PHYSICIAN SOLUTIONS magazine
July 2016
the You How Do h S tress, t i W e p o C Doctor? issue
HEALING THE HEALERS: How Coaching Can Help Physicians Find Balance and Manage Stress pg. 24
4 Strategies to Reduce the Stress Burden for Women in Medicine pg. 30
Which SPF (Stress Prevention Factor) is Right for You? pg. 28
Is Stress Beating You Down, Doctor? pg. 20
20
contents
IS STRESS BEATING YOU DOWN, DOCTOR?
features
20 IS STRESS BEATING YOU DOWN, DOCTOR? 24 HEALING THE HEALERS: How Coaching Can Help Physicians Find Balance and Manage Stress 28 WHICH SPF (STRESS PREVENTION FACTOR) IS RIGHT FOR YOU? 30 4 STRATEGIES TO REDUCE THE STRESS BURDEN FOR WOMEN IN MEDICINE
practice tips
8
WHEN SHOULD YOU OUTSOURCE MEDICAL CODING?
6
SIMPLE STEPS TO BETTER TRACK MEDICAL PRACTICE CONTRACTS
8
WHEN SHOULD YOU OUTSOURCE MEDICAL CODING?
12 HOW DOES COPD CARE BY PHYSICIANS COMPARE WITH NURSE PRACTITIONERS/ PHYSICIAN ASSISTANTS?
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PhysicianSolutions July 2016 Publisher Creative Director Contributors
Philip Driver Thomas Hibbard Naren Arulrajah Nick Hernandez, MBA, FACHE Amie Langbein, DO, CPCC, ACC Lara Salyer, D.O. Angela Savitri, OTR/L Vikas Vij Mark Wagner
contributors Nick Hernandez, MBA, FACHE is the CEO and founder of ABISA, a consultancy specializing in solo and small group practice management. He has consulted with clients in multiple countries and has over 20 years of leadership and operations experience. Visit www.abisallc.com for more information.
Amie Langbein, DO, CPCC, ACC is a Co-Active Professional Coach and board certified Family Physician, using her training in medicine, integrative medicine, health and wellness, mind/body/ spirit, mindfulness meditation, and coaching, as well as her love of story, to assist clients in discovering the very best in themselves. Connect with Amie on LinkedIn.
Lara Salyer, D.O.
Physician Solutions is a national monthly magazine committed to providing insights about the health care profession focusing on practical advice for physicians and practices. We are currently accepting articles to be considered for publication. For more information on writing for Physician Solutions, please email us at physiciansolutions@gmail.com.
P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com
is currently an employed family physician in rural Southwest Wisconsin, involved in teaching Family Medicine residents from University of Wisconsin, Madison and University of Illinois, Rockford. Her life is personification of Walt Whitman’s words: “You must always be curious.” Consequently, she is reinventing her career after additional certification in Functional Medicine to open a private practice to optimize corporate and individual wellness. Check out her progress at www.healthin8.com after December 2017.
Angela Savitri, OTR/L is a Chronic Stress Coach who helps professional women be free of burnout and chronic stress. She guides women to experience an unburdened and content life, even with a demanding career, through her signature 5-Step Freedom From Chronic Stress Program. Learn more at www. freedomfromchronicstress.com.
Mark Wagner is president and CEO of KIWI-TEK (.com), a medical coding company founded in 2002 to provide customized, flexible and practical outsourced coding solutions to hospitals, clinics and physician groups across the country. PHYSICIAN SOLUTIONS MAGAZINE | 5
practice tips
Simple Steps to Better Track Medical Practice Contracts By Nick Hernandez, MBA, FACHE CEO and Founder of ABISA
22|| JULY DECEMBER 6 2016 2013
Keeping track of contract renewals can be tedious. Whether practices renew such contracts all at once, or throughout the year, there are techniques to simplify the task. A healthy practice is one that manages its contracts (vendor contracts, service agreements, and leases) well. Many physicians and practice managers, however, are running nonstop and have never taken the time to track their practice’s contracts. Just as clinical pathways promote organized and efficient patient care, effective contract management promotes organized, efficient, and cost-effective practice management. There is actually a fairly simple method for headache-free contract tracking. I have found that using an Excel spreadsheet in conjunction with Outlook tasks is a proven system to accomplish this. Many contracts are auto-renewing (known as “evergreen”), meaning that once they are signed, they don’t terminate after a certain period but rather continue in effect. Most people get so busy with their practice that after signing the contracts, no one is diligent about reviewing the agreements on an annual basis.
Here are the key items to include in the spreadsheet: 1. A list of all of your contracts The spreadsheet should contain all contracts, including leases such as property leases and copier leases as well as service agreements and vendor maintenance agreements such as janitorial, landscape, etc. 2. The date each contract is up for renewal The first date to be listed on the spreadsheet is the date the contract is up for renewal. Be sure to make a note if the contract is auto-renewing and if this is the case, a separate “notification trigger” date should be included. 3. Notes regarding mandated price increases When reviewing the contracts, take note of any automatic price escalators and if this is part of the contract, a brief note should be included in the spreadsheet. The purpose here is to remind you next year that this contract not only is coming due for renewal, but also has a mandated price increase. This will allow you time to negotiate, shop around, or cancel your current agreement. The spreadsheet is a central repository for summary details of your contracts/agreements/ leases. After you create the spreadsheet: Make note of any of the dates included in the spreadsheet in your Outlook calendar. Outlook gives you the ability to effectively manage contract milestones via automated alerts. Based on the dates you have listed in the spreadsheet, you can set up reminders to negotiate rates (taking advantage of renegotiation windows to improve terms); cancel if so desired (without triggering any fees); or put it out for bid (if reminders are set up with enough advance notice). Going above and beyond: It is also advisable to digitize the contracts and store them as well as the spreadsheet on a shared drive where access can be granted to select members of the practice. When setting up the Outlook reminders, you may also want to ensure that more than one person receives the alerts. Setting this up for the first time can be time-consuming and with busy practices that are often short-staffed, this may be something worth getting a consultant to set up for you initially. Then, you can monitor it yourself on an annual basis.
PHYSICIAN SOLUTIONS MAGAZINE
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practice tips
When Should You Outsource Medical Coding?
