Med Monthly October 2012

Med Monthly

OCTOBER 2012

The Future of Nursing Education:

10

Trends to Watch pg. 42

LOCUM TENENS: A Physician’s View pg. 40

TRAVEL NURSES TO BENEFIT UNDER THE NEW HEALTHCARE REFORM pg. 12

the

locum tenveenls and tra nurses issue

A PHYSICIAN’S LOCUM TENENS AGENCY SPEAKS UP pg. 18

contents features 40 LOCUM TENEN AS A PHYSICIAN CAREER? Locum Tenens can be a rewarding, if non-traditional career for the right physician.

42 THE FUTURE OF NURSING EDUCATION: 10 Trends to Watch

48 GUIDING THE TEMP DOC 50 TRAVEL NURSES TOUT PROFESSIONAL GROWTH AND CAREER OPPORTUNITIES

52

The Art of Medicine

insight

practice tips

12 TRAVEL NURSES TO BENEFIT UNDER THE NEW HEALTH CARE REFORM

26 ICD-10 CONVERSION

14 EHR TECHNOLOGY:

Deciding When and How to Start the ICD-10 Conversion

28 HOW TO BE A GOOD WORKERS COMP DOC 30 BEST PRACTICE TO ENHANCE THE PATIENT EXPERIENCE

research and technology 32 DOCTOR CREATES “OBSESSIVE COMPULSIVE DISORDER” MOBILE APP

42

The Future Of Nursing

Key Highlights And Initial Reaction To The Final Rule For Stage 2 Meaningful Use

18 A PHYSICIAN’S LOCUM TENENS AGENCY SPEAKS UP 20 SELF-AWARENESS:

A Critical Nursing Shortage

24 TO LOCUM TENENS OR NOT TO LOCUM TENENS, that is the question.

legal 34 INDEPENDENT PAYMENT ADVISORY BOARD 38 HEALTH CLAIM TO BE INTERPRETED WIDELY

the arts 52 THE ART OF MEDICINE

Laura Maaske, Medical Illustrator

the kitchen 54 CHERRY-WALNUT PUMPKIN BREAD

in every issue 4 editor’s letter 8 news briefs

60 resource guide 80 top 9 list

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editor’s letter Greetings and happy October to everyone.

Time has just flown by for my staff and I as we complete the last minute touches for this issue. Is it true that time moves quicker when you are busy? You betcha! It seems like just yesterday that we sat in our desks for the first time, yet here we are publishing our second issue.

I have worked hard to direct our contributors towards providing engaging stories and information on this month’s theme of Locum Tenens and Nurses. We have learned that the physician’s temporary assignment industry can be very exciting while providing doctors and nurses alike with many beneficial options that can help to guide them along their way through their medical careers. Some of the benefits may seem small, but then when you take a moment to consider the impact they may have, you realize how the experience could truly change your life and/or career path. For instance, after just one year of accepting short term assignments, a physician locum tenens’ curriculum vitae will corroborate a myriad of new employers, environments and skills – a definite plus for the physicians/nurses’ future career endeavors!

You may notice some changes we have made to our table of contents. We have added a section called “Insight”. And it will do exactly that – give you insight to our monthly medical theme or other timely issues. We cordially invite you to read through those articles to gather those gems of insight into medicine and its related fields. We also encourage our readers to contribute to this section. Share your insights with us so that all may learn what you have learned. Feel free to contact me at: info@medmonthly.com.

In addition to what is new in the Magazine, MedMedia9 has also begun to expand on marketing services that we offer to medical professionals. Tom Hibbard’s article (our Creative Director), will review this exciting new step towards enhancing our available marketing tools.

Thank you for joining us this month. Here is a small but humorous account of medical history for you to ponder on: A SHORT HISTORY OF MEDICINE: "Doctor, I have an ear ache."

2000 B.C. - "Here, eat this root."

1000 B.C. - "That root is heathen, say this prayer."

1850 A.D. - "That prayer is superstition, drink this potion."

1940 A.D. - "That potion is snake oil, swallow this pill."

1985 A.D. - "That pill is ineffective, take this antibiotic."

2000 A.D. - "That antibiotic is artificial. Here, eat this root.”

Love it!

Monica Menezes Irwin Managing Editor 4 | OCTOBER 2012

Med Monthly October 2012 Publisher Philip Driver Managing Editor Monica Menezes Irwin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Mandy Huggins Armitage, MD James Bledsoe, MD, FACS Jane Durney-Crowley Lawrence Earl, MD, Medical Director, National Academy of DOT Medical Examiners (NADME) Vanessa Edwards Liz Ferron, MSW, LICSW Barbara R. Heller Larry Lanham II, Dinsmore & Shohl LLP Laura Masske Sebastián Romero Melchor Marla T. Oros Frank J. Rosello, CEO Environmental Intelligence LL Mary Pat Whaley, FACMPE

contributors Mandy Huggins Armitage, MD is a sports medicine physician with an interest in medical communications. She began her education with an undergraduate degree at Purdue University and subsequently received her medical degree from Indiana University. She then went on to complete a residency in Physical Medicine and Rehabilitation (PM&R) at Carolinas Medical Center in Charlotte, NC. Dr. Huggins finished her training with a primary care sports medicine fellowship at Emory University in Atlanta. She is board certified by the ABPMR and holds an added certificate of qualification (CAQ) in Sports Medicine. She currently lives in south Florida with her husband and dog.

Lawrence Earl, MD has owned and/or operated over 2 dozen medical centers over the past 27 years, including several DOT examination clinics in NJ and PA. After selling his last centers to Concentra in 2010, he spent about a year training and mentoring physicians, nurse practitioners and PAs at Concentra. Recently he consulted on the NRCME training program requirements for NADME.org, the National Academy of DOT Medical Examiners.

Liz Ferron, MSW, LICSW 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

is a senior consultant and manager of clinical services with Workplace Behavioral Solutions, Inc. and its Midwest EAP Solutions and Physician Wellness Services divisions. She has been with the company for over 10 years, and has been in the employee assistance field for over 20 years. Liz has her MSW degree from the University of Minnesota and is a licensed independent clinical social worker. For more information, visit www.physicianwellnessservices.com.

Frank J. Rosello is CEO & Co-Founder of Environmental Intelligence LLC, a Complete Outsourced Health IT Company providing End-to-End meaningful physician workflows consulting, integration, and implementation in EHR, Image Management Systems, and Practice Management to private and public practices and facilities and dedicated Health IT professionals. Visit Frank's website: http://www.goeillc.com MEDMONTHLY.COM |5

designer's thoughts From the Drawing Board It's time to get online!

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You only have a few seconds to impress possible patients with your website. People judge a book by its cover, and websites are just that – the new cover. If they find a website that looks unprofessional, they will move on to another site and physician.

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5 TOP REASONS FOR CREATING A MEDICAL PRACTICE WEBSITE: 1. Supplies available information about your practice 24/7, 365 days a year to existing and potential patients.

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6 | OCTOBER 2012

Medvertising

compound noun: 1. The action of calling attention to medical goods or services for sale. Exclusively refers to advertising in Med Monthly.

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Med Monthly

news briefs

Wireless ICs Adding Features to Cardiac Rhythm Management Implants As new-generation cardiac devices converge with wireless technology, medical professionals are acquiring the capability to monitor patient parameters and implanted device data continuously in nearreal time. Wirelessly enabled implantable devices represent a shift in the approach to ambulatory cardiac patient care – patients can remain active while retaining the benefits of caregiver connectivity.

The major cardiac rhythm management (CRM) device companies now offer implantable devices that incorporate wireless technology capable of automatically transmitting patient data externally (outside the body). This information is relayed to a continuously staffed data center that monitors/filters incoming data and notify caregivers of events requiring intervention or follow-up.

Design miniaturization and improvements in heart rhythm detection logic are creating opportunities for new classes of ambulatory monitoring devices. The FDA approval of the first wireless implantable vital signs monitor in 2007 allowed caregivers to monitor the cardiac health of patients continuously for years rather than the typical 14 to 21 days.

A detailed analysis of RF-enabled cardiac rhythm management implants is presented in a comprehensive report from Applied Data Research. Remote Cardiac Rhythm Management: Devices, Technology, Market Factors, Opportunities and Outlook provides assessments, comparisons, analysis, and forecasts of this expanding market segment.

Source: http://www.newswiretoday.com/news/75276/ 8 | OCTOBER 2012

INTOUCH HEALTH AND IROBOT UNVEIL THE RP-VITATM TELEMEDICINE ROBOT AT CLINICAL INNOVATIONS FORUM The RP-VITA is first to combine the latest in telemedicine with state-ofthe-art autonomous navigation and mobility.

InTouch Health, the leader in acute care remote presence telemedicine, and iRobot (NASDAQ: IRBT), a leader in delivering robotic technologybased solutions, announced the companies unveiled the breakthrough RPVITA (Remote Presence Virtual + Independent Telemedicine Assistant) at the InTouch Health 7th Annual Clinical Innovations Forum, held on July 26 – 28 in Santa Barbara, CA. The RP-VITA is the first remote presence solution for patient care that combines the latest in telemedicine technology from InTouch Health with the latest in autonomous navigation and mobility developed for the iRobot Ava™ mobile robotics platform.

For the hospital market, the RP-VITA improves patient care by ensuring the physician is in the right place at the right time and has access to the necessary clinical information to take immediate action.

The RP-VITA is a result of a joint development and licensing agreement the two best-of-breed companies announced a year ago and broadened earlier this year.

An expandable telemedicine technology platform, the RP-VITA is the remote presence device component of a total acute care telemedicine solution which includes an integrated ecosystem of technologies and support infrastructure, all part of the InTouch® Telemedicine System.

The RP-VITA will be sold by InTouch Health as its new flagship remote presence device.

"The hospital industry is undergoing significant changes, and as we strive to maintain our culture of ensuring an excellent patient experience, we face significant pressure on reducing operating expenses and managing staffing and resources. New technology such as the RP-VITA that dramatically increases the effectiveness and extends the reach of healthcare professionals is required," said Richard Afable, M.D., M.P.H., President of and CEO of Hoag Memorial Hospital Presbyterian. Hoag, Ronald Reagan UCLA Medical Center and Children's Hospital of Orange County (CHOC) participated in clinical validations as part of the U.S. Food and Drug Administration (FDA) review process for the RP-VITA. The RP‐VITA offers doctors the ability to take command of any clinical, patient or care team management process remotely. It provides a new level of mobility, utility and ease of use for healthcare professionals in the acute care market.

"The RP-VITA raises the bar for overseeing patient care remotely and allows me to proactively control a situation as if I were there," said Jason Knight, M.D., Director of the CHOC Transport Program and Assistant Clinical Professor at the University of California, Irvine. "The robot is so easy to use that I can forget about the technology and just focus on the clinical needs at hand." Dr. Knight led the clinical validation process at CHOC. • Some of the RP-VITA's new and unique features include: An enhanced navigation capability that enables the RP-VITA to better manage driving and navigation elements so the health care professional can put more focus on patient care tasks. State‐of‐the-art mapping and Obstacle Detection Obstacle Avoidance (ODOA) technologies allow safe, fast and highly flexible navigation in a clinical environment.

• An additional capability for the RP-VITA incorporates autonomous navigation and is being submitted to the FDA for 510(k) clearance. This capability will allow a remote clinician or bedside nurse to send the RPVITA to a target destination with a single click, enabling a number of breakthrough clinical applications. InTouch Health anticipates clearance for this feature in the fourth quarter of 2012.

• Real-time access to important clinical data, enabling a range of new workflow improvements for physicians, nurses and other patient care team members. For example, the RP-VITA can be integrated with live patient data from the electronic medical record and is equipped with the ability to connect with diagnostic devices such as otoscopes and ultrasound. It comes equipped with the latest electronic stethoscope.

• A new, simple to use iPad[1] user interface will enable quick and easy navigation to anywhere the RP-VITA needs to go, as well as interact with the patient, family and care team.

"The hospital industry is undergoing significant changes, and as we strive to maintain our culture of ensuring an excellent patient experience, we face significant pressure on reducing operating expenses and managing staffing and resources. New technology such as the RP-VITA that dramatically increases the effectiveness and extends the reach of healthcare professionals is required."

InTouch Health envisions that the expandable RP-VITA platform will provide additional value in orchestrating teamwide care, as a clinical assistant to enhance efficiency and quality, and as a patient advocate to enhance the care experience.

"The RP-VITA is a game changer for acute care telemedicine, and it will become the cornerstone for many new clinical applications and uses. The RP-VITA is a platform that will immediately improve existing healthcare delivery models, and through additional collaboration and development will create new clinical innovations that we can only imagine," said Yulun Wang, Ph.D., InTouch Health's Chairman and CEO. In January, iRobot invested $6 million in InTouch Health. This expanded the joint development and licensing agreement formed in 2011, which was established to explore opportunities for healthcare applications on iRobot platforms.

The RP-VITA will be added to the suite of devices included in the FDA-cleared Class II InTouch® Telemedicine System.

This clearance includes active patient monitoring in high acuity environments where immediate clinical action may be required, such as in the ICU and emergency department, to facilitate the rapid assessment and treatment of stroke and other time critical conditions.

Source: http://finance.yahoo.com/news/intouch-health-irobot-unveil-rp-120000833.html MEDMONTHLY.COM |9

news briefs

EKOS Corporation Announces Two More Pulmo SEATTLE I and II Clinical Studies Will Further Establish the Safety and Efficacy of Ultrasound Accelerated Thrombolysis for Treatment of Pulmonary Embolism.

EKOS Corporation today announced the launch of two more landmark clinical studies named SEATTLE I & II, intended to further establish the safety and efficacy of its unique, ultrasound-accelerated thrombolysis in treating patients with life-threatening pulmonary embolism(PE).

The SEATTLE I & II studies are, respectively, a multi-center, retrospective analysis of PE patients treated with EKOS, and a multi-center, prospective study of both massive and submassive PE patients treated with EKOS. The principal investigator for the SEATTLE series is Samuel Z. Goldhaber, MD, Professor of Medicine at Harvard Medical School, and Director of the Brigham And Women’s Hospital Venous Thromboembolism Research Group. The first patients to be enrolled in SEATTLE II are expected in June 2012 with complete enrollment from up to 25 study sites expected by mid 2013.

Collection of retrospective data for the SEATTLE I study has already begun at nine international sites and should be completed in Q4 2012.

EKOS launched its first PE study, ULTIMA, in 2010 with lead principal investigator Dr. Nils Kucher of Bern University Hospital (Switzerland). ULTIMA is an international, multicenter, randomized, controlled study comparing submassive PE patients treated with EKOS to standard-of-care anticoagulation. This study is more than half enrolled and is expected to be completed in 2013.

“When completed, the ULTIMA and SEATTLE studies will represent the largest and most rigorous medical device studies in medical history for the treatment of pulmonary embolism,” said Dr. Goldhaber.

Robert W. Hubert, President/CEO states, “With the staggering statistics of deaths and morbidity associated with PE, these trials are essential in fully defining the role that EKOS will play in addressing this major unmet medical need.”

The U.S. Surgeon General reports over 600,000 patients are stricken with this disease in the U.S. alone resulting in up to 180,000 deaths annually, more than AIDS, breast cancer and auto accidents combined.

A PE is caused when a large blood clot, usually from a vein in the upper leg, or pelvic veins, breaks away and lodges in the lungs. The resulting strain on the heart, which must push blood past the obstruction, causes symptoms similar to a heart attack and can result in death or permanent disability.

The use of blood thinners can reduce the risk of more clots developing; however blood thinners do not remove the existing obstruction. The patented EKOS EkoSonic® Endovascular delivery catheters are designed to condition the clot for more rapid absorption of clot busting drugs; a critical factor when every minute counts.

The EKOS system was cleared by the US Food and Drug Administration in 2005 and since then has been used by physicians worldwide to treat blood clots in arteries and veins throughout the body, especially in the arms and legs.

10 | OCTOBER 2012

onary Embolism Clinical Studies

‘‘

“When completed, the ULTIMA and SEATTLE studies will represent the largest and most rigorous medical device studies in medical history for the treatment of pulmonary embolism.”

The FDA further cleared the device to be used in the pulmonary artery in 2008. Shortly thereafter, users in the US and Europe began reporting success in treating patients with PE using the EKOS device. EKOS received the CE Mark to treat massive and submassive PE in January 2010. “Since 2009, over 600 PE cases have been treated with EKOS,” concluded Robert W. Hubert, President/ CEO. The most critical patients with major lung obstructions are those with massive PE who have deteriorated into cardiogenic shock and are close to death; less dramatic but still potentially life-threatening are those who are stable but still show clinical signs of cardiac dysfunction. These are sometimes referred to as submassive PEs. These two groups account for 5% and 40% of all PE patients, respectively. Multiple international medical journals report that patients who leave the hospital with residual cardiac strain from a remaining thrombus occlusion are at increased risk for long-term, permanent heart damage or even death. The timeliness of these studies was highlighted in a featured syndicated television broadcast, The Doctors, May 2, 2012 on the CBS network. Dr. Tod Engelhardt, a cardiothoracic surgeon from East Jefferson General Hospital (Metairie, LA) featured in the broadcast, described his pioneering use of EKOS to treat 42 PE patients. The published summary on his first 24 patients can be found in the May 2011 Thrombosis Research journal (128 (2011) 149–154).

