The Message, October 2014

2014 Officers and Board of Trustees

Table of Contents

David Bare, MD President Matt Hollon, MD President-Elect Anne Oakley, MD Immediate Past President J. Edward Jones, MD Vice President

President’s Message:Emerging Threat: Antibiotic Resistance – Staying Ahead of the Curve . . . 1

In-Depth Interview: Bruce Abbotts, MD: Cycling: Relaxation, Transportation and Recreation . . . 3

Gary Newkirk, MD Secretary-Treasurer Trustees Charles Benage, MD Audrey Brantz, MD Karina Dierks, MD Elizabeth Grosen, MD Clinton Hauxwell, MD Louis Koncz, PA-C Frank Otto, MD Fredric Shepard, MD Carla Smith, MD Brian Tryon, MD Newsletter Editor – Matt Hollon, MD

Medical Education: The Feasibility of Creating a New WSU Medical School . . . . . . . .

5

Medical Education: Homegrown Leaders in Medical Education . . . . . . . . . . . .

6

SPOTF: DEA Releases New Rules that Create Convenient but Safe and Secure Prescription Drug Disposal Options . . . . . . . . . . . . . .

7

Group Health Suspending Medication Take-Back Program . . . . . . . . . . . . . . 8

Reducing Radiation Dose in CT . . . . . . . . . . . . . . . . . . . . . . 10

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

Advertising Correspondence SCMS Publications Attn: Saraj Bailey 211 W 2nd Ave Spokane, WA 99201 509-343-0123 Fax 509-325-3889 Saraj@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.

Other News: Start Someting Big with Big Brothers Big Sisters of the Inland NW / Medical Students Reach Out to the Medical Community . . . . . . . . . . . . . . 13

In Memoriam: John Arthur Moyer, MD / Susan Jane Tewel, MD . . . . . . . . . . . . . 16

New SCMS Members . . . . . . . . . . . . . . . . . . . . . . . . . 18

Classified Ads: Real Estate / Medical Offices / Buildings . . . . . . . . . . . . . . 19

Classified Ads: Medical Offices / Buildings / Positions Available . . . . . . . . . . . . 22

Classified Ads: Positions Available . . . . . . . . . . . . . . . . . . . . . 23

Classified Ads: Meetings / Conferences / Events . . . . . . . . . . . . . . . . . 24

“The best way to find yourself is to lose yourself in the service of others.”

– Mahatma Gandhi

PRESIDENT’S MESSAGE

PRESIDENT’S MESSAGE CDC’S THREE CATEGORIES OF PRIORITIZED BACTERIA

use of antibiotics in people and animals would help greatly in slowing down the spread of resistant bacteria. This commitment, known as antibiotic stewardship, is to always:

EMERGING THREAT: ANTIBIOTIC RESISTANCE – STAYING AHEAD OF THE CURVE

By David Bare, MD

improved use of antibiotics that we

We as providers have the biggest potential,

SCMS President

as providers prescribe (prescribing

specifically in prevention and improvement.

Any time there is an uptick of a certain illness above expected historic levels or new diseases emerge, mass media is quick to report it as seen recently with the Ebola virus. But an emerging threat to global health that only intermittently receives attention is antibiotic resistance.

stewardship). But every day there are still huge numbers of ill patients who are receiving inappropriate or unnecessary antibiotics. In this epistle are listings of the organisms that are posing increasing threats (see inset box), along with an outline of what we as a nation and as providers can do to help in that effort.

The CDC is the go-to source of disease monitoring, prevention and treatment in the US. In 2013, they published “ANTIBIOTIC RESISTANCE THREATS in the United States, 2013 ”. Here, they

Prevention includes immunization, safe food preparation, hand-washing, and protective equipment when needed to include gloves, masks and eye protection. By preventing infections we also prevent the spread of resistant bacteria. These on the “to-do list” are matters of public health of which all medical providers should be aware and

Urgent Threats: (These are high-consequence antibiotic-

• Use antibiotics appropriately and safely,

resistant threats because of significant risks identified

• Only when they are needed to treat disease,

across several criteria. These threats may not be currently widespread but have the potential to become so and require

• To choose the right antibiotics, • Administer them in the right way in every case.”

transmission.)

The practicality of this occurs every day for those of us with direct

• Clostridium difficile

patient contact, and it puts science up against patient expectation

• Carbapenem-resistant Enterobacteriaceae (CRE)

and provider’s effort to please their “clientele”. Working in an

• Drug-resistant Neisseria gonorrhoeae

Urgent Care as I do, these expectations are high. The patient has paid to see a provider, they are ill and don’t feel well and need to

threats. For varying reasons [e.g., low or declining domestic

they are going to get is a pill to make them better. It is also much

incidence or reasonable availability of therapeutic agents],

easier to write out a prescription than spend five minutes talking

they are not considered urgent, but these threats will worsen

about disease resistance and how that occurs. I find that as a

and may become urgent without ongoing public health

subgroup are parents who bring their infants and children in for a

monitoring and prevention activities.)

pharmaceutical cure and actually become quite vocal and angry if it

• Multidrug-resistant Acinetobacter

is determined that the child has a viral infection and antibiotics are

• Drug-resistant Campylobacter

not appropriate. This is especially true when their sibling just got the

• Fluconazole-resistant Candida (a fungus)

Amoxicillin prescription yesterday at their primary care office and

• Extended spectrum β-lactamase producing

they expect the same course of treatment with this child.

spreading,

resistant infections is to change the way

resistant organisms yearly, and as a

• Tracking resistant bacteria,

antibiotics are used. Up to half of antibiotic

result of these infections, 23,000 people

• Improving the use of antibiotics,

use in humans and much of antibiotic use in

die, and the numbers are increasing year

• Promoting the development of new

animals is unnecessary and inappropriate

after year. I think most of us have been

antibiotics and new diagnostic tests for

and makes everyone less safe. Stopping even

exposed to the CDC effort of promoting

resistant bacteria.”

some of the inappropriate and unnecessary

1

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• Drug-resistant Shigella • Methicillin-resistant Staphylococcus aureus (MRSA)

States, 2013 are great handouts to aid in this process.

• Drug-resistant Streptococcus pneumoniae • Drug-resistant tuberculosis

So what’s our part in this?

• Understand the continuous emerging threat and the magnitude

Concerning Threats: (These are bacteria for

of that threat,

• Use our best clinical judgment to determine what illnesses will

people are infected with antibiotic

• Drug-resistant Salmonella Typhi

the CDC’s report ANTIBIOTIC RESISTANCE THREATS in the United

“Perhaps the single most important development and spread of antibiotic-

• Drug-resistant Non-typhoidal Salmonella

promote public awareness in how this occurs. Page 13 and 14 of

• Be proactive in educating our patients and the general public

and preventing resistant bacteria from

• Multidrug-resistant Pseudomonas aeruginosa

preventing resistant organisms from developing. We also need to

patients and our medical staff.

report that a lowly-estimated 2 million

• Vancomycin-resistant Enterococcus (VRE)

front so that all providers on all levels are aware of our role in

active in promoting their dissemination to our

action needed to greatly slow down the

Enterobacteriaceae (ESBLs)

To be the gold standard in the “fight” we need to have a united

actions that fight the spread of antibiotic

• Preventing infections from occurring

Serious Threats: (These are significant antibiotic-resistant

get back to work, and so frequently it is their expectation that what

According to CDC, “there are four core resistance including:

urgent public health attention to identify infections and to limit

2

which the threat of antibiotic resistance is low, and/or there are multiple therapeutic options for

about this threat,

resistant infections. These bacterial pathogens cause severe illness. Threats in this category

benefit from antibiotics.

require monitoring and in some cases rapid incident or outbreak response.)

If you have other suggestions on how we as your SCMS can be

• Vancomycin-resistant Staphylococcus aureus (VRSA)

instrumental in this effort, please let us know. n

• Erythromycin-resistant Group A Streptococcus

1, 2 ANTIBIOTIC RESISTANCE THREATS in the United States, 2013. U.S. Centers for Disease Control and Prevention.

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

• Clindamycin-resistant Group B Streptococcus

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IN-DEPTH INTERVIEW

IN-DEPTH INTERVIEW and transportation, and it’s a great way to travel

activities together. “In our younger years, we

for vacations,” he reasoned. “It also saves

did a lot of cross-country skiing, but now our

money and gasoline,“ he added. In fact, he enjoys

winter activity is snowshoeing,” he stated.

cycling so much that he is part owner of Two Wheel Transit, a local bicycle shop that sells Trek bicycles, and also provides sales and service, and includes a dedicated bicycle fitting studio.