Increased coding complexities have intensified workloads and responsibilities for in-house coding departments. Yet they’re expected to maintain productivity while containing costs. Outsourced medical coding could be a safety valve for the mounting coding pressures you’re experiencing. Let’s examine the medical, business and human issues that may affect your decision to outsource or not. 8
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The Game Changer
The transition to ICD-10 and its 68,000 diagnosis codes and 87,000 procedure codes has made coding exponentially more granular and specific. Coders now must be event managers, participating in true clinical analyses. They’re responsible for translating and interpreting the physician’s notes and then precisely documenting the problem, diagnoses and procedures,
By Mark Wagner President and CEO KIWI-TEK
Meeting this more challenging coding environment requires more experienced, better trained and appropriately certified coders. Does your in-house department have the capacity and capability to costeffectively function in this new, more specialized coding world?
The Cost of Expertise
As medical coding has become more detailed, patient encounters more specialized and carriers more compliance-demanding, in-house coding departments find themselves on a treadmill of continuous training and recertification. Sure, you can accept the overhead of staffing, training and compensating your in-house coders to keep them agile, knowledgeable and productive to handle all your coding types and workflow all the time. But that can be a pricey endeavor, unless you’re a small practice with a narrow band and volume of procedures. At some point the practicality of outsourcing your medical coding will outstrip the functionality of your in-house coding department, or, at least, keeping 100% of your facility’s coding in-house. Doesn’t it stand to reason there may be coding specialists out there more proficient and probably more cost-effective?
The Economics of Outsourcing
including body part(s), instruments and equipment used. Failure to perform this process with the correct level of specificity may result in a negative impact to your revenue cycle with increased denials and lower reimbursement. Some procedures now may extend beyond your coders’ usual coding context and experience, with unfamiliar codes relevant to a given event.
If your facility has high volumes and varied procedures, you may want to outsource some of your coding to help manage workflow overloads. It’s a lot less expensive than staffing up and then finding you have achieved idle capacity. Outsourcing provides you with the flexibility to bring more coders online as you need them and switch them off when you don’t. Some coding provides intrinsically higher reimbursement. You may find it more profitable and practical to keep labor-intensive, high-value charts such as IP and SDS in-house for your own coders, while outsourcing routine, low margin charts such as Diagnostics and ER that might get in the way of coding more lucrative charts. The opposite may also be true. Outsourcing complex Inpatient charts to specialists that are more highly trained than your in-house staff may be more practical for you. continued on page 10
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continued from page 9
Coding as a Business Service
Once you recognize medical coding as a healthcare business service—an extremely vital one, it encourages you to consider outsourced coding as you might any other business service—accounting, payroll, retirement planning, medical insurance, risk management insurance, legal representation, tax consulting, communications services, etc. There are specialists for every business discipline; coding is no exception.
What’s Holding You Back?
Security You don’t want your charts leaving your facility? Electronic charts stay on your applications and require secured connections for external access. You’re good for now If your coders are fully capable, efficient and productive over all your coding types, and you have workflow to keep them busy most of the time, you don’t presently have a pressing need for outside resources. But if workflow or chart types exceed their capacity or effectiveness, outsourcing could help you manage the overflow or specialty limitations. Cost With outsourcing, you’re paying only for a coder’s time on charts. You’re not absorbing in-house overhead such as recruiting, training, salaries, benefits or office space. With the relentless pressures to reduce healthcare costs, facilities are looking at every way possible to cut costs while improving quality. Coding may be an area where ensconced, traditional department costs will come under CFO review. Quality Outsourced coding companies must have stringent recruitment practices and rigid training, testing and certification procedures. They must have coders up to speed and up to date in applying the latest codes for all specialties, diagnoses, procedures and outcomes. That’s their business. They should be able to step into any coding situation you present and meet your expectations for turnaround time, compliance, accuracy and prompt and appropriate reimbursement. Because outsourced coding companies handle such an array of coding circumstances, they may bring valuable insights into interpreting the coding nuances of the total event, therefore applying more precise 10
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codes that might result in more appropriate reimbursement for your facility or practice.
Personnel and Personal Concerns
You’ve built your in-house department into a loyal group of competent coders. Reducing or eliminating coding staff would be a traumatic experience for all involved, even if it does make good business sense. But the fact is, you may have too much, too little and too varied coding demands to keep your department productive all the time. On an as-needed basis, outsourced coding can alleviate coding spikes quite conveniently and cost effectively, with no cultural impact to your department. But if you truly need to reduce your number of coders, outsourced coding takes on a surprisingly benevolent twist. It could become an employer.
Career Advancement
There’s a huge demand and competition for experienced, quality, industrious medical coders. Outsourced coding companies are snapping them up as fast as they can find them. Generally speaking, the income and benefits for full-time coding consultants is better than what you’re paying. Plus, coders can work remotely from home, which, if handled properly, can be a wonderful lifestyle perk. If you have to let well-qualified coders go, they’ll probably be hired quickly by a coding company offering more lucrative income and benefit packages. From the HIM Director or coding manager’s perspective, a facility will still require those positions to manage, coordinate and quality check the outsourced coding company’s efforts. You’re grappling with a new coding paradigm. But if you have to break up the band, the individual outcomes could be better for everyone.
Is it a Better Way?
Will partly or fully outsourced coding make your healthcare machine run better, faster, more economically and improve healthcare quality? Ideally yes, if you properly (and realistically) analyze your coding process—chart types, coding volumes, staff performance in terms of turnaround time, compliance, accuracy, rejections and optimal reimbursement. The simple answer to the complex question of when should you outsource your coding: When it makes sense for your facility’s business, culture, workflow and types of coding.
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practice tips
How Does COPD Care by Physicians Compare With Nurse Practitioners/ Physician Assistants?
Researchers from The University of Texas Medical Branch at Galveston investigated differences in care given to chronic obstructive pulmonary disease patients by medical doctors compared with nurse practitioners and physician assistants. This study is currently available in the journal, PLOS ONE. The United States is experiencing a shortage of primary care physicians; stemming from growth in the population of older adults, increased rates of chronic diseases and an additional 13 million newly insured patients needing medical services under the Affordable Care Act. To meet this growing need for primary care providers, many health systems are looking at alternate models of care by expanding the workforce of advance practice providers, or APPs, which include nurse practitioners and physician assistants. APPs are increasingly contributing to the care of those with health conditions requiring lifelong management such as chronic obstructive pulmonary disease, diabetes, high blood pressure and others. However, some physician organizations say that APPs have less training and experience managing these type of conditions and can’t deliver services of as high quality or as safe as those of physicians. UTMB’s study is the first to examine the quality of COPD primary care delivered by physicians versus APPs on a national level. For the study, records of 7,257 Medicare COPD patients who had at least one hospitalization in 2010 were reviewed. Researchers were looking for differences in the medical care given by the two types of providers and outcomes of patients. The researchers looked at which health care professionals administered tests to check breathing capacity, flu 12
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‘‘
“...many health systems are looking at alternate models of care by expanding the workforce of advance practice providers, or APPs, which include nurse practitioners and physician assistants.”
