The Message, October 2012

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A MON T HLY NE WS M AG A ZINE OF SPOKANE COUNTY MEDICAL SOCIETY –OCTOBER 2012

THE GROWING ROLE OF PHYSICIAN ASSISTANTS IN SPOKANE

By Terri Oskin, MD SCMS President

Physician Assistants and the Affordable Care Act Moving Toward the Future: Increasing Access to Care

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T a b l e o f C o n t e n ts

2012 Officers and Board of Trustees Terri Oskin, MD President Anne Oakley, MD President-Elect Bradley Pope, MD Immediate Past President David Bare, MD Vice President William Keyes, MD Secretary-Treasurer Trustees: Robert Benedetti, MD Audrey Brantz, MD Michael Cunningham, MD Karian Dierks, MD Randi Hart, MD Louis Koncz, PA-C Shane McNevin, MD Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – Anne Oakley, MD

The Growing Role of Physician Assistants in Spokane . . . . . . . . . . . . . . . . . . . . . . . . . 1 Physician Assistants and the Affordable Care Act . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The Role of a Physician Assistant at the HIV Clinic at Internal Medicine Residency Spokane . . . . . 4 A Walk-In Clinic That Supports Medical Home--a PA’s Perspective . . . . . . . . . . . . . . . . . . 5 Moving Toward the Future: Increasing Access to Care . . . . . . . . . . . . . . . . . . . . . . . . 5 Physician Assistant Student Involvement in Interprofessional Learning Opportunities . . . . . . . . 7 Physician Assistants in the Rockwood Urgent Care Setting . . . . . . . . . . . . . . . . . . . . . . 9 Physician Assistants in the CHAS Urgent Care Setting . . . . . . . . . . . . . . . . . . . . . . . . 9 Leadership from the Trenches: Local lessons to global applications . . . . . . . . . . . . . . . . . 10 SCMS Delegation to WSMA Annual Meeting and House of Delegates . . . . . . . . . . . . . . . 11 Being a Physician Assistant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Physician Assistants: From Past to the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Reflections on a PA Career from Two Veterans . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 October 6-12, 2012 Proclaimed as Physician Assistant Week . . . . . . . . . . . . . . . . . . . . 13 In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society.

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For Your Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Membership Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Physician Leadership Resource . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Meetings, Conferences and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 New Physicians and Physician Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“Autumn,

23

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October SCMS The Message Open3

The Growing Role of Physician Assistants in Spokane

By Terri Oskin, MD SCMS President As we move from the dog days of summer and swing into fall, we are all seeing our lives and schedules ramp up once again.

What better time to dedicate a month to our partners and colleagues who work by our sides, our physician assistants.

The profession of physician assistant (PA) was proposed by Dr. Charles L. Hudson in 1961. The first class of PAs was formed in 1965 at Duke University Medical Center by Dr. Eugene A. Stead, Jr., and it was comprised of former U.S. Navy hospital corpsmen. It did not take long for the University of Washington (UW) to recognize the need and value of physician assistants, and headed by Dr. Richard Smith, the UW established its physician assistant program in 1969.

Today, 156 accredited PA programs exist in the United States. A bachelor’s degree and either MCAT or GRE scores are required admission criteria. Graduates must pass the Physician Assistant National Certifying Exam (PANCE) to become a PA-C, which is required by all 50 states for licensure. Similar to physicians, PAs must obtain 100 hours of CME every two years and recertify every six years.

The Veterans Administration (VA) was the first to employ PAs and continues to be the largest single employer with nearly 2,000 PAs working within the VA system across the country. The need for PAs continues to grow with jobs expected to grow 27 percent between 2006 and 2016. The profession has been listed as the fifth best job in America according to Money Magazine and Salary.com.

National Physician Assistant Week is celebrated annually from October 6 through October 12. This week was chosen to honor the anniversary of the first Physician Assistant graduating class from Duke University on October 6, 1967.

Recently I spoke with Cindi Shineflew, PA-C, and Robert Bazzano, PA-C, about their profession and their experiences.

Cindi Shineflew graduated from the University of Osteopathic Medicine in Des Moines, Iowa, in 1989. She started her career in emergency medicine and family practice in South Dakota with a stop in Othello, Washington, before making her way to Spokane. She has practiced in Spokane for 17 years. Originally with Hillyard Family Practice with Drs. Vanderbosch and Brown and now with Columbia Medical Associates, she continues to practice in a family medicine clinic. She has her own practice and sees some of the doctors’ patients as needed.

How has your role changed during your career?

CS: As I worked with the same doctors for many years their level of trust grew regarding my abilities. This enabled me to see higheracuity patients. I know I can call on my physician colleagues for support with some of the more difficult cases, but I do function relatively independently.

How do you see medicine changing over the next five years?

CS: I am worried. I am already seeing patients that are sicker and choosing to wait longer before seeking health care. Many of my patients are losing their jobs and or health insurance. They are making hard decisions regarding forgoing medications or procedures due to cost.

Do you see a continued need for a local medical society?

CS: Yes. I will continue to support SCMS because we need to support our professions and need an organization that will be our voice in this ever-changing and increasingly complicated health care environment.

Robert Bazzano graduated from St. Louis University in 1985. He worked with Dr. Tohmeh for 11 years and together they have been practicing at Northwest Orthopaedic Specialists (NWOS), specializing in the spine for the past three years.

How do you see your role in your relationship with Dr. Tohmeh?

RB: We built a true partnership based on mutual trust and respect for one another. We share the practice usually alternating seeing the patient. Dr. Tohmeh depends on me to access the patient, order the appropriate tests and get him involved if surgery is expected.

How have you seen your role change during your career?

RB: Due to our close working relationship and respect for one another I have seen my responsibilities grow. I am responsible for seeing all our patients when Dr. Tohmeh is away. Of course I have the other spine surgeons available for consult if needed, and Dr. Tohmeh trusts my judgment to order the appropriate tests and treatments whether he is present or away.

How do you see medicine changing over the next several years?

RB: At the present time NWOS is independently owned. I am concerned with respect to the mergers and acquisitions occurring in our town and how that will affect our relationships with many of our local healthcare professionals. Due to our large size we have been somewhat immune to the recent acquisitions, however if this pattern continues I believe there will be more of an urgent need to form tighter alliances.

What do you see as the future role for local medical societies?

RB: We as professionals, independent or employed, need a central source to go to for information and structure - an entity that will continue to represent our views and be our voice.

During this month of October let’s all take a moment to honor our colleagues.

October SCMS The Message 1

The SCMS Strategic Plan was included in the September newsletter for your review. This month I am including a “visual� interpretation of the Mission, Vision and Strategic Activities. The Mission and Vision serve as the guiding principles for the future success of the organization. As members, we need your feedback on the relevance of these statements to you as an individual and as part of the larger community. The physician leadership at SCMS then interprets these statements and creates Strategic Activities which are also supported by staff. The four areas of Activity translate into initiatives, in some cases, that we carry out with partners or in collaboration with others in the broader community. Please let us know if this visual interpretation of the work of SCMS provides value for you as a member of the SCMS. Please feel free to contact me at keith@spcms.org or call me at (509) 325-5010.

Thank you. Keith Baldwin, CEO, SCMS.

October SCMS The Message 2

Physician Assistants and the Affordable Care Act

By Louis Koncz, PA-C President Washington Academy of Physician Assistants and member of the SCMS Board of Trustees The Physician Assistant (PA) profession was created in 1965 by Dr. Eugene Stead at Duke University Medical Center in response to a shortage of primary care physicians. It was geared toward military corpsman who had received considerable medical training during their military service. Today there are over 84,000 nationally accredited PAs and more than 150 accredited programs. Washington State has 2,621 licensed PAs. By design, PAs always practice in teams with physicians to provide high quality, cost effective medical care in virtually all healthcare settings, and are state-licensed to practice medicine with the supervision of a physician.

As we all know the Affordable Care Act (ACA) could infuse potentially 30 million new patients into primary care. That will create challenges to our current healthcare system. PAs will be a key part of the solution to the healthcare workforce shortage, but there are barriers both at the federal and state levels that need to be acted upon to be able to fully utilize PAs in the primary care workforce.

At the national level we believe that Congress must eliminate unnecessary federal barriers to the quality medical care provided

by PAs. They must also integrate PAs into all federal programs designed to promote growth in the primary care workforce.

The America Academy of Physician Assistants (AAPA) is seeking several changes to update Medicare and to better serve Medicare beneficiaries; specifically to permit PAs to continue to serve patients who elect the hospice benefit. For many patients, especially in rural or other underserved areas where the PA may be the primary provider, the inability of PAs to provide hospice care disrupts continuity of care at a time when patients are most vulnerable, forcing families to seek alternative healthcare professionals to manage hospice care services.

