The Message, September 2013 by Spokane County Medical Society

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September SCMS The Message Open2

Table of Contents

2013 Officers and Board of Trustees Anne Oakley, MD President David Bare, MD, President-Elect

Physician Leadership .

Terri Oskin, MD Immediate Past President

The Second Pillar: Nurturing Medical Education

Shane McNevin, MD Vice President Matt Hollon, MD, Secretary-Treasurer Trustees: Robert Benedetti, MD Audrey Brantz, MD Karina Dierks, MD Clinton Hauxwell, MD Charles Benage, MD J. Edward Jones, MD Louis Koncz, PA-C Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – David Bare, MD

with the Spokane Medical Humanities Committee .

Organized Medicine – A 25 Year Perspective . . . . . . . . . . .

In Memoriam .

Center for Justice Addresses Legal Needs to Improve Health .

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Reaching Our Children . . . . . . . . . . . . . . . . . .

Medical Education in Spokane Building Momentum . . . . . . . .

A project access client’s story . . . . . . . . . . . . . . .

Let’s Whip Whooping Cough: Vaccinate your patients for pertussis .

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Magnets Pose an Increasing Risk to Children . . . . . . . . . . 11 Updated Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors . Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society. Advertising Correspondence Quisenberry Marketing & Design Attn: Lisa Poole 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 Lisa@quisenberry.net All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

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New Physicians and Physician Assistant for september . . . . . . . 14 Continuing Medical Education, Meetings / Conferences / Events .

Classifieds . . . . . . . . . . . . . . . . . . . . . . 16 Positions Available . . . . . . . . . . . . . . . . . . . 17 SCMS Events .

“I f

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your actions inspire others to dream more, learn more, do more and become more, you are a leader .”

– J ohn Q uincy A dams

September SCMS The Message Open3

Physician Leadership By Anne Oakley, MD SCMS President

Did you know that ten percent of the signers of the Declaration of Independence were physicians? This political presence has dropped off over the past two centuries as physician training has become more rigorous and specialized, but is once again on the rise. Three percent of this year’s Congress has some form of medical background. Why are more physicians taking on highly visible leadership roles? Is there value in having someone work outside of their area of “expertise”? What are the personal risks and benefits of assuming a leadership position? Very few people get through the process of becoming a doctor without possessing the qualities we all look for and value in our leaders: problem solving, teamwork, intelligence, ethics and a desire to help people. A benefit to the long training process is that medical students have time to gravitate toward a specialty that best utilizes their particular strengths. Until recently, most doctors managed their own practices, but this has been made nearly impossible by the monumental amount of government regulation and required documentation. Hence the birth of large physician groups with office managers, billing services and employed practice models. It is only logical that many physicians feel compelled to be involved in the leadership of those organizations and are driven to take part in shaping the government policy responsible for all those regulations! This requires actual training and expertise in leadership, not just the logic and desire to lead. So is it valuable to train a person for eight or more years in a highly specialized job and then split their attention with leadership obligations? Of course it is. As physicians we are uniquely qualified to understand the real challenges of providing the medical care that the government is trying to regulate and that the practice systems are trying to manage. We can be the strongest voice for our patients and make sure that the challenges of providing the care twenty-four hours a day, seven days a week are understood and acknowledged in any policy decisions. Doing this well requires a commitment on the part of the physician leader to understand how to function in these new roles, just as they do as a physician. The Washington State Medical Association has leadership courses and conferences available to any interested member.

So what are the risks and benefits? Most of us enjoy being doctors and being really good at it. Diluting clinical practice time can put this at risk. Leadership itself is risky. One day everyone agrees with your decisions, the next day you are the bad guy. Implementing change in any way demands that people give up things they find important—daily habits, ways of “doing business.” Most business models advocate that the leaders operate both “in and above the fray.” In other words, they should work in the process then step out to regulate the process. Balancing clinical time with managerial time can be very difficult (or impossible) if the leadership role requires travel. Physician leaders can feel a loss of their original identity as a doctor. Any leader can become cynical or callous as they try to do their best at a challenging job. Hopefully the rewards of improving the system in which they work can mitigate those feelings. Thanks to all of you taking the reins at any level!

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The Second Pillar: Nurturing Medical Education with the Spokane Medical Humanities Committee By Jeremy Graham, DO - writing for the Spokane Medical Humanities Committee

Sir William Osler referred to Science and the Humanities as the “Twin Pillars” necessary to hold up the House of Medicine. The Spokane Medical Humanities Committee is dedicated to keeping the “second pillar” of Humanities structurally central as medical education grows in Spokane. The committee First-year medical student Jackie has worked over the past several Bolt tests the new stethoscope she received during her years to facilitate opportunities for orientation in August. reflection and insight into medicine for students and residents. The goal is to remind our trainees continually to perceive the patient as a fellow human being, and not just a data point. For the past two years, a Spring Term Humanities in Medicine course entitled “Becoming a Physician” has been a popular selective for the first year WWAMI medical students at WSUSpokane. Drawing on the history of medicine, reflective writing, film, ethics, and discussion seminars, students find a grounding and context for their demanding science courses: the goal of becoming a compassionate physician. This year by the students’ request, the course is expanding into two terms, gaining dedicated time for arts and humanities in the fall, and the history of medicine and ethics in the spring. Elements developed in the students’ course are now also modified and integrated into the Internal Medicine and Transitional Year residents’ curricula. In May 2013, the Spokane faculty group released the newest teaching-module on the Annals of Internal Medicine’s teaching website, entitled “The Prison Patient.” (see http://annals.org/public/onbeingdoctor. aspx). One of Spokane’s own internal medicine residents is also credited among the authors of this newest ACP teaching module. Using recorded narratives from the ACP “On Being A Doctor” collection, faculty facilitate seminar discussions and workshops on themes such as truth-telling, breaking bad news, professional burnout, and the values and pitfalls of medical paternalism.

However, the most important output of our medical humanities efforts in Spokane is coming from residents and students. In separate efforts, The Spokane Medical Humanities Committee invites students and residents to submit reflective essays about the experiences of “Becoming a Doctor”. This work is felt to be important enough that the Shikany Foundation in conjunction with the Spokane Humanities committee now offers a cash award to a student and to a resident for the top-ranked essays annually. The quality and depth of these essays has overwhelmed the judging panel, and many of the essays not selected for the prize are being encouraged for publication independent of the Spokane Committee prizes. Spokane Medical Humanities Committee has also worked with Spokane Society of Internal Medicine (SSIM) to launch the annual SSIM Osler Award, a recognition for humanism and the “Oslerian Virtues” at the bedside. While recognition exists elsewhere for high grades or leadership achievements, a medical community which values professionalism, altruism, compassion and empathy in a physician should honor the physician publically. Nomination forms for the annual Osler Award can be found at the SSIM website, and all physicians involved with teaching and the internal medicine community are encouraged to nominate a student, resident, and practicing community physician as an exemplar who teaches us all values through actions. In future action plans, much is afoot for medical humanities in Spokane’s immediate future: a medically-themed film outing night at the Magic Lantern; a new History of Medicine selective for the medical students; and a forthcoming didactic series to teach bedside observation through the arts and humanities for Spokane’s first-year residents. A new curricular project through WSU-Spokane will collect data about empathy-development scores among trainees. Of great delight to the Medical Humanities Committee, the medical staffs of both DMC and SHMC have committed funds to the Committee for purposes of an ambitious humanities and ethics conference and event to be held in Spokane, bolstering this expansion of our medical learning community. As medical education grows in Spokane, the time has come to guarantee that both pillars are developed to support the House of Medicine in Spokane.