Dr. Abbotts as he wears three different hats. Not only is he part owner of Two Wheel Transit, but you can also find him at

Of course, cycling has its physical

Providence Valley Young People’s Clinic as

By Shelly Bonforti

challenges, especially when riding long

a pediatrician on some days, and other days

SCMS Development Coordinator

distances and climbing hills. But the

he is teaching second year medical students

pros far outweigh any cons. Aside from

at Riverpoint Campus. He is also an active

the physical benefits, Robert Manning,

member of Adventure Cycling (a bicycle

professor of recreation management at the

touring organization), Washington Bikes and

University of Vermont, states that “time

Rails to Trails. He adds, “And, of course, the

spent in outdoor recreation also leads to

Friends of the Centennial Trail.”

Ah, the great outdoors! These words elicit panoramic visions of scenic settings and a feeling of tranquility rushes over you. Add a Trek bicycle to the mix and there you will find Dr. Bruce Abbotts. Havasupai Falls with its brilliant blue water contrasting against the stunning red rocks, or Yellowstone

strengthened family times.” And, according 1

to Kent State University professor Andrew

Dr. Bruce Abbotts was born in New Jersey and worked his way west until he hit Spokane. On his

with its abundant and diverse wild life, or

way, he obtained a Master’s degree in Zoology at

Sedona, Arizona with its multi-colored stone

the University of Alberta and went on to medical

formations are such destinations that have

school in Denver, where he met his wife, Marla

provided the perfect settings for time away

(also a pediatrician in their Spokane Valley clinic).

for Dr. Abbotts and his family.

They both came to Spokane and Valley Young People’s Clinic in 1991. Dr. Abbotts has been

Cycling is Dr. Abbotts’ main activity for relaxation,

BRUCE ABBOTTS, MD CYCLING: RELAXATION, TRANSPORTATION AND RECREATION

A typical workday is rarely the same for

selected to help develop curriculum and teach in

transportation and recreation. He’s been riding for quite some time, remembering the days of his youth of riding around the neighborhood with friends. It wasn’t until he was older that he realized there were more benefits to riding. Today, he frequently rides back and forth to work. “I can ride just about anywhere. It combines exercise

Spokane’s new four year medical school. n

Lepp, “Outdoor activities lead to increased confidence, improved creativity and better self-esteem. Natural settings rejuvenate

1 Manning, Robert E. Studies in Outdoor Recreation. www.healthyliving.azcentral.com.

and calm the mind, improve outlook and

2 Kent State University: Top Five Benefits of

increase positive affect.”2

Outdoor Recreation.

While cycling is Dr. Bruce Abbotts’ preferred relaxation activity, he enjoys many other outdoor activities with his family as well, including gardening, hiking, canoeing and camping. Although their two children are grown and on their own, he and his wife, Dr. Marla Struebin who is also a pediatrician in their practice, still find time to enjoy outdoor

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MEDICAL EDUCATION

MEDICAL EDUCATION

THE FEASIBILITY OF CREATING A NEW WSU MEDICAL SCHOOL

By Ken Roberts

already have a state-of-the-art facility

Acting Dean, College of Medical Sciences,

capable of handling classes of up to 120

WSU Spokane I want to start by welcoming our newest – and largest – medical class to WSU Spokane.

This year we have 40 first-year WWAMI students joining us on campus, in addition to nine second-year students. Another 30 thirdand fourth-year students are spending most or all of their required and elective rotations in the city’s hospitals; 69 others are doing at least one rotation in Spokane. That shows a strong and growing medical education program in Spokane.

• We would be able to develop strong

Assistant Dean for Regional Affairs &

occurred when doing an international elective

emergency medicine, dermatology and

pipelines with local schools and

Clinical Professor

in a small clinic in Brazil where she met another

ophthalmology residencies. Although by

students, so we wouldn’t need additional

universities to identify students interested

University of Washington School of

medical student who eventually would become

design, these residents are here only for one

capital funding. And we already employ

in becoming primary care doctors and

Medicine

her husband and convince her to move across

year. Many, like Dr. Wolff, have returned to our

many of the faculty we would need

funnel them into pre-med programs and

Associate Program Director

the pond. After completing medical school and

area. Dr. Wolff grew up in Las Vegas and has

to teach our classes. In addition, we

then on to a WSU medical school.

Providence Internal Medicine Residency

travelling she moved to the US in 2002 to begin

her undergraduate, medical and MPH degrees

Spokane

her psychiatry residency with the University

from University of Utah. She then came to

of Washington, Spokane Advanced Clinician

Spokane for her Transitional Year thinking she

would use a community-based model of medical education that has proven to be cost effective in other programs around the country. That model allows us to partner with existing hospitals and health systems around the state, rather than building our own hospital. It is a model that would complement, rather

• We would tailor our curriculum to emphasize primary care and to prepare our

Medical education has been a hot topic and

students for the practice of medicine in the

will continue to be for some time. Integral

21st century.

to the discussions of medical education in

• We would have a growing medical research program. Many of our faculty members who now teach spend a majority of their time doing basic and

As we look ahead to continuing that growth, we’re encouraged by what we’re hearing from our consultant, MGT of America, as

We would use a community-based model of medical education that has proven to be cost effective in other programs around the country.

it investigates the feasibility of creating a new WSU medical school. As I write this, MGT is scheduled to present its report to the WSU Board of Regents in a few days and the final decision of whether the university will move ahead hasn’t yet been made.

modest start-up funding to build the faculty and administration necessary to go through the process of accrediting our program and run the new school. We would anticipate beginning with a class of 40 students, the size that we’re now teaching, and building to 120 over several years.

than compete, with the University of

to the costs incurred by other U.S. universities that have created medical schools in the last 10 years. Why? We

cancer, sleep and neurobiology.

They bring in grant funding that would help to pay for a medical

• Along with that medical research

Washington’s medical education program

would come economic development

and would expand the state’s capacity for

opportunities through partnerships with

training physicians.

private companies and development of new products and services.

medical school, what would we get for

WSU has been proud to be a part of

our money?

WWAMI since 1971 and we look forward

• We would get a strong medical education program with an emphasis on primary care.

to our continued involvement as an equal, fully-accredited partner. But our region needs more than WWAMI if we want to satisfy our growing collective demand

• We would be able to control our own admissions process, which means we

Our startup costs would be low compared

applied research in areas such as

school.

With an independently-accredited WSU

A WSU medical school would need very

HOMEGROWN LEADERS IN MEDICAL EDUCATION

could target students with a desire to work in primary care careers and rural areas. We know that doctors who pursue careers in rural medicine often grew up in

for healthcare. We’re confident that a WSU medical school would provide a cost-effective alternative for Washington students who now must leave the state to attend medical school (and who often never return). n

rural areas.

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Spokane have been increasing the number of undergraduate medical education seats for Washington State residents and the expansion of graduate medical education. As medical education continues to grow to meet these needs, I would like to introduce two relatively new leaders in medical education – both whom are graduates of local residencies and have now become Program Directors for those same residency programs.

Tanya Keeble has been named program director for the resurrected Psychiatry Residency Program at Sacred Heart Medical Center. Psychiatry training locally has been on hiatus as the previous residency has been overhauled and restructured. Dr. Keeble has been instrumental in moving this process forward; she has been involved in recruiting community partners as well as preparing documents to submit to the Accreditation Council on Graduate Medical Education (ACGME) to ensure the new program is fully accredited. As a result of her hard work and leadership, the Psychiatry Residency Program will begin recruiting residents for its inaugural class this fall. Dr. Keeble grew up in England and completed medical school at University College London. Unanticipated changes

Track. The first two years of training took place

would go on to become an anesthesiologist.

in Seattle and the last two here in Spokane.

Based in large part on her positive experiences

Upon completion of her residency, Dr. Keeble

during her emergency medicine rotation while

and her husband decided to stay in Spokane

here, she reconsidered and then decided she

and raise their family here. Dr. Keeble’s clinical

was better suited for that field. Danielle went

practice consists of private practice focusing

on to do her Emergency Medicine Residency

on short term dynamic psychotherapy as well

at the Medical College of Pennsylvania/

as being embedded as a consulting psychiatrist

Hahnemann Medical Center (now Drexel). Dr.

at the CHAS clinic. She has remained involved

Wolff returned to Spokane in 2006 to join the

in medical education and has served as the

Emergency Medicine group at Deaconess

local psychiatry clerkship director for UWSOM

Medical Center. In addition, to her full-time

medical students and also as the assistant

work in the ED, Dr. Wolff has served as the

program director for the psychiatric residency

Medical Advisor to the Spokane Valley Fire

in Spokane. Dr. Keeble is passionate about

Department since 2007. Dr. Wolff has done an

finding innovative ways to teach, but is equally

admirable job of finding a work-life balance as

passionate about spending time with her three

she ensures that she has time outdoors with

young children, riding mountain bikes and cross

her husband, Jake, and their three children.

country skiing.