In addition, Medicare needs to allow PAs to order home health and hospice care. The inability of PAs to order those services delays access to needed care and disrupts continuity of care.

There have been bipartisan bills introduced recently in the House and Senate supporting those changes and we are hopeful they will pass.

Extending Medicaid Electronic Health Record (EHR) incentive payments to PAs with patient volumes including at least 30% Medicaid recipients is necessary to treat PAs in the same way that the law treats other primary healthcare professionals. That change is essential to meet the needs of the majority of medical practices and clinics in which PAs provide a high volume of care to Medicaid beneficiaries.

Building a robust primary care health workforce that recognizes the value of PAs and increases support for PA students and PA educational programs is essential. Over the past 45 years PAs have proven their merit in extending the ability of physicians to provide quality medical care and must be an integral component of the nation’s effort to reinvigorate the primary healthcare workforce.

At the state level we are introducing legislation to make some changes to the laws pertaining to PAs. We would like to see the number of PAs a physician may supervise be increased. Currently a physician may supervise three PAs. We believe that hinders access to care in some practices. In inner-city and remote practices, for instance, it is becoming increasingly difficult to recruit physicians. Hiring PAs for those positions could fill a need, especially with the ACA infusing increased workloads in those practices. If the supervising physicians were allowed to supervise more PAs that could help with the workload and allow more patients access to care.

We also would like to see a change in physician supervision requirements from a specified amount of time for the supervising physician to be on-site, which can be a barrier to care in some circumstances, and allow the practice to determine the appropriate level of oversight and review. This could be very helpful, for example, for rural practices where the supervising physician is at a different practice site. A much more patient sensitive approach is to allow the physician-PA team to match supervision to the specific needs of the practice. The physician must be available for consultation with the PA at all times either in person or through telecommunication systems or other means.

With EHRs, shared information is now always accessible and supervision becomes much easier and less cumbersome.

Finally, we would like the practice plan to be created at the practice site and not be pre-approved by the state prior to the PA starting to work. A copy would then be sent to the state and updated every two years with license renewal. Currently, the practice plan is sent to the state for approval prior to the PA starting work. The state has approved nearly 100% of all practice plans that have been submitted. We believe that this is an unnecessary step that delays when a PA can start working. This is what most other states are currently doing.

Physician Assistants are now found in many settings, but the role they play in physician-directed care is identical to the vision of the physicians who created the profession. The changes at the state and national levels will improve the efficiency found in the physician-PA team and address the challenges of healthcare delivery in the 21st century.

October SCMS The Message 3

The Role of a Physician Assistant at the HIV Clinic at Internal Medicine Residency Spokane

By Debbie Stimpson PA-C, Providence Internal Medicine Residency I am fortunate to have my passion also be my “work”. I am a Certified Physician Assistant (PA), HIV Specialist working in the ambulatory clinic for Providence Internal Medicine Residency Spokane Program. HIV became my passion in the mid-1990s when I moved to Spokane and became good friends with someone who had HIV/AIDS. Through volunteer positions in the HIV field, and work as research coordinator for a HIV Treatment Adherence Project, I realized I wanted to further my education. I graduated from the University of Washington’s MEDEX Northwest Physician Assistant program seven years ago. Since that time, I have worked as medical provider with HIV patients. Almost four years ago HIV/AIDS care was incorporated as a specific discipline into the ambulatory clinic by opening of The HIV Clinic at Internal Medicine Residency (The HIV Clinic at IMRS). I was hired to implement the project and have continued to provide HIV and primary care for the HIV/AIDS patients, alongside the internal medicine residents and faculty. Dr. John Frlan, faculty in the residency program, had an interest in HIV and became my supervising physician and is now also an HIV Specialist. We are both accredited through the American Academy of HIV Medicine.

New HIV/AIDS patients in our clinic are seen by both a resident and me during the office visits. Appointments are scheduled with both of us when possible but sometimes hospital or other electives don’t allow that coordination. Then the patient will be seen by me and sometimes a different resident. I provide the “continuity of care” for the HIV/AIDS patients and allow for overseeing of care and ongoing education regarding acute and chronic HIV care with the residents.

I enjoy working with the residents who are extremely bright and eager to learn. I share my knowledge of HIV and they, along with the faculty, share their enormous wealth of medicine in general. Teaching of HIV/AIDS is done on one-on-one basis and group settings.

As the only PA-C in the internal medicine residency program, I believe I am well accepted by the faculty and residents. I am happy to be a part of this supportive, intellectually stimulating, continuous education setting.

Background on Debbie Stimpson, PA-C

By Mary Noble MD, Director, Ambulatory Care Clinic, Providence Internal Medicine Residency Debbie joined our faculty in 2008 when we opened The HIV Clinic at IMRS. Our goal remains two-fold: to increase access to expert, compassionate, comprehensive care for patients with HIV/AIDS and also to impact the future availability of physicians able to provide care to this patient population. Most residencies have Infectious Disease rotations where residents see HIV patients, and residents do see HIV patients in the hospital. But we know that people living with AIDS who are adherent to their treatment can live to a near normal life expectancy. It is important that physicians have familiarity with the multiple medications, co-morbidities and challenges these individuals deal with on a daily basis. The HIV Clinic at IMRS helps us achieve both those goals. Debbie is the consistent presence for each of these patients. She sees them in conjunction with the residents, interacts with their case managers and provides education to the entire team to help us stay abreast of what is current in the HIV/AIDS care.

In addition to The HIV Clinic, she also sees patients who need an urgent visit if a physician appointment is unavailable and has worked on some health maintenance projects for our clinic patients. Her presence has been a positive addition to the Residency program, allowing our residents to experience working with a non-physician provider colleague.

As residents graduate from the three year program, their HIV panel is transferred to incoming interns.

October SCMS The Message 4

A Walk-In Clinic That Supports Medical Home

We don’t refill their standard medications. We do, however, have the ability to consult directly with their doctor and to schedule appointments so they can see their physician within a reasonable time. I should mention that one other PA, Jane Whetzel, and a wonderful group of RNs, LPNs and MAs, make it possible to see the volume and complexity of patients that we take care of in the ACT.

A PA’s Perspective

By Lester Sloan, MPAS/PA-C Several weeks ago, an elderly gentleman walked into the clinic with a productive cough. He’d been running a fever, was a little short of breath, his pulse oximetry reading was 94. He had a history of chronic obstructive pulmonary disease, diabetes and mild hypertension. He had not been to see his doctor for six months. He had been contacted by his doctor through email that he needed a series of tests and an appointment.

We diagnosed and treated his bronchitis. He asked me if I could refill his medications. I was able to access his records immediately and found that he was low on his medication, but was not completely out. Although I informed him that his routine medications needed to be reviewed and refilled by his personal physician, I would order his labs and schedule an appointment with his physician to follow-up on his bronchitis, address his ongoing health issues, take care of his routine refills and evaluate his labs. He was happy with his treatment and appreciative of the help getting him in to see his doctor.

A few years ago, the idea of the Medical Home started showing up in our emails and at our conferences. The idea that each patient is personally cared for by a physician (or a team led by a physician) was reviving the concept that medical care is personal and best done by a core group that know and care about the patient, very much like the family doctor of old.

We have made a commitment at Group Health Cooperative (GHC) to utilize the Medical Home concept in all of our primary care clinics. To the best of our ability, each patient is identified with a particular doctor and team, so the patient’s care can be consistent.

This can be a particular challenge for people who need to be seen on an acute basis. We have addressed this through our walk-in clinic (which is called the Acute Care Team, or ACT).

Over the last several years, it was determined in my clinic that our patients were over-utilizing the emergency department and urgent care, partly because they didn’t need to schedule an appointment, and partly because they were unaware that we were able to take care of most of their minor problems at the clinic. We decided to set up a walk-in clinic--not like the standard urgent care, but a clinic that would actually support the Medical Home process. Before we started the ACT, we agreed to see patients on an acute care basis but determined that we would not take over routine care that could be more effectively handled by their own doctor or team.

We have, over the last year, significantly decreased the number of patients who go to urgent care or the hospital unnecessarily.

We deal with the patient’s immediate problems but do not try to manage their hypertension or diabetes.

It is our responsibility to take the best medical care of our patients.

I believe that the Medical Home model is an effective way of promoting continuity of care. The goal of the ACT is to address the patient’s immediate problems and to support the concept of the Medical Home by getting the patient back to the physician and team responsible for their ongoing care. As new problems arise, we continue to re-evaluate and make changes in how we deliver care on our Acute Care Team. It has been working well. Other clinics at GHC are considering the adoption of a similar model.