About EKOS Corporation: EKOS Corporation pioneered the development and clinical application of ultrasound infusion technologies in medicine, introducing its first system for the treatment of vascular thrombosis in 2005. Today, interventional radiologists, cardiologists, cardiothoracic and vascular surgeons at leading institutions SOON G N I M O around the world use the EKOS C ONTHLY EkoSonic® Endovascular System M D E M IN to provide faster, safer and more complete dissolution of coming In the up , thrombus. www.ekoscorp.com 012 issue Reprint Source: http://www. ekoscorp.com/press%20 releases/EKOS_at_Iset07.pdf

er 2 Novemb into ly looks th n o M Med re Reform a C h lt a He

Top Doc America Launches National Multi-Media Health Care Promotion The Top Doc America sites, which will be launching initially in New York, Los Angeles, Chicago, Boston, San Francisco and San Diego will be the first health care sites to offer patients the ability to watch HD interviews, read reviews and schedule their appointments online for free.

Top Doc’s promotion will benefit participating health care professionals by generating new patient referrals. The multi-media marketing campaign includes: 1. A weekly commercial segment with FOX entitled, “Meet the 2011 Top Doctors and Dentists.” The segment will air in each local market during commercial breaks of the Dr. Oz Show and feature award-winning Doctors and Dentists.

2. Individual Doctor and Dentist TV commercials to run on the 4 network stations.

According to Baqi Kopelman, Top Doc’s Director of Media, “Top Doc has assembled a national production team that will produce introductory videos and commercials for participating doctors and dentists.

We will place their videos online and on television so patients can learn more and book appointments online.”

3. Print ads to run in the New York Times, New York Post, Chicago Tribune, Los Angeles Times, San Francisco Chronicle and Boston Globe.

4. AdWords campaigns.

For information, visit Top Doc America --Los Angeles: topdoclosangeles.com / San Diego: topdocsandiego.com / New York topdocnewyork.com / Chicago topdocchicago.com / Boston topdocboston.com / San Francisco topdocsanfrancisco.com.

Source: http://www.newswiretoday.com/news/76998/ MEDMONTHLY.COM |11

insight

Travel Nurses to Benefit Under the New Health Care Reform

by Angela Morgan Travel Nurse Across America

12| OCTOBER 2012

The Health Care Reform Bill is expected to benefit traveling nurses and other health care professionals along with the staffing agencies that employ.

W

ith the U.S. Supreme Court upholding the Patient Protection and Affordable Care Act (ACA), health care staffing agencies are now assessing how the more than 1,000 page document will impact their contingent labor, hospital clients and company. The goal of the ACA is to extend healthcare coverage to millions of Americans that are not currently covered through mandates for individuals and employers, subsidies for people who cannot afford coverage on their own, consumer-friendly rules clamped on insurers, tax breaks, and marketplaces to shop for health plans.

Although hospitals and health care groups have praised parts of the of the Supreme Court’s ruling on the Patient Protection and Affordable Care Act, hospitals still face tough challenges when the 2014 regulations kick in, The Washington Post reported. Although hospitals won’t have to bear as much of the cost of treating the uninsured, according to The Post, they still must comply with quality-care regulations to qualify for reimbursement. Payments will be based on readmission rates and patient satisfaction scores. Physicians will also be under the same guidelines.

Starting in 2015, doctors will get paid for keeping their patients healthy not necessarily for every test and procedure.

As for the individual American, traveling nurse or otherwise, they will be required to secure health insurance under the new bill. The need for travel nurses to take permanent positions

to secure full health insurance will no longer be an issue. Though most travel nursing agencies offer health insurance, travel nurses will also have the option to obtain insurance through federal subsidies or private insurance companies without being denied for pre-existing conditions.

Though it will take up to two years for all the regulations in the health care Reform Bill to be in place, analysts say the Affordable Care Act will positively affect the nursing and physician’s field and the staffing agencies that employ them as the demand for health care workers will increase when an additional 30 million people become

insured. As more people acquire health insurance, they are more likely to seek medical services, have necessary medical procedures and make regular doctors visits, creating a cascading effect in the health care staffing industry.

With Registered Nurses already in short supply, the Federal Government is issuing additional education incentives and more Federal loans as a way to entice more students towards the medical field and hopefully ease the strain on the nursing industry.  Reprint Source: www.nurse.tv/

‘‘

"As more people acquire health insurance, they are more likely to seek medical services, have necessary medical procedures and make regular doctor visits, increasing the strain on an already short supply of registered nurses.."

MEDMONTHLY.COM |13

insight

EHR Technology: Key Highlights And Initial Reaction To The Final Rule For Stage 2 Meaningful Use

aggressive health IT strategy is critical to successfully reforming our healthcare system which will eventually lead to improving operational efficiency of medical organizations and patient care quality, safety and outcomes.

Prior to the release of the final rule for Stage 2 Meaningful Use, CMS first posted its proposed rule for Stage 2 in the Federal Register on March 7, 2012.

This action opened the sixty day public commentary period that allowed interested parties and individuals to submit comments, challenges or concerns regarding any portion of the proposed rule. According to the Stage 2 final rule, approximately six thousand one hundred items of timely correspondence was received prior to the May 6, 2012 submission deadline.

CMS and the ONC have included summaries of the timely public comments that were within scope of the Stage 2 proposed rule throughout the final rule document.

Key Highlights of the Final Rule For Stage 2 Meaningful Use Are:

by Frank J. Rosello, CEO Environmental Intelligence LL The Centers for Medicare and Medicaid (CMS) and the Office of the National Coordinator for Health IT (ONC) released the final rule for Stage 2 Meaningful Use on Thursday, August 23, 2012. The final rule for Stage 2 Meaningful Use defines the requirements that both hospitals and eligible healthcare providers must meet in order to continue to qualify and receive payments under the Medicare and Medicaid electronic 14| OCTOBER 2012

health records (EHR) incentive programs.

The Medicare and Medicaid EHR Incentive Programs are in place to promote and expand the meaningful use of certified EHR technology, which is one important component of a broader national strategy to deploy health information technology infrastructures throughout the entire ambulatory and hospital healthcare system of the United States. This

1) Stage 2 Attestations Start in 2014 – The meaningful use final rule for Stage 1 established an original timeline that would have required eligible providers enrolled in the Medicare EHR Incentive Program who attested to meeting meaningful use in 2011 to meet Stage 2 requirements in 2013. Now under the final rule for Stage 2, any eligible provider that attested to Stage 1 of meaningful use in 2011 will now attest to Stage 2 requirements starting in 2014. This significant change provides more flexibility and allows both eligible providers and certified EHR vendors more time to upgrade EHR systems to the 2014 edition. CMS and the ONC have also published the criteria in the final rule that EHR systems must meet in order to achieve or maintain their ONC-ATCB certification for Stage 2.

2) Changes to Stage 1 and Introduction of New Objectives and Measures in Stage 2 – In the final rule for Stage 2, CMS and the ONC has maintained the same core-menu structure found in Stage 1. In Stage 2, there are a total of twenty measures that eligible providers must meet or qualify for exclusion to seventeen core objectives and three of six menu objectives. For eligible hospitals and critical access hospitals (CAHs), there are a total of nineteen measures they must meet or qualify for exclusion to sixteen core objectives and three of six menu objectives. The final rule has added the “outpatient lab reporting” to the menu for hospitals and CAHs and “recording clinical notes” as a menu item for both hospitals and eligible providers.

Also, the “exchange of key clinical information” core objective from Stage 1 has been replaced with the more robust “transitions of care” core objective in Stage 2, and the “provide patients with an electronic copy of their health information” objective from Stage 1 was eliminated in favor of the new “online, download, and transmit” core objective in Stage 2.

The final rule for Stage 2 also introduces two new core

objectives. For eligible providers, the new core objective is “use secure electronic messaging to communicate with patients on relevant health information” and for hospitals and CAH’s, the new core objective is “automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR).”

required statute taking effect in 2015. The final rule states that any Medicare eligible or hospital that demonstrates meaningful use in 2013 will not be imposed a payment adjustment in 2015.

Furthermore, a Medicare provider that first demonstrates meaningful use in 2014 will not be imposed a payment reduction penalty as long as they successfully register for the EHR Incentive Program and attest to meaningful use by July 1, 2014 for eligible hospitals or October 1, 2014 for eligible providers.

One significant policy change to Stage 1 effective as of 2014 is eligible providers, hospitals and CAHs that meet an exclusion for a menu set objective do not count towards the number of menu set objectives that must be satisfied to meet meaningful use.

3) Streamlined Group Practice Reporting – The final rule will now allow group practices to batch and submit meaningful use attestation data for all of their individual eligible providers, in one file.

4) Process for Medicare Payment Adjustments – The final rule has defined the process that will determine whether an eligible provider, hospital, or CAH will experience a Medicare payment adjustment. All future imposed Medicare payment adjustments will be determined by an EHR reporting period prior to the

In the final rule, CMS defines four specific categories of hardship exceptions for eligible providers to avoid a Medicare payment adjustment penalty which are: new eligible providers, infrastructure barriers, unforeseen circumstances and specific specialist/provider type that includes radiology, anesthesiology and pathology.

For the most part, initial reactions by several healthcare associations regarding the final rule for Stage 2 Meaningful Use were quite favorable.

The Medical Group Management Association (MGMA) expressed that they were pleased overall with the final rule specifically noting the change that allows groups to report batch information for certain measures continued on page 16

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that now removes the administrative burden on eligible professionals. They also expressed satisfaction with the threshold decrease of providing online access for the patient to get a hold of their medical records from the proposed 10 percent down to five percent in the final rule. While the MGMA welcomed the decrease, they went on to express that this requirement continues to present a number of challenges to providers, including the cost to integrate an online portal and the reliance on patients' usage.

The American Health Information Management Association (AHIMA) expressed that they were happy to see CMS acknowledge and continue to make efforts to align meaningful use quality reporting requirements with other quality reporting systems in order to reduce duplication and reporting challenges.

The AHIMA also shared that this reporting alignment will drive efficiency and reduce cost over time. Both the MGMA and AHIMA were also glad to see that the Stage 2 Meaningful Use requirements will begin in 2014, as opposed to the proposed starting date of 2013.

On the other hand, the American Hospital Association (AHA) expressed concern about the timeline in which providers have to meet the Stage 2 requirements. The AHA believes that the final rule sets an unrealistic date by which hospitals must attest to initial meaningful use requirements to avoid financial penalties.

They also went on record to say that the final rule makes the reporting of clinical quality measures more complicated and the addition of new meaningful use objectives has created new burdens for hospitals.

In conclusion, the journey to digitize the healthcare system of the U.S. requires all stakeholders to effectively manage change while navigating a very long and winding road. The fact is, EHR adoption along with meeting all of the requirements for Stage 2 Meaningful Use is not going to be easy and not everyone will be in agreement with the final rule. However, the time will come when the efforts of today will lead to a more robust coordination of patient care, eliminate redundant screenings and tests, reduce medical errors, reduce healthcare costs, and foster improved patient engagement and outcomes in the near future.

To view the Stage 2 Meaningful Use final rule click here. 

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insight

A Physician’s Locum Tenens Agency Speaks Up

by Monica Menezes Irwin, Managing Editor

18| OCTOBER 2012

O

ne of the most important decisions to be made by a locum tenens physician or traveling nurse is who will represent them. They are the experts in the field and will be the liaison between them and the search for the perfect match in a temporary position.

Med Monthly spoke to the owner, Mr. Philip Driver, of Physician Solutions, Inc., a locum tenens staffing company with 24 years of seniority in the industry located in Raleigh, North Carolina. We questioned Mr. Driver regarding the steps his agency must take to evaluate their potential locum tenens candidates. “We have recruiters that interface with physicians looking for either part time or full time work. The recruiters obtain copies of their medical licenses, national provider identification (NPI) number and DEA certificates. They verify every applicant’s specialty with their respective state’s medical board to affirm a clean legal status and then scrutinize their curriculum vita (CV).

Typically, their CV will provide where the physician has worked in the past and what, if any, continuing medical education courses they have taken.

This in-depth investigative work begins to paint a picture of the doctor’s experiences and capabilities.

Next we discussed with a physician the benefits of choosing locum tenens versus opening a private practice or perhaps joining a group. We learned that like most of us, doctors enjoy having choices and through the locum tenens experience, they can explore those choices by working in two or three practices in a geographical area or in different states. “They can now determine if they like the area, people, shopping, housing and schools,” states Mr. Driver. “Also, a doctor gets the chance to kick the tires of the practice a bit and make sure the practice offers the type of opportunity and advancement they seek. Remember, when a doctor gets out of medical school, opening a practice is one huge leap into the real world. Decisions like hiring medical employees, leasing

office space and finding your niche in the medical community are not necessarily the decisions a “fresh out of school” doctor is ready to make.

Locum tenens offers options and flexibility in their schedule.”

Now that we understand why physicians may choose to be a locums doctor, we questioned why an existing practice would use a locums company instead of hiring their own additional doctor to see patients, and found that the answer to both questions were very similar. When a practice uses a locum tenens staffing agency, they can call them and offer objective criticism, request to continue with the provider or ask to switch and schedule another provider for shift coverage that may be a better fit. So while many practices do hire their own doctors, once a commitment is made, making a potential change becomes more difficult. Again, flexibility is a big plus.

We asked Mr. Driver, in his opinion, what is the most common reason that practices utilize a staffing agency. “A practice called us last year and two of the three doctors in the partnership went on maternity leave at about the same time. These two lady doctors both planned to take 4 months off and enjoy their babies. They called us in advance, and we were able to put two female doctors in their practice for a 4 month assignment. Other situations that occur might be when doctors take vacation, or don’t feel well. And of course, doctors have to be part of the real world and attend that destination wedding! We have been in business for over 20 years, and have heard dozens of reasons why practices turn to us for physician support and scheduling. Though we prefer to schedule in advance, we can usually provide overnight solutions to practice scheduling emergencies. Our office receives calls almost weekly asking if we can supply a physician at their urgent care practice tomorrow.” About 8 times out of ten, Physician Solutions can accommodate that unexpected assignment.

I was also interested in knowing

‘‘

"Locum tenens can now determine if they like the area, people, shopping, housing and schools. Also, a doctor gets the chance to kick the tires of the practice a bit and make sure the practice offers the type of opportunity and advancement they seek."

if agencies handled the placement of traveling nurses as well or any other practice staff positions? “Some do", he explained, “while other agencies choose to be very specialized. I can’t imagine a physician staffing agency not having a web presence. Just perform an online search for locum tenens staffing agencies in your area. It will be a good place to start. I am certain their websites will provide you with all their placement capabilities.” 

Med Monthly would like to thank Mr. Driver and his locum tenens physician for their candid and informative interview. For additional information, contact Mr. Philip Driver at physiciansolutions.com.

MEDMONTHLY.COM |19

insight

Self-Awareness: A Critical Nursing Shortage

by Liz Ferron

A nurse’s workday is full of people in need: patients and their family members struggling to understand and cope with their medical conditions, co-workers requiring assistance, demanding physicians and administrators.

Then at home, they are often still helping others: children, spouses and partners, elderly relatives, friends, volunteer work - the demands and requests may seem never-ending.

20 | OCTOBER 2012

Most nurses are drawn to their professions by a desire or need to care for others—and many are more likely to think that taking time for selfexamination or self-care is highly selfindulgent. As a result, nurses are often less apt than the general population to pay attention to who they are, what they like, value and fear, what they need and why they do what they do.

Nurses who lack this “self-awareness” are often: • Overwhelmed with responsibili ties at work and at home— because they never say “no.”

• Resentful that they are over worked and overtired—because they don’t believe it’s right to request time to recharge or request that their organizations provide resources to help them.

• Willing to accept punitive or negative feedback—because of their own unrealistic and un achievable expectations for themselves.

Developing and using a healthy sense of self-awareness is a necessary first step toward being able to not only take better care of themselves, but also to becoming more resilient, setting healthy boundaries at home and work, engaging in healthier behaviors—and, ultimately, becoming a better nurse and caregiver.

A Practical Guide to Self-Awareness.

Some people have an intuitive knowledge of their feelings. But, for most, raising self-awareness takes a conscious effort. Paying attention to one’s “inner dialog” is critical to becoming more aware of one’s needs and recognizing that individual approaches taken often only rationalize and justify less than healthy ways of thinking and acting.

In coaching nurses who are feeling overwhelmed or burned out, we ask them if they: • Know which emotions they are feeling and why?

Example: “I’m feeling dis- appointed and uncomfortable with the way that surgeon is communicating with me.”

• Realize the links between their feelings and what they think, do and say? Example: “I asked to be transferred because the nurses on this unit are critical and I end up feeling inadequate when I work with them.”

• Recognize how their feelings affect their performance?

Example: “I’m so upset that I need to take a few minutes to calm down before I start filling medication orders.”