Please join me in welcoming and

Danielle Wolff has been named program

congratulating both Dr. Keeble and Dr.

director for the Transitional Year Residency

Wolff as they assume these leadership

Program, following in the footsteps of her own

roles in medical education. They both

former program director, Larry Schrock. Dr.

serve as great role models and examples

Schrock led the program from 1980 until his

of the quality of physicians that can be

retirement this past June. Dr. Wolff herself was

produced by our local training programs.

a transitional year resident in this program in

While they are the point persons for their

2001-2002. Recall that the Transitional Year

respective programs; all of us involved

Program is for those residents pursuing highly

in medical education realize that medical

specialized residency programs requiring

education expansion and these exciting

a broad clinical base. In recent years, the

times of growth would not be possible

Transitional Year residents have gone on to do

without your participation. Thank you. n

radiology, radiation oncology, anesthesiology,

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SPOKANE PRESCRIPTION OPIOID TASK FORCE (SPOTF)

DEA RELEASES NEW RULES THAT CREATE CONVENIENT BUT SAFE AND SECURE PRESCRIPTION DRUG DISPOSAL OPTIONS

The U. S. Drug Enforcement Administration’s (DEA’s) Final Rule for the Disposal of Controlled Substances, which implements the Secure and Responsible Drug Disposal Act of 2010, was made available online for preview by the Federal Register at https:// s3.amazonaws.com/public-inspection. federalregister.gov/2014-20926.pdf. The Act, in an effort to curtail the prescription drug abuse epidemic, authorized DEA to develop and implement regulations that outline methods to transfer unused or unwanted pharmaceutical controlled substances to authorized collectors for the purpose of disposal. The Act also permits long-term-care facilities to do the same on behalf of residents or former residents of their facilities. The Final Rule was officially published on September 9, 2014 and will take effect on October 9, 2014.

“These new regulations will expand the public’s options to safely and responsibly dispose of unused or unwanted medications,” said DEA Administrator Leonhart. “The new rules will allow for around-the-clock, simple solutions to this ongoing problem. Now everyone can easily play a part in reducing the availability of these potentially dangerous drugs.”

enforcement, and banned pharmacies,

to an opioid overdose. No words can

doctors’ offices, and hospitals from

lessen their pain,” said Michael Botticelli,

accepting them. Most people flushed their

Acting Director of National Drug Control

unused drugs down the toilet, threw them

Policy. “But we can take decisive action,

in the trash, or kept them in the household

like the one we’re announcing today, to

medicine cabinet.

prevent more lives from being cut short

Unused medications in homes create a public health and safety concern because they are highly susceptible to accidental ingestion, theft, misuse, and abuse. Almost twice as many Americans (6.8 million) currently abuse pharmaceutical controlled substances

ever taking hold. These regulations will create critical new avenues for addictive prescription drugs to leave the home and be disposed of in a safe, environmentally

collection receptacles at long-term care facilities.

• The public may find authorized collectors in their communities by calling the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539.

• Law enforcement continues to have autonomy with respect to how they collect pharmaceutical controlled substances from ultimate users,

enforcement to conduct take-back events.

• Patients also may continue to utilize

on their website at http://www.fda.gov/

Survey on Drug Use and Health. Nearly

www.dea.gov or call 1-800-882-9539

downloads/Drugs/ResourcesForYou/

110 Americans die every day from drug-

to find a nearby collection site. At this

Consumers/BuyingUsingMedicineSafely/

related overdoses, and about half of

time, DEA has no plans to sponsor

UnderstandingOver-the-

those overdoses are related to opioids, a

more nationwide Take-Back Days in

class of drug that includes prescription

order to give authorized collectors the

painkillers and heroin. More than two-

opportunity to provide this valuable

prior to these new regulations being

thirds (70 percent) of people who misuse

service to their communities.

implemented continues to be valid.

As a temporary measure, DEA began hosting National Prescription Drug Take-Back events in September, 2010. Since then, the DEA has sponsored eight take-back days.

Enormous public participation in those events resulted in the collection of more than 4.1 million pounds (over 2,100 tons) of medication at over 6,000 sites manned by law enforcement partners throughout all 50 U.S. territories.

available for viewing on the DEA website at

registration with the DEA to become authorized collectors.

• All collectors may operate a collection receptacle at their registered location, and collectors with an on-site means of destruction may operate a mail-

who has tragically lost a son or daughter

back program.

7

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been safely removed from circulation.

We’ve also learned over the past eight years that Group Health can’t be the only pharmacy system receiving unwanted medications.

By suspending our program, we hope to give the community a chance to recognize the need and respond in a meaningful way. As we have so many times in the past, Group Health will

We’re proud that our medication take-

actively share our knowledge and

back and disposal program was the

experience as we address this issue.

basis for new federal regulations aimed

share our experience.

prescription medications on a routine basis.

an on-site pharmacy) to modify their

works, because earlier this year, we

Enforcement Agency (DEA) in 2012 to

at www.regulations.gov. It will also be

pharmacies, and hospitals/clinics with

in landfills. We know that the program

Health testified before the Federal Drug

securely dispose of potentially dangerous

narcotic treatment programs, retail

of unwanted medications.

facility pharmacies nationwide. Group

in the Federal Register, it will be viewable

distributors, reverse distributors,

as a pilot program to see how the public

retail, clinic, hospital, and treatment

expand the options available to safely and

“Every day, I hear from another parent

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

CounterMedicines/ucm107163.pdf.

• Any method of disposal that was valid

When the Final Rule is officially published

DEA registrants (manufacturers,

leader in safely and effectively disposing

at encouraging similar programs in

DEA’s goal in implementing the Act is to

• The Final Rule authorizes certain

that we can continue to be an industry

pharmacies. This program began in 2006

pounds of unwanted medications have

pharmaceutical controlled substances

http://www.deadiversion.usdoj.gov. n

removing the receptacles from our

noted that more than 100-thousand

Take-Back Day. The public may visit

medicine cabinet.

existing receptacles in order to make sure

the environment through flushing or

non-registrant—may partner with law

combined, according to the 2012 National

or relatives, including from the home

our program at this time and removing the

medication take-back program and

being diverted to others or getting into

person or entity—DEA registrant or

listed by the Food and Drug Administration

report obtaining the drugs from friends

Group Health is suspending its pioneering

way to keep unwanted medications from

including holding take-back events. Any

On September 27, the DEA held its last

prescription painkillers for the first time

GROUP HEALTH SUSPENDING MEDICATION TAKE-BACK PROGRAM

would respond and if it was a practical

hallucinogens, heroin, and inhalants

than the number of those using cocaine,

Controlled Substances Act made no legal

substances except to give them to law

prevent misuse and dependence from

with an on-site pharmacy may operate

the guidelines for the disposal of

states, the District of Columbia, and several

of unwanted pharmaceutical controlled

unused painkillers from the home, we can

• Retail pharmacies and hospitals/clinics

friendly way.”

Prior to the passage of the Act, the provisions for patients to rid themselves

far too soon. We know that if we remove

SPOKANE PRESCRIPTION OPIOID TASK FORCE (SPOTF)

We will begin removing the original receptacles from our pharmacy lobbies at the close of business September 19, 2014. Large posters will be left in place to inform people that we are not accepting unwanted medications and directing them to other community resources, such

The new DEA rules will allow pharmacies

as takebackyourmeds.org. At this time

to take back a broader range of materials,

no date has been set for resuming the

including narcotics. We’re suspending

program in Group Health pharmacies.