I was taught in PA school many years ago that our primary function was to fill gaps in medical delivery. PAs were utilized wherever they were needed, and over the years we have been used in every specialty and aspect of medicine. PAs have worked at Group Health since the late 1960’s. Our profession at that time was very new, and Group Health was a pioneer in the use of non physician providers. It is no big surprise that change is the one constant element for PAs and medicine in general.

Moving Toward the Future: Increasing Access to Care

By Steve Meltzer, PA-C As noted by my colleagues Lou Koncz, PA-C and Theresa Schimmels, PA-C in their articles, the physician assistant (PA) profession continues to grow in partnership with medicine and provide opportunities to a wide range of health professionals to enter the profession. It was reported just this September by the National Commission on the Certification of Physician Assistants, that the 100,000th PA was recently certified – a milestone of quality education and access to care.

The University of Washington MEDEX Northwest PA Program has graduated over 1800 PAs since 1970, and has one of the highest percentages of graduates working in primary care – approximately 54% versus 32% nationally. Part of this success is the result of students having long exposure to primary care during their clinical training year and rural/underserved rotation sites.

Three recently awarded federal grants are providing MEDEX the opportunity to work with select family medicine residencies on integration of PAs; supporting students with a focus on rural primary care; and funding development of a new campus in Tacoma that will be linked to the Joint Lewis-McChord Military Base to increase opportunities for ex-military medical personnel to transition to the civilian workforce as PAs.

October SCMS The Message 5

Continued on page 6

Continued from page 5 This past summer, MEDEX joined the Department of Family Medicine and is looking at ways to improve PA education and integration of physician-PA teams at the newly relocated UW Family Medicine Clinic at Northgate in Seattle. The expectation is that this will help create a model that can be used throughout the WWAMI region to encourage integrated practices through physician-PA teams in support of patient centered medical homes. Participating PAs will have an expanded role in seeing patients as well as teaching, team-building and outcomes development.

MEDEX also received a federal grant as part of the initial stimulus funding to increase emphasis in primary care. Nine entering students each year are selected to participate in the project and receive partial tuition payment to offset added expenses of completing more clinical year rotations in rural communities. They also participate in several workshops and small discussion groups during the didactic and clinical years to increase their knowledge of rural practice and systems.

The most recent grant, just awarded in September, will provide funding to develop and implement a new MEDEX PA program in conjunction with the UW Tacoma campus. If accreditation can be achieved quickly, the MEDEX is striving to have the program up and running in Fall 2013. There has already been much interest around the region and MEDEX has been working with the various military branches and bases in Washington to set the groundwork in place.

The MEDEX program was initiated at the University of Washington

by Dr. Richard Smith, with significant collaboration by WSMA, and was based on utilizing the advanced skills of ex-military corpsmen and medics. This new expansion is a tremendous way to “bring it back home” for the profession and expand the opportunities for current veteran’s with incredible knowledge and skills. MEDEX is proud to have this opportunity and looks forward to working with providers around the entire WWAMI region!

The new 2012 MEDEX Primary Care Scholars. This amazing group of students recently met to share their personal stories of what inspired them to become PAs in Primary Care.

Bottom Row: (left to right) Eduardo Garza, Shigone Beighle, and Matt Loudon.

Center Row: (left to right) Jesus Rosales, Leslie Lewis, Rachel Ragosta, Teresa Vasicek, Rachel Fisher, and Sam Deblauw.

Back left: Bradley Smith.

Comments from MEDEX Students As an allied healthcare practitioner living in a small, rural town, I experienced first-hand that “patient care” doesn’t clock-out at 5pm. It continues during visits to the post office, market, local diner, and wherever else one might bump into a patient throughout the course of a day. After years of developing patient relationships in a close community, I saw a need to do more.

Becoming a PA answers that need.

Rita Klabacha, 1st year MEDEX student I decided to become a PA because I have a passion for patient care. Giving back to my community has always been something I hold near and dear to my heart and it gives me great joy to know that I, in some small way, have the potential to make a difference in somebody else's life. There is no better opportunity to achieve this right now than in the PA profession.

Gretchen Foley, 1st year MEDEX student I enjoy the opportunity to work collaboratively with patients while still maintaining a certain degree of independence. I value the expectation that continued education and innovation are integral to the profession. I also appreciate the emphasis on family health in our rural communities, so essential to our national fabric. That's why I've chosen to become a Physician Assistant.

Harry Lawrence, 1st year MEDEX student

Back row: (left to right) Daniel Larimer, Randy Robbins, Catherine Cleveland and Andrew Ashford Middle row: (left to right) Ken Ferrera and Jeffrey Smith Front row: Angela Tague October SCMS The Message 6

Physician Assistant Student Involvement in Interprofessional Learning Opportunities

Teams receive the initial patient scenario two weeks in advance of the live event and are instructed to work collaboratively to formulate a patient-centered plan of care.

By Barbara Richardson, PhD, RN | Interprofessional Education Washington State University Division of Health Sciences Students enrolled in the University of Washington’s MEDEX physician assistant (PA) program on Spokane’s Riverpoint campus have opportunities to interact with other health professional students in classroom, extra-curricular and practice settings.

In the simulation lab, PA students may work with nursing and pharmacy students to practice team work, role clarification, and improve collaborative communication. This fall, MEDEX students will engage in small interprofessional (IP) group discussions reviewing the book, “The Spirit Catches You and You Fall Down”

by Anne Fadiman (1997). This true story, about a Hmong child that suffers from grand mal seizures, commonly provokes strong reactions from students when they consider the implications of cultural barriers that ultimately result in the child living in a persistent vegetative state. Such opportunities provide PA students with an opportunity to engage in dialogue around ethical and moral issues common to all health professionals.

Also lined up for fall semester are extra-curricular opportunities organized by the Riverpoint Interprofessional Education & Research student group. These activities include learning with, from and about other health professions through the “Getting To Know You” programs, where students and faculty from one health profession share information about entrance requirements, a typical course of study, licensure requirements, potential job placements and current areas of research common in that profession. Over brown bag lunches, PA students learn from their peers in the Physical Therapy, Nursing, Speech & Hearing, Occupational Therapy, Nutrition & Exercise Physiology, dental hygiene, health policy administration, RIDE dental, and WWAMI medicine programs. All health professional students are welcome to attend the viewing of a series of DVDs titled, Unnatural Causes, that explores social determinants of health that commonly impact care providers in all professions. PA students can also participate in the Community Action Poverty Simulation, a simulation experience that is designed to help participants begin to understand what it might be like to live in a typical low-income family trying to survive from week to week. The object is to sensitize students to the realities faced by clients living in poverty. Every spring, PA students engage with students from other health professions to participate in the popular Health Care Team Challenge (HCTC) event. The HCTC is a clinical case-based competition.

On the day of the event, the teams present their plan in front of a live audience of faculty, peers and community members. As one PA student remarked, “It was one of the best experiences of my educational career because it showed me where I fit in to the big picture of collaborative health care. It also taught me a lot about the other fields that I will have contact with once I graduate and begin working.”

Opportunities for PA students to engage in collaborative practice opportunities with other students are being developed.

In June, PA student Travis Henderson worked with peers from the WWAMI medicine, WSU nurse practitioner, pharmacy, and RIDE dental programs that were all in Othello doing clinical rotations at Columbia Basin Health Association (CBHA). With funding support from the Empire Health Foundation, this IP team of students identified two important community health issues (teen pregnancy and domestic partner violence) and collaborated on a project to address those issues with the youth they encountered on a daily basis in their clinical settings. The students wanted to reach out to girls aged 15 to 25 to provide contraception and relationship safety information and deliver it in a non-confrontational and culturally sensitive way. To attract young clients, the students created what they called “summer survival kits.” They purchased recyclable bags and filled them with items such as Frisbees, beach balls, personal hygiene products and cards with information about contraception and healthy relationships. Along with the bags students offered individualized guidance to their patients. Henderson noted one tangible benefit of the project was that five girls opted to be vaccinated for the human papilloma virus (HPV), which is spread through sexual contact. He also recounted another less concrete victory, telling a story about how clinic nurses quietly arranged for one young woman they suspected was a victim of partner abuse to be pulled away from her boyfriend to talk with Henderson about potential options for improving her situation. All members of the team and their preceptors at CBHA were pleased with the outcome of this collaborative project. The CEO of CBHA noted, “the interprofessional project was well received by all of the staff involved. This was a very dynamic group of students, and I think the fact they were from many different disciplines helped to create the passion that they put into this project.

In the future, we hope to create and offer interprofessional service learning and collaborative practice opportunities in a wide variety of settings in order for students in the PA program to work with peers in other professions in order to be “workforce ready” members of a collaborative health care team.

