Orlando Medical News August 2015

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PHYSICIAN SPOTLIGHT PAGE 3

Hector Ramirez, MD ON ROUNDS

Nemours: An Integral Cog in Medical City’s Wheelhouse Children’s Hospital at Lake Nona One of Nation’s Best in Many Categories

By LyNNE JETER

Editor’s Letter The Times They Are a-Changin’

Undergoing transformative change, this industry has been tasked with fundamentally altering delivery methods and asked to meet heightened consumer expectations and increased demands for interaction and engagement. ... 5

The Orlando door wasn’t exactly held open for Nemours when plans materialized in 2005 to construct a children’s hospital in Orange County’s burgeoning Lake Nona Medical City.

In fact, lobbied by Central Florida hospitals, community leaders and some economic developers declined to help Nemours move forward to seek regulatory approval to build a freestanding hospital, even though public funds weren’t requested.

“And then Bill Brooks, the mayor of Belle Isle, of all places, stepped up to

publicly support our plan, and that led to more local support, and the rest is history,” said Roger Oxendale, MBA, president of Nemours Children’s Hospital at Lake Nona Medical City in Orlando and a senior vice president with Nemours.

(Coincidentally, Oxendale and his wife, Diane, chose Belle Isle as their residence when Nemours hired him in April 2010.)

In 2008, regulatory approval was finally granted to begin construction of (CONTINUED ON PAGE 4)

Sanford-Burnham Gift Will Expedite Institution’s 10-Year Strategic Vision $100 Million Will Also Accelerate Delivery of Innovative New Treatments

By LyNNE JETER

Conrad Prebys

ONLINE: ORLANDO MEDICAL NEWS.COM

HE GT N I T PUT

W E N S NEW L A C EDI IN M

In June, Sanford-Burnham Medical Research Institute (Sanford-Burnham) announced receipt of a $100 million gift from Conrad Prebys, a prominent San Diego developer, philanthropist, and SanfordBurnham honorary trustee. His gift marks the largest donation ever made by Prebys and will be used to further implement the Institute’s 10-year strategic vision to acceler-

ate the delivery of innovative new treatments that will have a tangible impact on improving human health.

“A gift of this magnitude is significant in many ways,” said Sanford-Burnham CEO Perry Nisen, MD, PhD. “It enables us to conduct translational research to advance laboratory discoveries and clinic-ready drug candidates further along the development pipeline, progressing toward therapies, pre(CONTINUED ON PAGE 6)

We’re excited to unveil our brand new online format designed to bring the news you use to your laptop, tablet or smartphone.

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The promise of a life in motion.

Hip dysplasia, a common cause of hip pain in adolescents and young adults, belongs in the differential diagnosis for patients presenting with unilateral or bilateral activity-limiting pain localizing to the hip, groin, buttock or knee. Clicking or snapping may be reported; locking may occur if the acetabular cartilage has torn. Hip dysplasia may be missed on radiographs if recently updated measurement criteria aren’t applied.

Nemours is proud to offer Periacetabular Osteotomy (PAO), a single-incision surgical procedure practiced by only a few orthopedic surgeons in Florida including Dr. Ryan Ilgenfritz. PAO gives adolescents with hip dysplasia the potential to return to unrestricted activity.

By improving acetabular alignment to correct for cartilage overloading in the dysplastic hip, PAO can improve a youth’s quality of life by: • • • • •

Ryan Ilgenfritz, M.D., M.S. Orthopedic Surgeon

extending the life of the natural hip normalizing the anatomy and function of the natural hip delaying or avoiding prosthetic hip replacement removing or reducing activity restrictions increasing range of motion

PAO is appropriate for correction of hip dysplasia after pelvic growth is complete, which may be as early as age 10. Although an eight-week offloading period is required after PAO to facilitate bone growth and healing, a return to unrestricted activity is usually feasible within six months.

For questions about hip dysplasia, PAO or to refer a patient for evaluation, call (407) 650-7715 or visit Nemours.org/PatientReferrals.

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PhysicianSpotlight

Home (again) in Orlando OB/GYN Hector Ramirez, MD, Returns to His Residency Roots

By JEFF WEBB

ORLANDO - When he was growing up in Puerto Rico, Hector Ramirez was fascinated with fish. He had four fish tanks in his home. His favorite recreational pastime was fishing. And when he left the island to attend Boston University, his plan was to become a marine biologist.

“It was the thing I liked to do, but it was difficult,” said Ramirez, who said he soon realized the profession also would be limiting, intellectually and financially. “I asked myself ‘I enjoy science, but what am I going to do?’”

Ultimately, Ramirez decided he would follow in the footsteps of his father, Lucas Ramirez, MD. “He’s a work-alcoholic,” said Ramirez, and “with dad being a solo practitioner, we went through all the stages of his career, including when we were not doing that well and we lived in a very small house” with his younger brother and sister. Ramirez said he saw his dad, an OB/GYN, “living through all the sacrifices to achieve his career goals, sacrificing family for the well-being of his patients at all times made me realize the importance of the medical profession.”

But once his father’s practice “settled in,” Ramirez said, he got a taste of a different life. “My father would say to us ‘I’m not going to leave you any money when I die, but I’m going to show you the world now.’” Ramirez remembered. “We traveled and went to the best restaurants.” At some point in college, Ramirez said “I realized I’m not going to be able to afford all that I like to do as a marine biologist.”

So, he returned to Puerto Rico and told his dad “I want to go to medical school, but I do not want to be an OB/ GYN. I want to be a general surgeon.”

However, while at the Ponce School of Medicine, Ramirez changed his mind. “I saw some surgeries I did not like and I said ‘I can’t do this.’ Then I said I wanted to be a psychiatrist,” he said.