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Arthritis Northwest | Rheumatology 105 West 8th Avenue, Suite 6080 | Spokane, WA 99204 | (509) 838-6500 www.arthritisnw.com

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

8

Howard M. Kenney, M.D. Jeffrey B. Butler, M.D. Gary L. Craig, M.D. Sean P. LaSalle, M.D. Eric C. Mueller, M.D. Christopher M. Valley, N.D. Diana M. Webster, ARNP Erin E. Saunders, PA-C Dale R. Raschko, PA-C Kari M. Holman, PA-C

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Spokane County Medical Society presents

Moderate (Conscious) Sedation/Analgesia

SEMINAR

At the conclusion of this program participants will be able to: •

•

THURSDAY, OCTOBER 30, 2014 5:30 pm – 9:00 pm

• •

PROVIDENCE SACRED HEART MEDICAL CENTER MOTHER TH JOSEPH ROOM - 101 W 8 AVE, SPOKANE, WA 99204

•

Agenda & Faculty 5:30 – 5:55 pm

Registration/Dinner

•

5:55 – 6:00 pm

Program Welcome, Announcements, and Overview – Dr. Lloyd Halpern

•

6:00 – 6:15 pm

Practice Standards and Risks for Moderate Conscious Sedation/Analgesia – Dr. Eric Johnson

•

6:15 – 6:45 pm

Monitors: Why Use Them, How They Work, and What is Measured – Dr. David Burns

6:45 – 7:00 pm

Adults: Pharmacology of Commonly Utilized Anesthetics – Dr. Eric Johnson

7:00 – 7:30 pm

Practical Considerations for MSA for Adults – Dr. Eric Johnson

7:30 – 7:45 pm

Break

7:45 – 8:15 pm

Two Critical Case Presentations/Adult with Simulator – Drs. Halpern & Johnson

8:15 – 8:45 pm

What’s New in Pediatric Sedation? – Dr. Lloyd Halpern

8:45 – 8:55 pm

Course Question/Answer Session

8:55 – 9:00 pm

Closing Comments – Dr. Lloyd Halpern

Moderate (Conscious) Sedation and Analgesia Seminar

)

Gordon Teel, MD

The Spokane County Medical Society designates this educational activity for a maximum of 3.0 hours in Category 1 to satisfy the re-licensure requirements of the Washington State Medical Quality Assurance Commission.

Reducing Radiation Dose in CT

 Regular Dinner  Vegetarian Dinner

Taking a proactive approach to a public health issue

______ SCMS Members (MD, DO) $115 ______ PA Member $100 ______ Retired SCMS Members (MD, DO, PA) $95 ______ Non-Members (MD, DO) $175 ______ Non-Member PA and ARNP $125 ______ Allied Health (RN and Others) $85 ______ Residents $25 ______ Medical Students $25 ______ NW Telehealth Sites (Dinner Not Included) $95 (Offsite) ______ Total Enclosed

Zip:

RSVP by October 24, 2014 No cancellations or refunds after October 24, 2014 Please make pre-payment by:  Check Make checks payable to: SCMS Account Number: Exp Date: Card Holder’s Billing Address & Zip:

The Spokane County Medical Society is accredited by the Washington State Medical Association CME Accreditation Committee to sponsor continuing medical education activities for physicians.

Attendance includes dinner and course materials

Specialty: State:

3.0 Hours

The Spokane County Medical Society designates this live activity for a maximum of 3.0 AMA PRA Category 1 Credit(s).

Physicians should only claim credit commensurate with the extent of their participation in the activity.

(Please Print)

Other:

•

Identify the risks associated with Moderate Sedation/Analgesia (MSA).

Comprehend relevant national and state standards of care.

Apply best-practice monitoring for patients receiving MSA. List medical conditions and characteristics of patients at higher risk during MSA, with particular attention to the airway.

Understand the necessity for maintaining patient consciousness and the elevated risks associated with unconsciousness.

Select appropriate anesthetic agents and doses based on the knowledge of the pharmacology of these agents and patient condition, age, and size.

Advise patients which medications should be continued or stopped prior to surgery.

Develop office protocols for the treatment of untoward events such as airway obstruction, anaphylaxis, bleeding, and hospital transfer.

Outline practical considerations for MSA for both adults and children.

CME Category 1

Moderate (Conscious) Sedation is utilized by an increasing number of officebased physicians and dentists. Attendance at this seminar will enable medical professionals to understand pertinent guidelines, monitoring standards, and discuss practical considerations for adults and children.

Name: E-mail: Physician: Day Phone: ( Address: City:

Photos by Ryan Lindberg

Course Objectives

 VISA  MC

For more information about the research of Inland Imaging radiologists in the Providence CT dose reduction project, email gteel@inlandimaging.com or rhines@inlandimaging.com.

Contact Karen (509) 325-5010 for more information Fax form to (509) 325-5409 or mail to SCMS–Orange Flag Bldg, 104 S Freya St, Ste 114 Spokane, WA 99202

FINAL OPPORTUNITY TO COMPLETE THROUGH SCMS

Together, Inland Imaging radiologists and staff in Providence hospitals are providing safer CT scans to patients. Years of data collection and collaboration among providers place the Spokane community well ahead of national norms.

For the past several years, the Inland Imaging radiologists who read all CT scans for Providence Sacred Heart Medical Center and Providence Holy Family – as well as multiple smaller hospitals in Eastern Washington – have been recording every dose of radiation utilized for every CT examination.

Radiologists, physicists and technologists have been working together to determine what imaging parameters will result in a diagnostic examination using the minimal amount of radiation.

Led by Gordon Teel, MD, Providence hospitals and Inland Imaging radiology teams began a CT Dose Reduction Project to meet or exceed industry standards for eliminating avoidable radiation from CT scans. The work included a number of components: • collecting baseline data (beginning in 2011); • creating a database to track the radiation dose used in every CT; • developing scanner-specific settings to minimize dose; and • ensuring every CT technologist is knowledgeable and competent in managing radiation dose measures.

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MD

Where it all started a diagnostic study. Detailed exams are for complex cases in which exquisite definition is necessary. Low-dose exams provide exceptionally low radiation exposure and are used for specific indications, such as follow up of the size of a lung nodule.

Protecting the most vulnerable

Everything that lives on this planet is subject to radiation from naturally occurring sources in the environment (radon, terrestrial rock and naturally occurring radionuclides) and cosmic rays from outer space. Background radiation from these sources in the United States is estimated to be an average of 3 mSv (milliSieverts)/year, with increased amounts at higher elevations and in areas with more natural environmental emissions. We know, based primarily on knowledge gained from nuclear explosions (Hiroshima and Nagasaki) and nuclear accidents (Chernobyl and Fukushima), that high-level radiation results in radiation sickness/poisoning and low-level radiation (doses in the range of 50-150 mSv) results in some increased risk of cancer. We also know that 4 out of 10 Americans will be diagnosed with cancer in their lifetime. There is no specific data linking medical imaging with cancer – no study of radiationinduced cancers from CT or other imaging modalities – but it follows that as we add to the population’s radiation exposure, the risk of imaging-induced cancers will increase.

Research supported by the National Council on Radiation Protection and Measurements (NCRP) reported that radiation dose to the general population in the United States attributable to medical sources increased six-fold over 25 years, increasing from 0.5 mSv/year to 3 mSv/year, doubling average background radiation. Medical procedures utilizing radiation include X-ray, fluoroscopy, CT, angiography and nuclear medicine. CT represents only 5% of all imaging but alone accounts for greater than 60% of radiation exposure which patients receive in a health care setting.

In 2011, radiation dose was vaulted into the national limelight when a group of patients in California received unacceptably high radiation doses during CT examinations. Later that year, a Joint Commission Sentinel Event alert highlighted increased exposure and increased risk to patients.

While acknowledging that “…diagnostic radiation is an effective tool that can save lives,” experts also noted that the higher the radiation dose delivered at any one time, the greater the risk for long-term damage.

CT offers extraordinary detail, is quick and painless, offers early, definitive and accurate diagnoses, and decreases the need for exploratory surgery and unnecessary treatments. CT is undeniably an invaluable, life-saving tool, especially in cases of traumatic injury, stroke, cancer surveillance and many other conditions, but carries with it some potential of increasing cancer risk over a lifetime. It is believed that if exposure is high in patients who are young and have many years to live, an incremental risk of cancer attributable to medical imaging will be expressed.

The most vulnerable patients are children, young adults and pregnant women. Risk from radiation exposure is cumulative, so reducing radiation risk from medical imaging involves reducing dose from each examination as well as limiting the number of examinations whenever possible. Radiation is more damaging to actively dividing cells, and young people have more dividing cells than mature adults. “Non-essential” tissue (fat, muscle) attenuates ionizing radiation entering the body. Children have less “non-essential” tissue so “essential” (glandular, more vulnerable, radiosensitive) tissue absorbs more radiation.

Applying the ALARA principle—radiation dose should be “As Low As Reasonably Achievable”—is a central tenant in our practice.

• For individual patients, the benefits of medical im aging in the appropriate setting substantially outweigh the risks. Evaluate the benefit-to-risk ratio of medical imaging for every patient.