October SCMS The Message 7

COLUMBIA MEDICAL ASSOCIATES is currently seeking a BC/BE Internist to join our Northside Internal Medicine Group in Spokane, Washington to meet our increased service utilization. We are a group of over 40 physicians providing comprehensive medical care to families and

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best care in Spokane.

To apply or inquire for further information

Learn more by calling us at 509.892.2700 or visit www.incytepathology.com.

please contact: Nancy Longcoy, Physician Recruiter Longcoy.n@ghc.org; Ph: 206-448-6132

Proudly serving SCMS physicians and their patients since 1957

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Physician Assistants in the Rockwood Urgent Care Setting

The first PAs were veterans, but as the usefulness of non-physician providers became apparent, programs opened up in universities all over the country to train candidates to meet the growing demand. We are fortunate to have MEDEX, one of the oldest and best PA programs in the nation right here in Washington providing us with well-trained practitioners.

By Jana Tritto, PA-C Washington State Physician Assistants (PA) are licensed by the State Board of Medicine and have a relationship with a sponsoring physician. In most instances, especially in urgent care clinics, the PA works quite independently alongside the physician.

The relationship is one of trust and respect.

The most important thing for a PA to know is “to know what they don't know". We want and need the support of our doctor partners. We are pleased and grateful for the trust and respect we have worked hard to earn. We are proud of our profession and our abilities. A mutually comfortable and trusting relationship with a physician is built over time as we work together; both independently and collaboratively.

The MD-PA relationship in Urgent Care is satisfying for both parties. The PA may work independently, but has a doctor there who can provide insight or answer specific questions. The physician, too, will collaborate with a PA on patient concerns or an X-ray. Each provider has his/her areas of expertise, such as training in joint injections or trauma, and each is respected for it.

Knowing each other’s' strengths, and relying on them provides better patient care. It has the added benefit of a more productive and less stressful work environment for the staff.

Urgent care medicine has been recognized as a specialty and has much in common with emergency medicine. Therefore, there is a need for specific training and ongoing education. PAs are board certified in general medicine and/or surgical assist, and maintain that certification with 50 Category 1 CME credits a year and a retest every seven years. In the urgent care setting, both the physicians and PAs are usually required to maintain Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certification and to take part in or lead monthly drills for the other staff members.

Urgent care demands practitioners with a broad knowledge base to meet the needs of the young and old and everything in between. We see patients of all ages, with every injury and illness; from the worried well to an evolving myocardial infarction.

It is vital to stay alert, keeping an open differential diagnosis with each patient. PAs in the urgent care need to have training and skills to perform minor procedures and suturing, splint sprains and fractures, counsel the anxious and depressed and differentiate between the patient in pain and a drug seeker.

PAs have seen increased acceptance since the profession was established to legitimize and use the skills of the combat medics from the Vietnam War.

Patients, too, have accepted mid-level practitioners both in primary care and in the urgent care setting. Many patients think that they are given more time and attention from their PA and will actually request a PA at their visit. Gone are the days that physician assistants were seen as a glorified "coat holder" for the doctor. Patients, physicians, and other ancillary staff now view PAs correctly as physician extenders, with abilities and knowledge to effectively diagnose and treat, within their scope of practice.

PAs in urgent care medicine are able to provide excellent patient care, and are also able to fill a growing need as this specialty area increases in popularity. It is a winning combination.

Physician Assistants in the CHAS Urgent Care Setting

By John Colver, MSPAS, PA-C I have been with Community Health Association of Spokane (CHAS) for a few years now working as a primary care provider for approximately 2000 patients in our community. Recently I have found interest in working with our newly opened urgent care team on an as-needed basis. It has been an adjustment to shift my mental paradigm from a ‘preventative first’ approach to a more emergent ‘what-is-most-critical-now’ approach. Adding this new dimension to my skill-set has been both advantageous to me as a clinician as well as a benefit to the patients I treat.

Whether in the urgent care or a family practice clinic, it’s my belief that knowledge from experience, understanding limitations and effective use of resources build the foundation of a well-qualified physician assistant (PA).

It is essential that as an urgent care PA I am able to recognize the acuity of the patient’s condition and then set in motion a treatment plan to address these needs. Often I find myself consulting other providers or resources to meet this end. I am not embarrassed when I don’t know the answer to a particular situation so long as I keep the patient’s best interest in mind. In fact, as PAs we are trained to work as a team with supervising physicians with whom we can consult when needed. It is a model that has proven effective in every medical specialty–urgent care without exception. Similarly, physicians are required to identify their own limitations in practice and will often consult when needed for the patient’s best interest. I have found that my efforts to provide quality care through this team-centered approach have been met, in most instances, with respect.

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Continued on page 10

Continued from page 9 As time develops experience and knowledge, PAs are relied on to give educated and quality care. In the urgent care setting I am able to diagnose and treat independently with delegated autonomy in a way that has generated respect from my patients and other providers. Additionally, I have found that my background in family practice has given me an advantage over some of my peers. I am familiar with chronic disease management and can troubleshoot the acute patient with much comorbidity. I can also better guide the acute patient through the aftercare process, understanding many of the turns in long-term management. Because of this I am an asset and resource to the urgent care team.

As I grow in experience in urgent care medicine I find that it carries over to my day job in family practice. I am increasingly able to recognize acutely ‘sick’ from ‘not sick’ and able to perform more of the simple procedures in-clinic rather than sending out referrals. This is a huge benefit in my practice as many of our patients are without insurance and would not be able to afford a specialist visit. I enjoy my role in both urgent care and family practice settings, each with its challenges and successes. I anticipate further growth and look forward to helping others as part of a complete healthcare team.

Leadership from the Trenches: Local lessons to global applications

that occurred at the volunteer direction of a number of attorneys in the state. They also clarified that entities would have to have certified Electronic Health Records (EHRs) in order to connect to the network. The next patient centered steps in development will include, in this order, transitions of care; patient engagement; population-based care model and clinical integration/accountable care organization (ACO) in the stages of development.

Dr. McCrary stressed the fact that there are many challenges to HIE development but that there are as many solutions if providers lead the process to overcoming the challenges. She also advocated for all providers joining the health information sharing process to provide the necessary leadership for a successful initiative. The required minimum data set in the systems will include demographics, procedures, medication lists, diagnostic test results, problem lists/ diagnosis, allergies and immunizations. She is also advocating for full HIE-Query functionality, a national information exchange capability with direct secure clinical messaging and state level interfaces.

In addition, a panel of presenters from Group Health, MultiCare Health System and the Franciscans updated the audience on the progress toward implementation and use of the EPIC system. All the systems will be using the same electronic medical record (EMR) in the near future so they all addressed the ability to share patient information across the community of providers as a result. Geoff Ling, MD, Ph.D., spoke about the truly innovative work being done in the military in his talk about “Developing Medical Innovations the DARPA Way” to support our soldiers in the military, especially those that are injured and with loss of limbs. He was most poignant about the ability to develop sophisticated mechanical limbs driven by the individuals own thoughts. Truly incredible advances!

By Keith Baldwin, CEO, SCMS The Pierce County Medical Society organized the Leadership from the Trenches: Local lessons to global applications conference held on Friday, September 14, 2012, prior to the WSMA Annual Meeting in Tacoma. It was well-attended, addressed valuable topics and included a number of top notch speakers. Spokane physicians who attended included Terri Oskin, MD, SCMS President; Jeff O’Connor, Chair, SCMS Informatics Committee and Jeff Collins, CMO, Providence Health.

Laura McCrary, Ed.D, Executive Director of the Kansas Health Information Network (KHIN), was a great segue into the topic of Health Information Exchange (HIE) and the purpose for sharing patient information. She noted that the KHIN is in the formative stages of development and is focused on developing Data Exchange and HIE Services or data portability. The KHIN was legislatively authorized to be the statewide HIE in Kansas. They spent a number of years normalizing all the patient privacy issues with HIPPA prior to beginning their development process and

Additional presentations included Pierce County’s Community Transformation Grant: Lessons for Transformational Leadership, Understanding the Hospital’s Bottom Line: A CFO’s Perspective and Quantifying Quality in Healthcare Systems: Pay for Performance – The ABCs of Value Based Purchasing. I applaud Pierce County Medical Society’s efforts to bring relevant content to their CME offering and look forward to a possible collaboration in the future.

(The slides of individual presentations are available on request.

Contact Keith Baldwin at keith@spcms.org or (509) 325-5010.)