Since writing is an important part of the reflective process, the faculty group have modeled this behavior by publishing humanities materials in Cell 2 Soul, Annals of Internal Medicine, American Journal of Medicine, and invited commentaries as far as the International Journal of Dermatology.

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Organized Medicine – A 25 Year Perspective

Fortunately the WSMA CEO at the time (Tom Curry) carefully crafted a policy of advocating only for those issues where a general statewide consensus existed. This policy has served the WSMA very well over the years. The WSMA was, and still is, an extremely important organization for all Washington physicians.

By Rod Trytko, MD, MBA

I went to my first medical society meetings in Spokane in 1988. At the time, physicians were almost completely independent or in small groups, physician payments were “usual and customary,” a third of our hospital business came from outside of the county, all hospital and surgical care was received at one of the five locally-owned hospitals and multiple local and regional health plans existed. A physician was expected to advocate for their patients, provide high quality medical care and take ER call. If you did, you could expect to work your entire career in Spokane. No physician was bound to any single health plan or hospital. The Spokane County Medical Society (SCMS) was by far the most important medical society at the time. Physicians joined the SCMS because of the numerous social activities (including a very active Auxiliary), to get credentialed at local hospitals, to utilize the SCMS library and to be credentialed by MSC (now Premera). At the time, all politics was local - as were all healthcare providers. The early 1990s saw a huge move away from “usual and customary” billing and toward a physician fee schedule. HillaryCare and the associated state legislative actions resulted in rapid horizontal consolidation by health plans and hospitals. Managed care was the new way to control medical costs. While managed care was very effective at controlling medical inflation, it resulted in physician animosity and a very public consumer backlash. Capitation created divisions inside the house of medicine that proved to be long-lasting. The introduction of fraud and abuse programs by the Clinton administration in order to create a steady revenue source forever ended the positive relationship between physician and payors. By 2000, state politics ruled supreme and the value of the WSMA became very evident to all Washington physicians. The WSMA responded by dramatically expanding its advocacy function, especially in the areas of legislation and practice management. As your 2000 SCMS President, I was only able to effectively advocate on local issues with the strong support from the WSMA and the AMA. Creating a consensus among physicians at the state level was not as easy as many would think. There is a wide diversity of opinions among physicians in Washington State. At the time, many physicians in King County strongly believed that a single payor system was the obvious choice for the state’s healthcare problems. A variety of special interest groups (subspecialists, ASC, etc.) were gaining political strength. The primary care versus specialty care division continued to widen.

The period from 2000 to 2010 will likely be remembered by three significant events. First, hospitals, having benefited financially from the earlier decade of consolidation, began supporting physician practice. This support was minimal in 2000 and grew rapidly over the next 10 years. Of course with support came associated “strings.” Second, there was the loss of many local healthcare providers. Hospitals and health plans merged with or were sold to regional and national companies. Many hospital-based physicians joined (or were replaced by) national companies. Most of the important healthcare decisions were no longer made in Spokane. Third, primary care started calling for “medical homes” as an alternative payment model to the fee-for-service physician payment system. By 2010, the importance of national medical and specialty medical societies had never been greater. ObamaCare has clearly created a national framework for healthcare reform. The AMA has been at the center of healthcare reform and a host of other issues. It has effectively created a strong Federation of medical societies, specialty societies, and other medical associations that represents the vast majority of physicians in the country. Few physicians appreciate the breadth of its advocacy. The AMA House of Delegates is the entity that makes legislative and policy decisions for the AMA. Every state and specialty society is represented, and the range of issues and opinions is enormous. In my opinion, geography is far more important than specialty. The south (including Texas) is intensely conservative while the northeast and west coasts are far more liberal. Also, some areas (like Washington State) are farther along the reform path. Naturally, this creates an interesting and complicated forum for decision-making and very long meetings. No issue has been more important at the AMA over the last five years as health care reform. It has been intensely and passionately debated at every meeting. AMA policy clearly carries great weight on Capitol Hill. A great example of that is the current house bill on SGR repeal (HR 2810). Two years ago, the AMA called for the complete repeal of the flawed SGR, a period of price stability and a new payment system for physicians. At the time the 10 year cost of SGR repeal was over $300 billion and expected to exceed $500 billion in a few years. Nobody thought it would ever occur. HR 2810 does precisely what the AMA called for and has strong bipartisan support. Given the fact the 10 year cost of SGR repeal has not been this low for a long time ($139B), there is a rush to fix the problem before the price goes up. I would not be surprised to see this bill pass this fall.

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CONTINUED ON NEXT PAGE

CONTINUED FROM PREVIOUS PAGE I have mixed feelings about HR 2810. While repealing the flawed SGR is extremely important and must be done; HR 2810 clearly limits the future of fee-for-service, separates primary care (from all other physicians) into patient centered medical homes, and likely will force hospital physicians to opt-out of fee-for-service in order to participate in acute care episode demonstration bundles. Specialists will have to hope that their specialty societies are able to create a full range of approved and specialty-specific Alternative Payment Models for unbundled services. I have greatly enjoyed my 25 years with organized medicine. A lot has changed over that time. I have been impressed by the dedication that a number of physicians demonstrate toward organized medicine. The diversity of opinion among physicians throughout the state and country is fascinating and refreshing. Perhaps most important, organized medicine is one of the few remaining venues where advocating for patients and physicians is the primary objective. Being active in your local, state and national medical societies is the best way to influence the future of your medical practice. Washington State is at the forefront of change, and having strong medical associations to advocate for physician-led reforms will help ensure that Washington State continues to be the best place to practice medicine and to receive care. Dr. Trytko is a past president of the SCMS and WSSA, a current board member of the WSMA, and a delegate to the AMA.

Financial Planning for Physicians The Washington State Medical Association (WSMA) Young Physicians Section would like to invite all physicians to a special reception and 1-hour presentation on Saturday, September 28, from 4:30 p.m.–6:30 p.m. as part of the WSMA annual meeting at the Davenport Hotel in Spokane. While this is a young physician sponsored event, all interested physicians are welcome to attend. Our presenter, James K. Wilson, CFP, says “In today’s increasingly challenging financial medical environment personal planning is more important than ever.” Topics covered during his session will include retirement, college, insurance and estate planning. In addition it will provide a general overview of the types of financial professionals physicians may find themselves interacting with, how they are compensated and potential conflicts of interest. Jim Wilson is a graduate of Whitworth University with a Bachelor’s degree in accounting and business and has over 20 years of experience in the financial services industry. A Certified Financial Planner™, he has achieved a designation as an Accredited Investment Fiduciary®. Jim continually draws on these disciplines to help his clients achieve their financial goals. Currently he is president, CEO, and advisor representative at Northern Capital Management, Inc. in Spokane. For more information call (206) 956-3622.