• Know your patient’s imaging history and be cogni zant of issues of radiation exposure.

• Consider alternative imaging modalities (ultra sound, MRI) that do not use ionizing radiation.

For instance, the American College of Radiology now recommends using ultrasound as the primary modality to evaluate children for possible appen dicitis, reserving CT for difficult, indeterminate cases. (Inland Imaging began using Ultrasound as the primary modality for evaluation of possible appendicitis nearly 10 years ago.)

The results By the end of 2013, significant reductions in CT dose had been achieved, with the greatest improvements noted at Providence Sacred Heart Medical Center & Children’s Hospital and Providence Holy Family Hospital. Radiation dose reductions from CT averaged 45% with reductions measuring up to 70% in individual patients.

Recording radiation exposure in the patient’s medical record is not yet a requirement in Washington State, but it is being done at Providence Health Care. By the time national standards for radiation exposure are in place, Inland Imaging’s practices will have already been refined and will surely set the example for other practices to follow.

Reducing radiation exposure to the population at large – and thus reducing an increased risk of cancer in the future – is a public health goal. While we cannot say today with certainty that eliminating an unnecessary exam will save one individual from developing cancer, we do know that reducing exposure to the population will help. We may never live to see the outcome of this rigorous work, but we know that it is the right work to do.

It takes a team.

The work to reduce radiation exposure requires the support of many. Some of the champions from Sacred Heart’s radiology department are: (clockwise from top right) Gordon Teel, MD, section chief of Thoracic Radiology and program director of Radiology Residency; Matt Cohrs, CT supervisor; Robin Hines, MD, section chief of Emergency Radiology and medical director for PHC Radiology; and Gerry Altermatt, director of Radiology for Sacred Heart and Holy Family.

Ensuring quality CT is an enormously powerful tool and when CT is necessary, clinicians need to be sure that a reduction in radiation dose won’t negatively impact the diagnostic quality of the images. Radiology technology vendors have focused for years on improving the quality of images, so it may seem counterintuitive that we would purposefully reduce radiation and potentially decrease image clarity. What we have achieved is a balance: producing slightly “noisier” images of diagnostic quality while substantially decreasing radiation dose. Actively managing radiation exposure while producing diagnostic examinations has a very positive impact from a public health perspective and has zero financial impact.

It has taken time and effort to identify the optimal settings on each of our CT scanners, reviewing the images and gaining consensus from the radiologists on the diagnostic quality of the exams. We identified and adopted three levels of scan parameters based on clinical indications – standard, detailed and losedose exams. Standard settings are appropriate for most scans and use the lowest possible dose to yield

Talking points for patients and their families • • • •

•

CT is an excellent diagnostic tool.

There is always some radiation exposure associated with CT scanning.

Exposure from CT scans is generally considered low-level radiation.

There is some small risk of developing cancer from exposure to low-level radiation and this risk increases with dose.

The amount of radiation from CT is variable and depends largely on equipment and protocols used.

For Your Reference Radiation exposure from nature: 3 mSv per year X-ray Dental (bitewings): 0.005 mSv Hand: 0.001 mSv C Spine: 0.2 mSv Chest: 0.1 mSv Abdomen : 0.7 mSv L Spine : 1.5 mSv CT Scans (before dose reduction) Head: 2.0 mSv Low Dose Chest: 2.0 mSv Chest: 7.0 mSv Abdomen/Pelvis: 14.0 mSv Head and Neck CT Angio with Perfusion: 16.4 mSv Chest/Abdomen/Pelvis: 21.0 mSv Fluoroscopy Upper GI: 6.0 mSv Barium Enema: 8.0 mSv See more at xrayrisk.com.

For general information about imaging and radiation dose, visit the Alliance for Radiation Safety in Pediatric Imaging at www.imagegently.org.

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OTHER NEWS

START SOMETHING BIG WITH BIG BROTHERS BIG SISTERS OF THE INLAND NW AT OUR ANNUAL BENEFIT BREAKFAST: FRIDAY, NOVEMBER 7TH AT 7:30AM AT NORTHERN QUEST RESORT AND CASINO relationships that changes their lives for

individuals who would like to attend the

the better, forever.

Benefit Breakfast on their own, as well

We partner with parents/guardians, volunteers, and others in the community to help each child in our program have higher aspirations and greater confidence, avoid risky behavior, and Bailie Guinn, Partner Relations Associate Big Brothers Big Sisters of the Inland Northwest believes that every child has the ability to succeed and thrive in life, and we’re here to help! We provide children facing adversity with strong and enduring, professionally supported one-to-one

achieve educational success.

On Friday, November 7th at 7:30am, we are holding our Annual Benefit Breakfast at Northern Quest Resort and Casino to get the word out about who we are, what we do, and why it’s important to support our organization. We’re looking for

as Table Captains to invite friends, family,

group at the WSU Riverpoint campus is currently seeking Spanish speaking preceptors.

Started this year by three UW/WSU WWAMI medical students, the group witnessed a growing interest among classmates who were interested in shadowing providers who speak Spanish in a clinical setting in order to observe and experience applied medical Spanish. The

Group Goals • ​Improve and maintain Spanish-speaking skills

making a donation or getting involved by

Active internal physician and staff directories

volunteering to mentor a child, and Start

Active regional physician directory for medical society members

Something BIG with us!

For more information, go to our website www.

Email and text enhanced notifications

nwbigs.org or contact Bailie Guinn at bguinn@

Ability to set a time priority for urgent messages

nwbigs.org or (509) 328-8310 x239. n

MEMBERSHIP RECOGNITION FOR OCTOBER 2014 Their contribution of time and talent has

non-English speaking patients and those of different cultural backgrounds

group plans to expand to become an inter-

Interested in Being Involved?

professional organization open to all Riverpoint

If you are interested in getting involved,

campus health professions students.

please email Izzy Nuttall at ejn5@uw.edu

DocbookMD offers physicians, groups, and hospitals: A communication solution that keeps doctors in control

Time-stamped read receipts Message forwarding Ability to create customized care team groups Local pharmacy directory

Society the strong organization it is today.

An up-to-date, mobile internal directory

Message dictation

50 Years

Fast, HIPAA-secure messaging

Critical value reporting (HL7 and API)

Ability to attach high-resolution images, including X-rays and EKGs, to any message

External branding

Bruce D. Powell, MD

10/27/1964

10 Years Mihai Alexianu, MD

Tuesdays are the easiest to schedule. n

13

Sender notifications for unread urgent messages

Editable favorites list

with your availability. Afternoons and

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

Push notification with priority-specific ring tone

Coordination across the full care team including nurses, PAs, and office staff

helped to make the Spokane County Medical

• Learn best practices for working with all

Intuitive features for your needs

to attend, we just ask that you consider

• Increase cultural awareness of Spanish-

in Spanish with patients

Download and Register your free copy of DocbookMD today. (See instructions below.)

Big Brothers Big Sisters. There is no cost

Thank you to the members listed below.

• Become more comfortable speaking

FREE mobile web-based communication and organization app.

a great breakfast while learning about

• Learn medical Spanish speaking populations

DocbookMD

coworkers, clients, etc. to come and enjoy

MEDICAL STUDENTS REACH OUT TO THE MEDICAL COMMUNITY A newly-formed medical Spanish interest

IS PLEASED TO OFFER A NEW BENEFIT EXCLUSIVELY TO MEMBERS

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10/8/2004

Outgoing fax (coming soon)

Download DocbookMD today.

1. Go to the App Store or Google Play from your mobile device and download DocbookMD. 2. Tap "Create Account" and complete the registration process.

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

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EASTERN WASHINGTON PHYSICIAN HEALTH COMMITTEE (EWPHC)

IN MEMORIAM

over 7000 babies from Spokane and the

Chamber of Commerce; Children’s Home

JOHN ARTHUR MOYER, MD

outlying areas. He also consulted in the

Society of Washington; United Way;

outlying areas of Othello, Deer Park,

Allegro Baroque and Beyond; founding

Colville and Newport. He introduced the

member of the Leah Layne Foundation

Lamaze method of prepared childbirth

in Othello; founding member of the

in Spokane, introduced fathers to the

Spokane Family Birth Center; founding

delivery room and hired the first nurse

member, Friends of the Falls; steering

midwife for his practice.

committee for Historic Cannon Addition

John Arthur Moyer, MD passed away

EWPHC is a “quick call” to find assistance

on August 27, 2014 due to complications

Assistance is available to you in the following areas:



Drug/Alcohol Misuse

This commi�ee, a fusion of the former SCMS commi�ee and one including members of medical staffs of Community Health Services and Providence Health Care Hospitals, meets quarterly to educate ourselves about physician health issues, review u�liza�on and sa�sfac�on with the Wellspring Employee Assistance Program (EAP) and plan ac�vi�es, programs and resources to address needs in those areas.