• Have a guiding awareness of their values and goals? Example: “My patient’s safety is more important to me than what Dr. X will say when I wake him up when he’s on call.”

• Know the things they want others to know about them? Example: “I take care of my elderly mother.

I take responsibility for what I do.

I love camping and hiking!”

• Know the things that they want and need? Example: “I’m sad about losing that patient. I need to take a walk outside and come to terms with my current feelings of grief. “ • Draw appropriate boundaries with others? Example: “No, I can’t help out with the class trip next week. I’ve been looking forward to seeing a dear friend.”

It’s important, when working toward greater self-awareness, to recognize that nobody makes anyone feel anything when they’re truly selfaware—we choose how we feel. In the end, we’re better caregivers when we take care of our own needs.

Translating SelfAwareness Into Self-Care.

After becoming more aware of one’s feelings, it’s time to put that knowledge to work in daily life. In making choices in terms of how to

react to situations and how to balance work and life responsibilities, we coach nurses to do the following: Manage emotions: Things will still happen that will leave feelings of anger, frustration or unhappiness.

However, the impact of those emotions—the degree they’re felt and for how long—can be a choice, not a foregone conclusion. For example, getting yelled at is never pleasant, but it doesn’t have to be devastating. Below are some techniques we couch our nurses to explore.

• Communicate concerns clearly and quickly. Example: “I feel hurt and angry with how Dr. X communicated with me today.

I’m going to let her know how I experienced her communication and get it off my chest. Hopefully, it will make a difference the next time we work together.”

• Refuse to dwell on negative thoughts or emotions.

Example: “I resent being talked to that way but hanging onto this resentment makes me feel awful.

Is there anything I can do to change the situation? I will choose to invest my mental energy in other places and think about more uplifting things.”

• Avoid negative behaviors.

Example: “I’d like to tell everybody what a jerk Dr. X is but that only adds to the gossip mill and keeps me thinking about it longer than I have to. I’m going to mention it to my nurse manager in case it happens again and then let go of it.”

• Admit to mistakes. Everyone makes mistakes, sometimes small, sometimes catastrophic.

Agonizing over mistakes doesn’t erase them—looking for short and long-term solutions can.

Example: “What can I do right now to improve the situation?

What could I have done differently? How can I avoid continued on page 22 MEDMONTHLY.COM |21

‘‘

continued from page 21

making the same mistake again?”

• Accept and act on valid feedback. While nobody has the right to yell at others, a doctor, supervisor or co-worker may occasionally point out a performance area that needs improvement. If it’s valid, own up to it, apologize if necessary and commit to improving whatever skill or behavior is deficient. Unless the mistake is life threatening, nobody will expect changes to occur overnight. They’ll be looking for progress, not perfection.

Self-advocate: For many caregivers, putting themselves first doesn’t come naturally. Putting off exercise, sleep and fun is so ingrained that many nurses have to formally add exercise, sleep and fun to their daily to-do lists—and give them the same weight as work or family responsibilities (that’s why it’s called work/life balance). Our recommendations are: • Journal: Keep a notebook at the bedside and spend a few minutes each night writing down every positive experience from that day and then things to do tomorrow.

• Exercise: Commit to regular exercise—the more fun it is, the more appealing it will be.

• Sleep: Identify sleep patterns and needs and strive to optimize them. Getting adequate sleep is critical to both emotional and physical health.

• Stretch and meditate: Both are proven to reduce stress and increase energy.

• Indulge in indulgence: Find affordable treats and luxuries —from bubble baths and ice cream cones to picnics or grocery store flowers.

• Connect with friends: Regular events like book clubs are a wonderful way stay in touch without having to coordinate schedules each time.

22 | OCTOBER 2012

It’s important, when working toward greater self-awareness, to recognize that nobody makes anyone feel anything when they’re truly self-aware – we choose how we feel.

•

Disconnect technology: When not on call, turn off cell phones and computers while having dinner, visiting with friends—or just relaxing.

Case Study: From SelfAwareness to Self-Care.

A middle-aged nurse contacted us because, a year after ending her marriage to a mentally ill spouse, she was depressed, exhausted and frustrated that she wasn’t getting the help with chores she felt she needed from her adolescent kids at home.

In discussing her kid’s nonresponsiveness, she realized that her guilt over staying in the marriage as long as she had now made her reluctant to hold her kids accountable for meeting her perfectly reasonable demands. In discussing her exhaustion, it became clear she was working too many hours and then spending her free time meeting the needs of everyone else in her life except herself.

With that new awareness, she

began insisting that her kids shoulder their fair share of household chores.

She also began building a network of exercise buddies and a schedule for working out that was both fun and got her to work feeling more energized, confident and happy.

In just two weeks, this nurse had discovered a variety of small ways to make a dramatic improvement in her outlook and life.

Other Avenues to Explore.

Everyone experiences the journey to self-awareness and selfcare differently. For those who are struggling, there are many avenues to explore. The first might include an Employee Assistance Program (EAP), if one is available, for counseling, coaching and other resources.

Aside from an EAP, there may be affordable counseling services in the community. In most cases, employee health insurance provides coverage for these services. A session or two may be all that is needed to provide some insight about what is going on in one’s life and to create a plan for aligning behaviors and attitudes with a more rewarding nursing career and life.

Other resources to consider include: • Clergy or spiritual advisors • Hospital chaplains • Self-help courses and books • Mindfulness meditation courses • Local support groups (especially ones with other nurses and health professionals) There is more support out there than most are aware of. Committing to taking better care of oneself is an important part of achieving greater self-awareness.  Liz Ferron is a senior Employee Assistance Program (EAP) consultant and manager of clinical services at Midwest EAP Solutions in Minneapolis, Minnesota. . For more information, visit www.physicianwellnessservices.com.

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insight

To Locum Tenens or Not to Locum Tenens, That is the Question

by Mandy Huggins Armitage, MD

Read about the research one physician did when considering the life of a locum tenens physician and what she learned.

24 | OCTOBER 2012

I first heard about locum tenens when I was in residency. As most readers know, locums work is temporary employment for physicians in order to fill short-term staffing assignments wherever they are needed; in single practices, hospitals and even government facilities. In its inception, it was primarily utilized by small, one-physician practices in rural areas.

If the doctor became ill or went on vacation, there was no need to close up his practice.

Initially temporary work did not appeal to me, as I enjoy establishing relationships with my co-workers and getting to know a city. However, the more I learned about it, the more interested I became. I was especially interested in the international opportunities, so I began to do some online research and seek out advice from those who were well-versed.

According to surveys, reasons for choosing locum tenens work are many, but they tend to vary by age. One survey published in 2004 indicated that older (>54 years of age) physicians chose this work because of a desire to work part-time. However, younger physicians were seeking a more flexible work schedules and the ability to experience several different practice environments to help them learn where they felt most comfortable.

Schedule flexibility was also the dominant reason among women who may, for instance, have children and a home to care for. So, while some physicians would like to experience how health care systems operate elsewhere, others (including myself) appreciate the opportunity to be free from administrative responsibilities.

Another interesting thing I learned about locum tenens positions is that the duration of employment is totally variable, depending upon the needs of the hiring organization. The job could last anywhere from one week to several months or longer. The temporary nature was appealing to

me at the time because I wanted to experiment with different locations and explore life in different parts of the world. There is no long-term commitment, which is ideal for a young physician fresh out of residency.

At the time, I was nearing the time of residency, when it’s time to look for a “real job.” I thought, “Why not try a new location? I’m not married; don’t have kids… perfect time to do this.”

My fellow residents who were also looking into locum tenens work at the time were in the same social boat.

Of course, we knew that oftentimes these temporary positions can transition into permanent work, if the temporary position is a good fit for the physician and the hiring organization.

They didn’t really give too much consideration to the long-term, however. They were more interested in the adventure of finally being done with residency and relocating to a new city or country.

Another reason I wanted to look into short-term work was the competitive pay. After researching his options after residency, my family medicine friend was attracted by higher salaries offered in some locations, especially in more rural areas. This was appealing to those of us coming out of training with six-figure loans. Other perks of locum tenens are not limited to competitive pay.

Often, housing, local transportation and professional liability insurance are also covered. One physician I know was offered a position in a small town in a not-so-desirable state to address a shortage of anesthesiologists. However, her husband was finishing his residency in another state. At the end of the day, she couldn’t turn down the offer because of the highly competitive pay. Another locum I worked with requested an assignment in a coastal town near the ocean. He packed up his family, worked only 3 days a week and they spent quality time together for a few weeks in a beautiful, vacation

like setting.

I found plenty of advice online, mostly from physicians offering advice about the contract you sign with your placement agency. They recommended confirming details of on-call and practice hours, expectations of duties performed, payment schedules and professional liability insurance. All the specifics of your agreement should be in writing. I could only assume that these words of wisdom were spoken from experience.

Overall, I have no doubt that locum tenens work can be an enjoyable and exciting experience for a physician seeking change or exploring his or her options. My anesthesiologist friend had such a good experience that she recommends it as a way to search for a permanent position. She cautions that it is not fitting for all personalities, though the same could probably be said for most aspects of medicine.

As for me, I didn’t end up doing any locum tenens work at that time. I went on to complete a fellowship and, in the meantime, met my future husband.

Although I found a position in a good location after fellowship, my husband and I dream of moving around some before having children. I still foresee working as a locum tenens physician in my future. We haven’t yet decided where we want to settle down and the locum field allows for employment and the much needed paycheck much quicker these days than searching for a full time position. I also believe I may want to consider shorter work weeks after my first child is born. It is reassuring to know that there are options available through the locum tenens industry that will allow for the work schedule flexibility physicians may want or need.  1. Locum Tenens on the rise; employers cite doctor shortage.

Medical Economics 2011;88(5):25.

2. http://www.locumtenens. com/about/locum-tenens. Accessed September 1, 2012.

MEDMONTHLY.COM |25

practice tips

Deciding When and Ho To Start the ICD-10 Con Here Are Some Ideas.

by Mary Pat Whaley, FACMPE managemypractice.com

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.

The compliance deadline for implementation of ICD-10 is October 1, 2014. Most coding experts recommend training staff 6 months before the deadline. What’s a practice to do with the other 18 months?

Who chooses the ICD-9s in your practice today?

There are many methods physicians/providers use to choose a diagnosis code: 1. Encounter forms (AKA superbills, fee slips, routing slips, etc.) are used in many practices, even those with EMRs, for the physician/ provider to choose the service and corresponding diagnosis. In some practices, medical assistants or nurses may complete the encounter form with the physician’s instructions.

2. Physicians/providers may write out their diagnoses and leave staff to translate it into a code.

3. Surgical practices may have encounter forms for non-office surgeries, or they may use other means to communicate to the biller what actually was done in the OR. Surgeons 26| OCTOBER 2012

may use smartphone or iPad charge capture, dictation or surgery cards or duplicate-form tear sheets. Coders may abstract the codes from the dictation the physician completed in the hospital.

4. Electronic Medical Record packages may offer physicians choices of diagnoses based on those most-used in the practice, and/or related to the documentation entered and those CPTs and ICD-9s, once chosen, are interfaced to the billing system.

5. Some physicians may use both an EMR and an encounter form.

6. Coders may abstract the diagnosis straight from the documentation without any intervention on the physician/provider’s part.

Regardless of who chooses the ICD-9 today, realize that ICD-10 will require the diagnoses descriptions in the documenting process to be to be much more specific. If the physician/ provider is doing the choosing (always my recommendation for non-surgical services), the documentation must support the diagnosis code just as if a coder is abstracting the code.

Physicians could start by improving their diagnosis documentation now.

Closer to the October 2014 deadline, your practice may want to have an audit of your diagnosis documentation to see how you would fare in ICD-10 world, and to assist physicians in improving their documentation skills.

Take this opportunity to make your current system better.

A host of changes can potentially use ICD-10 as a scapegoat! For groups using EMR and relying on encounter forms “because it’s comfortable”, the move to ICD-10 is an excellent reason to get rid of the encounter forms.

Pushing the code straight from the EMR to the practice management or billing system is the most efficient method overall.

For groups using paper charts, there are a number of free and pay ICD-9 smartphone apps for all brands of phones. Undoubtedly apps will soon be available that crosswalk ICD-9 to ICD-10, so get started now getting comfortable with searching for and bookmarking your most used diagnoses on your phone or iPad.

?

ow nversion Physicians, does your EMR do this?

Some EMRs already have ICD-10 information in place and available for use now. If it does, start looking at the ICD-10 information provided and begin compiling your new list now. Start your own internal crosswalk to help train your brain for the future.

Think about the life of an ICD-9 code in your practice today.

Make a list of every place and every process an ICD-9 touches. Think beyond attaching a diagnosis to the patient visit, and consider other ways you use ICD-9s -- referrals, test ordering, registries, research, etc.

Consider who in your practice should become the ICD-10 specialist.

It could be a physician, a nurse, a coder or a biller. Someone in your practice should attend webinars or classes to understand the structure of ICD-10 and take on the mentor role for the practice. It may be your coder, but if your coder doesn’t have formal anatomy and physiology training, it might be someone else in the practice.

Who should it be?

Is there a possibility ICD10 will be further delayed or even go away?

Absolutely! Anything is possible.

Personally, I don’t think it will, and I would rather hedge my bets by spending some time between now and

October 2014 preparing for it, then be taken by surprise and try to ramp up in a very short amount of time.

If you start thinking about it now, you will have 2 years to budget and train for the conversion. You can make ICD-10 a standing item in your board and staff meetings. You can start evaluating physicians, providers, clinical staff and administrative staff for a starring role in the “big change”.

Start the walk, the crosswalk, that is.

Some ICD-9 codes will have one ICD-10 code only. The rest will have more than one possible ICD-10 code.

Start by running a report from your billing system or EMR on your top twenty ICD-9s and check to see which of your top 20 ICD-9s have more than one possible ICD-10.

Resources from CMS – Implementation Guides.

CMS has developed implementation handbooks to assist with the transition from ICD-9 to ICD-10 codes. Each guide provides detailed information for planning and executing the ICD-10 transition. Use the guides as a reference whether you’re in the midst of the transition or just beginning.

The appendix of each handbook has templates that are available for download in both Excel and PDF files. The templates can be customized for your use and have been created to help entities clarify staff roles, set internal deadlines/responsibilities and assess vendor readiness.

View the tailored step-by-step plans and relevant templates for each of the following audiences impacted by the transition: Large Practices (PDF, 2,773KB) 1. Templates Small Hospitals (PDF, 3,548KB) 1. Templates Small/Medium Provider Practices (PDF, 3,116KB) 1. Templates Also available are detailed timelines of activities that providers, payer and vendors need to carry out to prepare for ICD-10, download timeline widget available at CMS.gov to your desktop or mobile device.

(Please note the widget and timelines can be used to calculate how long specific ICD-10 transition activities will take. Dates in the widget and timelines are based on the original October 1, 2013, deadline, which HHS has extended to October 1, 2014.)  http://www.cms.gov/Medicare/Coding/ICD10/ICD-10ImplementationTimelines.html MEDMONTHLY.COM |27

practice tips

How to Be a Good Worker’s Comp Doc

by Lawrence Earl, MD

Physicians do a disservice to patients with work related injuries by not understanding basic “return to work” practices. Given the same injury, patients who go back to some type of productive work as early as possible have less long term disability, are more productive, and happier than those who are kept out of work. In her article “7 Signs Your Injured Worker is Treating with a Physician Who is Not Employer Friendly,” Rebecca Shafer makes some excellent points about physicians treating worker’s comp injuries. Her article is geared towards the payor side, so I will add comments that the treating physicians/providers need to consider when treating these patients. (This is a huge topic, but these are the basics.)

• Placing the Patient Off Duty As Ms. Shafer states, if a patient is off duty, it means they are totally disabled, as in the hospital, going directly to surgery or absolutely unable to move. This is rarely the case. Often times, the patient will tell the provider “there’s no light duty at my job.” I generally explain to the worker that they will improve quicker if they return to some type of productive work immediately. I further explain that I must first determine what their job duties are, then determine if the injury prevents them from doing the essential elements of the job. If they can return to full duty with only “first aid” level care, the injury may not even be OSHA recordable, which will help your clients (the employer) immensely.

If they cannot do their regular duties, physicians should write specific restrictions on what they can or cannot do in terms of stand, sit, walk, lift, carry, push, pull, climb, crawl, reach, grasp, etc., and how many pounds for what period

28 | OCTOBER 2012

of time–occasional, frequent or continuous. Any physician providing workers comp services should have some type of form on which you can indicate these restrictions.

• Follow Up After the first visit, follow ups, should be in just 2 or 3 days.

Many times the injury will be significantly improved and the patient can be returned to full duty. Other times the patient will complain they are worse. Should this occur, be sure not have a “knee-jerk” reaction and take them off duty. Rather, focus on their demonstrated level of functional ability in order to determine work status, not subjective complaints.

Be sure to always write the restrictions based on examination of their ability to function, and always explain that it is in their best interest to continue to work to this level of ability. Generally, my subsequent follow ups are scheduled weekly.

