1,2 In a 2011 study of 750 walk-in patients at a primary care clinic, 17.8% were perceived as difficult, but the level of physician experience played a key role in how encounters were perceived: • Physicians with more than 20 years of experience reported just 2% of their encounters as difficult.

• Clinicians with less than 10 years of practice described 23% of their encounters with patients as difficult.3 Younger physicians may not have the insight that: • A patient who seems challenging or suspicious may actually be frightened.

• A patient who repeatedly misses appointments for tests may be avoiding facing reality.

• A patient’s attitudes may have nothing to do with the physician at all.

• Their own communication skills aren’t as good as they think they are.

Experienced doctors have an advantage, up to a point.

They’ve encountered difficult patients in the past and have developed methods for coping. The problem is when workloads increase or other stresses come into play, physicians may not employ those skills as successfully--and as a result patients may seem more difficult than they have in the past.

Patient issues are clearly a stressor for many physicians.

In the physician surveys that Physician Wellness Services has done over the past couple of years on stress and burnout, culture and physician engagement, difficult patients—and difficulty with patients—comes up repeatedly. Yet, most physicians highlight the fulfillment they experience from their patient encounters, validating why they went into medicine in the first place.

However, patients who are demanding, ungrateful, drug seeking or non-compliant, or exhibit other negative behaviors, undermine the satisfaction physicians get from their work. Complicating this, there is no clear roadmap on how to deal with these issues and, given their nature, there is often little the organization can do to help, other than empathize.

IS IT THE PATIENT—OR THE PRACTICE? In many cases it is not the patient who is difficult, it’s the practice environment that’s difficult. When physicians are given only a few minutes to determine what is wrong with a patient, they might start feeling more like they are working in a factory than practicing medicine.

Doctors who are satisfied with their working conditions tend to be more satisfied with their patient interactions.

Negativity about working conditions often translates into negativity about the patients themselves. Mathers et al found that 60% of the variance in the number of difficult patients that general practitioners reported could be accounted for by four variables: • Greater perceived workload • Lower job satisfaction • Lack of training in counseling and/or communication skills • Lack of appropriate postgraduate qualifications Lawsuits can also play a role in negative doctor/patient relationships. A physician who fears making a mistake may be nervous when dealing with a similar patient or diagnosis. If patients pick up on that hesitancy, they may begin questioning the doctor’s experience or competency. It can very easily become a vicious circle.

TIPS FOR IMPROVING PHYSICIAN/PATIENT ENCOUNTERS Here are a few methods physicians should considering using with all patients regardless of their perceived difficulty ratings: Listen actively: Take time to listen to what the patient has to say. (It may seem counterintuitive that taking a little extra time on the front end may end up being a time saver in the long run.) Rephrase whatever the patient tells you to convey that you heard and understood what was said.

Confirm understanding: Ask the patient to repeat what you said. You may be amazed at how much of what you say is unheard or misinterpreted. Invite your patients to call if they have more questions or concerns about what’s being recommended.

Test impressions: Is this patient difficult with everyone or just you? Can a colleague or referring physician give you any insights that may help?

Encourage note taking: Invite your patient to take notes if they seem to be highly emotional or having trouble grasping what is being discussed.

Welcome support: Overly anxious patients may appreciate having a family member invited into the exam room. continued on page 22 WWW.MEDMONTHLY.COM | 21

practice tips continued from page 21

Resist resentment: You may resent having your authority questioned or a patient judging your knowledge or credibility, but you can choose not to let it get under your skin. Those irritating questions may be related to a patient’s fear and desire to maintain control over something that is feeling uncontrollable. Avoid arguments at all costs.

Detach emotionally: You can’t solve every problem or cure every disease—and the fact that patients seem to expect that from you doesn’t make it reasonable.

Document thoroughly: Documentation is always important, but particularly so after a challenging encounter

WHEN CHALLENGING PATIENTS START CHALLENGING YOU A generalized and growing dislike of patients should be a red flag. The satisfaction of helping people is what attracted many physicians to medicine, so if all the joy has gone out of your practice, that’s not good for you or your patients.

Additional red flags may include: • Poor patient satisfaction surveys • Finding yourself disliking your work • Being irritated with patients • Increased non-compliance from patients • Having difficulty setting boundaries or limits on your own time or unreasonable requests • Feeling like you’re working harder to help patients than they themselves are working • Being overly afraid of making a mistake Before you find yourself taking early retirement or embarking on a second career, consider taking steps to improve the way you interact with patients. An experienced physician peer coach can help you sort through the difficulties you’re encountering today and help you figure out what, if any, changes are needed in your workload, work attitudes or communication skills.

Speaking with trusted colleagues can also be helpful in providing feedback on your approach and suggestions on how to deal with problematic patients.

DIFFICULT ENCOUNTERS OF A DIFFERENT KIND: CASE STUDIES Scenario: A patient was referred by his physician to a neurologist’s office and presented with an iPad full of research, insisting the referring doctor had recommended the wrong test, and demanding an explanation of the rationale for and the cost of the exam he was about to undergo.

22 | MAY 2014

While it was tempting to ignore the patient’s concerns and try to hurry him through the procedure, there were many risks involved with this course of action. There was concern that the patient might leave without having the procedure done—or have the procedure done and complain about it to the referring physician, or give the referring physician and the neurologist poor online ratings, or spread negative comments about them to friends, family and in the community.

Recommendation: The neurologist took a few extra minutes to listen to the patient’s concerns. During the course of this discussion a valid indication for the exam that the patient was about to have came to light.

The neurologist then reassured the patient about the appropriateness of the test and the need for that particular study to be done. He was also able to decipher what the patient’s additional concerns were—for instance, what was involved with the procedure, when the results could be expected and what the cost of the procedure would be. By answering a few simple questions, it placed the patient in a different, more pleasant frame of mind.

Scenario: A gynecologist with degrees from impressive universities and many years of experience couldn’t understand why the patients referred to her at a practice she’d recently joined didn’t seem to have the same trust in her diagnoses as patients at previous practices. The physician began to worry that she was losing her edge or had joined the wrong practice. Her self-doubt seemed to beget patient doubt and she found herself wondering if she should even take time to finish unpacking her boxes.

Recommendation: When exploring the differences between her old and new practice—down to variables such as location and décor—she came to realize she hadn’t taken time to hang her diplomas on the wall. She took a recommendation to hang them above and behind her desk.

Once they were up, she noticed patients who came in to her office for consultations initially looking over her head.

Immediately after that she could see significant shifts in patients’ attitudes. She hadn’t realized the role her framed credentials had played in building trust.  Steinmetz D and Tabenkin H. The ‘difficult patient’ as perceived by family physicians. Family Practice 2001; 18: 495-500.

2 Mathers N, Jones N, Hannay D. Heartsink patients: a study of their general practitioners. Br J Gen Pract. 1995; 45:293296.

3 Sherri A. Hinchey, MD MPH and Jeffrey L. Jackson, MD MPH, A Cohort Study Assessing Difficult Patient Encounters in a Walk-In Primary Care Clinic, Predictors and Outcomes, J Gen Internal Medicine 2011; June 26 (6) 588-594 1

practice tips

Website Blogging:

An Affordable and Effective Way to Boost Google Rankings and Patient Traffic

By Amanda Kanaan President, WhiteCoat Designs

When I mention the word “blog” to most medical practices, I see practice managers and physicians alike begin to cringe. Don’t worry, blogging doesn’t mean taking an hour out of your day to share life lessons. Instead, I’m referring to writing short patient education articles and announcements on practice news and events. Sounds reasonable right? Below is a guide to blogging and why it’s so important.

Do I really need to blog?

Yes, if you want to attract more new patients online; 80% of internet users search online for health information and 44% of those are looking for treatment and/or a provider. If your practice doesn’t have a great website that is easily found online then you 24 | MAY 2014

are missing out on patients. Blogs are a very effective Search Engine Optimization (SEO) tactic since they add relevant content to your site and keep it fresh with new information.

the topic of your website rather than write a poor, short article stuffed with keywords.

How many words do the blog articles have to be?

In a perfect world, we would all blog a couple times a week but that’s just not feasible for most small businesses, especially medical practices. Most practices realistically aim for one blog a week or one blog a month at minimum. Any less frequent than one blog a month and your efforts will be futile.

Google does not give a black and white answer to this one, however most SEO agencies will tell you to shoot for around 400-600 words (there’s been more recent arguments for longer articles if the topic warrants it). Google has made a shift over the last couple years away from stand-alone keywords and towards quality content. That means it’s more important that you write a quality article about something relevant to

How often should we be blog?

What should I write about?

You want to try and strike a balance between relevant practice news/information and good quality

educational content (one serves Google’s purposes and the other serves patients’ needs). Sure, every once in a while you’ll need to just write a short announcement about how your hours have changed or an event you’re hosting but it’s good to mix that in with longer, keyword-rich articles. If you have the luxury of an SEO agency who can perform keyword research for you then you know exactly what keywords to write about. Let’s say one of those keywords is “robotic surgery”.

Knowing that is a popular search term, it would behoove you to write various blog articles about robotic surgery to help Google understand that your website is a relevant source of information for this topic.

specific keywords for SEO purposes.

Attempt to use the keyword in the title of your blog as well as at least 3-4 times in the body of the article. You certainly don’t want to keyword stuff but you do want to help Google understand what the blog is about.

If you do have Wordpress (by the way, your current site can be converted to Wordpress if not), then there’s a free plugin you can download called Wordpress SEO by Yoast. The plugin forces you to select a focus keyword for your blog article and then essentially tells you exactly where to use the keyword throughout the article to optimize it for SEO. It’s basically a super easy, DIY way to optimize your own blogs for SEO.