IN MEMORIAM

Alex VanderWilde, MD 1926-2013 Born in Bandung, Indonesia, Alex received his medical education in Leiden, Netherlands and at the University of Amsterdam. Alex came to the Spokane area in 1956. As a young doctor, Alex worked at St. Luke’s Hospital at the old West Central location, where he met Louise Leitz, of Waverly, Washington, a nursing student there. They were married and had five children: Patricia, Brenda, Russell, Wanda and Heidi (and twelve grandchildren). One of Alex and Louise’s accomplishments was the acquisition and improvement of land that became the family tree farm in Fighting Creek, Idaho. It was a great source of refuge and tranquility for Alex and his family. Memories of his adolescent years in a prison camp in Indonesia, where he was separated from his siblings during World War II, followed him through life. His lifelong interest in that war, and his study of it, were perhaps his way of bringing meaning to that terrible conflict. Alex served as a family physician for decades in the Spokane community, and he did so with a sense of humor and compassion.

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“The Spokane County Medical Society Foundation’s Hot Spotters initiative is rooted in deep collaboration among private and public providers of health, housing, legal, and other social services in an effort to efficiently stabilize the health of the region’s most complex patients while reducing overall costs to the system. The Center for Justice is a key partner in those efforts. We’ve turned this month’s Foundation column over to Tim Connor and Barry Pfundt for a perspective from the legal side of this work.”

Center for Justice Addresses Legal Needs to Improve Health

population patients. One key emphasis of this work is to find better ways to engage low-income patients with complex needs who have frequent contact with health care providers, which is why the society provided support for the initiative.

What if a doctor could prescribe safe and affordable housing, income to help with a patient’s essential needs or changes to the law that would offer disabled individuals the support they need to live independently? Those remedies are not as far-fetched as they may seem.

Says Lee Taylor, the society’s Director of Strategic Initiatives: “We know generally that a lot of the folks who are in this population of very complex and vulnerable people have a broad variety of legal challenges. We need the expertise that Barry and others can bring from the legal community to try to figure out how to address those challenges in the most expedient way.”

By Tim Connor and Barry Pfundt, Center for Justice

The Center for Justice, Spokane’s non-profit legal advocacy organization, is announcing the launch of its “Health and Justice Initiative.” The announcement follows successful collaborations with the health care community over the past year and speaks to the Center’s commitment to using its legal and advocacy resources to enhance health care delivery. “The Center has always looked for innovative ways in which we can provide essential legal services to our community,” explains Rick Eichstaedt, the Center’s executive director. “We really see this new initiative as an opportunity to fill an important gap, to address issues of health with our tool, which is the law.” Although new to Spokane, a variety of “medical-legal partnerships” have successfully taken root in cities across the country. They typically deploy lawyers and legal assistants to work with health care providers to address underlying legal or social obstacles to delivering the best treatment for economically disadvantaged patients.

One early and active component of the Center’s Health & Justice Initiative is its participation with the Spokane “Hot Spotters Group.” The project focuses on high risk, low-income patients who repeatedly enter the health care system through emergency rooms. The goal is to lower costs to the community while improving the lives of some of the most vulnerable members of our society. Dr. Darin Neven, an emergency room physician who is a member of the Hot Spotters leadership team, recognizes the importance of the Center’s involvement in the effort. “I’d like to see people get the legal resources they need, when they need them,” Dr. Neven says. “It’s better to help these people with these problems, because it’s going to cost us more in the long run if we don’t, and it’s the right thing to do.”

At the Center, the opportunity to develop the Health and Justice Initiative arrived with staff attorney Barry Pfundt. Barry first learned about medical-legal partnerships at an Access to Justice Conference, where he instantly recognized that it would be a great fit in Spokane. He kept an eye out for a chance to advance the effort. One year ago, he joined the Center and took advantage of the opportunity to make the vision a reality. This diagnosis of how the Center could contribute came at an opportune time. It complemented work already underway through the Spokane County Medical Society with initiatives such as Project Access and Consistent Care Washington, both of which focus on low-income

35 West Main Avenue #300 Spokane, WA 99201 (509) 835-5211 www.cforjustice.org

Reaching Our Children

By Colleen Zimmermann, MD Providence Family Medicine Residency of Spokane In 2011, 66% of our nation’s public school fourth graders were behind in reading proficiency. Sadly, this number jumps to 83% of children in low-income families. Why does fourth grade matter? At that age, readers are expected to move from learning to read to reading to learn. Imagine what those schoolchildren are missing in the classroom as they struggle with reading. This handicap can be very difficult to overcome; those who do not prevail are at high risk of dropping out of high school. However, as in medicine, an ounce of prevention can be worth a pound of cure. The Providence Family Medicine Residency of Spokane has recently partnered with Reach Out and Read to prepare our youngest patients for reading success by prescribing books and encouraging families to read together. Children delight in taking home new books after well child visits, caregivers discover the benefits of reading aloud and our residents learn to use books as a tool to assess child development. I recently presented on-site training to our residents as our program kicked off. During our discussion of language development, we reviewed a study linking non-reading families to a higher risk for developmental problems. One of our residents correctly pointed out that this correlation may not represent causation and questioned whether placing books in the hands of our patients will be enough to affect change. Thankfully, the Reach Out and Read model is also evidence based. Fifteen peer reviewed, published studies have shown remarkably consistent results over the past 20 years. Children served by the program are more likely to be read to, have more books in the home and they demonstrate statistically significant improvements in receptive and expressive language scores that give them, on average, a six-month developmental edge over their peers at the start of preschool. Many of those studies were done in high risk, low income families whose children are most vulnerable to reading failure. We can make a difference. Perhaps you have already joined Reach Out and Read to promote literacy in your practice. There are already 159 sites in Washington State. But there is room for one more. If you would like to learn more about this inspiring program, please visit reachoutandread.org. Even if you do not see children for well visits in your practice, you can still join in our effort by stocking your waiting room with children’s books, encouraging families to read together and supporting our local library.

Medical Education in Spokane Building Momentum By Doug Nadvornick, WSU Medical Sciences

One of the highlights of the new student orientation for Spokane’s first-year medical students occurs when members of past classes return to give advice to their successors. For the first time, a panel of returning second-year students was convened, their go-round as first years still fresh in their minds. Fifteen of the 19 students in Spokane’s inaugural second-year class this fall studied last year in Spokane. The first question at the August 7 discussion came not long after UW School of Medicine dean Paul Ramsey had exhorted the students to seek a healthy work-life balance: “Which fitness center would you recommend? Oz or the YMCA?” After panel members dispensed with that question, one of the new students turned to something deeper: “Why did you choose to come back to Spokane?” Second-year panelists Lauren Benson, Erik Larson, Kelli McEntee, Sara Hatlen and Spencer Schulte offered a variety of answers. Some have family-related reasons for staying. Benson’s mother Judy is the director of the Providence Internal Medicine Residency program. Hatlen’s husband Tim is a first-year resident in that program. Larson’s grade-school age son lives here. But there were other reasons too. For example, a few like the idea of helping to start the new WWAMI (Washington Wyoming Alaska Montana Idaho) second-year pilot program in Spokane. It will, in many ways, be far different than the second-year program in Seattle, which relies heavily on large-group lecture sessions. Spokane’s model will split the 19 students into two groups. And instead of going to class each day to be exposed to new material for the first time, the students will be asked to do their assigned reading before convening so that they’re familiar with the material and class time can be dedicated to discussions and case studies. WWAMI Spokane faculty call it a ‘flipped classroom’ model. They say it has proven to be successful and popular in many other medical schools around the nation. The second-year students say they had a taste of that in Dr. Chris Coppin’s cell physiology unit last year. It took some getting used to, said Larson, but students prepared so well that all of them scored high marks on the unitending test. First-year students then moved the discussion to some of the other usual subjects: Which textbooks should I buy (or avoid)? What study arrangements worked best for you? Did you have a life outside of medical school? What kinds of projects did you work on to satisfy your III (Independent Investigative Inquiry) requirements after your first year? Continued on Page 8

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Your help is needed!