Lawsuit Educa�on and Support

Some of the guiding principles of the commiƩee are:



MQAC/OSTEO Board Issues





Boundary Issues



Disrup�ve Behavior



Marital and Family Issues



Death of a Spouse or Family Member

 



Elder Care



Prac�ce Management

The medical profession and healthcare community should foster physician well‐being

from Parkinson’s disease. He was born February 25, 1922 in Glendive, Montana. In his high school years, his family moved to Fargo, North Dakota where upon graduating began studies at North Dakota State University until drafted into the Army. Early in his service, he received high marks on a qualifying exam for medical studies, and was sent to Washington and Lee College in Virginia.

John represented Spokane in the State Legislature for ten years, serving the 6th and 3rd districts, working tirelessly for his constituents. He was president of the Spokane County Medical Society and the Washington State Medical Society, Spokane OB/GYN Society and was on staff at Sacred Heart, Deaconess, Holy Family and St. Luke’s Hospitals.

John’s creed was, “if you live in a

A sense of community with one’s peers is vital to personal well‐being

John attended the University of North

Assess the changes in the healthcare environment

from the University of Illinois School of

Dakota and received his medical degree Medicine in Chicago, and did his residency in Obstetrics and Gynecology at Cook County Hospital.

community for a major part of your life, or even a minor part, it is vital that you make some sort of contribution to community effort.” A man of his word, he served on many boards: Advisory Board Washington State Basic Health Plan; St. Luke’s Rehab; Community Development, City of Spokane;

neighborhood, among many others. He was especially honored to serve on the board of the now Providence Adult Day Health; he co-chaired their capital campaign to build the facility. He was privileged to attend one or two days each week in his later years, and to receive care from their wonderful staff.

John was preceded in death by his first wife Caroline Atkinson Moyer and his sister Geraldine Viel of Sioux Falls, South Dakota.

He is survived by his wife of 27 years, Joanne, his ten children, two step-children, three brothers, thirty-three grandchildren and several great-grandchildren. John was a consummate gentleman and will be remembered for his graciousness, his dry wit, and his love of jokes.

Physician Commi�ee Members

John moved to Spokane in 1955. During

(Name and Contact Informa�on)

his 30-year medical career he delivered

(MAC); MAC Foundation Board; Spokane

IN MEMORIAM

She specialized in Obstetrics and

Susan is preceded in death by her

SUSAN JANE TEWEL, MD

Gynecology and was a gifted surgeon

parents, James and Lavinia Tewel.

who cared very much for her patients.

Susan is survived by her daughter,

Northwest Museum of Arts and Culture

Jim Shaw, Chair 710‐3151 Barry Barnes

255‐6557

Michael Metcalf

927‐4102

Paul Russell

954‐4989

Steve Brisbois

953‐3798

Michael Moore

747‐5141

Robert Sexton

624‐7320

Andi Chatburn

624‐2313

Mira Narkiewicz

889‐5599

Tasca Snow

565‐4000

Deb Harper

443‐9420

Sam Palpant

467‐4258

Alexandra Wardzala

990‐1938

Susan Jane Tewel,

Michael Henneberry

448‐2558

Tad Pa�erson

939‐7563

Hershel Zellman

993‐4274

MD passed away

Greg Loewen

844‐8476

Rod Peterson

944‐5781

from complications of Lupus on September 12,

Caduceus Al Anon Family Group ‐ Meets every Thursday evening from 6:15 pm un�l 7:15 pm at 626 N. Mullan Rd., Spokane, WA. Non‐smoking mee�ng for spouses and signicant others of Healthcare Providers who are in recovery or who may need help seeking recovery. Facilitated 12 Step Al Anon Format. No dues or fees. Contact (509) 928‐4102 for more informa�on.

Physician Family Alanon Group ‐ Physicians, physician spouses or signicant others and their adult family members share their experience, strength and hope concerning difficult physician family issues. This may include medical illness, mental illness, addic‐ �ons, work‐related stress, life transi�ons and rela�onship difficul�es.

We meet Tuesday evenings a�er 6pm. The format is structured by the 12‐Step Alanon principles. All is conden�al and anony‐ mous. There are no dues or fees. To discuss whether this group could be helpful for you, contact Bob at (509) 998‐5324.

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2014. Susan was born April 4, 1950 in Cincinnati, Ohio. She later moved to Middletown, Ohio and graduated from Middletown High School. She completed her undergraduate degree at Miami University in Ohio and medical school at Colorado University School of Medicine.

One of her greatest joys was her daughter, Rachael Coppola, who she adopted in 1985. Susan married James Holman in 1996. They later divorced, but remained best friends. Susan enjoyed spending time at her cabin in Priest Lake, Idaho, her spiritual retreat where she found peace and comfort.

She found strength through her faith in the Lord Jesus Christ and the love she received from her friends at First Presbyterian Church.

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Rachael (Victor) Coppola of Brooklyn, New York; her brother, David Tewel (Janice) of Spokane; her sister, Karen Mitchell, of Marshfield, Wisconsin; and nieces and nephews. The family would like to express their gratitude to Margaret Shugert, Horizon Hospice of Spokane, and Evergreen HematologyOncology for their support and care.

Susan had requested any donations be made to the Lupus Foundation of America in her name.

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Spokane County Medical Society 2014 PHYSICIAN CITIZEN OF THE YEAR NOMINATION FORM

DEADLINE for nominations is November 30, 2014.

Any member of the Spokane County Medical Society is eligible for nomination.

Nominee: EXAMPLES FOR

EACH OF THE FIVE SECTIONS MUST BE INCLUDED:

NEW SCMS MEMBERS 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.

3RD & BROWNE BUILDING 104 West 3rd Avenue Spokane, WA 99201

PHYSICIANS (Attach pages as needed.)

1. Contributed to public understanding and appreciation of the role of medicine and to an improved public image of our profession and its members.

Lyman, Jeffrey, MD Orthopedic Surgery Med School: U of Washington (1997) Internship: U of North Carolina (1998) Residency: U of North Carolina (2003) Joined The Lyman Knee Clinic 1/2013

AVAILABLE FOR IMMEDIATE SALE!

PHYSICIANS PRESENTED A SECOND TIME

2. Demonstrated high standards of competence, ethics and professionalism.

Great downtown investment on lighted corner near hospitals and I-90. 14,000 s.f. for $300,000 (Only $27.00/s.f.)! 7,000 s.f. on first floor and 7,000 s.f. partially finished basement. Full HVAC, good roof, sprinkler and security system. Could be medical offices, general offices, commercial/retail or even storage.

Shino, Trent, MD Family Medicine Joined Family Medicine Center 08/2014

For more information, please call Gordy at 404.822.8488 or email gordy@flagship-group.com

PHYSICIANS ASSISTANTS PRESENTED A SECOND TIME

3. Showed outstanding ability in medicine.

Lee, Brandon, PA-C Physician Assistant Joining Emergency Consultants, Inc. TBA

4. Worked for the advancement of the medical profession.

$300,000

IN THE NEWS

Invested in Your Comfort and Your Care Hospice of Spokane’s first priority is patient care so our patients can focus on what’s important to their lives.

5. Contributed to the betterment of our community and nation.

NOMINATED BY:

DATE: Please submit to: SCMS Physician Citizen of the Year Nomination Orange Flag Building 104 S. Freya St., Ste. 114 Spokane, WA 99202-4868 Or fax to: (509) 325-5409 Or email to: shelly@spcms.org

| $21.50/SF Commercial Building | On Highly Visible Corner

“I’ve got an excellent team with Hospice of Spokane that’s doing everything they can to keep me comfortable and feeling better. They give me the will to live.”

Northwest Urogynecology is delighted to announce that Linda Partoll, MD, FACOG, FPMRS and Sarah Hammil, MD, FACOG, FPMRS are Board Certified in Female Pelvic Medicine and Reconstructive Surgery. This subspecialty Board Certification was recognized by the American Board of Physician Specialties in 2013. Northwest Urogynecolgy offers the only two fellowship trained, and now FPMRS Board Certified Surgeons in a 300 mile radius of Spokane, WA. Northwest Urogynecology is comprised of Dr. Partoll, Dr. Hammil, Krista Kahl, PA-C, Susan McFadden, ARNP, and provides a full spectrum of Urogynecology services, advanced testing, conservative treatment and surgery, and other treatment options.