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SCMS Delegation to WSMA Annual Meeting and House of Delegates A number of physicians represented you, the SCMS membership, at the recent WSMA Annual Meeting and House of Delegates (HOD) that occurred in Tacoma on Saturday and Sunday, September 15 and16. Preparation for the Annual Meeting and HOD occurred in Spokane first with the SCMS Executive Committee and then with the Caucus on September 12 to discuss and prepare for the recommendations to the HOD on September 16. The process involved the submission of resolutions and WSMA bylaw amendments prior to the HOD. Significant topics included marijuana; peer review; Joint Commission regulations and bylaws amendments related to WSMA/County relationships, WSMA Board composition, nominating committee and AMA delegation standing. The process started with a presentation of the reports, resolutions and amendments to the reference committees. And, a lot of testimony was given on all sides of the issues. The reference committees then make changes based on the testimony for final submission to the HOD. Dr. Brad Pope chaired one of the reference committees this year.

It is challenging but rewarding work on behalf of the physician community. The HOD voted not to de-unify the nine remaining WSMA unified county medical societies. They did vote to change the representation of the WSMA Board but retained AMA delegates as voting board members.

Please thank all of your hard working delegates to the WSMA Annual Meeting and HOD who gave their weekend time to represent Spokane physicians at this annual meeting and delegate gathering. Those attending included Drs. Brad Pope, Anne Oakley, Beth Peterson, Terri Oskin, Deb Harper, Rick Shepard, Brian Seppi, Anne Montgomery, Gary Knox, Rob Benedetti, Rod Trytko Dean Martz, Melanie Lang and Lou Koncz, PA-C.

Being a Physician Assistant

By Dean W. Crosgrove, PA-C Providence Hawthorne Urgent Care "Call me Dean." With apologies to the fans of Herman Melville, this is my standard response to the inevitable question, "What should I call you?"

Physician assistants (PA) have a unique role in the hierarchy of medicine. We are in the gray area called "mid-levels." For the uninitiated, a physician assistant, (not physician's assistant), is a master's level trained medical professional who has the skill set to perform about 80 percent of what a family medical doctor can provide. This obviously varies due to specialty training and experience.

In urgent care, for example, our backgrounds lean more toward emergency medicine and urgent care. We are licensed to practice medicine in conjunction with a licensed medical doctor. I believe that this preceptor relationship is what helps PAs be accepted as a professional healthcare provider and not a physician replacement like some have suggested. We are not referred to as "doctor" (unless we have a PhD or some other doctorate) and “Mister Crosgrove� makes me want to look around for my father. So I have found that the informality of using my first name is the approach that works for me.

I have spent my career as a PA working in rural emergency departments (ED) and have now landed in the perfect blend for a job at Providence Hawthorne Urgent Care. Urgent care is the best of ED and family practice medicine combined. The medical team can make a rapid and significant impact on patient care and every member, from the front desk to medical assistants and nurses, has valuable input and is encouraged to share insights into a patient. This creates an information base on a patient that allows for rapid evaluation, treatment and final disposition in an efficient manner. Whoever is assigned the patient is in charge of the patient’s care, with input from the rest of the team. A typical day can consist of all aspects of acute family medicine and a liberal serving of lacerations, abscesses, sprains and broken bones. We fill the niche as a place where family practice clinics can refer their patients, knowing we are not taking over the care of their patients but acting as a support facility for better treatment of their patients. The patients seem uniformly pleased with the rapid care and the knowledge that we send prompt reports to their doctors while encouraging close follow-up with the primary care providers.

I have found that, in general, the newer physicians accept PAs as peers rather than subordinates. In urgent care, physicians and PAs routinely run patient concerns by each other to make sure they are on the right track since this is the first time they have seen the patient and maybe the last. This may be a unique setting, but in my 15 years as a PA, this has been the norm rather than the exception.

The enjoyment of urgent care comes from the daily variety of patients, everything from chest pain and dehydration to fishhooks and pinkeye. We are jacks-of-all-trades (hopefully masters of some). I am fortunate to work with a very experienced group who are willing to share information and techniques. Andrea Johnson, MD has a very compassionate approach to patient care.

She actively listens to patients and has demeanor that makes you want her as your own provider. Joshua Beers, MD and Mitchell Tippets, MD bring an energy and knowledge base that stimulates me as a practitioner to learn more. Connie Langford, PA-C has an experience base that makes my background experience a mere shadow. She is the PA I try to emulate. With 17 years as a King County Medic One paramedic, I would not change my second career as a PA. I am very fortunate to be working with this group.

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Physician Assistants: From Past to the Future

By Theresa Schimmels, PA-C It was over 40 years ago that a group of physicians looked at America’s healthcare system and realized there was a critical need for healthcare delivery in underserved areas. They envisioned a new type of health professional, one that would be able to enhance their practice, freeing them to see more patients, utilize their time and talents more efficiently and provide better care to their communities. They would train the new “assistants” in medicine just as they had been taught, yet in a shorter amount of time, requiring physician supervision. Dr. Eugene Stead at Duke University, followed a few months later by Dr Richard Smith of the University of Washington, created what would be known as the Physician Assistant (PA).

Those doctors were visionaries. Their dream of a physicianphysician assistant team was realized and has taken healthcare in America to a better place. The efficiency of this team has led to utilization in all medical and surgical specialties, from primary care to orthopedics, infectious disease to cardio-thoracic surgery.

The team is effective because of similarities in training and the PA profession’s commitment to maintaining practice with physician supervision; utilizing the strengths of each member of the team.

According to the Bureau of Labor and Statistics Occupational Outlook Handbook, 2012-13 Edition, “Employment of physician assistants is expected to increase 30 percent from 2010 to 2020, much faster than the average for all occupations. As more physicians enter specialty areas of medicine, there will be a greater need for primary healthcare providers, such as physician assistants.” Health and Human Services Secretary Kathleen Sebelius recently announced $2.3 million in grants to train primary care PAs and help veterans transition from the military to civilian PA careers when they return home.

So, you ask, what is going to happen with the PAs in the future?

How does this make a difference in how I practice? I can honestly answer you in one short phrase: The PA profession remains committed to the concept of the supervising physician and highly values the physician-PA relationship. PAs are geared to step in to help physicians fill the need for more primary care providers. We will continue to evolve to provide patientcentered care whether it is in a medical home environment or providing postoperative care in a hospital. We are here for one reason: because physicians believe the need to establish a new healthcare entity to practice medicine under the direction of physicians and surgeons, formally training us to examine patients, diagnose injuries and illnesses and provide treatment. We are here to serve.

In the past 15 years, since I entered and completed my training, the role of the PA in medicine has changed. The physician shortage has created an opportunity for a physician’s practice to utilize a PA’s skills to augment their practice, increase their income and patient volume, and provide quality care in a timely manner.

The American Academy of Physician Assistants’ (AAPA) 2010 census states approximately 32% still practice in primary care medicine, down from the approximately 55% that did so in 1997.

Being able to branch out into surgical and medical subspecialties closely follows the direction of physicians moving out of primary care medicine.

With lack of incentives and increasing costs of medical school training, the waning number of training for primary care doctors is disturbing. A projection from the Association of American Medical Colleges suggests the U.S. could have nearly 63,000 fewer doctors than needed by 2015. Physician training takes two or more years after medical school, depending on specialty.

Unlike physicians, PAs are trained as generalists. Those of us who choose to go into a medical subspecialty have the flexibility to move into another specialty without additional training or residency requirements.

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Reflections on a PA Career from Two Veterans This month we asked two seasoned Group Health physician assistants (PA) to look back on their careers and discuss where the profession is headed. Our guests are Dan Myhre, PA-C, of Veradale Medical Center and Tom Charles, PA-C, of Riverfront Medical Center.

How did you first decide to become a physician assistant?

Dan Myhre: I served as a medic in Vietnam, and then I attended the University of Washington in its third class of PAs between 1971 and 1972. When I started at Group Health, I was the first PA at its Lynnwood Medical Center. After that I bounced between family practice, surgery and emergency medicine. I’ve been at Group Health most recently for 15 years.

Tom Charles: I was a math and physics major and went into military service after college in 1968. I lived overseas and went to PA school at Hahnemann University in Pennsylvania between 1975 and 1977. After practicing in North Dakota for a year, I moved to Spokane and have worked for Group Health for 33 years.

My military experience triggered my interest in medicine. I accompanied physicians into orphanages and worked as a Vietnamese-language interpreter. The dramatic things I saw chisel an impression on a person. I could see how medical care helped kids do well, which prompted me to work in health care. I’ve always worked in family practice.

What was it like being the new guy in a new profession?

DM: Early on, it was a struggle. Some physicians didn’t want to work with us and didn’t appreciate that PAs could prescribe medications. I remember caring for a patient with a fracture and I called the on-call orthopedist for a consult. The doctor said he didn’t talk to PAs so I had to ask a family physician to make the referral. We took care of the patient. Of course now it’s completely the opposite working with physicians. And family medicine doctors have always seemed to welcome us with open arms and have been great teachers and mentors.