We are interested in exciting, different and/or unusual

The Spokane County Medical Society is changing the

to skydiving. We just need your help getting names and

monthly newsletter, The Message, and is looking to

ideas. Our writers will contact members to do interviews.

include human interest stories about our physician

Please contact Michelle at michelle@spcms.org or

and physician assistant members.

(509) 325-5010 with any information. Thank you.

activities and hobbies. It can be anything from gardening

WSMA Medical Staff Leadership Workshop Peer review can be a challenging endeavor, even for the most seasoned medical staff leader. WSMA’s new Medical Staff Leaders Workshop is designed to address the skills needed to help you be a more effective leader. The course will provide information on the fundamentals of peer review, identification of peer review “best practices,” effective communication skills and offer hands-on learning through role-play activities. The workshop is an all-day event led by University of Washington’s Dr. Ed Walker and WSMA’s Director of Legal Affairs Denny Maher, MD, JD. Pre-registration is required. The cost is $850. The workshop is limited to 36 physicians. To register, contact Lynda Sue Welch at (206) 441-9762 or lyndasue@wsma.org. The workshop will be held from 9:00 am to 5:00 pm on Friday, October 18, 2013 at the SeaTac Hilton Hotel. The WSMA is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The WSMA designates this live activity for a maximum of 6 AMA PRA Category 1 Credits™. This activity meets the criteria for up to 6 hours of Category 1 CME credit to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission.

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CONTINUED FROM PAGE 6 Many of the same questions came up shortly afterward during a second panel with five third- and fourth-year medical students who will spend most or all of this year doing clinical rotations in Spokane. At least one panelist said that while they enjoyed their second-year experience in Seattle, they wish they had had the opportunity to stay in Spokane. Most of the students now in the clinical phase will spend little or no time this year on the WSU campus; their chance at having dayto-day contact with the new students has passed. But with the two classes now occupying classrooms close to each other (especially in the new Pharmaceutical and Biomedical Sciences Building when it opens on the WSU Spokane campus in January), there’s a chance for students to mix. Erik Larson attended the whole of the first-year orientation. He and Spencer Schulte participated in the first-year students’ annual float trip down the Spokane River. They say that while they’ll be immersed in their own studies, they’re open to helping their first-year colleagues where they can. The two groups were scheduled to lunch together after the second-year orientation on August 22 (first-year students will already have almost two weeks of classes behind them) and there are other joint opportunities scheduled throughout the year.

The decision to move out of Pullman provides a new opportunity for the first-year WWAMI program in nearby Moscow to expand. This fall, the Idaho group is growing from 20 students to 25, thanks to an increase in funding from the state legislature, with an eye toward further growth to 40 students. “We are pleased that WSU’s plans will dovetail with our own,” said Don Burnett, interim president of the University of Idaho. “Both universities will continue their long-standing relationship with the University of Washington, providing exceptionally high-quality medical education through a remarkably cost-effective arrangement.” “The University of Idaho/WSU relationship remains strong and the WSU Pullman faculty are committed to continuing to educate medical students in the Moscow/Pullman area,” said WSU President Elson Floyd. “This is an exciting opportunity for Idaho to expand its number of physicians and, as the WWAMI Spokane program grows, for Washington to increase its physician workforce as well.” Though WSU Pullman will no longer host an annual class, the Pullman-Moscow area will continue to serve as an active clinical training site.

First-year WWAMI program in Spokane to expand The UW School of Medicine has announced that it will consolidate its first-year eastern Washington WWAMI program at the WSU Spokane campus in the fall of 2014. It will merge the program it has operated at WSU Pullman for 40 years with the Spokane program that began in 2008. That will double the size of the Spokane class from 20 students to 40. The move is subject to approval from medical education’s accrediting agency.

I make house calls. Jurene Phaneuf SPECIALIZING IN P H Y S I C I A N R E L O C AT I O N S

C E L L : 5 0 9 -2 9 4 -119 2 O F F I C E : 5 0 9 - 5 3 5 -74 0 0 J U RE N E P H A N EU F @ G M A IL .C O M

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Under normal circumstances, Project Access receives and coordinates referrals from clinics and physicians for uninsured, low-income patients who need specialty care. But what about those patients who do not have a primary care physician? Many individuals learn that they need to see a specialist only after a visit to the emergency room, where their medical history is often a mystery and where it is impossible to track their future care with any degree of continuity or comprehensiveness. In those cases, it is important to establish the baseline of care that is inherent in a regular doctor-patient relationship, not only for the purpose of treating the immediate diagnosis, but also to identify any other health concerns that may have been ignored due to the inability to access care. Since early 2012, Group Health and the Providence Internal Medicine Residency Spokane Clinic have been donating Primary Care slots to Project Access clients who fit this profile. This expands our capabilities enormously by allowing us the flexibility to work with patients who clearly need our help, but who don’t necessarily have all of the workup documentation that would ordinarily be required in order to get them an appointment with a specialist. Without this invaluable resource, many of these patients would simply go untreated until their next ED visit, leaving them to suffer and ultimately compounding the overall cost of their care.

A Project Access Client’s Story

Physician Testimonial

By Jim Ryan, Project Access Program Coordinator A 23-year old client we’ll call “Karen,” came to us as a self-referral after a lifelong struggle with gastrointestinal issues that had become increasingly disruptive, interfering with her ability to be in school. Those issues had never been evaluated due to her lack of insurance and inability to pay for services. Her own research into her symptoms and family history led Karen to be concerned about Chron’s disease and she came to us presuming that she might need surgery. What Karen needed, first and foremost, was a primary care physician to start from scratch with her—to ask the relevant questions, perform the necessary tests and work through her medical issues in a comprehensive way. Project Access staff set Karen up with Dr. Robinson at Group Health and together they worked step-by-step through her health issues. Karen was referred for multiple imaging appointments and, eventually, for a GI evaluation. Karen re-enrolled in May of 2013 and continuing to work with Dr. Robinson to get to the root of the problem while finding new ways to manage the most problematic symptoms. Thanks to the generous donation of Primary Care slots by Group Health and Providence Internal Medicine Residency Spokane, clients can address serious medical concerns with their doctor in addition to routine ailments that need medical attention, such as cold and flu symptoms. This access to care allows minor medical ailments to be treated in a timely fashion and keep the emergency departments from being bogged down with nonurgent patients. So far this year, approximately 30 clients have gained access to a primary care physician for at least a six-month period through Project Access.

Tommy Le, D.O. Lidgerwood Medical Center, Group Health Permanente

“I have been participating with Project Access for four years. Project Access is a well run program that provides finite medical needs for patients in Spokane. The organization does a fantastic job of screening patients to match the medical availability of primary and specialty care physicians and centers so the patient’s specific medical condition can be addressed in a few visits or with a certain procedure.