• Medications If an injury is minor and the worker is returning to full duty, treat the injury as “first aid”, to avoid an OSHA recordable.

Prescribing OTC NSAIDs at OTC strength is generally fine for most minor injuries. Remember, if you prescribe Motrin 600 instead of 400 it is going to be recordable. If you are not completely familiar with what is or is not considered first aid regarding OSHA recordables, please refer to my article on OSHA recordables on my website at UrgentCareMentor.com.

• Physical Therapy Yes, physical therapy (PT) can be easily abused, but also mandatory

for injuries showing a functional deficit. If the worker cannot return to full duty within a week or so, or if they are off duty and not in the hospital, I am aggressive with PT to restore mobility, function and also importantly, confidence and motivation. I personally prefer having a close working relationship with the therapist so we are a team working to get the patient functional as soon as possible. I did not have a PT department in my last urgent care center, but would if I had the space.

• Specialist Referrals Obviously, if there is a surgical problem, the patient needs to be referred right away, and be watchful that do not end up in “limbo” with no duty prescription or excessive lost time waiting for the specialty appointment. If the patient is not progressing, (e.g. showing signs of improvement in function, with progressive lightening up of work restrictions within 2-4 weeks), generally it is best to consult a specialist.

• Communication Yes, notes, restrictions, meds, PT, diagnostics, referrals and follow up plans, as well as expected date of maximal medical improvement (MMI) or prognosis should be legible and reported at each and every visit.

Providing customized, simple

NUTRITION SOLUTIONS to

ENHANCE HEALTH and

OPTIMIZE SPORTS PERFORMANCE

Treating injured workers effectively requires an understanding of proven return to work practices and strong cooperation and communication among providers, employers, adjusters, payers and patients. 

Tracy Owens, MPH, RD, CSSD, LDN Ashley Acornley, MS, RD, LDN 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 919-876-9779

Reprint Source: http://urgentcarementor.com/2012/02/

Blue Cross Blue Shield of North Carolina insurance provider.

practice tips

Best Practices to Enhance the Patient Experience

by Frank J. Rosello, CEO Environmental Intelligence LL In recent years, much has been written about electronic health records (EHR) technology. Practically everything published about EHR centers around Meaningful Use adoption, government incentive programs, and how the technology itself is a tool for physicians to deliver more efficient and higher quality care to patients.

While all of these articles on the subject of EHR are well written and relevant, one very important aspect of the health care equation seems to be consistently overlooked.

30 | OCTOBER 2012

What about the patient? How do patients feel about their physician using EHR technology to provide care and treatment? Do patients see the value and recognize the difference in their care between physicians that use EHR versus those that don’t?

The following story happened recently in North Texas and probably takes place many times everyday through the United States.

A patient relocated from one area of town to another and the time came for their annual physical examination.

Given the distance between where the

patient’s current physician practice was located and their new home, the patient decided to choose a new physician. The patient performed the necessary due diligence, selected a new physician and made the appointment for their annual physical.

The patient arrived for their scheduled appointment and as expected, was handed a clip board that contained at least eight pages of documents. The patient, relying on memory alone, completed the documents knowing that some specific details and occurrences regarding

their medical history are not one hundred percent accurate. Shortly after returning the completed documents to the receptionist, the patient was called to the examination area.

Once the patient was situated in the exam room, a nurse entered with the completed documents. The nurse proceeds to ask the patient specific questions regarding their responses and records that information on a computer. After this question and answer session is complete, the nurse hands the patient a form that contains detailed instructions on how to set up an online account with the practice.

The nurse explains the purpose of the account and that it is used by the physician to communicate directly with patients including the delivery of any lab and test results. The patient was really impressed with this capability, which provided additional assurance that they made the right decision selecting this physician.

‘‘

Patients love gadgets and this technology will not only enhance the patient experience and save medical practices time and money.

At different times during the actual physical examination and dialogue exchanged between the patient and the physician, the same nurse was physically present in the exam room recording information on the computer. Being that this approach was a new experience for the patient, there were times where the patient felt a little bit uncomfortable with all the in-and-out of the exam room by the nurse. After the exam and all necessary tests were complete, the patient was sent on their way with the expectation that all test results, along with the physician notes, would be sent via the online account. One week following the appointment, the patient retrieved a comprehensive report on all tests performed along with specific notes from the physician. All in all, the patient viewed this new health care approach as extremely positive and the most thorough and professional they have ever experienced.

This patient experience speaks to the mutual benefit that EHR technology brings to patients and physicians. The technology allows patients to be more empowered around their health and it allows physicians to be more efficient and accurate in the care they provide.

Along these same lines, here are a few more best practices that could further enhance the patient experience while creating even more efficiency to the day to day operations of a practice:

Adopt electronic patient check-in software to replace paper-based patient check-in.

There are several stand-alone applications that will integrate with existing EHR platforms that even include the capability for patients to use either computer tablets or even iPad’s to capture new patient information or for existing patients to update their information. This

capability may also allow new patients to automatically enroll in the practice patient’s portal at the time of completing new patient forms. Patients love gadgets and this technology will not only enhance the patient experience and save medical practices time and money.

Adopt a medical speech recognition solution or equip physicians with computer tablets.

This emerging technology is designed to help clinicians create medical notes directly into their EHR platform in real-time. This capability may dramatically improve both physician and patient workflows, thus making the practice more efficient, save patients time, and save the practice money. This will eliminate unproductive time spent by nurses performing the in-and- out functions between exam rooms

Improve patient communications about EHR adoption and utilization.

This last best practice is about educating patients about EHR. I believe that the vast majority of patients have no idea what an EHR is and the value the technology brings to their care. Educate patients about EHR technology. Familiarizing patients with the investment made to deliver the highest quality care will go a long way to sustaining the confidence patients have in their physician.

Effective communication will also encourage patients to take more control of their health as many EHR platforms have the capability to transfer their EHR information to their own personal health record (PHR).

By the way, the patient was me!  MEDMONTHLY.COM |31

research & technology

Technology in medicine has things on the move and in constant change.

And now there’s some high tech help for those with Obsessive Compulsive Disorder (OCD).

OCD is an intrusive anxiety disorder that produces uneasiness, apprehension, fear or worry. Those afflicted are plagued by repetitive behaviors they believe will reduce their anxiety or by a combination of obsessions and compulsions. The often misunderstood, alienating and time-consuming symptoms of the disorder can include excessive washing or cleaning; repeated checking; extreme hoarding; preoccupation with sexual, violent or religious thoughts; relationship-related obsessions; aversion to particular numbers; and nervous rituals, such as opening and closing a door a certain number of times before entering or leaving a room. To others, they may appear paranoid and even psychotic. What may be worse, OCD patients generally recognize their irrational behavior causing deeper emotional distress.

Left untreated, OCD symptoms can progress to the point to where leading a normal life becomes impossible.

Sufferers may become consumed, while behaviors impede their ability to work and maintain or enjoy important relationships. Many people with OCD have suicidal thoughts.

Medication is usually part of treatment along with: Cognitive Behavioral Psychotherapy - Cognitive/ 32| OCTOBER 2012

behavioral therapists help patients change the negative styles of thinking and behaving that are often associated with the anxiety involved with obsessive compulsive disorder.

Behavioral Therapies - Behavioral therapies for OCD include ritual prevention and exposure therapy.

A mental-health professional can assist through prevention of rituals which involves encouraging the OCD sufferer to endure longer and longer periods of resisting the urge to engage in their compulsive behaviors. Exposure therapy is the process by which the individual is put in touch with situations that tend to increase the OCD sufferers need to engage in compulsions and helping them resist doing so.

Dr. Kristen Mulcahy is an expert in the use of Exposure and Response Prevention (ERP) therapy. Dr. Mulcahy received her Ph.D. in clinical/ school psychology from Hofstra University. She developed a specialty in OCD spectrum disorders through research and clinical work at the BioBehavioral Institute, an internationally renowned treatment and research center in New York. She is currently the director of the Cognitive Behavioral Institute in Cape Cod, Massachusetts.

Dr. Mulcahy’s research and 15 years of treating ODC sufferers through ERP led to the creation of a mobile health therapy application that puts often

much needed treatment in the hands of the patient full time. The application was developed in collaboration with leading professionals, sustained rigorous pilot testing and was extensively researched to support efficacy. According to Dr. Mulcahy, the interactive application, “Live OCD Free”, has been designed to guide users through the only evidence-based treatment for OCD. OCD sufferers can now carry along their own personal pocket therapist, available any time to help coach them through their battles with this debilitating and consuming mental disorder.

The application can be easily downloaded and includes video tutorials and a comprehensive user guide. Users are prompted upon completion to move from one exercise to the next and can set daily reminders to practice their challenges. They can set their own compulsion-resisting goals and receive rewards for making progress. Plus, the app tracks the user’s progress and sends reports directly to their therapist. There are two versions currently available, one for adults and one for children which is set up to be played like a game.

There is an estimated 4 million people in the United States suffering with OCD, many of which don’t receive treatment or have access to a therapist. These stats are what motivated Dr. Mulcahy to develop “Live ODC Free”.  Dr. Kristin Mulcahy. (n.d.). About Dr. Kristen Mulcahy. In OCD: Real Stories, Real Help. Retrieved September 21, 2012, from http://drkristenmulcahy. com/about-dr-kristen-mulcahy/.

Retrieved September 21, 2012, from http://en.wikipedia.org/wiki/ Obsessive%E2%80%93compulsive_ disorder.

(April 30, 2012). Live OCD Free Mobile Therapy App Now Available. In Live OCD Free in the News. Retrieved September 21, 2012, from http:// liveocdfree.com/in_the_news.phd

MEDMONTHLY.COM |33

legal

The Independent Payment Advisory Board:

The Stalking Horse of Payment Reform

This article will provide you with a general understanding of the IPAB’s structure, the surrounding controversy, and the likely impact going forward.

The health care industry and government policymakers are confronting a familiar paradox in the industry's finance. With an aging population, rising medical costs and an assortment of new subsidies following health care reform, the topic of next month's issue, increased spending seems unavoidable for the foreseeable future.

On the other hand, with limited revenue growth and other noteworthy burdens on the federal budget, increased spending is no longer an option.

34 | OCTOBER 2012

by Larry L. Lanham II, Dinsmore & Shohl LLP, Columbus, OH

In a report issued earlier this year, the Congressional budget office estimates that federal spending on healthcare programs will double in the next ten years, from $847 billion in 2012 to a staggering $1.8 trillion in 2022.1 With an aging baby-boomer population, the primary culprit in the spending boom is Medicare, which is estimated to account for about onehalf of increased spending.

Under Section 3403 of the Affordable Care Act (ACA), Congress created the Independent Payment Advisory Board (IPAB).2 With a goal of reducing the growth rate in Medicare spending, the IPAB will be responsible for developing payment reform proposals if projected Medicare spending exceeds certain targets.3 Unless Congress enacts its own legislation under a new and expedited legislative procedure, the Secretary of the Department of Health and Human Services (HHS) must implement the IPAB’s proposals.4 The IPAB’s potential influence over payment reform has served as kindling for an increasingly heated debate.5 As recently as March 22, 2012, the House of Representatives approved the repeal of the IPAB through its passage of H.R. 5, the Protecting Access to Healthcare Act.6 Though it is expected the repeal legislation will die in the Senate, the debate will continue.

IPAB Structure Member Composition/ Qualifications

The IPAB will consist of 15 voting members who will be appointed by the President for a six-year term, subject to the advice and consent of the Senate.7 The President must appoint nationally recognized experts in areas such as health care finance, actuarial science, integrated delivery systems and facility management.8 Appointments also must ensure broad geographic participation.9 While the IPAB must include

physicians and other health care professionals, the majority of IPAB members must be individuals who are not involved in the provision or management of Medicare-covered items or services.10 IPAB members will be subject to federal ethics laws and be required to make public disclosures of potential conflicts of interest.11 Among the most interesting qualifications for IPAB membership, also aimed at preventing conflicts, is the requirement that appointees may not engage in “other business, vocation or employment.12”Accepting the appointment will require a fulltime commitment. Once appointed, IPAB members may be removed only in relation to their neglect of duty or malfeasance in office.13

The Three-Year Cycle

The IPAB’s goal is to reduce the growth rate in Medicare spending, but only if the projected growth exceeds certain thresholds. Whether the IPAB develops proposals depends upon two annual projections that will be made by the Chief Actuary of the Centers for Medicare & Medicaid Services (CMS).14 The three-year cycle of the IPAB is composed of a determination year, proposal year and implementation year. The “determination year” is the first year in the cycle, during which the Chief Actuary makes projections about Medicare growth rates that will exist two years into the future, known as the “implementation year.”15 If projected growth exceeds a defined threshold, the IPAB will be required to develop proposals during the second year of the process, known as the “proposal year.”16 The two key projections include the “Medicare per capita growth rate” and the “Medicare per capita target growth rate.”17 If the projected per capita growth rate exceeds the projected per capita target growth rate, the Chief Actuary must establish a “savings target,” at which point the IPAB must develop proposals.18 The

IPAB’s proposals must not include any recommendations to “ration health care, raise revenues or Medicare beneficiary premiums . . ., increase Medicare beneficiary cost-sharing . . ., or otherwise restrict benefits or modify eligibility criteria.”19 The inaugural three-year cycle begins next year. The Chief Actuary must complete the initial round of projections by April 30, 2013.

If projected growth exceeds target growth for 2015, the IPAB must develop and submit payment reform proposals by January 15, 2014.

Thereafter, the process is repeated annually. The Chief Actuary already estimates that target growth rates will be exceeded in 2015-2019.20 While IPAB proposals must be designed to achieve target savings, the ACA does not require that IPAB proposals address all excess growth.

Instead, the ACA mandates only that IPAB proposals achieve savings equal to the lesser of excess growth or certain minimum percentages.21 The minimum percentages range from 0.5 percent to 1.5 percent depending on the year.22 For example, if the projected Medicare per capita growth rate for 2015 is 10 percent and the projected Medicare per capita target rate is 3 percent, the IPAB’s proposals only need to achieve savings equal to 0.5 percent rather than 7 percent. Although the IPAB could make proposals that achieve savings greater than 0.5 percent in 2015, it will satisfy its legal obligations by developing proposals that are far less drastic.

IPAB Proposals Development to Implementation

After the Chief Actuary determines that projected growth will exceed target growth in the determination year, the IPAB must create draft proposals by September 1 of the same year, at which point the draft proposals must be submitted to continued on page 36 MEDMONTHLY.COM |35

continued from page 35

the Medicare Payment Advisory Commission (MedPAC) and HHS Secretary for review and comment.23 Following consultation, the IPAB will submit final proposals to Congress and the President by January 15 of the following year.24 Each proposal must include: (1) Recommendations for achieving savings.

(2) An explanation for each recommendation.

(3) An opinion from the Chief Actuary that the recommenda tions meet the savings target.

(4) Draft legislation that implements the recommendations.

(5) All other information the IPAB deems relevant.25 Upon receipt, the IPAB proposals are introduced in the Senate and House of Representatives by the respective majority leaders.26 The ACA then provides an expedited legislative procedure with limited committee review, time limitations for debate, and the consideration of only germane amendments that achieve the same savings targets.27 Congress must enact legislation rejecting or amending the IPAB proposals within six months, prior to August 15.28 To change the expedited procedures, an affirmative three-fifths supermajority vote is required.29 If Congress neither enacts alternative proposals by August 15 of the proposal year nor revises the expedited procedures, the HHS Secretary must implement the IPAB’s final proposals to Congress.30 The Secretary’s “implementation” of the IPAB’s proposals is not subject to administrative or judicial review.31

Rationale/Criticisms

The Obama Administration touts the IPAB as a panel of experts who will help ensure Medicare’s financial sustainability.32 As explained by one author, the IPAB grew out of concern that “Congress was unable to enforce fiscal discipline on itself.”33 36| OCTOBER 2012

For proponents, many of the fears expressed about the IPAB are believed to be overstated. The IPAB is viewed as nothing more than a pragmatic mechanism for confronting rising costs through experts who will be more insulated from the political pressures that plague Congress.34 Though IPAB members are unelected, supporters argue that Congress itself created the IPAB, that judicial and regulatory positions are regularly filled by appointees upon confirmation by the Senate, and that Congress still has the power to reject or amend the IPAB proposals.35 Leading the opposition to the IPAB are the American Medical Association (AMA) and other industry stakeholders.36 Hundreds of organizations have called for a full repeal of the IPAB.37 Opponents criticize the IPAB’s scope of authority and lack of flexibility,38 as well as its potential impact on patient access to quality care.39 In relation to IPAB members, the AMA argues that practicing physicians are excluded by virtue of the full-time nature of the position.40 Once the IPAB begins developing recommendations, the AMA also contends that physicians will bear the brunt of any spending cuts, since hospitals, home health care, and hospice are specifically exempted.41 Others are less concerned with the substance of proposals than the IPAB’s perceived usurpation of Congress’ authority.42 The belief is that payment reform proposals should be fully vetted and approved by Congress.