TC: It was a new profession. By the time I started the doctors were familiar with it, but the patients weren’t. We had to carve out a niche in patient teaching and our distinct skills.

DM: That’s true about creating a niche. The health care team learns what you are good at. At our clinic, because I’ve been able to do the mechanical things, our doctors don’t do a lot of casting and splinting. Our other PA at Veradale handles a lot of women’s health care, freeing up doctors to practice more internal medicine.

Where do you think the profession is headed?

TC: At Group Health, PAs were geared to go into pediatrics, OB/ GYN and family practice. But the vast majority of new graduates today are going into a specialty and they are in demand. Here in Spokane, virtually all specialists employ PAs, which improves their patients’ access to care. In the future I predict that demand will swing back to family practice and general medicine as we gear up for baby boomers and new patients entering primary care. Family practice needs to ramp it up to be ready for them all.

DM: The future is unlimited for PAs. Studies predict a looming shortage of primary care physicians and PAs can fill part of that role. We need the family doctors, of course, but some studies suggest that PAs can see 60 percent or more of the patients who come through the door and deal with their medical issues competently.

Both of you are edging toward retirement. What advice do you have for PAs just starting out?

DM: The profession has evolved but the important thing to always remember is to be intellectually honest about your capabilities.

Know your limits, know when you need help and stay out of trouble for the patient’s sake. When you don’t know what you are facing, go to the physician and ask “What am I seeing here?”

TC: Medicine is unpredictable and chaotic. My advice for all medical professionals, not just PAs, is to give every patient your absolute best. When you see them, go over in your mind, “What more can I do to help?” You can’t have a bad day or just get by because the stakes are too high. Human beings are unpredictable and they can get hurt quickly. At the end of the day you want to know you’ve given your best.

October 6-12, 2012 Proclaimed as Physician Assistant Week On September 5, 2012 Governor Christine O. Gregoire proclaimed October 6-12, 2012 as Physician Assistant Week. In her proclamation she stated that “PAs are often the first point of contact for patients and serve a vital role in helping them understand their medical needs and empowering them to become their own advocates.” The entire proclamation can be read at http://www.washington.edu/medicine/som/depts/medex/.

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In The News Jon Boyum, MD Joins Surgical Specialists of Spokane Dr. Boyum has roots in Spokane as a graduate from Gonzaga University. He is a board certified general surgeon with advanced training in thoracic surgery. Dr. Boyum received his medical degree from University of Washington Medical School and completed his general surgery residency at University of Vermont/ Fletcher Allen Health Care, Burlington, Vermont. Dr. Boyum completed his thoracic training at Oregon Health Sciences University, Portland, Oregon.

The Physicians of Cancer Care Northwest are pleased to announce the addition of Jason Call, MD; Mei Dong, MD, PhD and Srivalli Gopaluni, MD Dr. Jason Call, Radiation Oncologist, graduated cum laude with a double major in Zoology and Russian from Brigham Young University. He pursued his medical school training at the Medical College of Wisconsin, Wauwatosa, Wisconsin and his residency training in Radiation Oncology at the Mayo Clinic in Rochester, Minnesota. He has been active in research throughout his career, publishing his works in several scientific journals.

Dr. Mei Dong, Medical Oncologist, completed her Internal Medicine residency at Norwalk Hospital, Yale University. She successfully pursued her fellowship in Hematology/ Oncology at Duke University, Durham, North Carolina and MD Anderson Cancer Center, Houston, Texas. Dr. Dong conferred her Ph.D. in Biomedical Science at the University of Connecticut and her MD was achieved at Harbin Medical University, Harbin, China. Dr. Dong is an advocate of patient-centered care.

Dr. Srivalli Gopaluni, Medical Oncologist, completed her residency at Internal Medicine SUNY Upstate Medical University; Syracuse, New York and her internship was completed at Gandhi Medical College, India. She pursued her Hematology/Oncology Fellowship at SUNY Upstate Medical University; Syracuse, New York. She is very enthused about the new treatments in Melanoma and GU Oncology and has a special interest in enrolling patients to clinical trials.

Inland Northwest Health Services names Deb Harper, MD to the Board Dr. Deb Harper has been named a new member of the Inland Northwest Health Services board of directors. Dr. Harper is a part-time general pediatrician at Group Health and a clinical assistant dean for the University of Washington School of Medicine.

CHAS Appoints New Medical Director Dr. William Lockwood to oversee CHAS clinics Community Health Association of Spokane (CHAS) is proud to announce a visionary new leader at the helm. As of September 1, 2012, Dr. David Bare will hand over Medical Director responsibilities to Dr. William Lockwood.

After graduating Summa Cum Laude with a B.S. in Medical Physics from Oakland University in Rochester, Michigan, Dr. Lockwood continued on at the University of Michigan’s Medical School where he completed his M.D. in 1987. He completed his Emergency Medicine residency at Wright State University School of Medicine in 1990. Dr. Lockwood has worked in emergency medicine for over 20 years and has worked as a volunteer EMS medical director, attending physician, and provided a year of service in Australia.

Dr. Lockwood joined CHAS in 2010 to help build and grow Spokane Urgent Care and is excited about his upcoming move to the Medical Director position. In his words, “I’m prepared to work hard and do my best.” And in a wonderful ode he recently recited to the providers of CHAS he said, “I’m happy, thankful, and honored to be a piece of CHAS’ great mission –bringing healthcare to people, regardless of social condition.” Dr. Bare’s career includes 35 years of exceptional service to patients and communities in Washington State, including the role of Medical Director at CHAS since 2003. He will continue to work for CHAS as an urgent care provider. Dr. Bare jokingly states, “I made the switch from private practice when I started to get grumpy with the 2 a.m. phone calls. I am switching from Medical Director to provider before people start getting grumpy with me.”accountability for quality and value.

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For Your Information

The membership overwhelming voted to pass the suggested changes to Section 6.2 (h) Membership Classes. The updated bylaw now reads as follows:

WA DOH has implemented a $2 convenience fee. “While the online renewal process is more convenient for our customers, it does not reduce agency costs. We will continue to mail renewal notices and licenses to our credential holders. Our current renewal process is already mostly automated; therefore, this new optional system will not decrease staff time. The purpose of convenience fee is to help cover costs of making the online system available and credit card processing.”

6.2 (h) Membership Classes

Renew Online at http://www.doh.wa.gov/hsqa/Renewals.htm

Physician Assistant members shall consist of physician assistants who are licensed, and in good standing, by the State Board of Medical Examiners. They shall pay annual dues as established by the Board of Trustees, but such membership does not entitle the member to vote. One seat on the Board of Trustees may be filled by a physician assistant.

NOTE: You will not be able to renew online if:

Changes to SCMS By-Laws Passes

»» Your credential has already expired. »» You are currently in any other status such as military, inactive, or retired. »» You want to change your status from active to military, inactive, or retired.

Online License Renewal - Six new professions available

»» You have an address change. »» You have a name change.

On September 17th, 2012 six additional professions were released for online renewal. Physicians and Physician Assistants are two of the newly added professions.

Please contact WA DOH Customer Service Office at (360) 2362750 for assistance.

Some of the Professions That Can Renew Online:

Is your contact information current?

Osteopathic Physician & Surgeon

DOH must have your current mailing address in ITS system for you to renew online. They will mail your updated credential to the address on file. The United States Postal Service will not send your credential to a forwarding address.

Osteopathic Physician & Surgeon Limited Pharmacist Pharmacy Technicians Physician and Surgeon Physician Assistant Podiatric Physician and Surgeon

If your contact information is not current in the DOH system, please complete and submit the address change form. Please include a valid email address. Contact DOH prior to online renewal to make sure your contact information has been updated.

Podiatric Physician and Surgeon Limited Surgical Technologists

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Membership Recognition for October 2012

UPCOMING SCMS EVENTS

Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.

30 Years

OCTOBER Senior Physicians’ Dinner – 18 DECEMBER

Michael J. Kraemer, MD

10/26/1982

Curtis G. Wickre, MD

10/26/1982

Steven Wolf, MD

10/26/1982

Board of Trustees’ Meeting – 12

20 Years Stephen J. Darling, MD

10/28/1992

David Sandler, MD

10/28/1992

David R. Greeley, MD

10/27/1992

10 Years Erik D. Skoog, MD

10/7/2002

Stephanie R. Moline, MD

10/28/2002

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Physician Leadership Resources A link for any of the resources listed can be found at the SCMS website (www.spcms.org) Leadership Resources tab.