and pneumonia vaccines, COPD medications and referrals to a pulmonary specialist. Outcome measures were emergency department visits, number of hospitalizations and readmissions within the first month after being released from the hospital. “We found that APPs were more likely to prescribe short-acting inhalers or oxygen therapy and to consult with a pulmonary specialist, but less likely to give flu and pneumonia vaccinations compared to physicians,” said Amitesh Agarwal, MD, lead author and fellow in the UTMB division of pulmonary critical care & sleep medicine. “Patients receiving care from APPs had lower rates of ER visits for COPD and a higher follow-up rate with a pulmonologist within 30 days of hospitalization for COPD than those cared for by a physician.” Agarwal said that the more frequent specialist consults with APP care may be due to the recognized need for expertise and skills outside of the APP’s scope of practice for complex patients. Lower use of influenza vaccination in the APP group is likely related to the lower age group of the COPD patients under their care. The study also found lower rates of follow-up clinic visits after hospitalization for sudden COPD flare-ups in the APP group than in the primary care physician group. However, patients cared for by APPs had more clinic follow-up visits with a pulmonary specialist than the patients of physicians. Higher follow-up rates with a pulmonologist following hospitalization in the APP group may partly explain the lower trends in emergency visits and readmission. Source: http://www.pressreleasepoint.com/how-does-copd-care-physicians-compare-nurse-practitionersphysicianassistants PHYSICIAN SOLUTIONS MAGAZINE
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U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.commerce.state.ak.us/dnn/ cbpl/ProfessionalLicensing/DispensingOpticians.aspx Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847 California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 http://www.optometry.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.ct.gov/dph/cwp/view. asp?a=3121&q=427586 Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 http://www.pof.org/opticianry-board/ Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 http://sos.ga.gov/index.php/licensing/ plb/20 Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 http://hawaii.gov/dcca/pvl/programs/ dispensingoptician/
Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 http://www.ironforidaho.net/
Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 http://www.oregonobo.org/optque.htm
Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296 http://www.opticiantraining.org/optician-training-kentucky/
Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 http://sos.ri.gov/govdirectory/index. php? page=DetailDeptAgency&eid=260
Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 http://1.usa.gov/zbJVt7
South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us
Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/
Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://tn.gov/health
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.njsop.org/aws/NJSOP/pt/sp/ home_page 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/
Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 http://www.tob.state.tx.us/ 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 http://www.dpor.virginia.gov/Boards/ HAS-Opticians/ Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission. aspx
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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 https://www.commerce.alaska.gov/web/ cbpl/ProfessionalLicensing/BoardofDentalExaminers.aspx 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/
Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://cca.hawaii.gov/pvl/boards/dentist/ 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://www.isds.org/LawsLegislation/ boardOfDentistry.asp Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm
Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 https://www.colorado.gov/pacific/dora/ Dental_Board
Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/
Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/cwp/view. asp?a=3143&q=388884
Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.dental.ks.gov/
Delaware Cannon Building, Suite 203 861 Solver Lake Blvd. Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ
Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/
Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://floridasdentistry.gov/ 16
Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 https://gbd.georgia.gov/
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Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://dentistry.ky.gov/
Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-72600_72603_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd. P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://bsd.dli.mt.gov/license/bsd_ boards/den_board/board_page.asp
Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://dhhs.ne.gov/publichealth/Pages/ crl_medical_dent_hygiene_board.aspx
Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/
Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044 http://www.nvdentalboard.nv.gov/
Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037 http://www.ok.gov/dentistry/
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://njpublicsafety.com/ca/dentistry/
Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Dentistry/ Pages/default.aspx#.VbkfjPlPVYU
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 New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/ North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/ North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/
Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/ South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/ Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://tn.gov/health
Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/ Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://governor.vermont.gov/boards_ and_commissions/dental_examiners Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp
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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://www.medlicense.com/alaskamedical-license.html 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/cwp/view. asp?a=3143&q=388902 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://doh.dc.gov/bomed 18
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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://www.maine.gov/md/
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/
Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://michigan.gov/lara/0,4601,7-15472600_72603_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/Pages/default.aspx
Minnesota University Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd. P.O. Box 1335 Jefferson City, MO 65102 (573)751-0293 http://pr.mo.gov/healingarts.asp
Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bsd.dli.mt.gov/license/bsd_ boards/med_board/board_page.asp Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 https://www.nebraska.gov/LISSearch/ search.cgi Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://www.medlicense.com/new-jerseymedical-license.html New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/
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://www.tmb.state.tx.us/
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/licensing/physician_surgeon.html
Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/ Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/ Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/ Pages/default.aspx#.Vbkgf_lPVYU 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://tn.gov/health
Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK 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://dsps.wi.gov/Boards-Councils/ Board-Pages/Medical-Examining-BoardMain-Page/ Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/
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features
Is Stress Beating You Down, Doctor?
By Naren Arulrajah with Vikas Vij Ekwa Marketing
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A simple search on patient experience will pull up a mountain of literature on what patients expect from their healthcare providers. There is a lot of talk about brand impressions and perceptions, as well as disappointment that patients experience when dealing with a physician of their choice. The patient is the star attraction, and rightfully so, for healthcare practice brands that need to increasingly and often aggressively compete for market space. However, in all this noise about meeting expectations, empathizing with patients and respecting choices and doing what is right for the patient in keeping with the dictates of delivering stellar patient experience, the physician is often forgotten. While there is no denying the fact that the role and responsibility of a physician is magnanimous in every way, it comes with immense work pressures that can sometimes severely limit the life of a physician outside his clinic. In a lot of instances, physicians experience a professional burnout, but still feel compelled to continue.
Straining Under the Weight of the “Noble” Profession Healthcare providers are required to be caring and compassionate at all times. Being a doctor is a 24/7 job - however, trying to do what is right all the time with a smiling face can take its toll. Professional burnout is not uncommon among physicians. It is estimated that close to 30% to 40% of physicians in the United States experience a burnout. In the course of upholding his professional responsibilities, a phy-
sician often faces difficult situations where decisions need to be made in haste. And in every situation, the responsibility and accountability of the outcome falls fairly and squarely on the shoulders of the physician. They are also required to deal with evolving mandates on patient care, navigate through reimbursement policies that are increasingly being linked to the new standards healthcare delivery, while also constantly keeping abreast with clinical developments and technological advancements in healthcare. Understanding and empathizing with this kind of responsibility and the ensuing stress that comes with it is almost impossible for those outside the medical fraternity. All of this is made worse by the fact that doctors are seen as custodians of good health and admitting to an emotional or physical condition such as stress or a burnout carries a stigma. The unspoken yet implied inference being – can a doctor who finds it difficult to shoulder the stresses of his profession be allowed to treat and care of patients.