The goal of Northwest Urogynecology is to provide consultation, treatment as necessary, and to return a satisfied patient to their referring provider.

– Denis, Hospice of Spokane patient Northeast Washington’s only nonprofit hospice, providing care and support for terminally ill patients and their families since 1977.

Comfort. Dignity. Peace of Mind.

509.456.0438

hospiceofspokane.org

Linda Partoll, MD, FACOG, FPMRS

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Sarah Hammil, MD, FACOG, FPMRS

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CLASSIFIED ADS REAL ESTATE RIVER FRONT AND ACREAGE, 3,300 sq. ft., 4 Bedroom Home for Lease (Or Sale) $1,850/ month. Close in but feels like the country.

Four bedroom, three and ½ bath, master suite with corner jetted tub and large walkin closet, open living and dining area with great views and gas fireplace, family room with wood stove, attached two-car garage and detached two-place carport. Forced air natural gas furnace. Large multilevel deck and patio looking toward river. Wooded acres on the Little Spokane River with private trails, sandy beach and swimming hole. Plentiful wildlife. School bus comes to front drive. Mead school district. Close to Whitworth, shopping and freeways but very quiet and secluded. Cable hookup. Grounds are river irrigated. First and last plus cleaning deposit. Utilities not included.

No indoor pets. $150/month grounds maintenance fee if you choose not to do it yourself. Contact Scott (509) 435-7099. For photos go to Craig’s list - http://spokane. craigslist.org/apa/3984125910.html.

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.

NEW 2,400 SQ. FT. HOME Located five minutes from downtown Spokane in country setting. Three bedrooms, three bathrooms, full kitchen and completely furnished. $250.00 day/$1,000.00 week/$3,000.00 month with a month maximum stay unless arranged by owner. Call Sheri at (208) 6419069 or email 209homedesign@gmail.com.

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! $665,000 Call Marilyn Amato at (509) 979-6027.

NEW MEDICAL PLAZA - DOWNTOWN SPOKANE has available a 2,000 sq. ft.

Ambulatory Surgery Center within a newly constructed integrated medical plaza. Medical Plaza is comprised of complimentary clinical specialties including dermatology, age management, wellness programs and a medical spa.

Surgery Center is ready for immediate custom build out to your specifications.

Conveniently located within one mile of two major hospitals at the intersection of 3rd and Sherman. Plenty of onsite parking with heated sidewalks. Building amenities include shared conference room, beautiful lobby, coffee kiosk and more. Partnership/ ownership opportunity possible subject to terms of lease. Financing available. For further information, and to schedule a tour, contact John Driscoll at (509) 624-1184, ext. 1123.

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

ALL COSTS INCLUDED--UPSCALE VIEW CONDO One of a kind, separate entrance condo built into an upscale home on the north side. (Owners rarely in residence) This home is located in a quiet, gated community, with panoramic views overlooking a small lake and golf course. It is totally turnkey furnished, dishes, linens, cleaning supplies etc. All new appliances, modern decor. One bedroom (king size bed/rollway for guests) one bath, complete laundry room w/full size washer/dryer and one car garage with extra storage. ALL COSTS ARE INCLUDED! Heat/AC, Utilities/Water, Cable TV, Internet/Wi-Fi, Long Distance phone. Golf and walking trails right out the door. Close to Holy Family Hospital and Whitworth University. Freeway access to South Hill hospitals. Call (509) 954-8339 for details. Available immediately. Willing to rent “unfurnished.”

CONDO FOR RENT- Very nice and clean 2BR, 2BA one-level, 1,200 sq. ft. 7th and Monroe, City views, one block walk to Deaconess, Shriners, shopping. Convenient to SHMC, Rockwood and downtown. Covered underbuilding parking. Quiet, nicely updated, fireplace, dishwasher, washer/dryer, elevator. $800/month. Call (509) 263-1746 for more information and to see.

PLASTIC SURGERY 41% NEUROLOGICAL SURGERY 39% URGENT CARE 38% NEUROLOGY 36% PATHOLOGY 33% CARDIOVASCULAR SURGERY 32% ORTHOPEDIC SURGERY 32% UROLOGICAL SURGERY 32% GENERAL SURGERY 31% RADIOLOGY 30% EMERGENCY MEDICINE 30% OBSTETRICS AND GYNECOLOGY 29% FAMILY PRACTICE 29% OPHTHALMOLOGY 28% INTERNAL MEDICINE 27% PULMONARY DISEASES 26% GENERAL PRACTICE 26% GYNECOLOGY 24% PEDIATRICS 24% GASTROENTEROLOGY 21% PSYCHIATRY 20% PHYSICAL MEDICINE & REHAB. 18%

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www.phyins.com HOME OFFICE: Seattle, WA

rockwoodretirement.org 800-727-6650 You might be surprised at what you find.

Rockwood South Hill features custom homes, duplexes and apartments nestled in a quiet, park-like neighborhood.

We are a locally owned and operated nonprofit with a strong history of providing innovative retirement living environments. Our new 11-story luxury apartment tower, The Summit, is being constructed and will open in 2016.

MEDICAL OFFICES/BUILDINGS SOUTH HILL – ON 29TH AVENUE NEAR SOUTHEAST BLVD. - 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.

Come join us for a bus tour and lunch presentation and discover why Rockwood South Hill has been Spokane’s Community of Choice for over 50 years.

We look forward to meeting you.

You’re Invited to Discover

Your Future Home.

Come Explore Our Beautiful 90-Acre Community Please RSVP to Joanne at 509-536-6850

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Wednesday Oct. 8th

Thursday Nov. 13th

joanneb@rockwoodretirement.org 11am-1pm Community Center

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CLASSIFIED ADS

Explore the Possibilities.

Make a Difference.

As the largest community health center in the Pacific Northwest, the Yakima Valley Farm Workers Clinic offers the perfect balance between work, community and quality of life.

A few of our benefits include: • Loan repayment options • Monthly stipend for 3rd year residents • A competitive productivity-based compensation program • A comprehensive benefits package • Visa sponsorship

Riverstone Family Health Contact Tanya Gutierrez-Leishman: providerjobs@yvfwc.org | 1-877-983-9247 | yvfwc.org

Providence proudly welcomes Dr. Marven Cabling to our team.

Marven Cabling, MD, rheumatology, recently joined Medical Specialties at Providence Medical Park. Dr. Cabling specializes in treating adults with a variety of arthritic conditions, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), scleroderma, spondyloarthropathies, crystalline arthropathies and vasculitis.

PROVIDENCE MEDICAL PARK - SPOKANE VALLEY

Medical Specialties Providence Medical Park 16528 East Desmet Court Spokane Valley, WA 99216

Accepting new referrals.

To schedule a referral call 509.353.4318.

MEDICAL OFFICES/BUILDINGS, CONT’D

POSITIONS AVAILABLE

NORTH SPOKANE PROFESSIONAL BUILDING has several medical office suites for lease. This 60,000 sq. ft. 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 sq. ft. 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.

ESTABLISHED SPOKANE CLINICAL RESEARCH COMPANY is seeking primary care and specialty physicians interested in serving as Principle Investigators or as SubInvestigators. There is an opportunity to assume an on-going research portfolio and to join new studies that are opening in the fall of 2014. For more information, contact Dalyn Boehm or John Driscoll at Premier Clinical Research at (509) 343-3710 or research@ premierclinicalresearch.com.

OFFICE SPACES FOR LEASE 1315 NORTH DIVISION - Located 1.5 miles north of downtown Spokane and just west of Gonzaga and the university district.

SUITE #1 - Approx. 860 sq. ft. $900 /month, including utilities. Ideal for ancillary medical, chiropractic or therapeutic clinic. Space has a receptionist-enclosed area with several office, storage, or exam rooms.

SUITE #2 – 204 sq. ft. – $300/month, including utilities. Built-in cabinets, running water, and leaded walls. Originally used for C-Arm procedures.

SUITE #3 – 213 sq. ft. $300/month, including utilities. Small built-in cabinet and solar tube. The rest of the building is occupied by a physiatry practice. Amenities: Free on-site parking and shared reception area. Call for a showing of your ideal office space (509)3212276.

BC/BE PEDIATRICIAN WANTED, SPOKANE The State of Washington Division of Disability Determination Services seeks a BC/BE pediatrician to perform contract service in our Spokane office. Contract services include the evaluation of physical impairment severity from medical records and other reports, utilizing Social Security regulations and rules of law. Medical consultants function as members of the adjudicative team and assist staff in determining eligibility for disability benefits. Reimbursement: $65/hour base; potential for $68/hour for high productivity.