I love seeing Project Access patients because they truly are thankful for their care. I do not need to fly to distant third world countries when I can help people and make a difference right here in my own community. Giving back to the community is a big part of why I participate. As a Primary Care Physician, sometimes I need to send patients for specialty care or procedures and Project Access makes this step painless with their large resource of physicians and groups and by doing the follow up work to help the patients navigate the system. Medical care is vast and complex even for those with medical insurance and Project Access guides the patients each step of the way so there is never any question as to the next step. Each patient has a specific point of contact at Project Access and this cuts down on confusion, redundancy and streamlines their medical care. This background infrastructure and support is the most impressive aspect of Project Access to ensure a smooth experience for both the patient and the practitioner. Project Access is a solid program that says what it does and does what it says. It is quite rewarding for me to be able to participate in this program and I encourage other doctors and groups in the Spokane community to participate as well. I am thankful to be part of this program because it allows me to touch people’s lives whom I may have never been able to before.”

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Let’s Whip Whooping Cough: Vaccinate your patients for pertussis

Vaccinate your patients

By Dr. Kim Grandinetti, Group Health Cooperative As a pediatric hospitalist, I’ve witnessed first-hand the terror that families experience when their child is sickened by pertussis. Every year in Spokane I treat between one and five infants and children, several of whom are infected before they can get their first eight-week immunization. Nationwide, pertussis has resurged to its highest level in 50 years. Last year our state experienced a major epidemic with more than 4,000 cases. Generally, most of the adult family members I spoke with had already been vaccinated, but their child was exposed to people in the community who weren’t. That’s why it’s important for us as physicians to encourage all of our patients to get vaccinated. Most parents don’t realize that infants usually catch whooping cough from parents, grandparents and siblings who believe they simply have a mild cough and don’t realize they are infected. By July of this year, the state Department of Health had already reported 405 cases and one child had died. Because pertussis spreads easily within homes, schools and neighborhoods, family members and friends should get the vaccine too. A recent national poll from the University of Michigan shows that 60 percent of adults don’t know when they last received the vaccine. Only 20 percent reported getting it in the past 10 years.

As physicians and physician assistants, we can help fix this problem. We can check our patients’ medical records when they come in for a visit, regardless of whether they are seeking care for a bad cold or a broken ankle. Simply train your medical assistant to look at the patient’s shot record at the same time that he or she records vital signs. If the patient hasn’t been vaccinated recently, you can administer the booster shot right then and there. The Dtap booster is given to pregnant women, adults and teens, and the Tdap vaccine is given to children and babies who are eight weeks and older. When patients don’t want to receive the vaccine right then, you can encourage them to go to their primary care provider or call their closest Walgreens and inquire about low-cost vaccines, priced generally between $15 and $20. Yokes pharmacy at its Airway Heights location, 5th and Brown, and selected RightAid stores have all received lowcost doses. In addition, the health district is holding several free clinics in September. Visit www.srhd.org for dates and locations.

Silence Whooping Cough campaign Beginning this September, Group Health Cooperative, Providence Health & Services, and the Spokane Regional Health District are sponsoring a Silence Whooping Cough campaign to provide all the latest information on pertussis and how to prevent it. For more information visit the campaign web site at www.silencewhoopingcough.org. They also have materials for patients about pertussis and vaccination. To order materials call Pat Nash at (509) 241-7130. Families can join a contest to win free diapers for a year when they ask their friends and families to get vaccinated. To enter, they simply need to visit the campaign website and send an e-card that reminds their loved ones to get a booster shot. When I was a medical resident, pertussis was one of those preventable diseases that I never encountered because we had minimized it through vaccines. Now that it’s on the rise again, we clinicians must take the lead in protecting Spokane’s children. Please screen your patients and help them get vaccinated. Your leadership and action protects our entire community. Kimberly Grandinetti, MD, is a pediatric hospitalist who practices at Group Health Medical Centers in Spokane.

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Magnets Pose an Increasing Risk to Children

or other orifices. Nationally, this equates to approximately 22,581 magnet-related emergency room visits over the 10-year period.

Published August 6, 2013 In: Seattle’s Children’s Hospital Patient Care, Research, Research Findings, Safety – Reprinted by permission

Most of the cases the researchers reviewed – 74 percent – involved magnets in the intestinal tract. The incidence of these magnet ingestions increased from 0.57 cases per 100,000 children per year in 2002 and 2003 to 3.06 cases per 100,000 children per year in 2010 and 2011.

By Justin Matlick

An 8-year-old girl comes to the emergency room with what her parents think is stomach flu, then is rushed into surgery after X-rays show she swallowed three tiny magnets. A toddler eats magnets that look like candy, then has part of her bowels removed after the magnets click together inside her. They’re stories that make parents squirm – and they’re becoming all too familiar to Julie Brown, MD, co-director of pediatric emergency medicine research at Seattle Children’s. Brown treats children in Seattle Children’s Emergency Department and is seeing more and more cases where kids accidentally swallow magnets or insert them into their nose, ears or other orifices, with potentially lifethreatening consequences. In a study published Aug. 6 in Annals of Emergency Medicine, she and her colleagues found that this is a national trend: From 2002 to 2011, there was a significant increase in kids receiving emergency care after accidentally taking magnets into their bodies, indicating that magnet-related injuries are an increasing public health problem for children. The trend corresponds to the rising popularity of new, “rare earth” magnets – tiny, exceptionally strong magnets used in everything from train sets to jewelry clasps, to desk toys for adults. “These magnets seem innocuous but they pose an incredible risk to kids, and we need to do a better job regulating them so they stay out of children’s hands,” said Brown, who authored the study along with Jonathan Silverman, MD, Beth Ebel, MD and other colleagues from Seattle Children’s Research Institute and the University of Washington. Magnet ingestions far more common, especially in young children

“Ingestions most frequently involved toddlers and young children, and usually happened in the child’s home,” Brown said. Swallowing multiple magnets is especially dangerous The study found that cases where children swallowed more than one magnet increased between 2008 and 2011 – exactly when adult desktop toys like Buckyballs started hitting the market. The products are marketed as stress-relievers and each set can contain more than 200 tiny magnetic balls. “It’s easy for them to get lost in the carpet or fall into places where young children can find them and eat them,” Brown said. All children who ingest more than one magnet are at risk for complications and need to be followed closely, preferably with the involvement of pediatric specialists. The danger is greatest when magnets are ingested at different times, as they can travel separately through the digestive system and end up in different loops of tissue. When they attract between loops of bowel, the magnets can quickly erode through the bowel walls, causing potentially life-threatening injuries and infections. In some cases, surgeons have to remove sections of bowel and insert drains to treat infections. Additional research at Seattle Children’s identified 56 children with magnet ingestions between 2002 and2012, with an increasing incidence that parallels the national data. More than half of the 32 children with multiple magnet ingestions required a procedure. While 44 percent of children passed the magnets with close monitoring and medications, 25 percent required endoscopy to remove them and 31 percent required surgery. There were increasing numbers of multiple magnet ingestions in the last three years of study (2010-2012), corresponding with an increase in ingestions of small, spherical magnets. Teens at risk

The researchers reviewed records of emergency department visits at 100 hospitals nationwide, using data collected by the National Electronic Injury Surveillance System. Between 2002 and 2011, they found 893 cases where kids under 21 went to the emergency room with magnet-related injuries involving their mouth, nose, ears