Online Journal New Journal Prepares Young Physicians for Medical Management, Leadership A free online journal created by the American College of Physician Executives (ACPE) equips the next generation of physicians with the knowledge they need to succeed in the business side of medicine.

This bi-weekly publication, called LeadDoc, is designed to help medical students, residents and young physicians develop leadership and management skills that will advance their careers. Each issue features a physician profile and advice from established physicians.

“In essence, every physician is a leader at some level,” ACPE CEO Peter Angood said in a news release. “Our goal is to inform and guide young physicians as they launch their careers in health care—regardless of where their professional paths may eventually lead.”

Visit http://net.acpe.org/iimgs/newsroom/Press- releases/2012/06-05_LeadDoc.pdf to read more in an ACPE news release.

Book Clinical Integration: A Roadmap to Accountable Care, By Ken Yale Second Edition offers timely updates on key changes affecting the industry as clinically integrated networks (CIN) and accountable care organizations (ACO) emerge. This second edition expands the discussion of key issues affecting hospitals, physicians, insurers, government agencies, and legal professionals on efforts to establish organizations with greater accountability for quality and value.

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Continuing Medical Education Promoting Healthy Families (Practice Management Alerts from the American Medical Association) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain—positive changes for the whole family. The continuing medical education activity includes a video module, a detailed monograph and patient handout. These activities have been certified for AMA PRA Category 1 CreditTM. For more information www.ama-assn.org.

Medical and Therapeutic Management of Chronic Pain: This seminar is jointly sponsored by the St. Luke’s Rehabilitation and the Spokane County Medical Society. 4.5 AMA Category 1 Credits.

Conference will be held on November 9, 2012 from 8:00 AM – 3:30 PM at the Davenport Hotel. Additional information & online register available at www.cherspokane.org.

Yin of Medicine - Past, Present and Future October 10-13, 2012 21.25 hours of Category 1 credit Brochure, Tuition & Registration http://cmetracker.net/GHC/Login?FormName=RegLoginLive&Event id=1572 For twenty years, Yin of Medicine has served as a consistent gathering place for women in health care. This year's program celebrates the past successes of women in health care, the current state of health care, and a look forward to the roles women will play in its future. Alongside this content, we will continue to explore hot clinical topics and how each of us can participate in shaping the future of health care through our contributions as practitioners, leaders, and team members. Location: Alderbrook Resort 7101 E State Highway 106 Union, WA 98592 (360) 898-2200 http://www. alderbrookresort.com/ All reservations must be made by the cut-off date of 9/11/2012. Contact Maria Cárdenas-Anson at (206) 326-2084 for more information or at cardenasanson.m@ghc.org.

Engaging Patients – The ABIM Foundation Choosing Wisely® Campaign CPIN Lunchtime Webinar: Tuesday, October 23, 2012 – from 12:15 until 1:15 PM Evidence-based medicine is more than just using clinically-proven procedures; equally important is using the evidence to decide what not to do. Choosing Wisely® is part of a multi-year effort by the ABIM Foundation, along with many national specialty society partners, to help physicians become better stewards of our limited health care resources. Twenty national organizations representing medical specialists, as well as Consumer Reports, joined with the ABIM Foundation to help physicians, patients and other health care stakeholders think and talk about the overuse of health care resources. Each specialist organization has identified five tests or procedures commonly used in their field for which the necessity should usually be questioned and discussed.

The resulting lists of "Five Things Physicians and Patients Should Question" are intended to “spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments”.

This webinar will present an overview of this campaign. This activity has been approved for AMA PRA Category 1 Credit™; AAFP Prescribed credit is pending application.

Physicians can register online at http://www.wsma.org/clinicalperformance-improvement-network and anyone can register by sending an e-mail titled CPIN Oct 23 to kho@wsma.org, with the following info: Name, Phone, Clinic/Group Name and Number of Participants. Free for all physicians, medical group staff, or other care providers. $75 for non-clinical participants. Questions contact Kesley Howard at (206) 956-3620 or kho@wsma.org.

Rockwood Health Systems Breast and General Tumor Boards: These tumor boards are jointly sponsored by Rockwood Health Systems and the Spokane County Medical Society. Tumor Boards will be held weekly September – December 2012. Each Tumor Board is worth 1.0 Category I CME credits. For more information please contact Sharlynn M. Rima CME Coordinator at SRima@rockwoodclinic.com.

Meetings/Conferences/Events Institutional Review Board (IRB) - Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at 509.358.7631.

WSMA & UW Physician Leadership Course Offered in Spokane Spring 2013 Terri Oskin, MD, SCMS President wrote in the August Newsletter, “Through Leadership Spokane I developed a new and deeper understanding and appreciation of Spokane, both its strengths as well as its weaknesses. The program stresses the role of the servant leader and active participation.” The SCMS has and continues to stress the importance of physician leadership through its publications and activities in the community. If you are in a position of leadership or are contemplating it, read the many physician authored articles in the August Newsletter and consider advancing your leadership skills. The following announcement outlines an excellent leadership program that you should consider.

Physicians who lead are in a remarkable position - they know the culture of patient care as well as the culture of business. Safe and cost-effective care can only be achieved if more physicians take leadership roles in health care or form strong partnerships with administrators. Nevertheless, many physicians do not feel confident in their skills and need an opportunity to see what their future might be as leaders.

The WSMA/UW Physician Leadership course is a comprehensive leadership skills development program that offers 10 weeks of interactive hybrid distance learning specifically designed for physicians. The course is based on UW MHA and Certificate of Medical Management curriculum. The course offers 8 weeks of online assignments and group work bookended by two in-person weekend meetings, allowing physicians to develop and hone their leadership skills in a convenient manner without needing to take significant time away from their practice or personal lives. The 40hour course (CME and AAFP credit apply) focuses on: leadership and conflict management, strategic planning and management, safety and quality management, finance and communication and advocacy.

The Second Annual James McClellan Lecture Humanity In Clinical Care The Marcus Whitman Hotel and Conference Center, 2nd and Rose Street, Walla Walla, WA. Parking is available on site.

Friday, 9 November 2012 Welcome 12:00pm. Lecture 12:30pm Luncheon 1:30pm: FREE, with Symposium (1:30-4:00 PM) CME II, 2 hours Cost: None. The Lectureship is funded through donations from the medical community of Walla Walla as a loving memorial to Dr. James E. McClellan. Pre-registration is required. Space is limited: reservations will not be accepted after 4 November. Register by email: Carole Alexander at: cralexander@charter.net; include full name, occupation (physician, nurse, student, etc.), and mailing address.

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The following physicians and physician assistants have applied for membership and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME Perius, Nicholas J., PA-C Physician Assistant School: U of North Dakota Practicing with Valley Hospital and Medical Center 06/2012

PHYSICIANS IN MEMORIAM

Dunsmoor Su, Rebecca F., MD OBGYN Med School: U of Pennsylvania (2001) Internship & Residency: Hospital of the U of Pennsylvania (2005) Practicing with Obstetrix Medical Group of Washington 09/2012 Laselle, Brooks T., MD Emergency Medicine Med School: Feinberg School of Medicine (2004) Internship & Residency: Madigan Army Medical Center (2007) Fellowship: Denver Health Medical Center (2009) Practicing with Spokane Emergency Physicians 01/2013 Lowe, Gloria V., MD Family Medicine Med School: U of Washington (2008) Internship & Residency: Family Medicine Spokane (2012) Practicing with South Hill Family Medicine 09/2012

PHYSICIANS PRESENTED A SECOND TIME Kilaru, Ravi K., MD Cardiovascular Disease/ Electrophysiology Med School: Guntur Medical College (1998) Practicing with Rockwood Clinic 08/2012 Le, Steven K., MD Cardiovascular Disease Med School: UCLA School of Medicine (2006) Practicing with Providence Spokane Cardiology 09/2012

Bert Pedersen Jacobson, MD

Â

Bert Jacobson was born on January 23, 1918 in Spokane, Washington and passed away on September 3, 2012 at Providence Sacred Heart Medical Center where he had served as president of the medical staff from 1980-81. Bert was raised in Mead, graduated from Mead High School and Gonzaga University. He received his medical degree from Jefferson Medical College in Philadelphia in 1943 and joined the U.S. Navy as a medical officer on the battleship, U.S.S. Stringham, in the Pacific Ocean during World War II. He married his wife Helen, a nurse anesthetist, in 1944.

He began practicing medicine in Poulsbo, Washington (1946-50) before moving to Spokane and establishing a private practice as a general practitioner and surgeon from 1950-84. He served as a doctor for the Spokane Fire Department, the Northern Pacific (Burlington Northern) Railroad and the North Central High School football team.