Conclusion

The controversy surrounding the ACA’s enactment is a fitting prelude to the emerging debate over the manner in which health care providers and suppliers are reimbursed for services.

Given the complexity of payment reform and shallow discourse that saturates national politics, it is tempting to believe that payment reforms will not be adopted in the near future.

‘‘

"Leading the opposition to the IPAB are the American Medical Association (AMA) and other industry stakeholders."

Left unchanged, the IPAB will likely occupy a prominent role in driving reforms. With industry-wide growth regarded as the central malady, notions of shared responsibility will likely permeate IPAB proposals. As constituencies are asked to make sacrifices, the IPAB’s chief vulnerability resides within perceptions of unfairness among those who believe they are being asked to shoulder disproportionately large cuts without a full legislative process. At a minimum, the IPAB will force Congress to have a discussion about controlling health care costs, even if abbreviated. It is also possible that Congress will attempt to modify the IPAB to mitigate the perceptions of unfairness. As recent history suggests, modification or even a full repeal of the IPAB are possibilities.

In the absence of a Republican sweep of the White House and Congress or a Supreme Court ruling striking down the ACA in its entirety, it seems likely the IPAB will have a prominent role in the payment reform debate. With or without the IPAB, however, payment reform will continue to be a problematic regulatory and legislative enigma.  About the Author (larry.lanham@dinsmore.com) Larry Lanham is an associate attorney practicing in the Health Law Practice Group of Dinsmore & Shohl LLP. Based in Columbus, OH, Larry’s practice is primarily focused on the representation of clients in transactional and state/federal regulatory matters affecting the health care industry.

______

(1) Congressional Budget Office, The Budget and Economic Outlook: Fiscal Years 2012 to 2022, available at www.cbo.gov/doc. cfm?index=12699 (last accessed Jan. 2012).

(2) 42 U.S.C. § 1395kkk; Section 1899A of the Social Security Act. For a more in-depth analysis of Section 3403, see Michael H. Cook, Independent Payment Advisory Board: Part of the Solution for Bending the Cost Curve? J. Health & Life Sci. L. (Oct. 2010).

(3) 42 U.S.C. § 1395kkk(c)(B)(i)–(viii).

(4) 42 U.S.C. § 1395kkk(e). It should be noted there are a few limited exceptions to implementation by the Secretary, which are listed in 42 U.S.C. § 1395kkk(e)(3).

(5) Tom Cohen, Health Care Debate Shifts to Medicare Panel, CNN, Mar. 21, 2012, available at www.cnn.com/2012/03/21/politics/healthcare-ipab/index.html (last accessed Apr. 16, 2012).

(6) Ed. O’Keefe, Bill Stripping Parts of Health Care Law Passes House, Wash . Post, Mar. 22, 20120, available at www.washingtonpost.com/ blogs/2chambers/post/bill-stripping-partsof-health-care-law-passeshouse/2012/03/22/ gIQAp9LqTS_blog.html (last accessed Apr. 4, 2012).

(7) 42 U.S.C. § 1395kkk(g)(1)(A), (g)(2). The IPAB also will consist of three nonvoting members, including the HHS Secretary, and the Administrators for Centers for Medicare & Medicaid Services and Health Resources and Services Administration. Id. (8) 42 U.S.C. § 1395kkk(g)(1)(B).

(9) 42 U.S.C. § 1395kkk(g)(1)(B).

(10) 42 U.S.C. § 1395kkk(g)(1)(B). This is different than saying that health professionals, more generally, may not constitute a majority of IPAB members.

(11) 42 U.S.C. § 1395kkk(g)(1)(C).

(12) 42 U.S.C. § 1395kkk(g)(1)(C).

(13) 42 U.S.C. § 1395kkk(g)(4).

(14) 42 U.S.C. § 1395kkk(c)(6).

(15) 42 U.S.C. § 1395kkk(b)(1).

(16) 42 U.S.C. § 1395kkk(b)(2).

(17) 42 U.S.C. § 1395kkk(c)(6)(A).

(18) 42 U.S.C. § 1395kkk(b)(2), (c)(7)(A).

(19) 42 U.S.C. § 1395kkk(c)(2)(A)(ii). There are several other critical limitations on IPAB proposals that are not covered by this article. For example, IPAB proposals may not include any recommendations that would reduce payments for items or services that, prior to December 31, 2019, are scheduled “to receive a reduction to the inflationary payment updates of. . . in excess of a reduction due to productivity in a year in which such recommendations would take effect.” 42 U.S.C. § 1395kkk(c)(2)(A)(iii). This will preclude the IPAB from “making adjustments during the early years of its existence for . . . hospitals, home health agencies, and hospice.” Cook, supra note 2, at 110.

(20) Richard S. Foster, Estimated Financial Effects of the “Patient Protection and Affordable Care Act” as Amended, April 22, 2010, available at www.cms.gov/Research-Statistics-Dataand-Systems/Research/ActuarialStudies/ downloads//PPACA_2010-04-22.pdf (last accessed Apr. 18, 2012).

(21) 42 U.S.C. § 1395kkk(c)(7)(B).

(22) 42 U.S.C. § 1395kkk(c)(7)(C).

(23) 42 U.S.C. § 1395kkk(c)(2)(D)–(E).

(24) 42 U.S.C. § 1395kkk(c)(3).

(25) 42 U.S.C. § 1395kkk(c)(3).

(26) 42 U.S.C. § 1395kkk(d)(1).

(27) 42 U.S.C. § 1395kkk(d)(4).

(28) 42 U.S.C. § 1395kkk(e)(3)(A)(i).

(29) 42 U.S.C. § 1395kkk(d)(3)(D), (d)(4)(B) (v).

(30) 42 U.S.C. § 1395kkk(e)(1), (3). The ACA also limits implementation if, by February 1, 2017, both the House of Representatives and Senate, by joint resolution, votes to eliminate the IPAB. 42 U.S.C. § 1395kkk(f).

(31) 42 U.S.C. § 1395kkk(e)(5).

(32) Executive Office of the President, Statement of Administration Policy: H.R. 5 – Protecting Access to Healthcare Act, March 20, 2012, available at www.whitehouse.gov/ sites/default/files/omb/legislative/sap/112/ saphr305r_20120320.pdf (last accessed Apr. 17, 2012).

(33) Cook, supra note 2, at 104.

(34) Editorial: Medicare Cost Panel is Common Sense, USA Today, Apr. 9, 2012, available at www.usatoday.com/news/opinion/editorials/ story/2012-04-09/Medicare-cost-panelIPAB/54131068/1 (last accessed Apr. 17, 2012).

(35) See id.

(36) Group Letter to Congress, available at www.hlc.org/blog/wp-content/ uploads/2012/03/IPAB-Group-Letter.pdf (last accessed Apr. 18, 2012).

(37) Id. AMA, Independent Payment Advisory Board, available at www.amaassn.org/resources/ doc/washington/ipab-summary.pdf (last accessed Apr.18, 2012).

(38) See id.

(39) Group Letter, supra note 36.

(40) AMA, Health System Reform Insight – July 14, 2011, available at www.ama-assn. org/ama/pub/news/newsletters-journals/hsrinsight-archive/july-2011/14july2011.page (last accessed Apr. 18, 2012).

(41) See id.

(42) Cook, supra note 2, at 120.

Reprinted with permission. © 2012 American Health Lawyers Association. http://www.dinsmore.com/ independent_payment_advisory_ board/

MEDMONTHLY.COM |37

y l i s e a l E tib ‘Health Claim’ s e Definition to Be g i Interpreted DWidely,ily s EU Court Rules Ea b i t s e g i D

ly e l si Ea tib s ge Di

legal

by Sebastián Romero Melchor and Vanessa Edwards In its first judgment on Regulation 1924/2006 on nutrition and health claims made on foods, the Court of Justice of the EU adopted a broad interpretation on the definition of “health claim” by ruling that claims for merely temporary or fleeting effects of a food on human health, such as in the claim "easily digestible", are indeed health claims (Case C-544/10 Deutsches Weintor).

A health claim is defined as any claim that states, suggests or implies that a relationship exists between food and health. The Court stressed that since this definition does not provide information as to whether that relationship must be direct or indirect, or as to its intensity or duration, the term relationship “must be understood in a broad sense”.

Regulation 1924/2004 prohibits beverages containing more than 1.2% by volume of alcohol from carrying health claims. A German wine was described on its label as "easily digestible" accompanied by a reference to reduced acidity. The Court was asked in essence whether that amounted to a health claim.

38 | OCTOBER 2012

It was argued that, since digestion had only temporary or fleeting effects, a description such as "easily digestible" was not a health claim because it did not imply that the beneficial nutritional or physiological effect led to a sustained improvement in physical condition.

The Court rejected that argument.

It ruled that "health claim" covered not only an implication that health would improve as a result of consuming a food but also an implication that adverse or harmful effects on health which would otherwise accompany or follow such consumption were reduced or absent. Moreover, a health claim refers not only to the temporary or fleeting effects of a specific instance of consumption of a food but also to the effects of repeated, regular, even frequent consumption.

A claim which suggests that a wine is readily absorbed and digested implies that the digestive system will not suffer, or will suffer little, and will remain relatively healthy and intact even after repeated consumption over an extended period of time.

The claim might therefore suggest a sustained beneficial physiological

effect (consisting in the preservation of a healthy digestive system) in contrast to other wines.

Demarcation “objective information” vs “health claims” unresolved.

Contrary to the opinion of the Advocate General Mazák delivered on March 29, 2012 on this matter, the Court did not embark on the heated discussion of whether objective, factual statements linking consumption of a food and effects on human health (e.g. “glucosamine is an essential component of cartilages”) fall under the definition of health claim. According to Mazák, whilst the definition of health claim “is framed in fairly general terms”, “for there to be a health claim within the meaning of [Regulation 1924/2006], the description must imply that the food concerned has … specific health benefit or beneficial physiological effect”.  “Reprinted with the permission of “K&L Gates LLP”.”

e l b

MEDMONTHLY.COM |37

features

Locum Tenens as a Physician Career?

Locum Tenens can be a rewarding, if non-traditional career for the right physician.

by James H. Bledsoe, MD, FACS

W

ith all of the changes that medicine is experiencing, I felt compelled to write about my time spent as a locum tenens general surgeon. My experience is probably similar to many who already are going to places where their services are needed and very much appreciated. Having said that, I must state that there are no two physicians that have the exact same reasons to do locums nor are all of the assignments the same.

After serving two years in the Air Force, assigned to a regional hospital, I started private practice in Arkansas in what was a small community hospital in 1976. I was there for a year and a half before moving to a larger community hospital. Even though the hospital had only 165 beds, it was a very well run institution

40 | OCTOBER 2012

with great services. As a general surgeon, I was called on to perform major vascular and thoracic cases.

My associates and I were repairing abdominal aortic aneurysms – both elective and ruptured. During that time, we performed three distal spleno-renal shunts for bleeding esophageal varices. On two occasions we performed extra-anatomical grafts for infected aortic grafts. Some of the many thoracic procedures included pneumonectomies and esophageal resections. Since I was responsible for the patients’ follow-ups, I can state with certainty that with very few exception these patients did well.

During these years, we had a significant number of major trauma victims and unless they had a bad head injury we took care of them. I will not dwell any more on the types

of surgical cases I was involved in, but suffice it to say it was varied and many patients were involved. Early on we had no blood bank or arteriography capabilities. The arteriograms were done in a facility 25 miles away and we obtained blood from the blood bank 75 miles away. No ultrasounds were available much less MRI nor CAT scans which came later.

In my own personal practice, I was starting to stay more with strictly general surgery which by now included laparoscopy. Vascular and thoracic surgeons were starting to open practices in our area, so the decision to limit my doing these cases was much easier.

Also, the politics in medicine was becoming a real issue. Physician practices and hospitals were being bought up and this created awkward

situations for referring doctors to send patients to a specialist outside their network. Referral lines that had been present for years were disrupted. In short, instead of medicine being in large part a ministry it was becoming business. Physicians were now working for their respective corporations - not their patients. I am not necessarily saying that this is altogether a bad thing but it was quite different.

Another factor in my life was that my children were now married. My oldest son is an Emergency Medicine physician working in Alabama, my other son is a surgeon working in Louisiana, and my daughter is on maternity leave as an attorney for a firm specializing in malpractice defense law.

The factors mentioned all played roles in my decision to look for a change. Locum tenens appeared to be a viable possibility. It certainly seemed better than retirement.

I knew very little about locums so I had a lot of learning to do. Still I was so certain that I was ready to change courses that I stopped my private practice and began my research. I signed on with two locums companies and within weeks I started assignments with them. My first assignment was in New Hampshire, and I was able to start immediately because in this state you can get a temporary license. (Not all states have this provision and in most states it takes as long as six months to receive a license so it is wise to be proactive so that you can keep gaps in your work schedule at a minimum.)

Since I am classified as an independent contractor, I must withhold my own taxes. I do this by having a separate bank account and pay my quarterly taxes out of this. Also, I have to have my own personal health insurance.

At the onset of my locums career, was daunting but it worked out by looking at all of the options.

All of the locums companies I have signed on with have similar pay scales.

They all cover your travel expenses and malpractice premiums. Speaking of

‘‘

"The more you work, the better your compensation becomes."

malpractice coverage, I had to pay for my tail which consisted of one year’s payment coverage that I had with my old company and the locums group covers me while I work for them. I had one lawsuit filed against me in my 29 years of practice before locums and it was dismissed with my insurance company not having to pay anything.

However, just the fact that I had a suit filed against me was a red flag in all of my applications. I had to document everything. What I am saying is that malpractice issues may not preclude a physician from working as a locum provider but it will be a big issue when applying at a hospital.

The other expense is lodging and this is usually provided by the hospital where you are working. In fact, some hospitals allow their on-call physicians to eat there for no charge. Basically, your overhead is very low doing locum tenens.

Another aspect I greatly love is that you can decide if you want to work at a particular location and for how long. All of this will be decided before you arrive at a location and I can say that all parties have been very accommodating in this regard.

One thing I must strongly advise physicians when accepting an assignment is to be certain about your skills and what you ask for regarding privileges. For example, one of the small hospitals I was scheduled to work in required general surgeons be able to perform C-sections. Before I agreed to come, I made it clear that I would only do C-sections as an absolute emergency. This particular hospital was isolated and in a few instances the only safe thing to do was have the best medical personnel available perform whatever needed to be done.

Along the same lines, all operating rooms have some differences. It takes

a little while to feel comfortable with the personnel and their capabilities.

Some of the after hours personnel are not as familiar with the laparoscopic equipment, especially the instruments.

Some cases have to be converted to an open procedure, if for no other reason, due to a safety aspect. Also, there is a wide variety in surgical instruments, not just laparoscopic, at each hospital.

The larger the hospital where you are assigned, the less chance these issues become a real adventure.

I have doing locums since June 2005 and I am very happy. It is not for everyone. If a physician still has children at home, I would not recommend it. My wife accompanies me when she can, especially on long assignments. I have worked for as short a period as a weekend and as long a time as two years. I can definitely say that all of my assignments have been good with some better than others. I am licensed in six states, and this is all I plan to keep current as there are plenty of opportunities to work.

Regarding the location, time, and frequency of work—it is pretty much the choice of the individual practitioner once you are established into the system. The more you work, the better your compensation becomes. All of the locums companies pay a certain amount on a daily basis guaranteed. After six or eight hours, depending on the company and the work situation, you are paid an amount per hour overtime. Working at a Level II Trauma Hospital will pay more than a less active community hospital. I feel the pay structure is very fair.

In summary, for physicians who are tired of the hassle of private practice but want to stay fairly active, locums should be considered.  This article is republished from Freelance MD, a nonclinical physician community.

MEDMONTHLY.COM |41

features

by Barbara R. Heller, Marla T. Oros and Jane Durney-Crowley The millennium has become the metaphor for the extraordinary challenges and opportunities available to the nursing profession and to those academic institutions responsible for preparing the next generation of nurses.

Signal change is all around us, defining not only what we teach, but also how we teach our students.

42| OCTOBER 2012

Transformations taking place in nursing and nursing education have been driven by major socioeconomic factors, as well as by developments in health care delivery and professional issues unique to nursing. Here are 10 trends to watch, described in terms of their impact on nursing education.

1. Changing Demographics and Increasing Diversity.

2. The Technological Explosion.

3. Globalization of the World's Economy and Society.

4. The Era of the Educated Consumer, Alternative Therapies and Genomics, and Palliative Care.

5. Shift to Population-Based Care and the Increasing Complexity of Patient Care.

6. The Cost of Health Care and the Challenge of Managed Care.

7. Impact of Health Policy and Regulation.

8. The Growing Need for Interdisciplinary Education for Collaborative Practice.

9. The Current Nursing Shortage/ Opportunities for Lifelong Learning and Workforce Development.

10. Significant Advances in Nursing Science and Research.

1. Changing Demographics and Increasing Diversity.

Population shifts in the United States have affected health care priorities as well as the practice of nursing. Due to advances in public health and clinical care, the average life span is increasing rapidly. By 2020, more than 20 percent of the population will be 65 and older,

with those over 85 constituting the fastest growing age group.