Children inserted magnets through their nose in 21 percent of the cases the researchers reviewed. This was most common among preteens and teenagers, who sometimes

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CONTINUED FROM PREVIOUS PAGE use magnets to imitate nose piercings. Teens who ingested magnets reported accidentally swallowing them after sticking them to their braces or using them to imitate tongue, lip and cheek piercings. Stronger regulations needed For Brown, the new study, along with an upcoming paper showing a surge in magnet-related cases at Seattle Children’s, shows a need for more parent education and stronger regulations. Some of the most popular adult magnet sets, including Buckyballs, were recently taken off United States markets after warnings by the U.S. Consumer Product Safety Commission, but millions of sets were sold and are still available on the internet. Many other hazardous magnets are sold with bulletin boards or as fridge magnets. These magnets aren’t subject to child safety guidelines because they’re marketed as adult products. “The manufacturers say it should be up to parents to protect their kids, but these magnets are so much stronger than what was out there 10 years ago, and many parents don’t realize how dangerous they are,” Brown said. Tips for parents: Protecting kids from magnets • Take stock of the magnets in your home. Small, strong magnets are being used in common items like toy building sets, refrigerator and bulletin board magnets and jewelry clasps. • Teach your kids not to put magnets in or near their mouths. • Keep small magnets out of children’s reach and away from children with developmental disabilities, pica or autism. • Counsel your teens about the hazards of using magnets to imitate piercings. • Throw away or lock up your Buckyball-type magnets. These magnets are too dangerous to keep in a house with children.

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• If you think your child ingested a magnet, take them to your doctor or the emergency department immediately.

For more information regarding the study, contact Children’s PR team at (206)987-4500 or at press@seattlechildrens.org.

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Updated Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors By Felix Martinez, Jr., MD

The American Society for Colposcopy and Cervical Pathology (ASCCP) released the Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors in late April of this year. The guidelines were developed with 23 national health organizations and nine years of cervical precancer management data on 1.4 million women. Providers who have adopted the preferred method of HPV/cytology cotesting in women ages 30-64 have been receiving combinations of results, some of which are discordant (e.g., HPV+/Pap -, HPV-/HSIL). The new guidelines provide guidance on how to manage women with discordant results (see Table 1). In addition, screening is no longer recommended for adolescents. Data analysis shows that women ages 21-24 are at low risk for invasive cervical cancer, but high risk for HPV exposure and HPV-associated lesions. This suggests that less aggressive assessment will minimize potential harms of managing abnormalities likely to resolve spontaneously. A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in September of last year to update the 2007 ASCCP Consensus Guidelines. The groupâ&#x20AC;&#x2122;s goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, and diagnosed cancer precursors. These guidelines follow adoption of updated cervical cancer screening guidelines in 2012 incorporating longer screening intervals and cotesting. In addition to literature review for specific issues, data from almost 1.4 million women who are members of Kaiser Permanente Northern California provided evidence on risk of cervical precancer and invasive cancer over an eight year period after abnormal tests and follow up. The educational mission of the ASCCP is to improve clinician competence and performance and patient outcomes through educational activities focused on the study, prevention, diagnosis and management of lower genital tract disorders.

Table 1. Discordant Cotesting Results: Use cotesting management recommendations only for women â&#x2030;Ľ30 years of age. HPV+/Pap- women can be managed in two ways: Repeat cotesting in one year, with colposcopy if HPV+ or ASCUS+(including HPV-/ASC-US) and repeat cotesting in 3 years if cotest results are negative. Genotyping, with colposcopy if HPV16+ or18+ and repeat cotesting in 1 year if both HPV 16 and 18 are negative. HPV-/ASC-US results should be followed up with cotesting in 3 years, not 5 years, as these women are at marginally higher risk for CIN3+ than women who are cotest negative. Women with HPV- /LSIL results can be followed with cotesting in a year (preferred) or with colposcopy. Women with HPV+/LSIL or LSIL/no HPV result should have colposcopy. Women with HPV-/HSIL or HPV-/ASC-H are at high risk of high grade precancer and need colposcopy. Women with HPV-/AGC are at high risk and need colposcopy, often with endometrial sampling.

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For a complimentary consultation or brochure, call: Spencer T. Shelman, CFA (509) 838-4175 or (888) 864-8827 assetplanning.com September SCMS The Message 13

New Physicians and Physician Assistant for September 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 to the Spokane County Medical Society, 104 South Freya Street, Orange Flag Building, Suite 114, Spokane, Washington, 99202.

PHYSICIANS PRESENTED A SECOND TIME Alhafez, Fadi, MD Internal Medicine Practicing with IPC - Holy Family Hospitalists 08/2013 Carter, Gregory, MD Internal Medicine Practicing with St Luke’s Physiatry Practice 08/2013 Cope, Jeremy M., MD Internal Medicine Practicing with IPC - Holy Family Hospitalists 08/2013 Hwang, Becky J., MD Radiology Practicing with Inland Imaging Associates 08/2013

PHYSICIANS Costa, Ruxandra, MD Neurology Med School: Carol Davila U, Romania (1991) Internship: U of Louisville Humana Hospital (1999) Residency #1: U of Louisville Humana Hospital (2000) Residency #2: State U of New York (2002) Fellowship: U of Toronto, Canada (2004) Practicing with PMG - Neurology 09/2013

Jones, Geoffry, MD Family Medicine Currently practicing with Family Medicine Newport Li, Frank D., MD Pain Management Practicing with Spokane Pain Center 07/2013

Fralich, Laura S., MD Family Medicine Med School: Ross U (2008) Internship: Providence Family Medicine Spokane (2009) Residency: Providence Family Medicine Spokane (2011) Fellowship: U of Massachusetts (2013) Practicing with Columbia Medical Associates 09/2013 Houmard, Brenda Sue, MD Reproductive Endocrinology and Infertility Med School: Ohio State U (1994) Internship: Ohio State U (1995) Residency: Ohio State U (1998) Fellowship: U of Washington (2001) Practicing with SRM Spokane 10/2013

Santarpio, Camille, DO Obstetrics and Gynecology Practicing with Obstetrix Medical Group of WA 10/2013 Snyder, Jennifer C., MD Family Medicine Practicing with Providence Family Medicine Residency Spokane 08/2013 Tryon, Brian, MD Diagnostic Radiology Practicing with Radia, Inc., PS 09/2013 Vanderhoeven, Jeroen, MD Maternal-Fetal Medicine Practicing with Obstetrix Medical Group 07/2013

Lessman, Katherine L., MD Obstetrics and Gynecology Med School: U of Nebraska (2009) Internship: St Louis U (2010) Residency: St Louis U (2013) Practicing with Rockwood 08/2013

PHYSICIAN ASSISTANT

O’Connor, Rachel L., MD Diagnostic Radiology Med School: U of Toledo (2007) Internship: Arrowhead Regional Medical Center (2008) Residency: U of California, Davis Medical Center (2012) Fellowship: U of California, David Medical Center (2013) Practicing with Radia Inc. 09/2013

Simonson, Heidi, PA-C Physician Assistant School: Midwestern U (2002) Practicing with NW Pacific Emergency Physicians 09/2013