How do I optimize the blog for SEO purposes?

Can I recycle content from other websites or medical societies?

First of all, you want to make sure that your blog is a part of your practice’s website and on the same domain. If your practice’s website is www.mypractice.com but your blog is located somewhere else (such as www.myblog.com) then Google will recognize these as two separate domain names and you will not get the SEO benefit you are looking for. You’ve probably noticed that many practice websites have a “News & Education” section on their homepage (here’s an example: www.cornerstonepediatrics. org – see the “What’s New” section in the middle of the homepage). This is how most practices present their blog on their website (rather than calling it “blog”).

Hopefully your website is built on some sort of Content Management System (CMS) such as Wordpress; Wordpress is one of the best if not the best CMS for SEO purposes. This allows you to easily login to your website and add content/blogs as you please. If not then you’ll need to have your IT person or web host (whoever manages your website) add these blog articles for you. As we discussed in the previous question, ideally you’ll want to focus your educational blogs on

No. Google’s goal is to fill the internet with unique, quality content.

Therefore, recycling old content that already exists on the web will not get you the credibility you need to rank well in Google.

How do I get the most exposure for my blog?

If you participate in social media then the first step is to share a link to your blog on your social media channels. This will not only increase exposure for your blog but the link back to your website is good for SEO. You can also include social media share buttons on the blog itself so

patients can easily share the blog on their social channels if they like.

If you don’t participate in social media, then other ideas include adding a link to your blogs in your practice e-newsletter or asking other websites to share the blog (medical societies, etc.)

What if I don’t have time to write blogs?

One idea to share the demands of blog writing is to ask each provider in your group to write a blog; many times providers have articles on hand they’ve already written anyway that just needed to be edited for patient purposes. If you have several providers in your group then that significantly cuts down on writing responsibilities.

If your practice has no desire to write blogs I would consider hiring a freelance medical writer (one that has experience in SEO if possible so they can optimize the blogs for you). There are plenty of affordable freelance writers out there that charge anywhere from $50-$200 a blog depending on how long the article is. They will usually give you a quantity discount as well if you commit to ongoing articles.

Website blogging is an affordable and effective SEO tactic to boost your rankings in Google and is also a great way to maintain ongoing communications with patients.

Whether you do it yourself or hire a medical writer, I would highly suggest blogging to any medical practice that wants to increase their online footprint and attract more new patients online. 

Amanda Kanaan is the owner/founder of WhiteCoat Designs – an online marketing agency committed to growing doctors’ practices through cost-effective and powerful online marketing solutions. Amanda regularly speaks at medical association meetings and conventions and is a published expert in the field of medical marketing.

To learn more or for a free website evaluation, contact her at Amanda@whitecoat-designs.com or http://www.whitecoatdesigns.com.

WWW.MEDMONTHLY.COM | 25

international

Twenty Years After Genocide, Life Expectancy Doubles in Rwanda

The 1994 genocide in Rwanda resulted in the deaths of up to one million people and the displacement of millions more. In the years that followed, Rwanda was the poorest country in the world, with the highest child mortality and lowest life expectancy at birth anywhere. Less than one in four children were fully vaccinated. Many health workers had either been killed or fled the country, and health facilities across the country had been destroyed.

Twenty years later, Rwanda is likely to be the first country in Africa to achieve the Millennium Development Goals for health set by the United Nations. Child mortality has fallen by more than two thirds since 2000, and vaccination rates for many diseases are now higher than those registered in the United States.

On Friday, April 4, ahead of the International Day of Reflection on the Genocide in Rwanda, The Lancet publishes a peer-reviewed study on Rwanda’s progress in dramatically improving health outcomes between 1994 and 2014. Dr. Agnes Binagwaho, Rwanda’s Minister of Health, and Dr. Paul Farmer, co-founder of Partners In Health 26 | MAY 2014

and a professor at Harvard Medical School—along with an international team of public health experts—present data from the World Health Organization, the United Nations, the World Bank to show that life expectancy has doubled since 1995.

“In the last decade, death rates from AIDS and tuberculosis have dropped more steeply in Rwanda than just about anywhere, ever. There are important lessons to be learned,” said Dr. Farmer. “In the 30 years that I’ve been involved in the provision of health care services to the poor and marginalized, I can think of no more dramatic example of a turnaround than that achieved in Rwanda.”

In an editorial accompanying the new article, the editors of The Lancet write, “Two decades ago, Rwanda lay in ruins. The scars of the massacre seemed too deep to heal for some observers at the time. But, in what has been described as the Rwanda miracle, the country turned its situation around.”  Source: http://www.pressreleasepoint.com/twenty-yearsafter-genocide-life-expectancy-doubles-rwanda

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research & technology

Sepsis Study Comparing Three Treatment Methods Shows Same Survival Rate

NIH-funded clinical trial tested specific protocols against usual high-level care

28 | MAY 2014

Survival of patients with septic shock was the same regardless of whether they received treatment based on specific protocols or the usual high-level standard of care, according to a five-year clinical study. The large-scale randomized trial, named ProCESS for Protocolized Care for Early Septic Shock, was done in 31 academic hospital emergency departments across the country and was funded by the National Institute of General Medical Sciences (NIGMS), a component of the National Institutes of Health.

A five-year, randomized clinical trial indicated that survival of patients with septic shock was the same regardless of whether they received treatment based on specific protocols or the usual high-level standard of care.

Sepsis affects more than 800,000 Americans annually and is the most expensive condition treated in U.S. hospitals.

The results of the trial, led by Derek C. Angus, M.D., M.P.H., and Donald M. Yealy, M.D., of the University of Pittsburgh, appear online on March 18, 2014, in The New England Journal of Medicine.

“ProCESS set out to determine whether a specific protocol would increase the survival rates of people with septic shock. What it showed is that regardless of the method used, patient survival was essentially the same in all three treatment groups, indicating that sepsis patients in these clinical settings were receiving effective care,” said Sarah Dunsmore, Ph.D., who managed the ProCESS trial for NIGMS. Sepsis is a body-wide inflammation, usually triggered by an infection. It can lead to a dangerous drop in blood pressure, called septic shock, that starves tissues of oxygen and chokes out major organs: lungs, kidneys, liver, intestines, heart. It remains frustratingly hard to identify, predict, diagnose and treat.

According to the Centers for Disease Control and Prevention, sepsis affects more than 800,000 Americans annually and is the ninth leading cause of disease-related deaths. The Agency for Healthcare Research and Quality lists sepsis as the most expensive condition treated in U.S. hospitals, costing more than $20 billion in 2011.

The ProCESS trial set out to test three approaches to sepsis care. It enrolled 1,341 patients randomly divided into these groups:

Group 1: Early Goal-Directed Therapy Doctors inserted a central venous catheter—a long, thin tube placed close to a patient’s heart—to continuously monitor blood pressure and blood oxygen levels. For the first six hours of care, doctors kept these levels within tightly specified ranges using intravenous fluids, cardiovascular drugs and blood transfusions. This protocol was based on a 2001 study in an urban emergency department that noted a striking increase in sepsis survival using this approach.

Group 2: Protocolized Standard Care This alternative tested a less invasive protocol that did not require central venous catheter insertion. Doctors used standard bedside measures like blood pressure (taken using an arm cuff), heart rate and clinical judgment to evaluate patient status and guide treatment decisions. Doctors kept patient blood pressure and fluid levels within specified ranges for the first six hours of care.

Group 3: Standard Care Patients received the same high level of care they would typically get in an academic hospital emergency department. Their doctors did not follow specific guidelines or protocols associated with the study.

After using an array of statistical analysis tools, the ProCESS investigators concluded that the three treatment arms produced results that were essentially indistinguishable for a range of patient outcomes. These outcomes included survival at 60 days, 90 days and one year; heart and lung function; length of hospital stay; and a standardized measurement of health status at discharge.

“ProCESS helps resolve a long-standing clinical debate about how best to manage sepsis patients, particularly during the critical first few hours of treatment,” said Yealy.

“The good news from this study is that, as long as sepsis is recognized promptly and patients are adequately treated with fluid and antibiotics, there is not a mandated need for more invasive care in all patients,” added Angus.

In addition to clarifying sepsis treatment options, ProCESS was a milestone for NIGMS. “ProCESS was the first large-scale clinical trial to be supported by NIGMS, which primarily funds basic, non-disease-targeted research,” said Dunsmore. “We hope that ProCESS and other NIGMS- and NIH-funded sepsis research efforts will help improve treatment, speed recovery and increase survival rates for sepsis patients.”

Research reported in this release was supported by the National Institute of General Medical Sciences of the National Institutes of Health under grant number P50 GM076659. For more information about clinical trial NCT00510835, visit clinicaltrials.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/mar2014/ nigms-18.htm WWW.MEDMONTHLY.COM | 29

research & technology

Polaris Awarded $1.1 Million NIDA Grant to Improve Patient Engagement in Treatment for Addiction

Substance abuse has long been one of the greatest challenges facing health care systems. More patients drop out of treatment than complete it. And those who dropout are at greater risk of relapsing caught in a cycle with steep human and monetary costs.

With a $1.1 million, two year grant from the National Institute on Drug Abuse, Polaris Health Directions will launch in April the second phase of a project set to dramatically impact addictions outcomes.

Polaris will implement a cloudbased clinical system designed to predict and improve the likelihood of patient engagement in 12 addictions treatment programs of a 30 | MAY 2014

large behavioral health system. The evidence-based, patient engagement predictive model is the first ever developed for clinical use.