Greater life expectancy of individuals with chronic and acute conditions will challenge the health care system's ability to provide efficient and effective continuing care.

Significant increases in the diversity of the population affect the nature and the prevalence of illness and disease, requiring changes in practice that reflect and respect diverse values and beliefs. Disparities in morbidity, mortality, and access to care among population sectors have increased, even as socioeconomic and other factors have led to increased violence and substance abuse. Nursing practice, education and research must embrace and respond to these changing demographics, and nurses must focus on spiritual health, as well as the physical and psychosocial health of the population.

Student demographics are also changing. Students are entering schools of nursing at an older age and are bringing varying college and work experiences, as well as more sophisticated expectations for their education. They are typically employed in full-time careers, and many are raising families, which places constraints on their educational experiences and necessitates greater flexibility in scheduling.

Schools of nursing must be prepared to confront the challenges associated with today's more mature student body. Educational methods and policies, curriculum and case materials, clinical practice settings, and research priorities need to value and reflect the diversity of the student body, as well as the population in general. Schools must continue to focus recruitment efforts on the more traditional, younger student.

2. The Technological Explosion.

The rapid growth of information technology (IT) has already had

‘‘

Schools of nursing must be prepared to confront the challenges associated with today's more mature student body.

a radical impact on health care delivery and the education of nurses.

Beginning with the increased affordability of personal computers and the explosion of information technology applications. Advances in processing capacity and speed, the development of interactive user interfaces and in image storage/ transfer technology and changes in telecommunications technology. All the advances in digital technology have increased the applications of telehealth and telemedicine, bringing together patient and provider without physical proximity. Nanotechnology will introduce new forms of clinical diagnosis and treatment by means of inexpensive handheld biosensors capable of detecting a wide range of infectious diseases from miniscule body specimens.

Dramatic improvements in the accessibility of clinical data across settings and time have improved both outcomes and care management. The electronic medical record will replace traditional documentation systems.

Through the Internet, consumers will be increasingly armed with information previously available only to clinicians. Electronic commerce will become routine for transacting health care services and products.

Nurses of the 21st century need to be skilled in the use of computer technology. Already, distance learning modalities link students and faculty continued on page 44 MEDMONTHLY.COM |43

continued from page 43

from different locales and expand the potential for accessible continuing professional education. Technically sophisticated preclinical simulation laboratories will stimulate critical thinking and skill acquisition in a safe and user-friendly environment.

Faster and more flexible access to data and new means of observation and communication are having an impact on how nursing research is conducted.

3. Globalization of the World's Economy and Society.

Globalization has been brought about by many factors, including advances in IT and communications, international travel and commerce, the growth of multinational corporations, the fall of communism in Eastern Europe and the Soviet Union, and major political changes in Africa and Asia. With the "death of distance" in the spread of disease and the delivery of health care, there are both extraordinary risks and extraordinary benefits. Along with the potential for rapid disease transmission, there is also potential for dramatic improvements in health due to knowledge transfer between cultures and health care systems.

Nursing science needs to address health care issues, such as emerging and reemerging infections, that result from globalization. Nursing education and research must become more internationally focused to disseminate information and benefit from the multicultural experience.

4. The Era of the Educated Consumer, Alternative Therapies and Genomics, and Palliative Care.

The Educated Consumer

Despite some information gaps, today's patient is a well-informed, educated consumer who expects to participate in decisions affecting 44 | OCTOBER 2012

personal and family health care.

With advances in IT and quality measurement, previously unavailable information is now public information and consumers are asked to play a more active role in health care decision making and management.

Technological advances in the treatment of disease have led to the need for ethical, informed decision making by patients and families.

Consumers are thus becoming more interested and knowledgeable about health promotion as well as disease prevention, and there is increased acceptance and demand for alternative and complementary health options.

The increased power of the consumer in the patient-provider relationship creates a heightened demand for more sophisticated health education techniques and greater levels of participation by patients in clinical decisions. Nurses must be prepared to understand this changed relationship and be skilled in helping patients and families maximize opportunities to manage their health.

medicine, and the National Institutes of Health recently funded new initiatives dedicated to this field.

Increasingly, major health systems are seeking ways to provide both traditional, Western medicine while offering the best of the alternative therapies to their patients.

As is true for many trends, alternative medicine holds both promise and peril. While it is thought that it may unlock behavioral and spiritual components of health and healing heretofore resistant to most conventional medicine, risks of consumer fraud, therapeutic conflict, and patient noncompliance are real.

Nursing research has the potential to enhance knowledge regarding what constitutes a "healing" therapy.

Nursing education and practice must expand to include the implications of the emerging therapies from both genetic research and alternative medicine, while managing ethical conflicts and questions. The inclusion of nontraditional health care providers may augment the health care team.

Alternative Therapies and Genomics

Palliative and End-of-Life Care

Amazing growth is taking place at opposing ends of the technological spectrum. The impact of the Human Genome Project and related genetic and cloning research is unparalleled.

Gene mapping will drive rapid advances in the development of new drugs and the treatment and prevention of disease. Technological sophistication of the highest order is required for this research, which has the potential to lead to unparalleled ethical questions and conflicts while bringing about critical diagnostic and therapeutic developments.

At the low-tech end of the spectrum, the voracious demand by consumers for "alternative" or "complementary" therapies to enhance health and healing has begun to influence mainstream health care delivery. Several academic medical centers now have offices of alternative

Technological advancements in the treatment of illness and disease have created new modalities that extend life while challenging traditional ethical and societal values regarding death and dying. Greater recognition of the need to ensure comfort and promote dignity is reflected in the now nearly universal promotion of advanced directives, organ donation, and palliative care for the terminally ill. New settings for care, such as inpatient and home-based hospice and new forms of care, including pain management, spiritual practices, and support groups and bereavement counseling, are now likely to be part of well-developed health care systems. A significant gap in the body of scientific knowledge and clinical education with regard to palliative and end-of-life care remains, and nursing education must prepare graduates for a significant role in these areas.

5. Shift to Population-Based Care and the Increasing Complexity of Patient Care.

Rising costs and an aging population have led to new settings and systems of care across the health care continuum. Managed care and risk-based contracting mechanisms have forced a shift from episodic care with an acute orientation to care management with a focus on population-based outcomes.

The marriage of care with cost requires nursing professionals to have an understanding of practice methods that improve quality, respond to clinical complexity, and lower costs. Patients in inpatient settings are increasingly more acutely ill; the standard ratio of critical care/specialty beds to general use beds in hospitals today is close to 1:1, up substantially from a decade ago. Furthermore, expanded life expectancy has led to increases in the number, severity, and duration of chronic conditions, thereby increasing the complexity of the care provided and

managed by clinicians. The community has largely become the setting for chronic disease prevention and management.

Providing services for defined groups "covered" by managed care will demand skills and knowledge in clinical epidemiology, biostatistics, behavioral science, and their application to specific populations. Nurses must demonstrate management skills at both the organizational and patient care levels. All these concepts must be incorporated into the traditional nursing curriculum.

6. The Cost of Health Care and the Challenge of Managed Care.

Cost of Health Care

A concern of businesses and governments for at least 30 years, the cost of health care in the United States has approached 15 percent of the total gross national product.

Thus, individuals have joined the debate about health care costs. Despite the fact that more than 40 million Americans lack health care insurance coverage, and certain health indices lag by a wide margin behind those of other societies, total health care spending in this country significantly outstrips that of other developed countries. Many reasons have been suggested, including the advanced technology available to virtually all residents through academic medical centers, the scientific and technologic infrastructure that has led to most of the diagnostic and therapeutic breakthroughs in medicine, cultural norms regarding aging and endof-life, the cost of violence and drug addiction, and the

growing economic and health disparity between segments of the population.

Concerns about cost have led to the popularity of managed care options, first by corporations for their employees and by governments, through the Medicare and Medicaid programs. Despite recent federal budget surpluses and proposals to expand funding and benefits in Medicare, there is serious concern among economists, legislators and bureaucrats about the long-term solvency of both of the publicly funded programs.

Cost concerns are present in every form of nursing practice; they affect how work is organized and treatment plans for patients. For example, even individuals with health insurance are wary of increased out-of-pocket expenses and noncovered services.

And there is heightened concern about pharmaceutical costs, fueled, in part, by the development of sophisticated new drugs.

Managed Care and Reimbursement Challenges Within both the public and private sectors, managed care is quickly becoming the dominant reimbursement mechanism for health care providers, bringing both opportunities and problems. continued on page 46

MEDMONTHLY.COM |45

continued from page 45

Despite the promise for flexible financing that managed care risk was thought to offer, provider contracts are still based on fees for service, reducing the incentives to truly manage care, prevent illness, and promote health. Nursing professionals, who have historically taken the lead in health education and health promotion, are disappointed by the lack of financing and reimbursement available through managed care organizations for these vital services.

However, advanced practice nurses nurse practitioners and case managers in particular - have benefited greatly by the managed care movement. Nursing education programs must prepare students at all levels for roles in case management and employment in the managed care environment.

7. Impact of Health Policy and Regulation.

The impact of federal and state health policy and regulation on the practice of nursing cannot be ignored.

Issues surrounding health care are often complex, involving the fields of medicine and economics, and affecting individuals' rights as well as access to health care. Consumers are concerned about quality, and corporations and individual providers are concerned about economic survival.

Two major trends will have a significant impact on health care delivery. First, there will be an increase in state and federal regulation as costs rise and managed care continues to expand. Along with regulation, there will be attempts to shift to less expensive settings and apply market forces to restrain costs.

Second, shared responsibility for the Medicaid program and the shift to managed care has resulted in an increased oversight role for the states. States must define, measure, and assess quality, and serve as contractors for corporate entities while enforcing accountability of managed care organizations. Both 46| OCTOBER 2012

new regulation and devolution have serious implications for health care delivery and the practice of nursing.

Historically, nursing's influence on policy and regulation has been disproportionately low relative to the breadth of nursing practice and its importance within the health care delivery system. Nursing schools, scholars, executives, and professional nursing organizations must contribute more actively to the development of health policy and regulation. Ethical issues involved in working in an integrated system constrained by economic incentives are being defined more and more by government policy makers, not health care professionals.

Nursing leaders should contribute to the dialogue that defines these issues; students must be prepared for a meaningful role in the political arena.

8. The Growing Need for Interdisciplinary Education for Collaborative Practice.

A wide range of knowledge and skills are required to effectively and efficiently manage the comprehensive needs of patients and populations.

The health care delivery system of the future will rely on teams of nurses, nurse practitioners, physicians, dentists, social workers, pharmacists and other providers to work together. While interdisciplinary and

collaborative practice is still not the norm, there has been a heightened awareness of the need for coordinated care and a significant increase in the use of midlevel providers, such as APNs, as a part of the primary care team.

With care management a critical component in health care delivery, nurses must demonstrate leadership and competence in interdisciplinary and collaborative practice for continuous quality improvement.

Team-based, interdisciplinary approaches have been shown to be highly effective for improving clinical outcomes and reducing cost.

Teaching methods that incorporate opportunities for interdisciplinary education and collaborative practice are required to prepare nurses for their unique professional role and to understand the role of other disciplines in the care of patients.

9. The Current Nursing Shortage/Opportunities for Lifelong Learning and Workforce Development.

Nursing shortages have a negative impact on patient care and are costly to the health care industry. A significant nursing shortage exists today, particularly in acute and longterm care settings. It results from many factors. For example, nurses of the

"baby boom" generation are beginning to retire; women today have numerous career opportunities; and there is a lingering perception of nursing as a "trade," versus a "profession," which contributes to the lack of new individuals entering the field. As the age of entering students rises, the number of years of practice decreases, also affecting supply. While the number of male and minority students has been steadily rising, their ranks are still underrepresented.

The current shortage is judged to be deeper than past shortages and probably more resistant to short-term economic strategies that have worked before. Other recent advances in the profession and the health care industry are likely to have a positive impact on recruitment. These include the opportunity to practice in a variety of clinical settings; the dramatic increase in opportunities for APNs; new careers in care management and case management; and the interest of biotechnology, information technology, and pharmaceutical companies in hiring skilled nursing professionals. Nursing education must partner with the health care industry to develop innovative short- and long-term solutions that address the ongoing nursing shortage.

The need for more sophisticated nursing management and leadership to respond to the clinical, organizational and fiscal challenges faced by the health care industry has not gone unrecognized. Nurse managers and executives require clinical experience and strong communication skills, as well as business acumen and knowledge of financial and personnel management, organizational theory, and negotiation. A great need exists for educational support for experienced nurses to be developed into nurse executives, prepared to work competently alongside their business colleagues. Nursing schools are called on to expand their core and continuing education programs to effectively address these needs.

Rapidly evolving technology, increasing clinical complexity in many patient care settings, advances in treatment, and the emergence of new diseases are all factors contributing to the increased need for a strong emphasis on critical thinking and lifelong learning among professional nurses. Further, new clinical roles, the need for managerial and executive talent, the imperative to retain nurses in active practice over longer careers, and the desire by practicing nurses to move up the economic ladder lead to the demand for continuing education and career mobility and development.

Schools of nursing have many of the core resources needed to deliver continuing professional education and can provide appropriate courses efficiently and effectively.

10. Significant Advances in Nursing Science and Research.

Nursing research is an integral part of the scientific enterprise of improving the nation's health. The growing body of nursing research provides a scientific basis for patient care and should be regularly used by the nation's 2.5 million nurses. Most studies concern health behaviors, symptom management, and the improvement of patients' and families' experiences with illness, treatment, and disease prevention. Research is conducted to improve patient outcomes and promote the health and well-being.

Nursing research and scholarships have received significant funding by public and private agencies in the last decade. However, the challenges associated with advancing the research agenda in nursing are complex and varied. Schools of nursing are not sufficiently focused on the scholarship and science of nursing as top priorities, and, although graduate degrees in nursing have become more common, doctorally prepared nursing professionals are not being produced

in large enough numbers to meet the growing need. In addition, there is a need for enhanced mentorship for new researchers to strengthen their skills and capacity to conduct meaningful nursing research. Significant opportunities exist for schools of nursing, especially those affiliated with academic health centers, to address these challenges and enhance the research contributions of nursing scholars.

At the dawn of the 21st century and the long-awaited new millennium, nurse educators face a rapidly changing health care landscape, shifting student and patient demographics, an explosion of technology, and the globalization of health care, in addition to a myriad of everyday challenges. As we position ourselves to meet today's challenges and tomorrow's, we must understand the drivers affecting nursing. To quote Peter Drucker in Managing for the Future, "It is not necessary to be clairvoyant to know the future; it is only necessary to clearly interpret what has already happened and then project forward the likely consequences of those happenings" (Truman Talley Books, 1992).  _____________ About the Authors Barbara R. Heller, EdD, RN, FAAN, is dean and professor at the School of Nursing, University of Maryland, Baltimore. She is serving her second term as a member of the National League for Nursing Board of Governors. Marla T. Oros, MS, RN, is assistant dean for clinical practices and services, School of Nursing, University of Maryland. Jane DurneyCrowley, MHA, RN,.a member of the Board of Visitors, School of Nursing, University of Maryland, is Executive Vice President, Operations and Culture, Catholic Healthcare Partners, Cincinnati, Ohio.

Reprinted with Permission from: http://www.nln.org//nlnjournal/ infotrends.htm MEDMONTHLY.COM |47

features

Guiding the Temp Doc

by Monica Menezes Irwin, Managing Editor The physicians’ locum tenens industry can be an exciting adventure where you practice medicine around the country or even around the world.

Or on a more local basis, it can be an excellent way for you to find the perfect practice, earn average or better pay, enjoy flexibility in your schedule and investigate your favorite geographic location for you and your family to live. Whatever your reason for considering a locum tenens career, your life will be filled with options and maybe a few changes.

As a locum tenens physician, you are usually hired as an independent contractor and the rules may be a little different. If you are new at this or just contemplating the possibilities and, consequently, are unsure of what to expect, then you may want to be proactive and contact your tax 48| OCTOBER 2012

accountant. Your CPA will help to guide you through the rule changes.

Your staffing agency will also be experts who can help. They will be there to advise you along the way and answer whatever questions you may have on the “rules and regs” of the physicians/nurses' temporary assignment industry.

Speaking of your staffing agency, they will become administrators in your career and life while you travel through this adventure. Whether you travel or stay local to your licensed state, your recruitment firm will be the liaison between you and the contracting practice or hospital. Some of the services that are handled on your behalf are your pay, schedules, term, licensing, housing and insurance.

There are many factors to consider when approaching the task of choosing

your locum tenens staffing agency.

There are many to choose from, ranging in staff size, competing for your business.

Your might begin by asking your colleagues that work locums for their recommendations and views. Some pertinent questions when speaking to potential agencies might be: • What specialties does the agency focus on?

• What pay range can be anticipated?

• What are the assignment length options?

• What is the agency's geographical area?

• Does the agency provide housing and cover expenses like mileage?

• Will professional liability be covered? Is it occurrence-based or claims-made?

• Does the professional liability policy include tail coverage?