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Continuing Medical Education Moderate (Conscious) Sedation and Analgesia: 3.0 hours of Category 1 CME credit, sponsored by the Spokane County Medical Society. Tuesday, September 17 5:30 – 9:15 p.m. at the Providence Sacred Heart Medical Center Mother Joseph Room. This is SCMS’ annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety. For more information visit www.spcms.org or contact Karen Hagensen at (509) 325-5010 or karen@spcms.org. Spokane County Medical Society presents MEDICINE 2013: 7.0 hours of Category 1 CME credit, sponsored by the Spokane County Medical Society. The program will focus on the more challenging management issues that clinicians encounter. Speakers from the University of Washington, Virginia Mason Medical Center as well as several local experts will present. The conference will be held on Friday, September 27, 2013 at the Davenport Hotel. Visit the Spokane County Medical Society website for more information and to view the program brochure at www.spcms.org or contact Karen Hagensen (509) 325-5010 or karen@spcms.org. Rockwood Health System Breast and General Tumor Boards: The tumor boards are jointly sponsored by Rockwood Health System and the Spokane County Medical Society. Tumor Boards will be held weekly June – December 2013. Each Tumor Board is worth 1.0 Category 1 CME credits. For more information please contact Sharlynn M. Rima CME Coordinator at SRima@rockwoodclinic.com. 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. HPV and HPV Vaccine: Strategies for Patient Management and Increasing Vaccination, a workshop intended for clinicians who diagnose and manage HPV infection, provide HPV vaccine, and/or provide vaccination education to patients and parents 2.5 hours of Category 1 CME credits, sponsored by the University of Washington Department of Medicine and University of Washington Department of Nursing.. An update on HPV and HPV vaccines will be discussed in addition to addressing the barriers providers often face concerning vaccine hesitancy and series completion. Wednesday October 16 from 5:30 p.m.-8 p.m. at St. Luke’s Rehabilitation Institute. Registration fee of $20 includes CME/CNE, materials, dinner and parking. Register at http://stdtoolkit.srhd.org/hpvcme. Presented by the Seattle STD/HIV Prevention Training Center, Spokane Regional Health District, Spokane County STD Medical Coalition, Washington State Department of Health Division of Infectious Diseases and Immunization Action Coalition of the Inland Northwest. Contact Anna Halloran at ahalloran@srhd.org for more information.

2013 Chronic Pain Symposium - Management of the Chronic Pain Patient: Presented by St. Luke’s Rehabilitation Institute. The course is designed to address the wide range of clinical management issue associated with the treatment and care of chronic pain patients. Friday September 13, 2013 from 8 a.m. to 4 p.m. at The Lincoln Center, 1316 N. Lincoln St. Register at www.st-lukes.org or call (509) 232-8138. Registration fee $125. Providence Health Care designates this live activity for a maximum of 5.25 hours in Category 1 to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission. Providence Health Care designates this live activity for a maximum of 5.25 AMA PRA Category 1 CreditsTM.

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. Spokane Guild of the Catholic Medical Association- is pleased to present a lecture by Father Robert Spitzer, SJ, PhD, on “The Scientific Evidence for the Existence of God”. Father Spitzer is the past president of Gonzaga University. He is an author, educator, philosopher, and founder of the Magis Center of Reason and Faith. Please join us on 3 October, Thursday evening at 6 p.m. at Providence Auditorium, Sacred Heart Medical Center. All health care professionals are welcome. Atheists and agnostics are especially welcome. For more information contact Al Oliva, MD at (509) 220-3586. National Environmental Health Association Courses sponsored by the CDC and EPA available. Courses include National Environmental Public Health Performance Standards Workshop: Building Local and National Excellence, Biology and Control of Insects and Rodents Workshop, Environmental Health Training in Emergency Response and Environmental Public Health Tracking 101. For more information go to the website at www.nehacert.org. Physician Family Alanon Group: Physicians, physician spouses or significant others and their adult family members share their experience, strength and hope concerning difficult physician family issues. This may include medical illness, mental illness, addictions, work-related stress, life transitions and relationship difficulties. We meet Tuesday evenings after 6 p.m. The format is structured by the 12-Step Alanon principles. All is confidential and anonymous. There are no dues or fees. To discuss whether this group could be helpful for you, please contact Bob at (509) 998-5324. Medical Reserve Corps of Eastern Washington General Membership Meeting – Spokane Regional Health District Auditorium, 1101 West College Avenue, 6:00 – 8:00 p.m. Wednesday, 11 September 2013. Everyone is welcome to attend. Disaster response and preparedness involves all of us at home or at work. For more information contact David Byrnes at DByrnes@srhd.org.

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REAL ESTATE Custom Home - Little Spokane River Valley For Sale - Nestled on a slight hill overlooking the peaceful Little Spokane River Valley with 220 feet of waterfront acreage sits a beautiful custom home designed and built by the renowned architectural firm of Copeland Design and Construction. The home surroundings are wonderfully landscaped with paths that lead to the Little Spokane River and woods. The interior has natural wood details which accentuate each room. The many Hurd windows give panoramic views of the river valley. There are 4 bedrooms, library, sun room, master bedroom, master bath with imported European tile, great room with tiled gas fireplace, kitchen with Corian counters and bar seating, laundry room, mud room, large rec room, 2 and 1/2 baths, furnace room, utility/wine storage room and a 3-car attached heated garage. There is a heated green house with an adjacent fenced in garden area. A paver patio, back deck with hot tub and front porch allow for enjoyment of the pleasant summer evenings. The home has solar water heating and solar electric with backup batteries and generator. It is in the Mead school district and only 10 - 15 minutes from Providence Holy Family Hospital and 25 minutes from Providence Sacred Heart and Deaconess Hospitals. There are too many other details to list here. Please call: (509) 466-6947 or (509) 879-3770. Comfortable Three-Bedroom Home in quiet neighborhood for rent. Good storage in kitchen, gas stove, dishwasher, refrigerator, washer/dryer and fireplace. Comes furnished or can negotiate. Close to Hamblen Grade School, Sac Middle School and Ferris High School. Three bedrooms, three baths, large living room, family/TV room, master bedroom has private bathroom, two-car garage. Large windows in living room look out into large fenced yard with automatic sprinkler system (front and back). Snow blower and lawnmower provided. Call (408) 594-1234 or (509) 993-7962. Large Second Owner Custom Built Executive Home with unparalleled views of Liberty Lake and Spokane Valley on five acres available for sale or lease. Custom hardwood floors and woodwork throughout, cherry office shelves, cathedral ceilings, central air, three car garage, brick porch, tile roof, large deck, three fireplaces, four bedrooms, four bathrooms, formal dining room, large kitchen, large eating room and den. Walk out basement, wood stove, kitchen and bathroom. Large 30’ x 100’ pole barn with separate utilities, two phase power, three twelve-foot overhead doors. 30 x 60 sports court. Large animals allowed. Water rights included. 4Kw grid interactive, portable battery backup solar system available. Offered for $600k or for lease $3250, no pets/smokers. Seller is a real estate broker at (509) 220-7512.