When Stress Becomes a Real Problem Most physicians are averse to the idea of seeking medical help or treatment even if they are struggling with stress or a burnout. However, because of their professional expertise and also because they have much easier access to drugs, most physicians opt for self-medication. In some cases this works out in favor of the physician. Others are not as successful and end up misusing prescription drugs. This is often compounded with alcohol dependence or with a substance abuse issues.
‘‘
“Being a doctor is a 24/7 job - however, trying to do what is right all the time with a smiling face can take its toll. Professional burnout is not uncommon among physicians. It is estimated that close to 30% to 40% of physicians in the United States experience a burnout.”
The real problem however, is not the fact the physicians are not immune to stress and its other byproducts; the real issue being that most physicians tend to suffer in silence. Fearing professional ostracization, most healthcare providers shy away from seeking help. Unfortunately, physicians who choose to ignore the toll that stress is having or can have on their mental and physical health are on the fast-track to an emotional and physical burnout. This can lead to depression, diminishing job satisfaction, errors in judgment, excessive dependence on prescription drugs and alcohol and substance abuse, and even suicide. A life that is meant to care and heal others ending this way is a travesty.
Don’t Wait for a Professional Burnout to Happen Prevention is better than cure – if there ever was a better place or use for this popular proverb, this continued on page 22
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would be it! Don’t wait till you are completely stressed out. Recognize the sign(s) and act on it. Determine a period of time such a week or ten days and identify stress triggers during that time. Maintain a log of situations or conditions when your stress levels shoot up. Keep a record of your emotional and/ or physical response. Also make a note of actions or responses or any other steps you took to cope with your stress. Making adjustments or tweaking your response and coping mechanisms or even avoiding stress triggers becomes easier when you know what affects you and stresses you out.
Stress Busters that Really Work Condition your Mind It is not easy, but you need to let go of work once you are outside. Obsessing over your patient’s health is not going to cure them. It certainly won’t do you any good to stress about things that are not under your control. Even when faced with trying times, it is important to keep a positive attitude about your work and the kind of impact it has on people. You are helping people and that should always cloud any negatives you experience. Condition your Body Exercise keeps your mind and your body fit and can help in bringing down anxiety and stress. But as a physician you already know that. Also remember, you are not invincible - as much as there is a need for your services, you also need to recognize the need for taking some time out for yourself. At the very 22
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least, steal a few minutes to stretch your legs or take a little walk. Being away from the desk and/or from the office can and does bring a fresh lease of life even to the most mundane jobs. Don’t Isolate Yourself Family, friends, close colleagues, and support groups are and should be a part of your ecosystem. If you are facing problems or find yourself reeling under the stress and strains of your job, talk to those close around you and share your problems. Remember, talking and sharing your problems is less about finding a solution and more about unburdening yourself. Accept your Limitations Sometimes you just have to give in and take a step back. You are a
doctor with a world of professional expertise to back you – but don’t forget you need to contend with human limitations. Seeking help is a big part of accepting your limitations, so don’t delay registering with a GP or seeking professional help from a psychotherapist or counselor.
Conclusion Physicians live with enormous stress. No amount of medical school training can prepare a doctor or make him or her immune to the pressures of caring for patients. The doctor’s office is a stressful and emotionally charged space not just for patients but equally so for the physicians attending to the patients. So it is extremely unreasonable to expect physicians to deal with stress on a daily basis and not get affected
by it. As with any other profession, physicians need to guard themselves against stress and burnout before it causes irreparable damage to their professional and personal lives. About the Author: Naren Arulrajah is President and CEO of Ekwa Marketing, a complete Internet marketing company which focuses on SEO, social media, marketing education and the online reputations of Dentists and Physicians. With a team of 140+ full time marketers, www.ekwa.com helps doctors who know where they want to go get there by dominating their market and growing their business significantly year after year. If you have questions about marketing your practice online, call 855 598-3320 to speak one-on-one with Naren.
features
Healing The Healers: How Coaching Can Help Physicians Find Balance and Manage Stress
By Amie Gordon-Langbein, DO, CPCC, ACC
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• Do you feel stressed, overworked and undervalued? • Do you wish that you had more time to do what you love, or be with the people who matter most? • Do you want to change something about your current situation? • Do you long to feel fulfilled in your job and reconnect with what made you choose medicine in the first place? Renew your purpose? Make a difference in the world? • Do you want to make a career change? Rewrite the story of your life? If you answered yes to any of these questions, you are not alone. Physician burnout has reached epidemic proportions. Last year over 400 physicians committed suicide; double the rate of the general population.i Moreover, a recent study from the Mayo Clinic and the American Medical Association showed that of nearly 7,000 physicians surveyed in 2011, 45.5% reported feeling burned out, and that by 2014, that number had risen to 54.4%.ii These statistics are alarming. Arthur Caplan, the well-known medical ethicist goes so far as to say that “physician burnout” in this country is a public health crisis. While the majority of healthcare providers entered their fields with a deep-seated desire to help others and make a difference, the climate of medicine today has created a schism between how these wellintentioned providers want to practice medicine and how they need to practice medicine in order to survive. This creates a population of providers who are inundated, burned out, and marginalized from their patients and from what initially motivated them to choose the practice of medicine in the first place. It goes without saying that when the physicians themselves are feeling overwhelmed, it is exceedingly difficult for them to be present for their patients, let alone find the time to create balance and fulfillment within their own lives. How can coaches help? While coaching is relatively new to the world of medicine, the use of coaches in business has been commonplace for years. Executive coaches help employers and employees clarify goals, facilitate meaningful changes, boost productivity, bolster creativity, manage issues of work/life balance, institute effective strategies for stress management, set reasonable and attainable goals, foster a sense of self confidence, and empower employers to function
better. Coaches can help physicians address all these issues and more. As physicians, we have been trained in the medical model, focusing primarily on disease and pathology. “Psychological issues” have been the domain of psychiatrists /therapists. It is imperative to highlight the critical distinctions between coaching and therapy so physicians can see how they and their patients might utilize coaching (Table 1). All physicians have issues that can be addressed through coaching at one time or another but not all need therapy. Whereas physicians view patients as having a problem that needs fixing, coaches take a holistic approach and don’t believe clients need fixing at all. They believe the clients know what is best for them, and the coach acts as a sounding board, helping clients to discover the answers for themselves. Coaches do this by creating an environment of trust and growth – asking powerful questions – where clients feel challenged and inspired to explore what truly matters. Coaches work with clients on all aspects of their lives, both personal and professional. They help clients explore and research new opportunities, try on new hats, examine fresh perspectives and set actionable goals. Coaching is about transformation. The process of working with a coach helps clients bridge the gap between where they are now and where they want to be. Coaching is about forward momentum, and generally does not focus on past experiences. The core of the coaching relationship is about what clients wish to change within their life and creating the meaningful transformations necessary to make those visions become reality. So, what about specifics? Here are 5 ways that Coaching can help physicians. 1) Coaches can help physicians identify the exact causes of stress, what their personal stress triggers are, and help them create concrete stress management strategies Does being 2 hours behind in your schedule stress you? Do you feel stressed when administrators tell you how many patients to see and how long you should be spending with a patient? Coaches can help you to recognize what makes you feel most stressed and assist you in implementing new strategies to deal with those situations.