The Polaris Engagement Enhancement for Chemical Dependency System, EECD for short, is an advanced version of Polaris CD, Polaris’s outcomes management system for substance abuse treatment and a leading example of translating research into practice. It is a data-driven solution to help clinicians develop treatment plans that directly reflect the needs patients have reported, determine whether the current course of treatment is effective and red flag those patients who are likely to

dropout or relapse.

EECD extends the innovations of Polaris CD. The predictive model helps clinicians identify early those patients who are unlikely to engage in treatment. Additional enhancements include a motivational, personalized patient feedback report and a clinical report that provides guidance for Motivational Interviewing, a method known to be effective for improving engagement.

“The importance of patient engagement during substance abuse treatment cannot be overstated,” said Grant Grissom, Ph.D., president of Polaris. “Equipping clinicians with a validated tool that allows for earlier

treatment within six months.

“We are very excited to start phase two of the EECD project,” said Tony Comerford, Ph.D., president and CEO of New Hope, and a consultant for phase two. “The potential for the instrument looks extremely promising.

During phase one, we saw no-show rates for treatment drop 14 percent from the previous year, and counselors found the reports helpful to their work.”

Experts on motivational enhancement therapy from Yale University continue their support and consulting services for this highly significant project.

The project described was supported by Award Number 2R44DA032180-02 from the National Institute on Drug Abuse. The content is solely the responsibility of Polaris Health Directions and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. 

identification of at-risk patients and an evidence-based method for motivating them will improve engagement.

Better engagement will mean better outcomes, including reduced relapse rates and the human and economic costs associated with it.”

The new components were successfully developed with data from the New Hope Foundation, one of New Jersey’s largest addiction treatment centers. A prototype was field tested at New Hope during phase one.

In phase two, data from about 10,000 patients will be used to study the effectiveness of EECD for improving engagement and lowering the rate of patients re-entering

About Polaris Health Directions: Polaris Health Directions (polarishealth. com) has been a pioneer in the development of behavioral health outcomes management solutions for nearly two decades. Using innovative technology, Polaris’s cloud-based systems capture the information essential for determining the best course of care. Their advanced analytics help organizations execute quality improvement initiatives, identify cost reduction opportunities and, in many cases, indicate whether a particular course of treatment is likely to have a positive result. Systems are available for a wide range of health care settings; all support interdisciplinary coordination.

By recognizing the nexus between psychosocial health and physical health, Polaris offers powerful solutions for better health care delivery.

Source: http://www.newswiretoday. com/news/141377/

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research & technology

Angel Creative Solutions Creates

Diabegram,

the First-ever Diabetes Awareness Meal Photo-Sharing App

A

ngel Creative Solutions for Healthcare Innovative Company announced the creation of Diabegram, the first-ever diabetes awareness meal photo-sharing app. The company realized the need to come up with a fast and effective way of raising awareness about diabetes after reviewing alarming statistics from International Diabetes Federation. The IDF predicted that by 2035, the number of diabetes patients would increase to 592 million. The company decided that creating an app that utilized the ‘photo-sharing’ power of social media would be the fastest way of raising awareness about diabetes.

“There are millions of people worldwide who upload and share photos on social networking sites. We thought the idea of sharing meal photos on social networking sites using Diabegram would be a fast and effective way of raising awareness about diabetes. Using Diabegram app, users can take meal photos, add text and diabetes awareness digital ribbons, and share photos on social networking sites. The more people upload and share diabetes awareness meal photos, the more they will become aware about diabetes and its connection to nutrition. This will in the long run make people revaluate their daily food choices” Stated Esther Kinuthia,CEO/Founder of Angel Creative Solutions for Healthcare.

32 | MAY 2014

Diabetics can now use Diabegram to send their doctors daily or weekly meal photos for diabetes management.

Nutritionists and other Healthcare professional can also use Diabegram to review their patients’ daily or weekly meal photos for more accurate diet monitoring. Diabegram will also enable diabetics to sign up for the Diabegram Telehealth Program, where they can connect with healthcare professionals anytime from their mobile devices.

Angel Creative Solutions for Healthcare goal is to make Diabegram available to over 371 million diabetes patients around the world. The company plans to achieve this goal by partnering with diabetes and mobile health companies.  About Angel Creative Solutions for Healthcare: “Angel Creative Solutions for Healthcare is an innovative company based in Springfield, Massachusetts. We research, design and create brilliant product concepts which can be developed into marketable products. Our product concepts enable companies to significantly increase their revenue.

For more information, visit us online at http://www. acsforhealthcare.com”.

Source: http://www.pressreleasepoint.com/angel-creativesolutions-creates-diabegram-first-ever-diabetes-awarenessmeal-photo-sharing-app

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legal

Guidance on Mental Health & the HIPAA Privacy Rule - Health Insurance Portability and Accountability Act

By Christopher J. Shaughnessy McBrayer, McGinnis, Leslie and Kirkland, PLLC The U.S. Department of Health and Human Services recently issued guidance entitled, “HIPAA Privacy Rule and Sharing Information Related to Mental Health.” As the title implies, it offers information as to when it may be permissible under HIPAA for health care providers to share information related to a patient’s mental health, including instances when the patient may be a minor. The direction, issued in the form of Q&As, comes as HHS seeks to strike a balance between a patient’s privacy rights in mental health records and public safety concerns. The clarifications could not come at a better time, as the health care industry prepares for an influx of patients who now have insurance that includes mental health coverage. Below are some of the highlights from the guidance: 34 | MAY 2014

Family & Friends A mental health provider may communicate with, and disclose a patient’s PHI (including mental health information) to family and friends (or others involved with the health care or payment for services) when the patient is present and has the capacity to make health care decisions, so long as the patient does not object.

When the patient is not present or is incapacitated, the mental health provider may disclose relevant information so long as the provider determines, based on his or her professional judgment, that doing so is in the best interests of the patient. Lack of consciousness is the most common form of incapacity, but it can take other forms.

For instance, when a health care provider knows that a patient with a serious mental illness has stopped taking a prescribed medication, the provider can share that information with a family member, if doing so would be in the patient’s best interest. Providers should take into account any prior expressed preferences of the patient regarding the disclosure of his or her information.

In instances when the patient has capacity and objects to the sharing of information, the provider may share the information only if doing so is consistent with applicable law and standards of ethical conduct, and the provider has a good faith belief that the patient poses a threat to the health or safety of others, and the person to whom the information is disclosed is reasonably able to prevent or lessen the threat.

The Privacy Rule does not prevent providers from listening to concerns raised by family or friends about the health of the patient. These concerns can be withheld from the patient if the disclosure of such information would be reasonably likely to reveal the identity of the concerned individual.

Psychotherapy Notes These notes, defined as notes kept separate from the rest of the patient’s medical record that document or analyze

conversations held during certain types of counseling sessions, are afforded extra protection under the Privacy Rule. With a few limited exceptions, a specific, separate authorization is required before a mental health provider may use or disclose them, and a mental health provider is not required to disclose such notes to the patient under the individual’s Privacy Rule right of access. Two notable exceptions exist for the disclosure of these records: mandatory “duty to warn” situations or when a threat of serious and imminent harm to the health or safety of the patient or others is present.

Law Enforcement Certain PHI, including date and time of admission and discharge, may be disclosed in response to a law enforcement official’s request, for the purpose of location or identifying a suspect, fugitive, missing person or material witness. Information such as name and address and distinguishing physical characteristics (among other things) may be released, but some information (such as dental records or samples of bodily fluids) cannot be released.  http://www.natlawreview.com/article/guidance-mentalhealth-hipaa-privacy-rule-health-insurance-portabilityand-accountab

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medlisting@gmail.com medicalpracticelistings.com WWW.MEDMONTHLY.COM | 35

legal

WATCH YOUR MAIL! New Enrollment and Re-Validation Requirements for Providers/Suppliers for Participation in Medicare and Medicaid

By Lisa English Hinkle McBrayer, McGinnis, Leslie and Kirkland, PLLC Even though the Centers for Medicare and Medicaid Services (“CMS”) published final regulations to implement provisions to the Affordable Care Act (“ACA”) on February 2, 2011, it is likely that many Kentucky health care providers, including physicians, are not aware of the importance of the new requirements for revalidation of Medicare and Medicaid enrollment or the new and more burdensome requirements for initial enrollment.

The requirements are aimed at strengthening provider and supplier screening procedures to reduce fraud, waste, and abuse in federal health care programs. Because CMS contractors and KY Medicaid have been slow to comply with these new requirements, it is likely that many providers have 36 | MAY 2014

not noticed the enrollment/screening changes unless they have been asked to revalidate or have applied for new or additional provider/supplier numbers.

The requirements for revalidation, however, apply to all physicians and other providers/suppliers who were enrolled before March 25, 2011, which means that all physicians and physician groups must complete the re-enrollment process. Completing the revalidation of enrollment process is very important and a failure to do so means that CMS will deactivate payment until a successful re-enrollment process is completed.

In some cases, CMS may even revoke participation. Having a validated enrollment and provider/supplier number is also important for ordering

and referring items and services for patients as CMS rolls outs new payment requirements. At best, failing to comply with the requirements for re-validation will create cash flow problems; at worst, failing to comply will mean no reimbursement and revocation. And to make matters worse, the OIG just announced in its 2014 Work Plan that it will monitor the States’ progress toward rescreening and revalidating Medicaid providers.

Different Requirements for Different Types of Providers The ACA requires that the Secretary of HHS categorize providers and suppliers by perceived level of risk of fraud, waste, and abuse for each and

devise screening requirements for enrollment and revalidation for each category. Providers and suppliers are designated as “limited risk,” “moderate risk,” or “high risk.” The level of risk assigned to a provider determines the type and level of screening procedures that the Medicare enrollment contractor must use when processing the provider’s enrollment application.