The agency will create a credentialing file on you and your license, CME certificates and other important documents are in one organized place. It will now be the agency’s mission to confirm that all your credentials can be verified and if all goes well, they will begin reviewing your options for assignments. Once you have contracted with your recruitment agency, you will have the ability to accept or decline an assignment.

A few pertinent questions regarding your potential assignment might be: • Are hours guaranteed?

• Are there any on-call responsibilities?

• What is their policy on overtime?

• What shifts are available?

• What is the daily patient volume you will be expected to see?

• What are the patient demographics you will be seeing?

• Is the facility looking for someone to fill the physician job permanently? What happens if things go so well and they want to convert the assignment to a permanent hire?

• Can you speak with the medical director and/or other locum tenens at the client facility?

Your agency will ask several questions as well so they are able to provide you with assignments that are the best fit; what procedures have you conducted and practice environments

do you prefer? This exchange of information will begin to nurture your relationship and help to insure a positive partnership.

Locum tenens work can be exciting and one of the best experiences of your career, especially if you find the perfect match in an agency and your assignments. Its many benefits and overall flexibility may even lead you to become a locum tenens doctor for the rest of your medical career.  Anne Baye Ericksen. (Januray 15, 2009). Making a choice about locum tenens staffing agencies. In Locum Life.

Retrieved September 12, 2012, from http://locumlife.modernmedicine. com/locumlife/article/articleDetail.jsp ?id=575109&sk=&date=&pageID=4.

MEDMONTHLY.COM |47

features

Travel Nurses Tout Professional Growth and Career Opportunities

By Megan M. Krischke Contributor

Getting to travel and experience life in different parts of the country is certainly one of the main draws to working as a traveling nurse, but some of the more important benefits are the ways it can advance your career.

TravelNursing.com speaks to 3 nurse travelers who share about the opportunities for career growth and advancement they’ve experienced as traveling nurses.

50 | OCTOBER 2012

Charles Duffield, RN, ADN Critical Care Nurse with American Mobile Healthcare

“I’d never left the Southeast until I was in college, and I wanted to see the country, so I signed up as a traveler as soon as I was eligible.” explained Duffield, who began traveling, accompanied by his wife, last September.

“The breadth of my experiences and my confidence in my abilities are among the most important things I’ve gained as a traveler,” he said. “My hospital back home in Alabama was a 400-bed, level 2 trauma center. On my first assignment, I was placed in a 900-bed, level 1 center; my current assignment is in a small rural hospital. Through these experiences I’ve become more comfortable taking care of extremely sick patients, and I’ve learned how rural hospitals handle sick patients. I have now worked in ICUs with lots of ancillary staff and almost no ancillary staff.”

Duffield feels that his experience working in wellknown Yale University Hospital is now a highlight on his résumé, along with the assurance that he could work with confidence and ease in any hospital in the Southeast.

At the same time, Duffield is also fulfilling his dream of seeing the country: hiking in the Wind River Range of Wyoming, touring Yosemite and Yellowstone National Parks, and enjoying the coast of Maine during a beautiful New England fall.

“Travel nursing has opened a lot of doors for me. I’ve now worked in 5 hospitals, and we love it so much we will travel for another year,” he raved. “When I go home I can turn in a résumé listing numerous hospitals that will give me glowing references and who would be glad to have me back.”

Ginger Howell-Matheson, RN, BSN Medical–Surgical Nurse with NurseChoice

Ms. Howell-Matheson first worked as a traveling nurse in 2005 when her husband was sent on a year-long military deployment to Turkey.

Cherith Douglass, RN, BSN

“I chose to become a travel nurse for the money and because I like change,” she remarked. “I especially like assignments in small towns. Small hospitals just love travelers because they rarely see anyone they don’t already know.”

In her six months working as a traveler, Ms. Douglass has been pleased with her opportunities to broaden her skill set by performing different procedures, using different methods and tools, experiencing new computer programs and learning new ways of asking questions.

Howell-Matheson is using the extra money she is earning traveling to become debt-free. She also relishes the opportunities for professional growth.

“One of the most significant experiences for the trajectory of my career has been meeting new people. I love to ask them about their plans and it has gotten me thinking about different ways I could go in my career. It is good to hear different people’s perspectives on education and becoming a CRNA or an NP and about different specialties. It broadens my viewpoint,” stated Douglass. “And now I have a much wider range of nurses, physicians and other clinicians in my professional network.”

“Traveling helps you become very adaptable because you have to hit the floor running. When you are in a new place for only a short time, you have to do what they do.

I am very confident in what I do. I feel I can work in any situation in the United States thanks to my traveling nurse experiences.” she said.

Nurse Ginger, has also worked on a couple of electronic medical record (EMR) conversion assignments, notes that she has seen her computer skills improve as she has learned to navigate a variety of systems.

“I have always had great assignments and I’ve never had any problems,” she reflected. “NurseChoice has been a great fit for me because they guarantee a 48-hour work week, the pay is better and the housing has always been very nice.”

‘‘

“Travel nursing has opened a lot of doors for me. I’ve now worked in 5 hospitals, and we love it so much we will travel for another year.”

Emergency Nurse with NurseChoice

Nurse Douglass also values the chance she has had to see different examples of management styles and to be able to apply those lessons as she advances in her career.

“I expect that my future employers will be encouraged to see that I have worked at an institution such as Duke [University Hospital]. Also, because of my experience as a traveler, they will be assured that I can adjust quickly to new work environments and that I can work with a variety of people,” she remarked. “I think everybody should give traveling a try.

Having this experience in my background will definitely help my future job opportunities.” 

Reprinted with Permission of TravelNursing.com http://www.travelnursing.com MEDMONTHLY.COM |51

the arts

The Art of M

by Monica Menezes Irwin, Managing Editor

L

ast month, I formally introduced Laura Maaske who we are fortunate to have as a monthly contributor to Med Monthly beginning next month. This month, we are going to get more in depth into her past, her art and her passion of medical illustration.

I began by asking Laura about her inspiration and background. She fondly reminisced of the time as a child she spent learning about her Mother’s graphic design business. She loved art and drew every day. Obviously, the seeds of creativity and art were planted early. But she also loved science and read about the scientific method. Little did she know or understand at the time, that her love of detailed drawing and science would one day merge and lead her to her fascinating career.

Laura did her undergraduate work at the University of Wisconsin where she chose zoology but she remembers feeling very unsure of her future. By chance in her senior year, Laura visited the University of Toronto's St. George campus. Hanging in the Medical Sciences building, she saw framed along the corridors the gorgeous works of the medical illustration students. She was instantly engaged and suddenly realized that this was what she wanted to do. Finishing her undergraduate work, she then began to build a portfolio, taking courses at the Toronto School of Art, in preparation for her application to the University of Toronto Division of Biomedical Communications. In the fall term of 1994, she was accepted. And so it began…the road to the dazzling world of integrating art and medicine; certainly not your typical artwork nor a graduate course study that you might expect for an artist.

Her challenging graduate program required 3 years of coursework including gross anatomy, histology, 52 | OCTOBER 2012

embryology, physiology and neuroanatomy, to name a few. This was between the years of 1993 and 1997, when there was only a tentative certainty that the computer would be a dominant force for creating and designing art.

Consequently and fortunately for her, students at that time were being trained in the digital methods as well as the traditional arts. The traditional arts meant she would learn to express her creativity -- wash, carbon dust, pen & ink and watercolor all became part of her repertoire. But her experience thus far had only begun to open the doors to learning.

Laura did her masters research on interactivity in computer design and experimenting with the small world being offered by a computer interface. I asked Laura to further explain, “It was like science itself, in a nutshell. I wanted to be creating small worlds where you were able to learn how things worked.”

In completing her initial research she was on her way to her profession. She collaborated with a Toronto otolaryngologist, Jonathan Irish at Princess Margaret Hospital, to develop an exploration tool for his vocal cord palsy patients. This tool allowed his patients to use the cursor to drag a three-dimensional rendering of their vocal cords into different positions, mimicking the surgery itself, in order to see how their voices would be modified during the surgical procedure. What made their involvement particularly important was that these patients were conscious during the surgical intervention. The doctor would be making modifications to the patient while they were conscious, and then asking them to speak and to approve the adjustments he was making to their voices.

If you review Laura’s website, you’ll notice she states that all of her work is done by hand. Once again, having been

Medicine

Laura Maaske

Medical Illustrator

trained in traditional art, she always begins with a handsketch. “Bringing the work (sketch) to the computer is a useful step in the process, but I do this only when I feel I have captured the essential movements and curves on paper that are to be the underlying focus in the final piece.” Every project that Laura creates is custom done.

In the inception of each one she questions, “What does this individual piece have to say to its audience?” Only then can she truly begin to develop the perfect concept for her final piece.

What is the most difficult question to ask such a complex artist? What project are you the most proud of and why? After much thought, Laura replied, “As an artist, I am in search of a balance between the chaos and rich excess of information being offered in the surgical scene and simple educational objectives about that particular procedure. There is a particular series of surgical illustrations which gave me insight about this balance. It had been a goal of mine to render the surgical scene in a way as if the surgeon were operating in a clean field. It was my job to clear away what a photograph could not. But it occurred to me as I was beginning to draw the series that perhaps I was avoiding something beautiful about the nature of surgery, to avoid the dissolution. During a surgical procedure, the tissues become a little swollen, and there is some bleeding, and this is all understood as a way of adapting the body for a healthier state of being

when the surgical procedure is done. But it seems like a contradiction: destruction first before healing. We open the body, aware of this small loss, in favor of a greater gain. So I decided to render this dissolution in my surgical series.

The results worked in a way that seemed very natural to me, compared to what my cleaner renderings had been as in previous work. This lesson made this project very special.”

Laura takes pen to paper to begin her imagery design that expresses the human body and its inner workings in explicit works of vivid color and science. We are grateful for her visionary expression of the world within and look forward to her sharing more of her work every month with her articles.  Following is a list of some of Laura’s published work: Feature Article. Maaske, L. 1999. "A Study of Interactivity in Educational Patient Hypermedia". Journal of Biocommunication. V(3); 2-11.

Feature Illustration. Papsin, B., Maaske, L., McGrail, S., 1996 "Repair of orbicularis oris rupture". Laryngoscope.

V(6);757-60.

Cover Illustration. Chan, A., Ross, J., 1996. "The management of unstable coronary syndrome in patients with previous coronary artery bypass grafts". University of Toronto Medical Journal. 73(3);132-8.

Feature Illustration. Chung, H.T., Gordon, Y.K. Ng, and George, S.R.,1996. "Biochemical characteristics D2 receptor monomers and dimers expressed in Sf9 cells". University of Toronto Medical Journal. 73(2);86-93.

MEDMONTHLY.COM |53

healthy living

Cherry-Walnut Pumpkin

Bread

by Ashley Acornley MS, RD, LDN

Fall is finally here, and one of the most delicious and nutritious foods to consume during this time is pumpkin.

Canned pumpkin is considered a nutrient-dense food because it is low in calories and fat, yet high in vitamins and minerals.

Pumpkin is considered a “SUPERFOOD” due to its high content of vitamin A, vitamin C, iron, calcium and fiber.

Most commonly used for pumpkin pie during the holidays, it can also be added to a variety of nutritious dishes throughout the year. You can use canned pumpkin to make soups, smoothies, chili, Indian food, pancakes and other desserts such as cheesecake, breads, muffins, or cream pies. Our pumpkin bread recipe listed below contains tart cherries, walnuts, plus some additional foods that have great health benefits!

Ingredients: 2 cups all purpose flour 2 teaspoons pumpkin pie spice 1 teaspoon baking powder 3/4 teaspoon salt 1/2 teaspoon baking soda 6 tablespoons (3/4 stick) unsalted butter, room temperature

1 cup plus 1 tablespoon sugar 2 large eggs 1 cup canned pure pumpkin 1 teaspoon vanilla extract 2/3 cup buttermilk 1/2 cup dried tart cherries 1/2 cup coarsely chopped walnuts

Directions: Preheat oven to 350°F. Butter a loaf pan then line the bottom and two long sides with waxed paper. Whisk flour, pumpkin pie spice, baking powder, salt and baking soda in medium bowl to blend. Using electric mixer, beat butter in large bowl until fluffy. Gradually add 1 cup of sugar, beating until blended. Beat in eggs, one at a time. Beat in pumpkin, then vanilla. Beat in dry ingredients alternately with buttermilk in two additions each. Fold in dried tart cherries and nuts. Transfer batter to pan and sprinkle with one tablespoon of sugar. Bake bread for about one hour and 10 minutes or until an inserted toothpick comes out clean.

54 | OCTOBER 2012

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/LicensesPermitsand Certificates/ProfessionsNewReneworUpdate/DispensingOptician.aspx

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 | OCTOBER 2012

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/provider/ licensing/occupational/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/

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/

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/

Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm

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

Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa

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/

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://bit.ly/sEhr0Q Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp

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 | OCTOBER 2012

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://bit.ly/obJm7J p

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

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

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

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/

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/

MEDMONTHLY.COM |59

medical resource guide ACCOUNTING

Ajishra Technology Support

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

ADVERTISING

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

MedMedia9

www.medmedia9.com

Ring Ring LLC

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

ANSWERING SERVICES Corridor Medical Answering Service

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

Docs on Hold

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

BILLING & COLLECTION Advanced Physician Billing, LLC

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

60| OCTOBER 2012

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

Axiom Business Solutions

Find Urgent Care

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

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

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

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

Gold Key Credit, Inc. PO Box 15670 Brooksville, FL 34604 888-717-9615 www.goldkeycreditinc.com

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

Management Services On-Call 200 Timber Hill Place, Suite 221 Chapel Hill, NC 27514 (866)347-0001 www.msocgroup.com

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

VIP Billing

PO Box 1350 Forney, TX 75126 (214)499-3440 www.vipbilling.com

CAREER CONSULTING SEAK Non-Clinical Careers Conference Oct. 21-22, 2012 in Chicago, IL (508)457-1111 www.nonclinicalcareers.com

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

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

COMPUTER, SOFTWARE

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

American Medical Software

Mediserv

CDWG

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

Practice Velocity 1673 Belvidere Road Belvidere, IL 61008 (888)357-4209 www.practicevelocity.com

1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300 www.americanmedical.com 300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239 www.cdwg.com/

Instant Medical History

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

medical resource guide CONSULTING SERVICES, PRACTICE MANAGEMENT

DENTAL Biomet 3i

Manage My Practice

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

Medical Credentialing

(800) 4-THRIVE www.medicalcredentialing.org

Medical Practice Listings

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

myEMRchoice.com

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

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

Synapse Medical Management

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

Urgent Care America

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

Urgent Care & Occupational Medicine Consultant Lawrence Earl, MD COO/CMO ASAP Urgentcare Medical Director, NADME.org 908-635-4775 (m) 866-405-4770 (f ) ASAP-Urgentcare.com UrgentCareMentor.com

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

Dental Management Club

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

The Dental Box Company, Inc.

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

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

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

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

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

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

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

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

Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063 http://www.sigmondaknis.com/

INSURANCE, MED. LIABILITY Aquesta Insurance Services, Inc.

Michael W. Robertson 3807 Peachtree Avenue, #103 Wilmington, NC 28403 Work: (910) 794-6103 Cell: (910) 777-8918 www.aquestainsurance.com

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

Medical Protective

5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776 http://www.medpro.com/ medical-protective

MGIS, Inc.

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447 www.mgis.com MEDMONTHLY.COM |61

medical resource guide INSURANCE, MED. LIABILITY Professional Medical Insurance Services

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

Wood Insurance Group

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

LOCUM TENENS

Barry Hanshaw

Tarheel Physicians Supply

18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038 JHans76271@aol.com www.barryhanshaw.com

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

Ako Jacintho

MEDICAL MARKETING

chuchinho58@gmail.com www.facebook.com/akojacintho www.akojacintho.com

Julie Jennings

(678)772-0889 juliejenn@silksynergy.com http://silksynergy.com/ http://www.coroflot.com/naddie09

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

MedMedia9

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

MEDICAL PRACTICE SALES

MedImagery

Physician Solutions

www.thetps.com

Laura Maask 262-308-1300 Laura@medimagery.com

medimagery.com

Marianne Mitchell (215)704-3188 http://www.mariannemitchell.com http://www.colordrop.blogspot.com

MEDICAL ARCHITECTS MEDICAL EQUIPMENT

Medical Practice Listings

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

MEDICAL PRACTICE VALUATIONS

MMA Medical Architects

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

9975 Summers Ridge Road San Diego, CA 92121 (858)805-8378

www.artisanprinter.com

Deborah Brenner

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

Pia De Girolamo

www.piadegirolamo.com

Nicholas Down http://bit.ly/yHwxb0

Martin Fried

62| OCTOBER 2012

1295 Walt Whitman Road Melville, NY 11747 (888)862-4050 www.allproimaging.com

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

Biosite, Inc

MEDICAL ART Brian Allen

BizScore

ALLPRO Imaging

www.martindfried.com

MEDICAL PUBLISHING www.biosite.com

Greenbranch Publishing

Cryopen

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

www.cryopen.com

Carolina Liquid Chemistries, Inc.