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Distinctions Between Coaching and Therapy Coaching Client does not have a diagnosis and is not focused on treatment of a problem Focuses on helping clients explore issues of greater fulfillment in life Action-oriented with a focus on insight Coaches are non-judgmental sounding boards, stimulating clients to discover answers for themselves Focuses on bridging the gap between where the client is now and where they wish to be Involves action and explores beliefs that maximize self esteem Primarily focuses on external issues Incorporates exercises to identify and address major stressors, such as meditation, relaxation, and visualization Centers on inspiring and empowering Involves exercises between sessions to help clients move towards the goals Client-solution orientation Coaches take the time to figure out what makes you tick. Are you someone who used to exercise but doesn’t now because you don’t have the time? Are you someone who used to love to read, or paint, or teach? Not only are coaches trained in traditional relaxation techniques such as meditation and deep breathing, they understand the importance of connecting you to what matters most and recognize the strategic importance of self –care. Physicians often forget to take care of themselves because they are more focused on taking care of others. 2) Coaches act as non- judgmental sounding boards and facilitators for change. Most physicians are not used to asking for help. And yet, asking for help is actually a courageous move: it’s a realization that we are stuck and we want to move forward, away from where we 26
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Therapy Patient is viewed within the medical model, and has a DSM diagnosis that requires treatment Focuses on treating patients for psychological issues that compromise quality of life Problem-solving focus Therapists are non-judgmental but are viewed as experts Focuses more on past experiences and how they affect the present condition Explores the origins of behaviors that drive self esteem Primarily focuses on internal issues Sometimes incorporates stress management techniques Centers on healing and reflection Generally does not involve assignments between sessions Prescribed solution-orientation are. We all need to feel heard, valued and important. Coaches listen intently for what truly matters. One of the most profoundly inspiring aspects of working with a coach is that the coach can listen and act as a non-judgmental sounding board while encouraging the client to explore new perspectives. 3) Coaches quickly help you clarify and articulate your goals while holding you accountable Having someone who pushes you to explore what you want, and why you want it, is a novel concept for most physicians. Exploring issues such as work/life balance, feeling stuck and creating a life that is truly fulfilling, coaches help create action plans to empower clients to boldly and confidently make transformative changes. One of the most important aspects of the coaching rela-
tionship is that coaches hold you accountable. If your goal is to become a more effective leader in the workplace, or to find more time to spend with your family, coaches help you to design action plans to move you toward your vision. 4) Coaches help you identify the impact you wish to make in this world We are all more than the professions we choose. Coaches ask questions that will help you to discover what is the legacy you wish to leave. Since so many physicians chose medicine because they wanted to help others and make a difference, exploring this question is important to them; the disconnect they feel is often so profound. Coaches create a unique, thought-provoking process to help illuminate our lasting legacies. 5) Coaches can help you to identify areas where you are stuck The stories we tell ourselves are the stories we live. Often we are trapped in the same old stories and feel helpless to change. Coaching helps us discover that we have choices and empowers us to
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make the necessary changes to write new chapters. The first step to making any change is recognizing change is needed. Coaches are masters at helping you identify where you are stuck and what you are avoiding. They help you develop an awareness of your current story while challenging you to envision what your next page might be. Coaching can be life-changing for physicians, as it can help them find new ways to manage and identify their stress, achieve greater work/life balance, explore new opportunities personally and professionally and, ultimately, live the life for which they have always longed. American Foundation for Suicide Prevention. Facts about physician depression and suicide. http://afsp.org/ our-work/education/physician-medical-student-depression-suicide-prevention/ Accessed February 21, 2016 ii Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians with the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-1613. Abstract i
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features
Which SPF (Stress Prevention Factor) is Right for You?
By Lara Salyer DO
“Which SPF is right for your skin?” This question appeared in bold, glossy red font from the pages of a 1990 “Seventeen” magazine. Images of stonewashed denim and baby doll dresses flanked the more pressing query, “Which perm works for your face shape?” (One glance at my prom photo and it’s evident I did not read this article.) Born to a Finnish mother, I was certain Fitzpatrick forgot to include our Type 0 on his skin measuring system. Midwest summers underscored this discrepancy. Limbs belonging to my friends were bronzed with coconut Hawaiian Tropic Tan Accelerator. My
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sensitive appendages remained encased in thick, chemical paste. (I’d like to attribute this scent as inspiration for Nirvana’s “teen spirit,” perhaps?) Fast forward a decade and my skin is iron-clad tough. No credit to zinc oxide, though. This was a direct consequence of the grueling medical training resulting in board certification for Family Medicine. By the year 2000, my tough skin was forged from sleepless nights, pager alerts, betadine swabs, and insurance denials. Any holes in my integumentary armor were plugged with literature searches, grand rounds, and cold cafeteria sandwiches.
form Weber’s Concertino on stage. (SPF factor of 20 minutes of endorphin high). • Prior authorization paperwork piling up from the third attempt to get portable oxygen covered for COPD? Arrange a weekly sitter on Friday nights for uninterrupted dinner with your husband. Out of the house. Without the soundtrack of three children chiming, “I don’t want to eat THAT.” (SPF factor of 8-9 hours of residual bliss if you time it right and get home after the kids are in bed)
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“To remain balanced and equanimous in this era of increasing demand and diminishing returns, it’s imperative to protect yourself.”