“Limited Risk” includes physician or non-physician practitioners and medical groups or clinics except physical therapy providers, ambulatory surgical centers, federally qualified health centers, histocompatibility laboratories, hospitals (including critical access hospitals), mammography screening centers, pharmacies newly enrolling or revalidating, radiation therapy centers, religious non-medical health care institutions, rural health clinics, and skilled nursing facilities.

“Moderate Risk” includes ambulance suppliers, community mental health centers, comprehensive outpatient rehabilitation facilities, hospice organizations, independent diagnostic testing facilities, independent clinical laboratories, physical therapy including physical therapy groups, portable x-ray suppliers, and currently-enrolled home health agencies.

“High Risk” includes new home health agencies and newly-enrolling suppliers of durable medical equipment.

CMS may adjust an individual provider/supplier’s screening level from limited-risk or moderate-risk category to high-risk when: • A payment suspension on a provider/supplier has been issued at any time in the last ten years.

• The provider/supplier has been excluded from Medicare by the OIG. • The provider/supplier has had billing privileges revoked by a Medicare contractor within the previous ten years and is attempting to establish additional Medicare billing privileges by

enrolling as a new provider/ supplier or establishing a new practice location.

• The provider/supplier has been terminated from billing Medicaid.

• The provider/supplier has been excluded from any Federal healthcare program.

• The provider/supplier has been subject to any adverse action within the previous ten years.

Providers and suppliers categorized as “limited risk” have not noticed a significant change in the enrollment process with the exception of new 855 forms and filing requirements.

Specifically, “limited risk” providers and suppliers are subject to the following screening techniques during the Medicare enrollment process: • Verification that the provider/ supplier meets all applicable Federal regulations and State requirements for the provider/ supplier type.

• Licensure verifications, including licensure verifications across State lines for physicians or non-physician practitioners and providers/suppliers that obtain or maintain Medicare billing privileges as a result of State licensure.

• Database checks on pre- and postenrollment basis to ensure that providers and suppliers continue to meet the enrollment criteria for their provider/supplier type.

Medicare contractors are required to conduct the following screening procedures when Medicare enrollment applications are submitted by “limited risk” providers and suppliers: • Verification of any provider/ supplier-specific requirements established by Medicare.

• License verifications.

• Database check (e.g., to verify Social Security Number; the National Provider Identifier; the National Practitioner Data Bank licensure; an OIG exclusion; tax payer identification number; tax delinquency; death of individual

practitioner, owner, authorized official, delegated official, or supervising physician).

For providers and suppliers categorized as “moderate risk,” Medicare contractors are required to conduct unannounced preenrollment site visits in addition to performing the enrollment screening procedures applicable to the “limited risk” providers and suppliers. During the on-site pre-enrollment visits, the Medicare contractor determines whether the provider/supplier meets all Medicare enrollment requirements and is able to furnish the Medicarecovered items or services.

In addition to the enrollment screening tools applicable to the “limited risk” and “moderate risk” providers/suppliers, “high risk” providers/suppliers will eventually face fingerprinting and criminal background checks as a part of the Medicare enrollment process. All individuals who maintain a 5 percent or greater direct or indirect ownership interest in the provider or supplier are subject to the criminal record background checks and fingerprinting requirements. Although the majority of the enrollment screening rules promulgated under the ACA went into effect March 25, 2011, CMS continues to delay the effective date for the fingerprint-based criminal history background checks for high risk providers. This provision of the ACA will not take effect until 60 days following the publication of sub-regulatory guidance. The subregulatory guidance is expected to describe the process by which Medicare contractors will collect the required fingerprints from providers/ suppliers. To date, CMS has yet to publish the sub-regulatory guidance implementing the fingerprinting procedures.  Source: http://www.natlawreview. com/article/new-enrollmentand-re-validation-requirementsproviderssuppliers-participation-medic WWW.MEDMONTHLY.COM |37

legal

Sweeping Changes to Medicare Payment for Clinical Laboratory Services

By Paul Radensky, MD1,2, John Warren2, and Eric Zimmerman1,2 1 McDermott Will & Emery 2 McDermott+Consulting

On March 31, 2014, the Senate gave final approval to the Protecting Access to Medicare Act of 2014 (the Act), which includes significant reforms to the way Medicare pays for clinical diagnostic laboratory services. The House approved the Act on March 27, and the president is expected to sign the legislation.

Under the Protecting Access to Medicare Act of 2014 (the Act), Congress adopted a substantially different pathway for setting payments under the Medicare Clinical Laboratory Fee Schedule (CLFS). These reforms are intended to modernize the CLFS by moving away from a payment system based upon historical charge data that are now nearly 30 years old and moving to a market-based 38 | MAY 2014

payment system intended to provide accurate, transparent and timely rate-setting determinations for clinical laboratory services. Congress also adopted certain coding and coverage reforms alongside the payment reforms.

Market-Based Rate Setting Under the Act, laboratories that receive the majority of their Medicare revenues from payments made under the CLFS or the Physician Fee Schedule would report, beginning January 1, 2016, and then on an every three year basis thereafter (or annually for advanced diagnostic laboratory tests), private payor payment rates and volumes

for their tests. Private payors include health plans, Medicare Advantage plans and Medicaid managed care organizations.

The Centers for Medicare and Medicaid Services (CMS) will used the rates and volumes reported by laboratories to develop Medicare payment rates for the tests equal to the volume-weighted median of the private payor payment rates for the tests. The payment rates calculated under the Act will be effective starting January 1, 2017.

Any reductions to payment rates resulting from the new methodology are limited to 10 percent per test per year in each of the years 2017 through 2019 and to 15 percent per test per year in each of 2020 through 2022.

The Act eliminates CMS’ controversial new rule under which CMS planned to reassess rates for individual clinical laboratory tests paid under the CLFS considering “technology changes.”

Congress also increased the test collection fee from $3 to $5 for samples collected from individuals in a skilled nursing facility or by laboratories on behalf of a home health agency.

Advanced Diagnostic Lab Tests Congress adopted a somewhat different pathway for certain tests developed and performed by single laboratories—tests referred to as “advanced diagnostic laboratory tests.” For these tests, laboratories are required to report private payor rates on an annual basis, beginning in January 2016, and payment rates based upon such reports will begin in January 2017. The initial payment rate (for a period not to exceed nine months) for an advanced diagnostic laboratory test will be set at the “actual list charge” for the test as reported by the laboratory. Insofar as the actual list charge substantially exceeds private payor rates, when reported, CMS will have the ability to recoup payments in excess of 130 percent of the weighted median of reported private payor rates that were made during the initial nine-month payment period. Laboratories offering advanced diagnostic laboratory tests will need to pay careful attention to CMS rules and procedures for reporting the actual list charge to reduce the risk of recoupment.

The Act defines an “advanced diagnostic laboratory test” as a test “offered and furnished only by a single laboratory and not sold for use by a laboratory other than the original developing laboratory (or a successor owner)” and which is either (a) “an analysis of multiple biomarkers of DNA, RNA, or proteins combined with a unique algorithm to yield a single patient-specific result” or (b) a test that “is cleared or approved by the Food and Drug Administration.” CMS may expand the scope of advanced diagnostic laboratory tests to include other, similar single laboratory tests.

Expert Advisory Panel and New Test Rate Setting In order to ensure that payment and coverage decisions are made in a transparent and reliable fashion, the Act requires CMS to convene a Federal Advisory Committee Act-compliant panel of outside advisors, including clinicians and other technical experts. The panel will review and provide input to CMS on payment rates and coverage issues. While non-specific about the size and specific members of the panel, it is intended to encompass individuals with appropriate expertise in molecular pathology, research, laboratory sciences and health economics. The panel shall be established no later than July 1, 2015.

It is unclear how often the panel will meet or precisely how its input will factor into CMS’ ultimate decision making; however, it is clear that Congress intends for the panel’s input to contribute significantly to CMS’s coverage and rate-setting decisions. The panel should help address criticisms that CMS’ existing rate-setting process is not sufficiently transparent and that decision makers do not necessarily have the broad range of expertise important in making decisions about coverage and payment for modern laboratory testing.

The panel does not replace the current annual public meeting where CMS accepts recommendations from stakeholders as to whether rates for new tests should be assigned through gapfill or crosswalk. The Act specifies that for tests that are not advanced diagnostic laboratory tests, where a new or substantially revised Healthcare Common Procedure Coding System (HCPCS) code is established after the date of enactment of the Act, CMS must follow either the crosswalk or gapfill process to determine the initial payment rates. In addition, CMS is required to make available an explanation of how the gapfill criteria and recommendations from the advisory panel have been applied. The crosswalk versus gapfill process set forth in the Act mirrors the existing process used by CMS; however, by codifying the process, Congress is providing clear legislative direction for CMS’ rate-setting activities for new clinical laboratory tests.

Coding Changes The Act also updates the processes by which new laboratory tests are coded by Medicare. CMS is now required to adopt temporary HCPCS codes to identify new “advanced diagnostic laboratory tests” and new tests that are cleared or approved by the Food and Drug Administration (FDA). These temporary codes will be effective for a period of up to two years pending the adoption of a permanent HCPCS or Current Procedural continued on page 40 WWW.MEDMONTHLY.COM | 39

legal continued from page 39

Terminology (CPT).(CPT is a registered trademark of the American Medical Association.)code. In addition, by 2016, all advanced diagnostic laboratory tests and tests cleared or approved by the FDA, which are currently paid under the CLFS without unique codes, will be assigned unique HCPCS codes. This should reduce coverage and payment uncertainties associated with the current practice of using non-specific or not-otherwise-classified codes. The requirement for specific temporary coding should assist laboratories and manufacturers to commercialize new tests for which uncertainty or delay in obtaining test-specific codes has currently hindered market adoption.