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

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

www.dicomsolutions.com

info@greenbranch.com 800-933-3711 www.greenbranch.com

MEDICAL RESEARCH Arup Laboratories

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

www.aruplab.com

medical resource guide Chimerix, Inc. 2505 Meridian Parkway, Suite 340 Durham, NC 27713 (919) 806-1074 www.chimerix.com Clinical Reference Laboratory 8433 Quivira Rd. Lenexa, KS 66215 (800)445-6917

www.crlcorp.com

Sanofi US

55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491 www.sanofi.us

Scynexis, Inc.

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

STAFFING COMPANIES

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

Dermabond

Ethicon, Route 22 West Somerville, NJ 08876 (877)984-4266 www.dermabond.com

DJO

1430 Decision St. Vista, CA 92081 (760)727-1280

www.djoglobal.com

ExpertMed

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

Additional Staffing Group, Inc. www.scynexis.com

MORTGAGE PROFESSIONAL

8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601 Astaffinggroup.com

SUPPLIES, GENERAL

SunTrust Mortgage, Inc.

Nicholas Lay, Senior Loan Officer 910.368.8080 Cell nick.lay@SunTrust.com NMLSR# 659099 www.suntrust.com

BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157 www.bsnmedical.us

31778 Enterprise Dr. Livonia, MI 48150 (800)447-5050

www.expertmed.com

Gebauer Company

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

Scarguard

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

MEDMONTHLY.COM |63

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classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

Occupational Health Care Practice in Fayetteville North Carolina has two to five days of locums work per week.

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, and PH: (919) 8450054, email: physiciansolutions@gmail.com Occupation Health Care Practice located in Greensboro, NC has an immediate opening for a primary care physician. This is 40 hours per week opportunity with a base salary of $135,000 plus incentives, professional liability insurance and an excellent CME, vacation and sick leave package. Send copies of your CV, 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Family Practice physician opportunity in Raleigh, NC This is a locum’s position with three to four shifts per week requirement that will last for several months. You must be BC/BE and comfortable treating patients from one year of age to geriatrics. You will be surrounded by an exceptional, experienced staff with beautiful offices and accommodations. No call or hospital rounds. Send copies of your CV, 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Methadone Treatment Center located near Charlotte, NC has an opening for an experienced physician. You must be comfortable in the evaluation and treatment within the guidelines of a highly regulated environment.

Practice operating hours are 6 a.m. till 3 p.m. Monday through Friday. Send copies of your CV, 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, and PH: (919) 845-0054,email: physiciansolutions@gmail.com Immediate Full-Time Opportunity for Board Certified occupational health care MD in Greensboro, NC. Excellent working environment, wage and professional liability insurance provided. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Cardiology Practice located in High Point, NC has an opening for a board certified cardiovascular physician. This established and beautiful facility offers the ideal setting for an enhanced lifestyle. There is no hospital call or invasive procedures. Look into joining this three physician facility and live the good life in one of North Carolina’s most beautiful cities. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Board Certified Internal Medicine physician position is available in the Greensboro, NC area. This is an out-patient opportunity within a large established practice. The employment package contains salary plus incentives.

Please send a copy of your current CV, NC medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. email: physiciansolutions@gmail.com or phone with any questions, PH: (919) 845-0054.

Family Practice physician is needed to cover several shifts per week in Rocky Mount, NC. This high profile practice treats pediatrics, women’s health and primary care patients of all ages. If you are available for 30 plus hours per week for the remainder of the year, this could be the perfect opportunity. 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, N.C. 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Health department in North Carolina seeks FP/GP/IM for June 30-Aug 10 Health Dept in North Carolina seeks physician for jail. Primarily will treat minor ailments, small trauma, and sutures. The dates the physician will need to cover are: 7/31/12, 8/3/12, 8/6/12, 8/8/12, 8//12, 8/13/12. Please send a copy of your current CV, NC medical license, DEA certificate and NPI certificate with number along with your detailed work history and CME courses completed to: Physician Solutions, P.O. Box 98313, Raleigh, NC 27624. email: physiciansolutions@gmail.com or phone with any questions, PH: (919) 845-0054.

MEDMONTHLY.COM |65

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina

North Carolina (cont.)

Sports Medicine center in Charlotte seeks FP/GP/IM immediately FT/PT to perm Doctor needed immediately in Charlotte Sports Medical Clinic to help decrease the risk of sports injuries by evaluating baseline and preexisting conditions to provide treatment and rehabilitation. 8a-5p M-F no call. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Fayetteville Health Dept seeks FP/GP/IM for June 30-Aug 10 County Health Dept seeks physician for jail for minor ailments, small trauma, and sutures. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

GP needed immediately for Cary center to treat knee related disorders A small practice in Cary is looking for a physician for 2 weeks in July and intermittently. The physician will need to be able to do injections for Non-Surgical knee pain and the injection is done via video Flouroscopy . 8a-5p.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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Urgent care and occupational practice 30 minutes north of Greensboro, needs family practice doctor able to see all ages. Dates are Aug 13-17, likely further scheduling. 20-25 patients a day. Hours are 8:15 to 5:30. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

GP/FP/IM needed for urgent care near Greensboro Aug 13-17

Charlotte Health Department Seeks On-going General Practitioners: • •

• • •

County Health Department seeks physicians immediately to work 8am-5pm in the following departments: Child Health FP or pediatrician needed for intermittent dates to do physicals, immunizations, vision and hearing screenings among other basic procedures.

Need coverage July 12-13 & 20.

Employee Health GP/IM needed for physicals and sick visits for staff.

Family Planning FP sought for first time wellness check-ups; no follow-up appointments. Approx 20 patients per day.

Diabetes GP/FP needed for outpatient diabetic clinic. Approx 10 patients per day.

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

66| OCTOBER 2012

Wanted: Classified ads

Call today to find out about all the advertising opportunities available with Med Monthly.

919.747.9031

Visit us online anytime at

medmonthly.com

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

Practice for Sale in South Denver Neurofeedback and Psychological Practice Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputation based on 30 years experience in Denver. Private pay and insurances, high-density traffic, beautifully decorated and furnished offices, 378 active and inactive clients, corporate clients, $14,000 physical assets, good parking, near bus and rapid transit housed in a well-maintained medical building.

Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado

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

For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com

Woman’s Practice in Raleigh, North Carolina.

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 MEDMONTHLY.COM |67

Classified

To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina (cont.)

North Carolina (cont.)

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

Internal/ Family Physician needed in Fayetteville Well-established health department seeks ongoing coverage Monday–Thursday for Aug 20 - Sept 27 .

Physician will see about 20 adult patients daily, hours are 8am-5pm with an hour for lunch. No call.

Locum Tenens Primary Care Physicians Needed If you would like the flexibility and exceptional pay associated with locums, we have immediate opportunities in family, urgent care, pediatric, occupational health and county health departments in NC and VA. Call today to discuss your options and see why Physician Solutions has been the premier physician staffing company on the eastern seaboard. Call (919) 845-0054 or review our corporate capabilities at www.physiciansolutions.com Occupational Clinic in Greensboro NC seeks GP immediately PT General Practitioner needed for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8a-5p. Approximately 20 patients/day.

Excellent staff. Outpatient only. No call or hospital duties. Please send a current CV to physiciansolutions@gmail.com or call (919) 845-0054 for details on this and other opportunities across the state.

Physicians Needed Immediately We have several immediate needs for physician coverage for various facilities in North Carolina for addiction medicine. For immediate consideration please call or email us at physiciansolutions@gmail.com or call (919) 845-0054.

We can put you to work tomorrow! We have very competitive salaries, we pay for mileage, your accommodations if necessary. We look forward to hearing back from you.

68| OCTOBER 2012

Sports Medical Center in Charlotte seeks FP/GP/IM immediately. Two to four days a week. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Occupational Health Care Clinic seeks GP/IM. One to three days a week. Adults only. 8am-5pm. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com State Mental Health Facility in Goldsboro needs GP/ IM/FP. Physician needed for mental health facility about an hour east of Raleigh. FT ongoing 8am-5pm. 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, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Geriatric Physician Wanted Immediately, On-going 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 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 8:30am to 5:30pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Classified

To place a classified ad, call 919.747.9031

Physicians needed

Physicians needed

North Carolina (cont.)

Virginia

GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease 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. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, 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 Pediatrician or Family Medicine Doctor in Roanoke Rapids (1 hr north of Raleigh) In mid December, a pediatrician or family medicine doctor comfortable with seeing children is needed full time until a permanent doctor can be found. Credentialing at the hospital is necessary. 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 General Practitioner Needed in Greensboro Occupational health care clinic seeks general practitioner for disability physicials ongoing 1-3 days a week. Adults only. 8a-5p. No call required. 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

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.

MEDMONTHLY.COM |69

NC MedSpa For Sale MedSpa Located in North Carolina

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

We have recently listed a MedSpa in 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.

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

Call us today to place your classified!

919.747.9031

Contact Medical Practice Listings today to discuss the practice details.

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

Also available online 24/7

medmonthly.com

www.medicalpracticelistings.com

Does your Practice Accept Insurance?

We Can Help!

Call us at

1-855-4-THRIVE Visit us at

MedicalCredentialing.org

Also, ask us about Affordable Medical Billing!

EMPLOYING PEOPLE THAT FIT With over 30 years of experience, Additional Staffing Group can provide your practice with an exceptionally talented staff that will streamline operations in your health care facility.

OUR SERVICES INCLUDE:  Short/Long Term Temporary Placement  Direct Hire and Executive Permanent Placement  Payroll Services  HR Consultant Services

WE STAFF:  Receptionists  Medical Records Technicians  Accounting and Medical Billing Specialists

Adult & pediAtric integrAtive medicine prActice for sAle 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

WORKFORCE EXPANSION SOLUTIONS 919-844-6601 www.astaffinggroup.com

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com MEDMONTHLY.COM |71

PRACTICE FOR SALE

Practice for Sale in Raleigh, NC

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina

Primary care practice specializing in women’s care

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.

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.

List price: $435,000

Asking price: $385,000 Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings visit www.medicalpracticelistings.com To view more listings visit us online at medicalpracticelistings.com

Unfortunately, its motor is inside playing video games.

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Classified To place a classified ad, call 919.747.9031

Practice for sale

Practice for sale

North Carolina

North Carolina (con't)

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

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

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 well-equipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com 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 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

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 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

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.

MEDMONTHLY.COM |73

THINKING ABOUT SELLING YOUR PRACTICE?

Medical Practice Listings can help you sell your practice online!

Now offering two types of listings to better serve all practice specialties and budgets.

Standard Listing The Standard Listing offers you the opportunity to gain national exposure by posting your listing on our website which is viewed daily by our network of professionals.

This option also includes a brief practice consultation to explain the benefits of marketing through the Medical Practice Listings website.

Professional Listing In addtion to the benefits in the standard listing our Professional Listing affords you access to services provided by our expert legal and marketing team and a Bizscore Practice Valuation. This valuation compares your practice with other practices in your area, provides projections and determines what your practice is worth.

Visit us today at www.medicalpracticelistings.com to learn more.

919.848.4202 | medicalpracticelistings.com

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice Raleigh North Carolina This is a great opportunity to purchase an established ophthalmic practice in the heart of Raleigh. Locate on a major road with established clients and plenty of room for growth; you will appreciate the upside this practice offers.

This practice performs comprehensive ophthalmic and neuro-ophthalmic exams with diagnosis and treatment of eye disease of all ages.

Surgical procedures include no stitch cataract surgery, laser treatment for glaucoma and diabetic eye disease. This practice offers state-of-the-art equipment and offer you the finest quality optical products with contact lens fitting and follow-up care & frames for all ages.

Comfortable seeing children. Needed immediately.

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

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

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

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

List Price: $75,000 | Gross Yearly Income: $310,000

Contact Cara or Philip 919-848-4202 for more information or visit MedicalPracticeListings.com

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

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.

l One

of the oldest Locums companies l Large 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 List price is over $2 million

Contact us today to discuss your options confidentially.

Please direct all correspondence to mdstaffingforsale@gmail.com.

Only serious, qualified inquirers.

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

MODERN MED SPA AVAILABLE Located in beautiful coastal North Carolina

Modern, well-appointed med spa is available in a picturesque part of the state. This practice is positioned in a highly traveled area with positive demographics adding to the business appeal and revenue stream. A sampling of the services and procedures offered are: BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options.

If you are currently a med spa owner and looking to expand or considering this high profile med business, this is the perfect opportunity.

Highly profitable and organized, you will find this spa poised for success.

The qualified buyer can obtain detailed information by contacting Medical Practice Listings at 919-848-4202.

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202 76| OCTOBER 2012

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

Primary Care Practice For Sale Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches.

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

Excellent exam room layout, equipment and visibility.

Contact Medical Practice Listings for more information.

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

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

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

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

Medical Practice Listings Buying and selling made easy

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com MEDMONTHLY.COM |77

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.

Primary Care Practice for Sale Hickory, North Carolina Established primary care practice in the beautiful foothills of North Carolina The owning physician is retiring, creating an excellent opportunity for a progressive buyer.

There are two full-time physician assistants that see the majority of the patients which averages between 45 to 65 per day.

There is lots of room to grow this already solid practice that has a yearly gross of $1,500,00.

You will be impressed with this modern and highly visible practice.

Call for pricing and details.

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

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

Woman's Practice A vailable for Sale Available for purchase is a beautiful boutique women’s Internal Medicine and Primary Care practice located in the Raleigh area of North Carolina.

The physician owner has truly found a niche specializing in women’s care. Enhanced with female-related outpatient procedures, the average patient per day is 40+. The owner of the practice is an Internal Medicine MD with a Nurse Practitioner working in the practice full time. Modern exam tables, instruments and medical furniture.

Gross Yearly Income: $585,000 | List Price: $365,000

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com MEDMONTHLY.COM |79

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY

NC OPPORTUNITIES LOCUMS OR PERMANENT

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

By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients.

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

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

For more information about Physician Solutions or to see all of our locums and permanent listings, please visit physiciansolutions.com

medmonthly.com | 919.747.9031

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 MEDMONTHLY.COM |79

the top

Greatest Medical Discoveries of All Time

Compiled by Thomas Hibbard

1

ANESTHETICS VACCINATION

The discovery of vaccination, by Edward Jenner, has helped to greatly reduce some of the world’s deadliest epidemics and diseases from cholera, influenza and measles, to the bubonic plague. Thanks to vaccination, we no longer are susceptible to many threatening diseases which have plagued humankind for a millennia.

2

Anesthetics are easily one of the most important medical advances in surgical operations. By preventing pain during surgery, surgeons were given the ability to work in completely new ways with the human body. It allowed for more complex and intricate surgical procedures to be performed with a lower chance for complications such as shock.

PENICILLIN

The discovery of penicillin was the discerning moment that finally gave the medical profession a way to fight back against infections that would have once cost people their lives. Penicillin became the starting point for a whole string of healing antibiotics. This new way of treatment meant that amputations were significantly reduced, gum infections could be treated and infections of the blood were no longer fatal.

3

GERM THEORY

Germ theory, discovered by French chemist Louis Pasteur, allowed scientist to find the major causes behind disease and created a whole new understanding on why cleanliness was important.

Germ theory helped to acknowledge the importance of sanitation in disease prevention. The origin of diseases such as cholera, anthrax and rabies was a mystery until its discovery.

80| OCTOBER 2012

5

X-RAY

X-Ray, discovered by Wilhelm Conrad RĂśntgen, allows us to see inside the human body without having to perform dangerous surgeries. X-rays are one of the most common methods used in the field of medicine to make diagnosis related to bones and joints. As well as seeing anomalies in the human body, X-rays have benefitted the dentistry profession by allowing dentists to spot cavities before they turn in to painful abscesses.

6

BLOOD CIRCULATORY SYSTEM

In 1242, the Arabian physician, Ibn al-Nafis, became the first person to accurately describe the process of pulmonary circulation, penning him the father of circulatory physiology. Knowledge of the different blood types is crucial to performing safe blood transfusions, now a common practice.

8

INSULIN

7

DNA (DEOXYRIBONUCLEIC ACID)

The discovery of the DNA was made by the Swiss physician Friedrich Miescher. DNA is any of the various nucleic acids that are usually the molecular basis of heredity that are used in the growth, development and body functioning of all living organisms. DNA testing has been put to very beneficial use for decades not only in medicine but also in law enforcement and legal fields.

Frederick Banting and his colleagues discovered the hormone insulin (1920′s), which helps balance blood sugar levels in diabetes patients, allowing them to live normal lives. Before insulin, diabetes meant a slow and certain death. Insulin stops the use of fat as an energy source by inhibiting the release of glucagon.

9

VITAMINS

Frederick Hopkins and a few other scientists discovered (in the early 1900′s), that some diseases are caused by deficiencies of certain nutrients, later called vitamins. Through feeding experiments with laboratory animals, Hopkins concludes that these “accessory food factors” are essential to health.

Read more at: http://www. healthfiend.com/weeklytop/top-10greatest-medical-discoveries-of-alltime/ MEDMONTHLY.COM |81

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