In 1992, it was essential to lather on my SPF to protect myself from harmful UV rays. In 2016, SPF is crucial to preserve my tender humanity. We’re not dealing with Sun Protection Factor, but Stress Prevention Factors. As the landscape of Family Medicine changes underfoot, I apply my SPF liberally: • New EMR rollout with widescreen view? Take a few extra Zumba classes (SPF factor of 5 hours of good sweaty relief). • Coding rules changing again and forgot to add the bilateral modifier? Practice clarinet and per-
• Inbox overflowing with Patient Advice Requests, refills, result notes, or other busy work? Start running on the local trail over your noon hour. (SPF factor of immeasurable calm and lifetime longevity). • Another Press Ganey score got you down? Pick up a paintbrush. (Do not underestimate the SPF potency of painting the words “Bye Felicia”). • Angry patient demanding to be worked in *right now* for refills of “lost narcotics”? Impromptu kitchen dance party while cooking pancakes for dinner. (SPF factor of 10 giggly minutes. For SPF of 20, ask your kids to teach you the Whip Nae Nae.) These harmful rays of modern medicine still penetrate SPF….even with the most diligent use. So doctors must re-apply SPF often. No SPF is waterproof, not even through tears. To remain balanced and equanimous in this era of increasing demand and diminishing returns, it’s imperative to protect yourself. Find your SPFs. Ask yourself what were you doing when you last felt joyful? When you start pruning off the obligations, you find your brand of SPF much easier. And when the heat is still too strong, it might be time to get out from under the blazing sun. Sometimes there isn’t enough SPF to make your skin comfortable. Take a break from the rays; go on a mission trip, volunteer for homeless outreach, drop to parttime practice. Rethink the role of being a physician as a door opener to change and transformation. ….or if the heat is still too strong, and the destination doesn’t look like the pictures promised in the travel brochure, move to a different climate and reinvent yourself. (Just please leave the perms and stone washed jeans out of this.)
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features
4 Strategies To Reduce The Stress Burden For Women In Medicine
By Angela Savitri, OTR/L Chronic Stress Coach www.freedomfromchronicstress.com
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Medicine is stressful business. From long hours, caring for the sick, productivity requirements, and administration pressures, the weight is heavy on all physicians. Women in medicine navigate additional stressors in order to maintain a successful career, some of which are more implicit than others. In addition to the high work demands required of all doctors, the stress burden of female physicians is increased by the following challenges that require extra energy and attention: Advocate For Equal Pay Medicine is no exception to the gender wage gap, even within the same specialty. Researchers from Duke University and the University of Michigan Health System found that among 800 physicians who received an early career research grant, women earned an average of $12,194 less than men a year, even when all other variables were identical.1 Not Being Received as an Authority by Staff and Patients Even though women make up 1/3 of all practicing physicians in the United States, women still report that patients and medical staff frequently look to the male figure over the female physician as the authority, even when the male figure is a subordinate. Women use extra energy to fight for their well-earned right to be heard, responded to, and respected. Lack of Dedicated Support at Home, With or Without Children With work demands high for all physicians, it can be helpful to have
a supportive partner to take care of domestic responsibilities. Over double as many female physicians are single (14%) compared to their male peers (5.62%). Regardless of being single or married, male doctors are more likely to live with a partner (89%) than female doctors (76%).2 In my coaching practice of women seeking relief from chronic stress, all my female physician clients are either single or married to another physician. In these two scenarios – whether out of necessity, mutual agreement, or imposed by self or society – women take on the responsibility for managing domestic issues. Navigate Maternity Leave, Breastfeeding, and Childcare If a female physician desires a family, work-life gets more complicated. Women in medicine must balance patient care with their care to meet the nutritional needs of pregnancy and milk production, but time to eat is unfortunately a luxury in many medical settings. If a designated lactation room is not available, a nursing physician must work to secure a space with an already full schedule. Most women assume the responsibility for coordinating childcare, which takes further time and energetic resources to manage. These issues are not solely women’s issues, but humanitarian issues that need to be addressed with welcoming arms to honor the importance of proper human development. Medicine can get on board with that, right? For over a decade, almost 50% of graduating medical students have been female. The medical establishment must open up, listen, embrace, and take action to enthusiastically attract and retain quality
female physicians. In doing so, not only do you increase the job satisfaction for women in medicine, but you also create positive workplace dynamics and better patient care. The whole healthcare ecosystem benefits. To make this vision a reality, here are 4 strategies that medicine – both as a community and as individuals – can do to reduce the stress burden for women in medicine: 1. Don’t Operate Your Women’s Leadership Initiative in a Silo Kudos for organizing and having a women’s leadership initiative or mentor program within your organization. These initiatives provide a needed and safer environment for women to share, learn, and collaborate with issues specific to women in medicine. However, don’t just stick to yourselves. Your women’s leadership initiative needs to involve your male counterparts to encourage understanding, dialog, and advocacy. Most leadership positions remain held by men, and you need to include them in the dialog and exchange so everyone’s needs are equally appreciated, understood, and championed. 2. Stop Accommodating a Culture of Judgment, Both Within Yourself and in the Workplace One of the biggest stressors my female physician clients report is the pressure to do it all and do it all well. After working so hard to get where you are, continued on page 32
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who wants to let a ball drop or be perceived as the one dropping the ball? The internal pressure to keep everything perfectly held together is partially selfimposed, partially imposed by societal expectations, and partially imposed by a work culture that does not tolerate the necessary human need to yield to exhaustion. In a profession where ‘eat what you kill’ and ‘I suffered through it so you can too’ mentalities are commonplace, it is time to replace the harsh self-judgments with mindful self-compassion. By learning to value your worth because of your innate being instead of your accomplishments or how long you can plow through, physicians can learn to drop the unnecessary armor and be free to be human. By honoring and accepting your own needs for rest, nourishment, intimacy, and play, you give others permission to do the same. Doing so is not lazy or indulgent. It’s necessary for your well being, and I promise you will still get your work done.
GenX men – want a life too. While men hold most leadership roles in medicine, they are also held by older men, where a generational gap may be more broad than a gender gap as younger male physicians want to be available for their families and leisure pursuits. As younger physicians of both sexes grow in numbers, it is important for leadership styles to adapt. An overly masculinized authoritative ‘do as I say’ dictating leadership style won’t motivate or retain female or male physicians who seek a balanced lifestyle. While it would be great to have more women in leadership, the key is to have a flexible blend of feminine and masculine leadership qualities embodied in each leader, regardless of gender. Current women leaders in the system may have an overly masculinized leadership style formed by the necessity to ‘get ahead in a man’s world.’ But times are changing, and physicians are hungry for a true feminine, collaborative leadership style that genuinely listens, cares, and responds with meaningful action.