The Act also requires CMS to establish unique identifiers for advanced diagnostic laboratory tests or tests cleared or approved by the FDA. The unique identifiers will be assigned upon request by a laboratory or a manufacturer.

The unique identifiers are intended to allow tracking or monitoring of specific tests at a more granular level than currently may be feasible under established CPT codes.

Unique identifiers may be established as HCPCS codes, modifiers or through other means. Congress appears to be acknowledging the value of tracking individual tests, as has currently been accomplished through test identifiers under the MolDx program administered by Palmetto GBA, one of the Medicare Administrative Contractors (MACs).

Coverage Requirements In another nod to increasing transparency and nonarbitrary decision making, the Act has codified coverage rules for laboratory tests by requiring any local coverage determination to be made following the development and appeals processes for local coverage determinations as set forth in Section 1869(f)(2)(B) of the Social Security Act and regulations at 42 CFR 426. By requiring contractors to follow these well-known and widely accepted processes, Congress is stressing the importance of fair and open coverage decisions.

The Act also authorizes CMS to consolidate coverage policies for clinical laboratory tests among one to four laboratory-specific MACs. These same contractors may also be designated to process claims if CMS determines that such a model is appropriate. This contracting model is similar to the current coverage and claims processing model for durable medical equipment (DME), where there are four regional DME-MACs who set uniform coverage and payment policies for DME. Concentrating coverage and claims processing functions in specialized contractors has been shown to improve the integrity of Medicare coverage and claims processing for DME. Extending these models to clinical diagnostic laboratory services 40 | MAY 2014

would be expected to increase the accuracy and reliability of Medicare coverage and payment decision making for clinical laboratory services.

Oversight Congress appears committed to assuring that the Act has the intended effect of modernizing the CLFS and has provided two levels of oversight by the U.S. Government Accountability Office (GAO) and the Office of Inspector General (OIG) of the Department of Health and Human Services . Congress has instructed the GAO to analyze the impacts of the Act on beneficiaries and laboratories. The GAO report will also identify trends in coding, rate setting and utilization. The report is due not later than October 1, 2018.

Furthermore, Congress tasked the OIG with monitoring the implementation and effects of the new payment system, as well as compiling an annual report of the top 25 laboratory tests by expenditures.

Outstanding Issues The Act makes significant strides in modernizing a payment system that dates from the 1980s and has not undergone substantial modifications since its inception.

However, it raises a number of questions that, hopefully, will be addressed upon implementation of the new rules.

The relationship between Medicare’s public rates and private payor contracted rates has been understood by many to be tightly interwoven. Will tying Medicare rates to private payor rates change the dynamics of laboratory contracting with private payors?

Will rates that are set based upon reporting on an everythree-year basis improve or reduce laboratories’ confidence in predicting revenue forecasts?

How will CMS synchronize the initial periods of pricing for new advanced diagnostic laboratory tests with the permanent (annual reporting-based) rate setting process?

How will CMS incorporate recommendations from the advisory panel with recommendations received during its annual public meeting? Will the advisory panel process make the annual public meeting moot?

Conclusion Laboratories and manufacturers generally supported this move toward a market-based payment system and so should be encouraged by its adoption. The added predictability and transparency of this process should facilitate the adoption and use of novel clinical laboratory tests offered by innovator manufacturers and laboratories alike.  Source: http://www.natlawreview.com/article/sweepingchanges-to-medicare-payment-clinical-laboratory-services

features

A Career with Many Hats: Sharon Trahan, D.M.D.

Dentist, Business Woman, Visionary

By Garrett Ludwig President, Diversified Design Technologies

42 | MAY 2014

Attleboro Falls Family Dentistry

S

haron Trahan, D.M.D is a dentist and senior partner at Attleboro Falls Family Dentistry, which she purchased with the intent of practice growth.

Dr. Trahan is a woman who has, amidst her own career and personal developments, acquired a keen business sense. This deft confluence of vocational achievement and business acumen has positioned her for unprecedented success and prosperity.

Notwithstanding, this article is focused on Dr. Trahan as a woman dentist and senior partner in a practice, which she purchased and revitalized. From a personal perspective, she also became our primary contact during the development of the new physical plant; whereby I garnered the most visceral insight to her remarkable intuition. For those reasons her partner, Donald Pierce, D.D.S. will receive less direct recognition for many of the accolades that follow. However, it should be acknowledged that theirs is a highly functional and interdependent professional partnership and Dr. Pierce is equally deserving of recognition for his synergistic and congruent role in the success of a practice which has emanated from their profound due diligence.

My association with Dr. Trahan began in March of 2001, when my business associate and I were hired to design a facility for Dental Associates - a burgeoning family dental practice in Attleboro, Massachusetts. It is important to note that, in an effort to assess the needs of a practice, we provide a rudimentary check list of needs - the answers to which aid in establishing sizes and quantities of space, as well as the general short and long-term goals of the practice. However, since many responses to that practice data survey read like an ad in a personal column, I have learned that attentive observation is the key to discerning the core objectives and the client’s commitment to bring

those aspirations to fruition. It was evident from the very beginning that Sharon Trahan was a woman who said what she meant and meant what she said. I can honestly say that she is one of the most focused businesspersons I have ever encountered, while remaining socially conscious and genuinely congenial.

Although I will cite many other more distinctive examples of her adroitness, I have been most impressed with the more subtle endorsements that I observed. When she expressed her appreciation for her dedicated staff- as most do- it was brought to my attention that she actually made the effort to negotiate the lease of space in the basement of an adjacent multi-family home to afford her deserving staff a refuge from their respective office duties.

The basement had been used as a staff lounge by founding dentist, Dr. Gerry Rosenthal, who owned the property at that time. When the house was sold to a private party, subsequent to Dr. Rosenthal’s passing, Sharon tactfully facilitated an agreement to lease the space for continued occupancy as a staff lounge.

What is particularly distinctive about that effort is that most of the same staff have remained with the practice and are now enjoying an abundant lounge replete with kitchen, private lavatory and changing area. This is, of course, is a small factor in the overall appreciation that she fosters. But the message remains the same - a happy staff stays and the staggering alternative induces the need to advertise for, train and acclimate patients to new staff members and is dauntingly costly and non-productive. Although her efforts are profoundly sincere, this is business savvy at its best.

Interestingly, these expressions of appreciation would never surface without earned effort. Therefore the continued on page 44 WWW.MEDMONTHLY.COM | 43

continued from page 43

opportunity for achievement must first be established.

That can only be created by the discriminating delegation of responsibility, which, in turn, can only be achieved with an absence of ego and an instinctual and unwavering trust. Sharon Trahan has effectively combined those characteristics with her exceptional ability to attract and select people who mirror her own dedication to the respective tasks at hand. Besides her discerning decision to single-out Don Pierce as her partner in clinical practice, the most visible and notable examples of her extension of her own manner was through her retention of Dr. Rosenthal’s former chair-side assistant Dale Koehler, and office administrator, Lynn Robinson.

Besides being extremely personable and charming, Dale is, as Sharon states “... the glue that keeps the clinical practice together.” Having been with the practice since 1984, she brings a wealth of knowledge about the evolution of the practice and has been instrumental in the effective assimilation of clinical innovations and new technologies; not to mention the symbiotic and seamless integration of the growing clinical staff. In Sharon’s words, “I feel extremely fortunate to have her on my team and working without her would not feel right.”

Lynn, who joined the practice in 1992, is a diminutive dynamo who brings energy and vitality to the practice with an unmistakably sincere warmth and personality.

However, she is also tactfully tenacious when the need arises. If there’s a job to do, she gets it done, with the authority that was imparted to her by Dr. Trahan. There’s no room for micro-management. Therefore, if that includes diplomatically but assertively righting an injustice, she gets the job done with authority. Essentially, she’s a mirror of Sharon Trahan’s discriminating and measured approach to effective people management.

For starters, Sharon has mastered the vital skills of business administration: she’s insightful, trusting, delegates well and demonstrates appreciation for those in whom she has entrusted a responsibility. She approaches business with an unfettered focus on the goal. She’s not rash and is intellectually aware of the risks.

If I may digress, I would like to share an experience that I had with a motivational speaker who offered a simple challenge: Place a $10 bill at the end of a 12” wide wooden plank that was supported on each end by 8” concrete blocks. The task was to simply walk across the plank, pickup the bill and walk back. Not a single person balked at the challenge. The offer was then enhanced with a $1000 bill.

However, the plank was proposed to be suspended end to end between two buildings six stories above the ground.

There were no takers. The element of risk increased exponentially, and abruptly leveled the playing field.

Theoretically, Sharon Trahan approaches business with an unfettered focus on the goal. She’s not reckless, and is 44 | MAY 2014

intellectually aware of the risks. However, metaphorically, “If the board was an adequate means of conveyance to retrieve the $10 bill, it will work as well to seize the larger prize.”

We can all perform those low-risk tasks under ideal circumstances; particularly with a predetermined outcome.

However it takes an unusual individual to maintain the same composure and unfaltering commitment when the equation is compromised by uncertainty intensified by risk or clouded by cost. These are the factors that separate the “talkers” from the “walkers”. Sharon Trahan is clearly a “walker”.