Beautiful Priest Lake Cabins for Rent – Our newly restored cabins are located on the historic site of Forest Lodge in the entrance to the scenic Thorofare. Two cabins are available. Each sleeps 8. They are located at the water’s edge, have gorgeous views, bordered by the National Forest and 18 acres of private land. The beds and furnishings are all new and cabins have all the amenities - decks, docks, beaches with fire pits, walking trails and forest to explore. Boating, hiking, swimming, sailing, snowmobiling in winter or just relaxing in the sunshine. You will enjoy a peaceful, fun-filled vacation at this amazing site. For available dates, pricing, photos and details call Jeannie or John at (509) 448-0444. One of Copeland’s Best North Side Homes on over fifty acres with meadows, trees, complete privacy and gorgeous views. This home offers contemporary living at its best featuring four bedrooms, four bathrooms, three-car garage, hard rock maple floors, cabinets and built-ins, three balcony decks plus a patio with water feature. The second level has a distinctive master suite with custom built-ins, large walk-in closet, lovely master bath with lowboy toilet and bidet, a large sitting room with built-in shelving, raised gas fireplace and extraordinary views! The main floor great room boasts granite, stainless appliances, oversized pantry and very functional laundry suite with chute. Super-efficient geothermal heating and cooling affords economical year ‘round comfort. Twenty minutes from Holy Family Hospital. Mead schools! $750,000 Call Marilyn Amato at (509) 979-6027.

MEDICAL OFFICES/BUILDINGS 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. 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 medical office spaces available for lease from 635 to 10,800 contiguous usable square feet. and has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include urgent care, family practice, pediatrics, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials emailed upon request. A Tenant Improvement Allowance is available, subject to terms of lease. Contact Patrick O’Rourke, CCIM, CPM®with O’Rourke Realty, Inc. at (509) 624-6522, mobile (509) 999-2720 or psrourke@comcast.net.

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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 CHAS Human Resources at (509) 444-8888 or hr@chas.org. Visit our website to learn more and to apply www.chas.org. 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 tkwate@palousemedical.com. Contact us today and discuss your future at Palouse Medical! PROVIDENCE FAMILY MEDICINE RESIDENCY SPOKANE Immediate opening with Providence Family Medicine Residency Spokane (PFMRS) for a full- time BC/BE FP physician who has a passion for teaching. PFMRS 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 Linda Barkley, Program Assistant at (509) 459-0688 or Linda.Barkley2@providence.org. PROVIDENCE HEALTH & SERVICES has immediate opportunities for BE/BC Family Physicians to join our expanding primary care team in Spokane, eastern Washington’s largest city. Newborns to geriatrics, no OB. Regular 8-5 hours, five-day week. New physicians will join Providence Medical Group, our physicianled multispecialty medical group with clinics throughout the metropolitan area. Excellent compensation and benefits. Providence Medical Group (PMG) – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence.org or (509) 474-6605 for more information.

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 gmelkus@qtcm.com or visit our website www.qtcm.com to learn more about our company. PROVIDENCE MEDICAL GROUP (PMG) - Eastern Washington is recruiting for an excellent Family Medicine physician to join our care team in this scenic suburb of Spokane. Full-time opportunity with our growing medical group in what will be a large, state-of-the-art medical ambulatory center (construction completion target is spring 2014). No OB. Outpatient only. Competitive compensation and comprehensive benefits. Providence Medical Group – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence.org or (509) 474-6605 for more information. FULL-TIME LICENSED PHYSICIAN ASSISTANT PA wanted for expanding clinic in Spokane, Wash. Currently patients are seen four days per week, Monday through Thursday, 8am to 5pm. Approximately 24 patients per day. This could expand into five days a week in the future. No call, weekends or holidays. Fabulous benefit package offered. Vacation and CME benefits provided. Starting salary DOE. If interested, submit resume and cover letter to Kris Norton, Office Manager at knorton@neuroandspine.com. SPECTRUM HEALTHCARE RESOURCES has an immediate opportunity for a civilian Family Practice Physician at Fairchild Air Force Base. This contract position offers: Full-time; Outpatient setting; Monday through Friday, 7:30am to 4:30pm; Manageable patient load (20-25 per day) and Shared on-call responsibilities (mostly telephone consulting). The position will have the following requirements: Current and unrestricted medical license; Successful completion of a family medicine residency; Board Certified by the ABFM or AOBFP; BLS, ACLS, PALS and Ability to work in a team setting. Contact Spectrum recruiter Lisa Paska for more information at Lisa_Paska@spectrumhealth.com or (314) 744-4107.

September SCMS The Message 17

Chad Harbour, MD, recently joined Providence Orthopedics. Dr. Harbour is fellowship trained in trauma and hip reconstruction, specializing in complex fracture surgery for adults and children, hip and knee replacements and revision hip surgery.

Providence proudly welcomes Chad Harbour, MD to our team.

Providence Orthopedics surgeons offer patients a superior level of surgical, and non-surgical orthopedic methods of treatment. Our doctors are board-certified by The American Board of Orthopaedic Surgery and are subspecialty trained, providing state-of-the-art bone and joint care: n n n n

PROVIDENCE ORTHOPEDICS

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820 S. McClellan St., Suite 300 Spokane, WA 99204

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To refer a patient or for information please call (509) 838-7100.

phc.org

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Trauma and complex fractures Joint reconstruction/revision Hip and knee Shoulder and elbow Complex foot and ankle Arthroscopic surgery Sports medicine Musculoskeletal tumors

September SCMS The Message 19

You're invited to a

Region 9 Health Care Coalition FREE Event

Specialty Services Emergency Preparedness Summit Welcome by: Sally Abbott, Department of Health Presenters: Deanna Davis, Inspirational Speaker Dan Simonson, Spokane Eye Center Jim Barry, 360 Consulting Group, Business Resiliency Expert Region 9 Health Care Coalition Leadership

Thursday, October 17, 2013 Breakfast: 6:30 a.m. Speakers & discussion: 6:45 - 9 a.m. Shriner's Hospital Health Education Center, Room 1 FREE

Join our efforts to increase the resiliency of your practice's and our community's health care system emergency response capacity by:

   

Delivering the right care in the right amount of time during emergencies Meeting the planning and response needs of the broader health care system Having a voice in the community planning process Securing Medicaid reimbursement through active participation in preparedness planning

We'll also have facilitated table discussions and networking opportunities. Questions? Email: hcc@srhd.org Call: (509) 324.1465 Reserve your seat today! Registration closes October 1, 2013

September SCMS The Message 20

SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

U.S. Postage

PAID

Spokane, WA Permit No. 307

ADDRESS SERVICE REQUESTED

Printed on GP Spectrum® Paper: Certified by the Sustainable Forestry Initiative. Please recycle.

t s e w h t Nor

IF YOU COULD FIT THE

ON A PLATE

Join us at our all new restaurant Chinook Steak, Pasta and Spirits. Acclaimed Executive Chef Adam Hegsted highlights the best of the Northwest, including King Salmon from the Puget Sound, beef sourced exclusively in Washington, Columbia River Steelhead and wild local huckleberries. The menu caters to a variety of tastes, wood-fired pizzas, old-world rustic style pastas, all with thought given to affordability and five-star quality. Join us for dinner or for a drink at our non-smoking bar. C DAC A S I N O.CO M |

PRSRT STD

/C D A C A S I N O R E S O R T

Wed - Thur: 5 - 9 pm, Fri - Sat: 4 - 10 pm, Sun: 4 - 9 pm Lounge open daily: 3 pm - close

“WHAT MAKES OUR RESTAURANT UNIQUE IS ITS ‘RUSTIC SIMPLICITY’ AND THE BEST THE NORTHWEST HAS TO OFFER.” – EXECUTIVE CHEF ADAM HEGSTED