3. Balance Masculine and Feminine Leadership Styles What role does leadership play in reducing the stress burden? A big one. Medicine doesn’t offer much flexibility to have a life outside of work. Yes, it’s true that women seek work-life balance options like part-time, flextime, and job sharing, but men – especially millennials and
4. Keep Saying No This strategy is huge. Many women in medicine have learned the art of setting boundaries and saying no. It is not comfortable at first, but with continued practice, it gets easier as you experience the benefits of doing less and not tolerating the dysfunction of a fragmented system. Saying no can even help your career, as many earn respect from their
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managers and peers by drawing a line in the sand (although this is not always the case). Physicians rightfully carry the responsibility of patients’ lives in their hands, but administration has an equal ethical responsibility to support the health of the physicians that provide care. There is no healthcare without you, and as more women in medicine speak up for their needs and desires, the more normalized expecting and receiving a decent work-life balance can become. Change always happens from an unpopular minority, so take heart. Do the inner work required to make outer changes, and you will shift the paradigm of what it means to be a woman in medicine. Taylor, Kate. (2012, June). Even Women Doctors Can’t Escape The Pay Gap. Forbes. Retrieved from http://www.forbes. com/sites/katetaylor/2012/06/13/ even-women-doctors-cant-escapethe-pay-gap/#767d68c55127 1.
Medscape Physician Lifestyle Report 2012 Report. Retrieved from http://www.medscape.com/features/slideshow/lifestyle/2012/public 2.
Angela Savitri, OTR/L, is a Chronic Stress Coach who helps professional women be free of burnout and chronic stress. She guides women to experience an unburdened and content life, even with a demanding career, through her signature 5-Step Freedom From Chronic Stress Program. Learn more at www.freedomfromchronicstress.com.
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Practices for Sale Medical Practices Pediatric Practice Near Raleigh, NC
Location: Minutes south of Raleigh, North Carolina List Price: $145,000 Gross Yearly Income: $350,000 Year Established: 1980(s) Average Patients per Day: 16-22 Total Exam Rooms: 5 Building Owned/Leased: Owned. Will sell or lease. Contact: Philip or Wendy at (919) 848-4202
Urology Practice near Lake Norman, NC Location: Minutes from Charlotte, NC List Price: $165,000 Gross Yearly Income: $275,000 Year Established: 1980 Average Patients per Day: 12 to 15 Building Owned/Leased: Leased Contact: Philip or Wendy at (919) 848-4202
Primary Care specializing in Women’s Practice
Family Practice/Primary Care
Location: Hickory, North Carolina List Price: $425,000 Gross Yearly Income: $1,5000,000 Year Established: 2007 Average Patients Per Day: 24-35 Total Exam Rooms: 5 Building Owned/Leased: Lease or Purchase Contact: Philip or Wendy at (919) 848-4202
Location: Morehead City, N.C. List Price: Just reduced to $20,000 or Best Offer Gross Yearly Income: $540,000 average for past 3 years Year Established: 2005 Average Patients per Day: 12 to 22 Building Owned/Leased: MD owned and can be leased or purchased Contact: Philip or Wendy at (919) 848-4202
Med Spa
Family Primary Care Practice
Practice Type: Mental Health, Neuropsychological and Psychological
Location: Minutes East of Raleigh, North Carolina List Price: $15,000 or Best Offer Gross Yearly Income: $235,000 Average Patients per Day: 8 to 12 Total Exam Rooms: 6 Physician retiring, Beautiful practice Building Owned/Leased: Owned (For Sale or Lease) Contact: Philip or Wendy at (919) 848-4202
Location: Coastal North Carolina List Price: $550,000 Gross Yearly Income: $1,600,000.00 Year Established: 2005 Average Patients Per Day: 25 to 30 Total Exam Rooms: 4 Building Owned/Leased: Leased Contact: Philip or Wendy at (919) 848-4202
Location: Wilmington, NC List Price: $110,000 Gross Yearly Income: $144,000 Year Established: 2000 Average Patients Per Day: 8 Building Owned/Leased/Price: Owned Contact: Philip or Wendy at (919) 848-4202
Special Listings Offer We are offering our “For Sale By Owner” package at a special rate. With a 6 month agreement, you receive 3 months free.
Considering your practice options? Call us today. 34
| JULY 2016
PRESS RELEASE June 28, 2016
For Immediate Release
Physician Solutions is pleased to announce the hiring of Wendy Walker, MHA as Vice President of Client Development. Wendy was previously the Care Coordination Manager at DukeWell, Duke Medicine. Raleigh, North Carolina - Today Physician Solutions, North Carolina’s oldest Physician and Dental staffing agency, announced the hiring of Wendy Walker, MHA to head its Client Development Department. Wendy will spearhead our mission to double the Physician Solutions medical practice base in the next twelve months. With an attention to detail and her drive to deliver exceptional client relationships, I expect she will be receive a warm welcome from health care facilities across the South Eastern United States, Driver says. Ms. Walker will also work with the Physician Solutions team in the Listing and Sales of Medical Practices in all parts of the country. This Press Release can be re-printed by Medical Boards, Medical Associations, News Agencies, Reporters and State and County agencies. You can also download a copy of this Press Release at: www.physiciansolutions.com
Pediatric Practice Available Near Raleigh, NC
Pediatric practice located minutes south of Raleigh, North Carolina is now listed for sale. Located in an excellent area convenient to Raleigh, Cary, and Durham, it is surrounded by a strong health care community. This well established practice with a very solid patient base. The building is equipped with a private doctor’s office, five exam rooms, and an in-house lab.
Established: 1980s l Gross Yearly Income: $350,000 Average Patients per Day: 16 to 22 l List Price: $145,000
Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com
CALLING ALL WRITERS
Are you educated in the medical and health care field and looking to showcase your exceptional writing skills?