As her design professional, I experienced first-hand her exceptional business skills. Clearly, our best work has evolved in an environment of trust, with an open line of communication. Intrinsically, Sharon knew this, made her goals understood, and allowed us the liberty to create what she envisioned. Besides understanding the precepts associated with the delegation of responsibility, she also knows that her time is better spent doing what she knows and loves - dentistry. Professional passion aside, she also recognizes the value of “chair time” in contrast to performing a non-revenue-producing task or to intervene unnecessarily with responsibilities that she has assigned to others.

When we began the planning process to transform a former single-family home into professional office space for the rapidly-growing practice of Dental Associates, we familiarized ourselves with the needs and objectives of the proposed practice relocation. It became apparent that a portion of the cramped conditions in the existing space was self-imposed. Clearly, Dr. Trahan had purchased an aging practice in a physically encumbered, bi-level structure with limited parking and no room for growth. However, despite these conditions, she had hired cosmetic dentist, Don Pierce, D.M.D. while retaining Lynn Robinson in her position as administrator.

As a result, she and Don were each relegated to the use of one operative treatment room and resilient Lynn was confined to a “closet”, which she shared with multifunction phone, fax, scanner, copier, and printer. Some would question the rationale of these decisions. However, in my mind, any true businessperson would deem this to be insightful decision-making, and another prototypical trademark of a true entrepreneur.

Certainly, Sharon could have generated a comfortable living working out of two rooms, hired a bookkeeper and remained status quo. After all, one must consider that the new salaries impacted the revenue stream, as well as diminished her own chair-side production. However she had greater aspirations - not the least of which was to create a facility that projected a professional image that reflected the high level of dental treatment and the “whole patient” philosophy of her patient’s dental health. In brief, she accepted the challenge of a short-term compromise in

Furniture Layout Design for Attleboro Falls Family Dentistry

an effort to achieve a long-term goal. This is a huge key to her personal success as well as that of the practice itself.

A property was selected for development, approximately one mile from the existing office. Our research determined that the site was abundantly sufficient to support the practice, as well as the required parking. We, therefore, immediately began the design process. I won’t wax on in detail; but after two years of design revisions requested by a myopic group of local bureaucrats who repeatedly “raised the bar”, following the review of each “appeasement” that was submitted, it was clearly time to walk away or engage in a potentially endless legal battle. Despite expending $12,000 on design fees and $4,000 on fees associated with the numerous public hearings, the decision was made to cut their losses and move on. Time and money had been spent and the clock was still ticking. Yet Sharon and Don never broke stride, and patiently and methodically spent the following months searching for another site that offered greater potential.

As the opportunity arose to develop a facility at the present location in Attleboro Falls, an affluent suburb of North Attleboro, Massachusetts, numerous gut-wrenching decisions had to be made; the greatest of which was the selection of the contractor to develop the site and construct the building. In short, there remained a $135,000 discrepancy between the low and high bidders. Again, Sharon’s business logic took over. She and Don opted for the higher fee simply for the reason that the contractor of choice had a proven track record of being on time, and had promised completion within nine months. The low bidder

had proposed an eighteen-month period of development.

Besides realizing a savings in interest from the lender, the hastened occupancy of the facility promised a greater potential to generate revenue. True to form, the projected increase in production and enhanced efficiency would prove to comfortably offset the cost differential.

The factors that set Sharon Trahan apart from her peers and colleagues is her innate ability to assess a challenge, discern its positive and negative values and decisively and unwaveringly strategize its resolution. So, one year later in a new, stand-alone building, with the help of a new associate and two part-time specialists, Attleboro Falls Family Dentistry turned a profit and Sharon earned her “wings” as a reluctant and unassuming business prophet.

The bulk of effort that Sharon puts forth is pointedly proactive, and that requires forethought and decisiveness.

However, she wields as much power under circumstances in which she must be reactive. There’s a point where one has to accept that there is a price to pay for everything money, time, emotion, etc. It’s simply a matter of refusing to allow these “obstacles” to stand in the way of your success. Above all else, Sharon has mastered the art of letting go.

With sincere respect for Sharon Trahan’s business acuity I would like to close with a quote by an unknown author that epitomizes her demeanor, “Work like you don’t need the money, love like you’ve never been hurt and dance like you do when nobody’s watching” .... all the way to the bank.  WWW.MEDMONTHLY.COM | 45

features

An Overview of the Salaries, Bonuses, and Other Incentives

Customarily Used to Recruit Physicians, Physician Assistants and Nurse Practitioners

By Philip Miller VP Communications, Merritt Hawkins merritthawkins.com 46 | MAY 2014

Merritt Hawkins’ 2013 Review of Physician Recruiting Incentives reveals a number of trends within the physician and advanced practitioner recruiting market. l Primary care physicians remain at the top of the wish

list for most hospitals, medical groups and other healthcare organizations. For the seventh consecutive year, two types of primary care physicians - family physicians and general internists - were Merritt Hawkins’ top two most requested physician search assignments.

l Demand is increasing rapidly for non-physician

practitioners, including physician assistants (PAs) and nurse practitioners (NPs). For the first time in the 20 years Merritt Hawkins has been conducting this review, PAs and NPs were among our top 20 recruiting assignments.

l Geriatricians, who are members of a relatively

new specialty, are being more aggressively sought to supplement or enhance elder care traditionally provided by internists, pulmonary and palliative care specialists. For the first time in this Review, geriatrics is among Merritt Hawkins’ top 20 most requested search assignments, as a growing number of healthcare facilities require assistance in finding physicians specializing in elder care.

l Demand also continues strong for physicians providing

inpatient care. After family physicians and general internists, hospitalists ranked third among Merritt Hawkins’ top 20 search assignments. Hospitalists can reduce patient hospital stays, medical errors and hospital readmissions while increasing patient satisfaction – all goals central to new delivery models such as Accountable Care Organizations and emerging quality-based payment systems.

l Other hospital-based physicians, particularly

emergency medicine physicians, are in increased demand, as data show that a greater prevalence of insured patients does not necessarily decrease emergency room visits – a significant trend as millions of the previously uninsured begin to obtain coverage through the Affordable Care Act (ACA) and will seek “convenient care” in the ER.

l The dearth of psychiatrists continues to represent a

“silent shortage.” Psychiatry was fourth on the list of

Merritt Hawkins’ most requested search assignments.

Though the shortage of psychiatrists receives less attention than the primary care shortage, the 2013 Review suggests it remains equally acute, and that clinicians other than psychiatrists will be needed to provide behavioral care. l Demand for some medical specialists has decreased.

Radiology, which was Merritt Hawkins’ most requested specialty in 2001, 2002, and 2003 did not make the list of Merritt Hawkins’ top 20 most requested specialties in 2013. Anesthesiology, formerly a top recruiting assignment, also did not make the list.

l The recruitment of physicians into independent

practice settings such as solo practice and partnerships has almost entirely abated. Sixty-four percent of Merritt Hawkins’ search assignments in 2012/13 featured hospital employment of the physician, up from 11% in 2004.

l A proliferating number of sites of service, including

free-standing emergency departments, community health centers, retail clinics, and urgent care centers, are recruiting physicians, a sign that healthcare providers have adopted a strategy predicated on being “everywhere, all the time.” Like hospitals, these facilities also are employing physicians.

l Seventy-five percent of Merritt Hawkins 2012/13 search

assignments featured a salary with production bonus.

Most such bonuses (57%) are based on a Relative Value Units (RVU) formula. However, a growing number of production formulas also feature quality-based metrics.

Thirty-nine percent of the search assignments Merritt Hawkins conducted in 2012/13 offering production bonuses featured a quality-based component, up from 35% the previous year.

l Demand for physicians is not confined to traditionally

underserved rural areas. Merritt Hawkins worked in 48 states in 2012/13 and 49% of the firm’s search assignments took place in communities of 100,000 people or more, the highest percentage in the 20-year history of the Review. 

WWW.MEDMONTHLY.COM | 47

features

A Journey to Hope:

The Career of Dr. Stanislaw Burzynski

By Barbra Phillips Staff Writer

48 | MAY 2014

D

r. Stanislaw Burzynski has been treating some of the world’s most gravely ill cancer patients for over thirty years now. He has done it from a clinic he established decades ago in Houston, Texas that bears his name.

Born in 1943 in Nazi-occupied Poland, Stanislaw Burzynski grew up there through his teen-age years and stayed there well into early adulthood.

There was never a question that his education would continue well past his teen years. “In my family,” Burzynski says, “both my father and mother were classically educated, and both were university-educated in things like Ancient Greek and Latin cultures, the Humanities and such. This was of course before World War II. Initially I studied chemistry, but I found it to be too simple. That period was the beginning of biochemistry, and it was more complex.”

Biochemistry’s complexities absolutely fascinated him.

Burzynski completed university studies in Poland, and finished medical school there as well in 1967.

He graduated at the top of his class.

Burzynski obtained his medical license and began pursuit of a PhD in biochemistry. He says, as a young person working on his university studies, he never expected to spend an entire career in a medical practice, treating actual human patients. His passion had always centered around research not treatment.

While doing research for his doctoral thesis in 1967 and 1968, he took note of the marked differences in the levels of certain chemical substances in the blood and urine samples of very ill people, when compared to samples from healthy individuals. This finding would eventually become the foundation upon which he would eventually build his entire career and upon which so many cancer patients would begin building their own hopes for survival. He began to believe these “antineoplastons,” as he began to call

them, might somehow offer more successful and less damaging treatment options for patients who were facing the most hard-to-treat forms of cancer. He began to believe he had found another, possibly better effective treatment for cancer.