He and Helen raised three daughters and shared many happy days at Priest Lake, Idaho. He was preceded in death by his wife Helen and sister, Lina Ryan. He is survived by his daughters, Patsy (Frank) Etter, Nancy Bettesworth and Judy (Dave) Nail all of Spokane; nine grandchildren and ten great-grandchildren, and sister, Frances (Bill) Holcomb of Spokane.

Reveron, Ivan J., MD Family Practice Med School: Eastern Central U (1984) Practicing with Community Health Association of Spokane 08/2012 Schomberg, Paula J., MD Radiation Oncology Med School: Medical College of Wisconsin (1979) Practicing with Cancer Care Northwest 11/2012 Zimmerman, Colleen E., MD Family Medicine Med School: Sanford School of Medicine (2009) Practicing with Family Medicine Spokane 09/2012

PHYSICIAN ASSISTANT Lipps, Deanna R., PA-C Physician Assistant School: U of Washington (2012) Practicing with Rockwood Clinic 10/2012

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POSITIONS AVAILABLE PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact Toni Weatherwax at (509) 444-8888 or hr@chas.org.

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family Practice, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Gia Melkus at (800) 260-1515 x5366 or email gmelkus@qtcm.com or visit our website www.qtcm.com to learn more about our company.

PRIMARY CARE INTERNIST WANTED (Pullman) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential. Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments.

We can’t wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or email tkwate@ palousemedical.com. Contact us today and discuss your future at Palouse Medical!

CONTRACT BACK-UP PHYSICIAN 4 + HOURS/MONTH Octapharma Plasma is hiring a Contract Back-Up Physician in our Spokane, WA Donor Center! This position requires just 4 hours per month. GENERAL DESCRIPTION Provide independent medical judgment for issues relating to donor safety, health and suitability for plasmapheresis and immunization. Provide federal and international mandated training and supervision of donor center medical staff to assure compliance with applicable laws. We provide on-the-job training. WHO IS OCTAPHARMA PLASMA? Octapharma Plasma, Inc. is dedicated to improving the health and lives of people worldwide.

OPI owns and operates plasma collection centers critical to the development of life-saving patient therapies utilized by thousands of patients globally. Learn more at www.OctapharmaPlasma. com. Apply today by sending your resume/CV to Careers@ OctapharmaPlasma.com!

PREMIER CLINICAL RESEARCH, an independent dedicated research facility here in Spokane with 20 years of research experience is looking for a Pediatrician to be a part of our physician network for future studies. For more information please contact: April Gleason, Director of Business Development, (509) 390-6768, premierclincalresearch@gmail.com.

FAMILY MEDICINE SPOKANE Immediate opening with Family Medicine Spokane (FMS) for a full time BC/BE FP physician who has a passion for teaching. FMS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships. This diversity benefits our educational mission and prepares our residents for urban

& rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Diane Borgwardt, Administrative Director at (509) 459-0688 or e-mail at BorgwaD@ fammedspokane.org.

PROVIDENCE HEALTH & SERVICES is building its Urgent Care presence in Spokane. We are recruiting for BE/BC Urgent/ Immediate Care physicians and advanced practice providers (nurse practitioners and physician assistants welcome to apply). This is a great opportunity to join a growing employed medical group in beautiful eastern Washington. The exceptional Providence care team is implementing a system-wide standardized EHR and providers benefit from shared best practices and robust clinical and business support. Providence already operates hospitals, residency programs and numerous primary care and specialty clinics in Spokane.

Competitive compensation and excellent benefits package, including relocation. Learn more: Mark Rearrick, Providence physician recruiter (509) 474-6605, mark.rearrick@providence.org, www.providence.org/ physicianopportunities.

SPRINGDALE COMMUNITY HEALTH CENTER ARNP or PAC N.E. Washington Health Programs (NEWHP) has an immediate opportunity for an excellent Physician Assistant (certified) or Nurse Practitioner with Family Practice experience to join our Springdale Community Health Center located in rural Springdale, WA. This position is for Family Practice outpatient care; urgent care experience is a plus but not required. NEWHP offers competitive compensation, comprehensive benefits. . NHSC eligible site. EOE and provider.

Application Deadline: Until filled. Send resume to: N.E. Washington Health Programs Attn: Human Resources PO Box 808 Chewelah, WA. 99109 or electronically to desirees@newhp.org.

PHYSICIANS NEEDED FOR WORKERS COMPENSATION EXAMS Let us help you get started in earning additional professional income!

We are an established I.M.E. practice currently looking for Active Practice and Board Certified Orthopedic and Neurological Doctors, to perform Workers Compensation Exams. Located just minutes away from Rockwood Clinic in North Spokane, we offer a flexible schedule in a helpful, working environment. Previous experience performing Workers Compensation Exams is not required. Please contact Lorraine Stephens for further information at (509) 484-0380.

EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty. Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, (509) 565-4352, email maikeshi@ dshs.wa.gov. PO Box 800, Medical Lake, WA 99022-0800.

PARTNERING FOR PROGRESS is a humanitarian Spokane-based nonprofit that is committed to ensuring that residents of the Kopanga, Kenya community have improved access to healthcare, clean water, sanitation and education. Through generous donors, P4P built a clinic for the Comprehensive Rural Health Project that is run by Alice Wasilwa RN with two other Kenyan nurses and provides primary care.

Some of the common diseases include malaria, water borne illness as well as the diagnosis and treatment of HIV. There are approximately 12 deliveries per month and the clinic staff treats 900-1000 patients monthly. We are in need of medical providers, optometrists and dentists to travel to Kopanga to provide primary care on Oct. 18 – 28, 2012. If you would like to volunteer please contact Stacey Mainer at info@partneringforprogress.org.

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MEDICAL DOCTOR (MD/DO) (PRN openings in Spokane, WA) Physicians needed to perform physicals and health screenings at a non-commercial medical facility. MD/DO must have a current active, license from any state, available 1 to 3 mornings a week.

Send CV to or call: Gil: (210) 424-4008 meps@thi-terra.com EOE REAL ESTATE Luxury Condos for Rent/Purchase near Hospitals. 2 Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, very secure and quiet. Newly Remodeled. Full appliances, including fullsized washer and dryer. Wired for cable and phone. For Rent $ 850/ month. For Sale: Seller Financing Available. Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@inreach.com.

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue. The building has various spaces available for lease from 635 to 6,306 usable square feet available. The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include pediatricians, dermatology, dentistry, pathology and pharmacy.

Floor plans and marketing materials can be emailed upon request. A Tenant Improvement Allowance is Available, subject to terms of lease.

Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720. Email: psrourke@comcast.net.

Clinical Space for Lease - Built in January 2011. 1128 sq ft, four exams rooms, two administrative offices, one office with a counter (electronic bar for laptops, etc.), restroom, reception area and waiting room. Rates are negotiable. Interested parties contact Sharon Stephens at Bates Drug Stores, Inc. 3704 N. Nevada, (509) 489-4500 Ext. 213 or Sam@batesrx.com.

FOR SALE: 16909 N Triple Butte Court, Colbert, WA $789,000 Beautiful home, custom built in 1996 by Copeland Design and Construction. Situated on five wooded acres with two seasonal ponds and 220 feet of river frontage along the Little Spokane River. Idyllic country living but only 5 minutes from the Wandermere Shopping Center and only 10 - 15 minutes from Holy Family Hospital. There are 4 bedrooms, a library, a formal dining room, an open kitchen with eating area, great room, rec room, sun room, 2 full baths, a guest bath, mud room, laundry room, a 3-car attached garage and a greenhouse with fenced-in garden, covered front porch, large back deck with hot tub and a patio of cobblestones. Views from the back deck look over the Little Spokane River wetlands. Call Dr. Edward Petruzzello at (509) 879-3770. No realtors please.

Office space located at 1315 North Division. This location is two miles north of downtown Spokane and just west of Gonzaga and the university district. It consists of 902 sq. ft. and rents for $1015 per month plus 20% of the building Avista and City of Spokane bills. The rest of the building is occupied by a physiatry and pain management medical practice. The space would be ideal for an ancillary medical, chiropractic or therapeutic clinic. Parking is ample and convenient. The space has a nice waiting area and receptionistenclosed area, with several office, storage or exam rooms. Call (509) 321-2276 for more information or for a showing of your ideal location.

MEDICAL OFFICES/BUILDINGS

OTHER

South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting. Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals.

Phone (509) 535-1455 or (509) 768-5860.

Ten (10) adjustable rolling physician stools, teal - $35.00 each, all in great condition. For more information contact Colleen Kins at Internal Medicine Residency (509) 744-3965 or email Colleen.Kins@ Providence .org.

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