To become a contributing writer in Physician Solutions magazine, contact us at: medmedia9@gmail.com
Contact us:
919-845-0054 medmedia9@gmail.com physiciansolutions.com
Editorial Calendar: Aug. - Positioning Your Practice for Success Sept. - Social Media and Your Practice PHYSICIAN SOLUTIONS MAGAZINE
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Located on NC’s Beautiful Coast,
Morehead City
Primary Care Specializing in Women’s Health Practice established in 2005, averaging over $540,000 the past 3 years. Free standing practice building for sale or lease. This practice has 5 well equipped exam rooms and is offered for $20,000. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com
Women’s Health Practice in Morehead City, Newly listed Primary Care specializing in Women’s care located in the beautiful coastal city of Morehead City. This spacious practice has 5 exam rooms with one electronic tilting exam table and 4 other Ritter exam tables. Excellent visibility and parking make this an ideal location to market and expand. This practice is fully equipped and is ready for a new owner that is ready to hit the ground running. The owning MD is retiring and will be accommodating during the transition period. This medical building is owned and is offered for sale, lease or lease to own. The gross receipts for the past 3 years exceed $540,000 per year. If you are looking to purchase an excellent practice located in a picturesque setting, please contact us today.
PEDIATRICIAN
or family medicine doctor needed in
FAYETTEVILLE, NC
Comfortable seeing children. Needed immediately.
Medical Practice Listings Buying and selling made easy
Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com 36 | JULY 2016
Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com
Discounts as big as a house. Or condo. Or apartment. Lindsay Gianni, Agent 12333 Strickland Road Suite 106 Raleigh, NC 27613 Bus: 919-329-2913 lindsay.gianni.f23o@statefarm.com
See just how big your savings could be. Your savings could add up to hundreds of dollars when you put all your policies together under our State Farm roof. GET TO A BETTER STATE. CALL ME TODAY. ®
™
Med Spa in the Raleigh-Durham, NC Area Beautiful Med Spa located in the Raleigh-Durham is among our newest listings. This very upscale facility is established and boosts consistent gross revenues of a million plus. Some of the procedures performed are: Botox, Dermal Fillers, Minimal light based treatments, laser hair removal, cool sculpting (external cooling treatment that freezes the hair and the body metabolizes the fat). This practice is ideal for the Plastic Surgeon or Dermatologist. Established: 2010 l Annual Revenue: $1,000,000 Average Patients per Day: 15 to 25
1103155.1
State Farm Mutual Automobile Insurance Company, State Farm Indemnity Company, Bloomington, IL
Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com
PRIMARY CARE PRACTICE East of Raleigh, North Carolina We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly. We are offering this practice for $50,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased. Contact Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.
Medical Practice Listings Selling and buying made easy
MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202 PHYSICIAN SOLUTIONS MAGAZINE
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NC MedSpa For Sale MedSpa Located in North Carolina 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. 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
www.medicalpracticelistings.com
Pediatrics Practice Wanted Pediatrics Practice Wanted in NC Considering your options regarding your pediatric practice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina. Contact us today to discuss your options confidentially.
Medical Practice Listings Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com
Eastern North Carolina Family Practice Available Well-appointed Eastern North Carolina Family Practice established in 2000 is for sale in Williamston, NC. This organized practice boasts a wide array of diagnostic equipment including a GE DEXA scanner with a new tube, GE case 8000 stress testing treadmill and controller and back up treadmill, Autoclave and full set of operating equipment, EKG-Ez EKG and much more. The average number of patients seen daily is between 12 to 22. The building is owned by MD and can be purchased or leased. The owning physician is relocating and will assist as needed during the transition period. The gross receipts for the past three years average $650,000 and the list price was just reduced to $185,000. If you are looking to purchase a well equipped primary care practice, please contact us today. 919-848-4202 medlisting@gmail.com medicalpracticelistings.com
38 | JULY 2016
PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually. Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information. The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well. For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today. List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000
Medical Practice Listings Selling and buying made easy
MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202
We have several qualified MDs seeking established Urgent Care Practices in North Carolina.
Urgent Care Practices Wanted If you have an urgent care practice and would like to explore your selling options, please contact us. Your call will be handled confidentially and we always put together win-win solutions for the seller and buyer.
Call Medical Practice Listings today and ask for Philip Driver 919-848-4202.
Practice for Sale in Raleigh, NC Primary care practice specializing in women’s care Raleigh, North Carolina The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider. Exceptional cash flow and profit will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several well-appointed exam rooms and beautifully decorated throughout. New computers and medical management software add to this modern front desk environment. List price: $435,000
Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings visit www.medicalpracticelistings.com
PHYSICIAN SOLUTIONS MAGAZINE
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Modern Med Spa Available
Located in beautiful coastal North Carolina Modern, well-appointed med spa is available in the eastern part of the state. This Spa specializes in BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options. This impressive practice is perfect as-is and can accommodate additional services like; primary health or dermatology. The Gross revenue is over $1,500.000 during 2012 with consistent high revenue numbers for the past several years. The average number of patients seen daily is between 26 and 32 with room for improvement. You will find this Med Spa to be in a highly visible location with upscale amenities. The building is leased and the lease can be assigned or restructured. Highly profitable and organized, this spa POISED FOR SUCCESS. 919.848.4202 medlisting@gmail.com medicalpracticelistings.com
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
Medical Practice Listings
MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business.
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
Selling and buying made easy
Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com 40 | JULY 2016
Please direct all correspondence to driverphilip@gmail.com. Only serious, qualified inquirers.
Primary Care Practice For Sale in Wilmington, NC
Urology Practice minutes from Lake Norman, North Carolina
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.
Urology Practice minutes from Lake Norman is now listed for sale. This excellent located practice is convenient to Charlotte, Gastonia, Lincolnton and Hickory. With a solid patient base, procedures currently include; Adult & Pediatric Urology, Kidney Stones, Bladder Problems, Incontinence, Prostate Issues, Urinary Tract Infections, Wetting Problems, Erectile Dysfunction and related issues. Three exam rooms with two electronic tables and one flat exam table. Established: 1980 l Gross Yearly Income: $275,000 Average Patients per Day: 12 to 15 l List Price: $165,000
Medical Practice Listings
919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com
Contact Philip or Danielle at 919-848-4202 or email medlistings@gmail.com
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 PHYSICIAN SOLUTIONS MAGAZINE
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Physician Solutions, Inc. Medical & Dental Staffing The fastest way to be $200K in debt is to open your own practice The fastest way to make $100K is to choose
Physician Solutions
THE DECISION IS YOURS Physician Solutions, Inc. P.O. Box 98313 Raleigh, NC 27624 Scan this QR code with your smartphone to learn more.
phone: 919-845-0054 fax: 919-845-1947 www.physiciansolutions.com physiciansolutions@gmail.com