In 1970 Burzynski left Poland and its Communist Party rule. The thoughts of freedom in America beckoned him. His family had suffered hardship during the prior thirty years, so he came to America with not much to his name. Eventually Baylor College of Medicine hired him, and that marked the beginning of his life in Houston, Texas. There he continued working for the college, investigating the same chemical substances he’d first noticed and documented while studying in Poland. He began to think that since people who were seriously ill had such low or nonexistent levels of these antineoplastons, perhaps there could be a way to increase a patient’s antineoplaston levels and suppress progression of this disease or eliminate it entirely. Dr. Stanislaw’s antineoplaston therapy had in effect begun.

By 1973 he had earned his medical license in the United States of America.

Until the early 1970’s though, Stanislaw Burzynski had never planned to be a practicing medical doctor. “I didn’t believe I’d be treating people. I thought I’d do biochemical research.

The thought of treating chronic disease never came to my mind. Then by 1977 that changed, when I saw the first success.” He recorded his initial use of antineoplaston therapy in humans as promising. It was then he decided antineoplaston therapy must be his life’s work.

Burzynski’s research continued in Houston. He refined his theory about and knowledge regarding the optimum neoplaston therapy protocol. In 1976 his work began to receive praise from the medical community but by 1977 the initially positive reactions he’d received from the medical community had grown silent. “At first in 1976,

my research was met with great enthusiasm, but then began a long time of harassment.” He says it was in 1977 when the medical establishment began to see him as a threat. The FDA, his supporters believe, had become too deeply entrenched in preserving the profit margins of those companies that were paying the agency millions in application fees each year to be able to maintain objectivity when considering treatments that could change the dynamics of the whole industry.

Burzynski’s conclusion was that anything that upset the system or the market dominance of the products that pharmaceutical companies had spent years and billions of dollars to develop, produce, market and in some cases offer doctors incentives or consultant fees to prescribe or administer, was going to be a huge target. He believes now though that the struggles his family endured under Communist rule as well as those atrocities endured by millions in Europe before, during and for years after World War II are part of what has fortified his desire to fight for what he believes will truly help people.

“The Communist system... it will make you harder. But you have to do what’s right always. You must,” he says, “no matter what... no matter what it costs.”

The 25 years that followed the initial interest in Burzynski’s discovery included numerous investigations initiated by the Texas Medical Board of Examiners. Burzynski believes some large medical institutions and the FDA encouraged the board to investigate him for decades. He says in those early years of his practice, the investigations and unsuccessful attempts to make him stop using antineoplaston therapy as an alternative treatment for cancer were unnerving.

“This was unusual in my family. We lived in a Communist country, but it was not in the medical tradition there for politicians to try to stop a doctor from treating his patients.” continued on page 50 WWW.MEDMONTHLY.COM | 49

continued from page 49

Dr. Burzynski’s career in medicine has not been orthodox. He describes the dozens of years from the late ‘70’s until now which have included numerous investigations by the FDA and Texas Medical Board, as both painful and lengthy. He feels frustrated. He believes he has spent a lifetime, trying to help some of the nation’s sickest people; people for whom many traditional oncology therapies have, in their minds at the very least, proven ineffective. And all the while, the very government agency created to protect these people, is the same entity that seems determined to block the people’s rights to hope for, search for and possibly find health again in any way other than what the industry thinks will work best.

One fact that is indisputable though, regarding Dr. Stanislaw Burzynski’s practice: some of his patients have survived and are passionate in their message to the world that he is the one to whom credit should be given for saving their lives. Many whom Burzynski has treated over decades with antineoplastons swear that he not only cured them of cancer, but that his treatment did not leave them, as

chemotherapy, radiation and surgery would have, with the scars, sickness and disabilities that traditionally accepted practices in oncology would have most certainly given them.

Burzynski says “Of course we have not and could not have cured everyone. And it’s hard to have statistically significant trial data, when you’re only allowed by the FDA to treat people who have already been through years of chemotherapy and radiation and surgery before they even got to you. They are so sick when they first get to me.”

Over the years many of the patients whom the FDA has granted special permission to be treated by Burzynski have to be treated first by those who practice the more universally accepted methods of fighting cancer.

Most have had surgery, radiation or chemotherapy. Many have been simply too sick to have survived any treatment Dr. Burzynski might have hoped could give them a chance. But he maintains, if his medicines do help some of the people who come to his clinic, these people find themselves cured completely and rarely see any return of the cancer that initially plagued them.

Many of the people whom Dr.

Stanislaw Burzynski has treated who have seen their tumors shrink or go away completely have gone on to live for decades. Many of them who wish to go public with their personal journey have shared their story on a website ran by former patients www.burzynskipatientgroup.org and www.anpcoalition.com. They believe they will live the rest of their lives without ever seeing the cancer return.

They grow up. They marry. They have children. Something cured them. They say Burzynski has given them back everything which they had come so close to losing. They contend that he not only gave them their lives back; he gave them back their healthy bodies, free from scars from surgery and free from ever-lasting side effects from chemotherapy and radiation. Those who have survived truly believe in Dr. Burzynski and his therapy, and they are grateful. They are alive and healthy. They believe they will be forever free from the diseases that Dr. Burzynski has spent a lifetime trying to end.  If you are interested in learning more about the Burzynski Clinic, you can visit their website at www.burzynskiclinic.com or call them at 800-714-7181.

Subscribe to receive Med Monthly e-news Click here to join our e-news subscribers and get current medical news as it happens Visit us online anytime at medmonthly.com 50 | MAY 2014

features

Physician Salaries and Trends at a Glance

By Philip Driver CEO of Physician Solutions

Physician Salaries at a Glance These specialties will slightly vary depending on the geographical area with the Great Lakes earning slightly higher than any other region and the West Coast, California and Alaska earning the least. The other regions are pretty much in line with one another.

Physician Salaries & Careers Physician salaries are complied in this article based on research from 2011, 2012 and 2013. From our research, most specialist have increased in earning power with the exception of two specialties, Diabetes Endocrinology and Oncology.

These two specialties have been stable however.

Our research reveals that physicians that are board certified earn about $100,000.00 more per year than physicians without board certification. More doctors are opting in on billing insurance companies than requiring payment at time of services. Only about 2% of all specialists are participating in Concierge Practices and about 4% are accepting cash only.

The following salary range represents average annual Physician Compensation by practice settings: Employee $160,000 to $215,000 Independent Contractor $145,000 to $235,000 Practice owner (solo practice) $130,000 to $215,000 Practice partner $210,000 to $305,000 Male physicians that practice in specialty practices earn an average of $230,000 to $260,000 while their female counterparts earn $185,000 to $220,000. Taking a look at primary care, men earn about $185,000 while women earn just over $160,000. 

These average salaries are based largely on data compiled by Research, Government and Military contracts.

Allergy/Immunology Anesthesiology Cardiology Critical Care Medicine Dermatology Emergency Medicine Endocrinology Family Medicine Gastroenterology Gynecological Oncology Gynecology Hospitalist Internal Medicine Neurosurgery Neurology OB & GYN Ophthalmology Orthopedic Surgery Pathology Pediatrics Psychiatry Radiology Rheumatology Surgery-General Surgery-Cardiac Surgery-Plastic Surgery-Trauma Urgent Care Urology

$220,000 $315,000 $385,000 $240,000 $300,000 $205,000 $190,000 $190,000 $335,000 $390,000 $220,000 $200,000 $200,000 $550,000 $230,000 $265,000 $240,000 $570,000 $190,000 $180,000 $205,000 $415,000 $205,000 $320,000 $500,000 $370,000 $385,000 $195,000 $340,000

WWW.MEDMONTHLY.COM | 51

the arts

My Career in Medical Illustration

By Rob Flewell, CMI Medical Illustrator Madison Creative

“Disrupted partial aortic contour with a surrounding false aneurysm”.

Commissioned for: John A. Elefteriades, MD., Director, Aortic Institute at Yale

Growing up with a Navy Corpsman father, I was exposed to an assortment of medical information, which would probably be deemed somewhat inappropriate reading material for a kid of that age. However, reading my father’s anatomy, battle emergency procedures and physical diagnosis books left quite a mark on the person I was to become and my future profession. Also, having a somewhat precocious drawing ability didn’t hurt either.

I eventually received my Medical Illustration degree at The Rochester Institute of Technology (RIT). The RIT program was originally at the University of Rochester Medical School until it was moved in the early 1980’s. A small number other schools also offer the degree program (e.g. Johns Hopkins University, Medical College of Georgia, University of Toronto…etc). It is a rare degree to get, but I feel it was perfectly suited to my abilities.

After obtaining my degree I worked fulltime in various positions including pharmaceutical training, patient education, academics, and research at Duke Medical Center. But, for the past 12 years I have been a fulltime freelance Medical Illustrator with a great variety of work coupled with the challenges of maintaining my own business.

Even though the professional arena of being a Certified Medical illustrator (CMIs) is small, our organization, The Association of Medical Illustrators (AMI), counts 52 | MAY 2014

approximately 2,000 medical illustrators internationally (although not all are board certified). The AMI also lists the various avenues one can take after graduating from initial training. For example, a fellow CMI and I were included in a post-production team for an IMAX film (“Wired to Win”), where we were tasked with developing the film’s medical animations including storyboarding, anatomy consultation, and concept development. Other Certified Medical Illustrators delve into specialized fields such as Med-legal and forensics. There are also CMIs that specialize in a particular field of medical study such as Neuro-ophthalmology, biotechnology, Dentistry, and Veterinary medicine. Some of my colleagues even return to school for advanced PhD degrees in major scientific research fields.