Interested physicians should contact Chief Medical Consultant Dr. Gene Profant at (360) 664-7454 or Spokane Office Manager David Bennett at (509) 329-2508. This position reviews interesting cases; teaching is thus an integral function. Hours are quite flexible.

PHYSICIAN (OB/GYN AND URGENT CARE) OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE-Spokane Locations (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.

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 Psychology, Psychiatry, Physical Medicine and Rehabilitation, Family Medicine, Occupational Medicine, 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 Maggie Dillon directly at (909) 978-3548 or mdillon@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 Spokane Valley, a 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. PMG – Eastern Washington is our physician-led network of more than 450 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.

CONTINUED ON NEXT PAGE For a complete listing of Providence Medical Group physicians, visit phc.org.

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CLASSIFIED ADS POSITIONS AVAILABLE, CONT’D 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 MEDICAL GROUP (PMG) – Eastern Washington 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. Excellent compensation and benefits. PMG – Eastern Washington is our physician-led network of more than 450 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.

MANN-GRANDSTAFF VA MEDICAL CENTER in Spokane has immediate opportunities for Psychiatrists, Emergency Medicine Physicians, Internists, and Hospitalists and an immediate opening for a Director of the Emergency Department.

Recruitment incentives and Education Debt Reduction Incentives may be available.

Please contact Rodney Gile (509) 434-7590 (Rodney.gile@va.gov) or Robyn Highbarger (509) 434-7393 (Robyn.Highbarger@va.gov) for specific information about positions.

CLASSIFIED ADS

MID-LEVEL OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE-Family Practice ARNP and Physician Assistant needed in Spokane, WA and Moscow, ID. 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 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.

SPECTRUM HEALTHCARE RESOURCES has an immediate opportunity for a civilian Family Practice Physician at Fairchild Air Force Base. This contract position offers: Fulltime; 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.

We are looking for a COMPASSIONATE AND SKILLED FAMILY/INTERNAL MEDICINE PHYSICIAN/ FINAL YEAR RESIDENT for our growing clinic in the Olympic Peninsula. This setting provides a place and all the resources for setting up your own private practice in a complete turnkey manner with regulatory and administrative matters taken care of professionally. The organization is physician led and takes care of physicians very well.

We would expect the new physician to start with some urgent care hours and slowly transition to a full time private practice primary care. Candidates signing up in during their residency are eligible for a $1000 per month stipend for the remainder of their residency. For further details, please call (509) 414-6390.

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N.E. WASHINGTON HEALTH PROGRAMS LOON LAKE COMMUNITY HEALTH CENTER is seeking a family practice ARNP or PA-C. The ideal candidate will enjoy working with a medical team that is dedicated to the mission of NEWHP and have the ability to work autonomously. The Loon Lake clinic is nestled in the rural area of Loon Lake in N.E. Washington State. The area allows for the recreational enthusiast who enjoys, skiing, hiking, hunting, fishing, snowshoeing, horseback riding and any other outdoor event that you desire. Competitive salary and benefits. N.E. Washington Health Programs is also a NHSC/State student loan repayment eligible site. Please send resume to NEW Health Programs/Attn: HR DTR/PO Box 808/Chewelah, WA 99109 or email to: vickien@newhp.org. EOE & Provider PHYSICIAN WANTED NATIVE PROJECT/ NATIVE HEALTH CLINIC—Consider joining a growing, innovative, community health clinic in Spokane, WA. NATIVE offers patient-centered care in a medical home that provides medical, dental, mental health, chemical dependency and preventative health services in a multidisciplinary practice model and needs a Family or Internal Medicine physician.

Physician benefits include competitive salary and excellent medical, dental and life insurance benefits, 401(k), paid licenses and CMEs, I.H.S. and NHSC loan repayment and signing bonus. At NATIVE’s beautiful facility, we serve people of all ethnicities, income levels, ages and medical or behavioral health needs. For more information contact Dylan Dressler, Clinic Manager, at (509) 483-7535 or our website at www.nativeproject.org for the complete job description.

PHYSICIAN-BE/BC FAMILY MEDICINE - General Full Time, Spokane, WA Columbia Medical Associates (CMA) is a multispecialty medical group with more than 40 clinicians in 12 locations throughout the Spokane, Wash. region.

The providers of CMA are dedicated to providing patient-centered, evidencebased medical care for the 70,000 patients

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the organization serves each year. CMA employs 200 health care professionals and accepts all types of insurance. CMA is a subsidiary of Group Health Cooperative and its physicians are employees of Group Health Physicians. Benefits include: Full malpractice indemnification, medical/ dental/vision benefits, 401(k), 4 weeks paid vacation, CME, long-term disability, long-term care benefits. Competitive salary offered. Spokane is located on the eastern side of the state. Its unique location provides year round activities including skiing, hiking, boating and kayaking. Small town charm, pleasant neighborhoods, affordable housing and a highly rated school system make Spokane a great place to live and an unparalleled place to raise a family. Columbia Medical Associates is an Equal Opportunity Employer committed to a diverse and inclusive workforce. Interested candidates may send a CV to Jessica Billings at billings.j@ghc.org.

BC/BE MEDICAL CONSULTANT PEDIATRICIAN WANTED, Spokane The State of Washington Division of Disability Determination Services seeks a BC/BE pediatrician to perform contract service in our Spokane office. Contract services include the evaluation of physical impairment severity from medical records and other reports, utilizing Social Security regulations and rules of law. Medical consultants function as members of the adjudicative team and assist staff in determining eligibility for disability benefits.

Reimbursement: $65/hour base; potential for $68/hour for high productivity. Interested physicians should contact Spokane Office Manager David Bennett at 509-329-2508.

This position reviews interesting cases, thus teaching is an integral function. Hours are quite flexible.

FULL-TIME LICENSED PHYSICIAN ASSISTANT (PA) wanted for expanding clinic in Spokane, Washington. Currently patients are seen four days per week, Monday through Thursday, 8 a.m. to 5 p.m.

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, including vacation and CME benefits. Starting salary depends on experience. Submit resume and cover letter to Kris Norton, Office Manager Inland Neurosurgery & Spine Associates, P.S. 105 W 8th Ave, Ste. 200 Spokane, WA 99204 or knorton@neuroandspine.com.

BC/BE MEDICAL CONSULTANT PHYSICAL PHYSICIAN WANTED, Spokane The State of Washington Division of Disability Determination Services seeks a BC/BE pediatrician to perform contract service in our Spokane office. Contract services include the evaluation of physical impairment severity from medical records and other reports, utilizing Social Security regulations and rules of law. Medical consultants function as members of the adjudicative team and assist staff in determining eligibility for disability benefits. Reimbursement: $65/hour base; potential for $68/hour for high productivity.

Interested physicians should contact Spokane Office Manager David Bennett at 509-329-2508. This position reviews interesting cases, thus teaching is an integral function. Hours are quite flexible.

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

COMMUNITY OF PROFESSIONALS

MEETINGS/CONFERENCES/EVENTS MODERATE (CONSCIOUS) SEDATION AND ANALGESIA: 3.0 Hour(s) of Category 1 CME credit, sponsored by the Spokane County Medical Society. Thursday, October 30, 2014, 5:30 – 9:00 p.m. at the Providence Sacred Heart Medical Center Mother Joseph Room. This is SCMS’ annual and final 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 contact Karen Hagensen at (509) 325-5010 or email karen@ spcms.org.

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.

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For more information regarding the Community of Professionals program contact Dean Larsen, CEO at (509) 325-5010.

SAVE THE DATE! Spokane County Medical Society Presents

General Membership Meeting Thursday, January 22, 2015 Red Lion Hotel at the Park

Watch for more details!

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PRSRT STD

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

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ADDRESS SERVICE REQUESTED

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Explore the Possibilities.

Make a Difference.

As the largest community health center in the Pacific Northwest, the Yakima Valley Farm Workers Clinic offers the perfect balance between work, community and quality of life.

A few of our benefits include: • Loan repayment options • Monthly stipend for 3rd year residents • A competitive productivity-based compensation program • A comprehensive benefits package • Visa sponsorship

Unify Community Health Contact Tanya Gutierrez-Leishman: providerjobs@yvfwc.org | 1-877-983-9247 | yvfwc.org

Our business is turning them into realities.

We do this by helping our clients plan and manage their financial resources. Fee-only.

For a complimentary consultation or brochure, call: Greer Gibson Bacon, CFP® (509) 838-4175 or (888) 864-8827 assetplanning.com