What was once strictly traditional art created by hand has rapidly evolved as we constantly adapt to new technology. Many Medical Illustrators, including myself, exclusively work in the digital and the 3D realm. I still personally like to incorporate some of the traditional techniques in which I was originally trained but with the seamless work environment of digital media. I have found each CMI I know has developed a unique personal style, thus, adding new life to the profession. One artist’s interpretation of a basic heart illustration may be completely different than another’s. My colleagues and I

take pride in not just reproducing the same anatomy over and over again. We always find there is something new to show, especially as new science and procedures evolve. I held the honor of being one of the first artists to illustrate placental cord blood extraction, and brachytherapy seeding for prostate cancer. It is constantly changing and challenging—and for me, that’s what makes my profession so satisfying. There’s always something new and fascinating to show.

With that said, unfortunately, I have come across many artists that go by the title of Medical Illustrator but with little or no formal training. There is much more to medical illustration than just redrawing the anatomy out of textbooks, copying images from the web or reusing tired stock art. Being a Medical Illustrator means understanding what you are illustrating, being able to create new and unique views and knowing what not to show while still getting the essential information represented. I am of the professional opinion that training and even certification is essential for a Medical Illustrator on many levels. There is an inherent responsibility to the content being represented and to the education of those relying on your material. My certification, continued professional training with the AMI, and experience solidifies that resolve to my clients.

I feel that education, and specific training should be a minimum requirement when considering hiring a Medical Illustrator, I have found that I have to wear many content hats when I am approached by different medical/scientific disciplines. Clients expect me to know and understand what they are trying to portray in their commission. My in depth studies of anatomy, physiology, and medical technology is an on-going discipline also required of my respected peers. An easy way to identify artists that have met these professional standards is through certification by the AMI. Being a board-certified Medical Illustrator (CMI) through the Association of Medical Illustrators has had some distinct advantages. Our certification process is based on standards set by the NCCA (National Commission of Certifying Agencies). When a client sees a certification like mine, they know I was vetted among my peers as being highly proficient in many areas. Becoming board-certified requires an extensive exam as well as proof of advanced education (a full gross anatomy course is a absolute necessity), medical/scientific knowledge, craft, visual logic, copyright law and professional ethics. Continuing medical education requirements, called CME’s, keep us fresh and up to speed with new knowledge, procedures and technology. It was not an easy process, and keeping up with my CME’s can be a challenge, but I believe a necessary one.

I see myself not only as a professional educator but also a technical craftsman and an artist that interprets difficult visual concepts. I ask myself with every job: What is my client trying to convey? Who is their audience? How can I make this subject original and show it in a compelling and

“Trigeminal ganglion and nerve roots, and innervation zones” Commissioned for M.Tariq Bhatti, M.D. of Duke Eye Center

dynamic way? What is the most important aspect to center on? What details do I need to show or leave out? And, most importantly, how can I do all of that and make the client happy and come back again. Keep in mind that many clients I work with are all over the globe working remotely.

These are just some of things I consider with every project.

There have been countless occasions where a client has expressed appreciation after working with me because of previous frustration from working with artists who were not properly trained. Some clients were under the belief that my services would be prohibitively expensive, so they try what they presume to be a cheaper route first.

Unfortunately, they often find that “cheaper” costs precious time and wasted efforts on endless explanations and edits, that in the end, made the project far more costly and time consuming than necessary. As a professional, I work at making the project go as smoothly, quickly and as costefficient as possible. With budgets, grants and funding continually being slashed these days, I take affordability very seriously out of respect for my clients.

I still have some of my father’s old medical books, others I have obtained, and even some that I have illustrated myself. I find that it’s a privilege to be among those that have illustrated those books. And I love the idea that someone, many years down the line, will understand completely the concepts that I have illustrated and build upon them.  WWW.MEDMONTHLY.COM | 53

healthy living

Asparagus Soup with Herbed Goat Cheese

By Ashley Acornley, MS, RD, LDN

Nutritional Facts: Yield: 1 1/4 gallons (12 Servings) (excluding unknown items) 188 Calories 14g Fat (50.8% calories from fat) 19g Protein 11g Carbohydrate 3g Dietary Fiber 30mg Cholesterol 97mg Sodium

Ingredients:

Asparagus Soup

Herbed Goat Cheese

1 1/2 cups goat cheese – at room temperature 6 tablespoons chopped fresh basil kosher salt and freshly ground pepper cooking spray

5 tablespoons extra virgin olive oil 3 large leeks – white and green part only 12 cups low-sodium chicken broth 6 pounds asparagus – trimmed and cut into 1-inch pieces 1 1/2 cups chopped fresh basil kosher salt and freshly ground pepper

Preparation: GOAT CHEESE: Line a small baking sheet with parchment paper. Set aside.

Using a fork, in a small bowl, combine the goat cheese and basil until smooth. Season with salt and pepper, to taste. Using a 1/2-ounce cookie scoop or a round tablespoon measure sprayed with vegetable oil cooking spray, scoop the goat cheese into balls and arrange on the prepared baking sheet. Refrigerate for 30 minutes.

SOUP: In a Dutch oven or large saucepan, heat the olive oil over medium heat. Add the leeks and cook, stirring constantly until softened, about 3 to 4 minutes. Add the broth, asparagus and basil.

54 | MAY 2014

Season with salt and pepper, to taste. Increase the heat to high and bring the mixture to a boil.

Reduce to a simmer and cook until the asparagus is tender, about 15 minutes. Using an immersion blender, blend the soup until smooth. Season with salt and pepper, to taste. Keep the soup warm over low heat.

TO SERVE: Ladle the soup into shallow bowls and garnish with the herbed goat cheese.

COOK’S NOTE: The soup can also be pureed by ladling, in batches, into a food processor or blender and blended until smooth.

Yogurt can also be substituted for goat cheese

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 | 55

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 56

| MAY 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 | 57

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 58 | MAY 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 | 59

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

60 | MAY 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 | 61

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

62 | MAY 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 919845-0054 or email physiciansolutions@gmail.com. continued on page 65 WWW.MEDMONTHLY.COM |63

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 64 | MAY 2014

classified listings

Classified

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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 66 WWW.MEDMONTHLY.COM | 65

classified listings

Classified

continued from page 65

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 68

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.

66 | MAY 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 | 67

classified listings

Classified

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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 68 | MAY 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 71

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

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 68

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 72 WWW.MEDMONTHLY.COM | 71

classified listings

Classified

continued from page 71

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

72 | MAY 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 74

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 | 73

classified listings

Classified

continued from page 73

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

74 | MAY 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 | 75

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY

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

Primary Care Specializing in Women’s Health 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 76 | MAY 2014

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

Located on NC’s Beautiful Coast, Morehead City

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 WWW.MEDMONTHLY.COM | 77

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

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

the top About 76 million people were born during the baby boom years, which range from 1946 to 1964. As the first wave of these baby boomers reaches retirement age and becomes eligible for Medicare, physicians are focusing on health concerns that will become more prevalent among this generation.

1

CARDIOVASCULAR DISEASE

Cardiovascular disease is the leading cause of death for both men and women over age 60. After age 45, the risk of developing it increases significantly. Coronary artery disease, in which the arteries that deliver blood to the heart become narrowed or blocked, is the most common type of heart disease and a main cause of heart attacks. If you’re between ages 45 and 79, you should ask your doctor if taking aspirin might lower your risk of heart attack.

2

ARTHRITIS AND JOINT REPLACEMENT

As a person ages, the cartilage that cushions the bones at the joints begins to break down and the bones begin to rub together. The resulting pain, swelling and stiffness is called osteoarthritis. While it is a normal part of aging, it can also be caused by damage due to physical activity over a long period of time. Treatment ranges from pain medications to joint replacement.

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| MAY 2014

Health Concerns of Baby Boomers

3

TYPE 2 DIABETES

In 2011 people ages 65-74 were diagnosed with type 2 diabetes 13 times as often as people age 45 or younger. Diabetes increases the risk of serious health problems such as high blood pressure, vision loss, kidney disease, nerve damage, foot problems, amputation and cardiovascular disease. With lifestyle changes and proper medical care, diabetes and its associated risks can be managed.

4

ALZHEIMER’S DISEASE

Alzheimer’s disease is most common in people age 65 and older.

But up to 5 percent of people begin to experience symptoms in their 50s or even their 40s. While Alzheimer’s disease currently has no known cause or cure, a healthy cardiovascular system can help to ensure that plenty of nutrient-rich blood reaches the brain.

5 CANCER

After age 50, as many as half of all women will break a bone due to osteoporosis. By age 65 or 70, men and women lose bone mass at the same rate, with a similar decrease in the amount of calcium their bones absorb. Talk to your doctor about calcium supplements and other treatments that can help prevent osteoporosis.

7

DEPRESSION

Depression affects more than 6.5 million Americans age 65 or older. While many have struggled with depression throughout their lives, some may experience it for the first time later in life. Appropriate treatment is effective and may even lead to positive changes in brain chemistry.

8

Cancer is the second leading cause of death among people age 65 and older.

Aging is associated with higher rates of lung, skin colon, breast and prostate cancer. Quitting smoking and avoiding secondhand smoke can help reduce the risk for developing lung cancer, while regular screenings for skin, colon, breast and prostate cancer can catch these diseases early, while they are still highly treatable.

6

OSTEOPOROSIS

FLU/PNEUMONIA

Influenza and pneumonia and are among the top 10 causes of death for older adults. Annual vaccinations are now widely available for both diseases and are usually covered by health insurance or available at a very low cost. Ask your doctor if you should be vaccinated.

9

EYE PROBLEMS

Cataracts affect nearly 20.5 million Americans age 40 and older, and by age 80, more than half of all Americans have a cataract or have had cataract surgery.

Recent advancements have improved the precision and safety of cataract surgery, resulting in faster surgeries, easier and shorter recoveries, and in some cases, better vision than before surgery.

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