But, in time, he deduced that being an OB/GYN could feed his interest in both those specialties. “I liked surgery and psychiatry, and you use a lot of both” as an OB/GYN, he said. “It’s a good mix.

You talk to patients, hear their concerns, you help them out and you see a change,”

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whether it is in the operating room or following the stages of their pregnancies in his office. “I like having a problem to solve. … I love the progression. It is very dynamic,” Ramirez said.

After medical school, Ramirez accepted an offer in 2005 to complete the OB/GYN Residency Program at what is now Winnie Palmer Hospital for Women and Babies in Orlando. He was one of six in that class, and he fell in love with one of them. Atlanta native Tullie Ramirez, MD, and he married in 2007, and completed their residencies in 2009. That is when their attending physician, Terrence Peppy, MD, offered them jobs.

“I spent a lot of time teaching both of them. A lot of residents stick out … the very, very skilled physicians, we offer positions,” said Peppy, who is chairman of the Department of OB/GYN with Physician Associates, which is part of the resident faculty at Winnie Palmer. “But despite me trying to hire them, they moved to Puerto Rico,” said Peppy.

“We moved there because that’s where I am from and because of my dad,” said Ramirez. “It was always my intention to return and practice with him.

But that was before we knew my wife would be moving back with me, and it would not be just me and my dad. We were there for 5 years,” he said.

“But once we had our daughters (Claudia is 4 now and Gabriella is 1) things started changing. I was so busy I was never at home, I was always on call, the medical reimbursements were much lower than in the states, and there were big problems with crime and unemployment. We factored everything in and decided to come back to Orlando” in 2014, said Ramirez. That opportunity was facilitated by Peppy. Ramirez now practices in

the Physician Associates office in Ocoee, and Tullie is an OB/GYN nocturnist at Winnie Palmer. “Peppy has been a key factor in my career,” said Ramirez.

“They’re both wonderful people.

Very good doctors, skilled surgically and clinically,” said Peppy. “To have all those components in a married couple is rare.”

Ramirez is not one to shy away from taking risks. When he was in Puerto Rico, with his father’s help, he delivered both his children (and harvested and banked their cord blood; a practice he strongly endorses). He also performed a hysterectomy on his mother. “Some of my friends said that took real guts,” he laughed.

Ramirez has another, and arguably less perilous, method of getting his adrenalin surging. “I love cars and I like to drive fast. I go with friends and we rent a track.

We’ve done it in Vegas and here, too. We’ve rented Ferraris and Lamborghinis a couple of times,” said Ramirez, who also owns a couple of pretty serious sports cars: A BMW 1 Series M and a Porsche 911 GTS. Ramirez stays in shape with CrossFit training workouts at 5:30 a.m. three or four times a week.

But what he really likes to do, still, is go fishing, whether it’s for a large-mouth bass in the lake near his home in Windermere, or teasing a trout while fly-fishing in a Wyoming stream. “I love it,” he said.

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Nemours: An Integral Cog, continued from page 1 a medical campus and freestanding hospital. A year later, the building process began on the Lake Nona medical campus.

It opened Oct. 22, 2012.

Less than three years later, the $400 million asset has become an essential cog in Lake Nona Medical City’s wheelhouse.

After only a year, the hospital received an HIMSS Analytics Stage 7 Award for efficient EHR (electronic health record) use and achieved LEED Gold Certification as one of three children’s hospitals nationwide. In 2014, it was among only nine children’s hospitals across the country to land on Leapfrog Group’s Top Hospitals list. Its emergency department was recognized among the nation’s cream of the crop. The accolades keep growing.

“Within less than three years, we’ve brought this hospital from nothing to clearly on our way to being one of the nation’s top children’s hospitals,” said Oxendale. “We’re very proud of being considered a major pediatric provider and referral for children throughout the world.”

Nemours Health System, parent company of Nemours Children’s Hospital at Lake Nona, was established in 1936 via the Nemours Foundation with funds granted from the estate of the late Alfred I. DuPont. The Alfred I. DuPont Institute, a pediatric orthopedic hospital in Wilmington, Del., opened in 1940. Nemours’ expansion into Florida began in 1980 with clinics and practices.

The Nemours Florida network has

grown to a dozen primary care offices covering Dr. Phillips, Kissimmee, Lake Nona, Longwood, Maitland, Ormond Beach, Oviedo, Waterford Lakes and Vero Beach.

Four specialty clinics operate in downtown Orlando, Lake Mary, Lake Nona, and Melbourne. Six urgent care centers operate in Altamonte Springs, Dr. Phillips, Hunters Creek, Melbourne, Sanford and Waterford Lakes.

Nemours pediatric hospitalists are based at the Heart of Florida Regional Medical Center in Haines City, Indian River Medical Center in Vero Beach and Wuesthoff Regional Medical Center in Rockledge.

Located near the Orlando International Airport, Nemours has made a global impact, caring for children from all 50 states and 53 countries.

Beyond the clear benefits of awardwinning design and advanced technology implementation, many features at Nemours Children’s Hospital make it special: Six oversized, high-tech operating rooms with windows allowing in natural light and an enviable arsenal of drop-down equipment.

Patient rooms with sophisticated technology identifying every team member who enters.

The region’s only Muscular Dystrophy Association clinic, led by a world-renowned pediatric neurologist Two rooftop gardens and a one acre Discovery Garden where patients and families may enjoy the outdoors without leaving the campus.

A teaching kitchen where dieticians

are able to provide cooking demonstrations for parents charged with their children’s’ special dietary needs.

A mini-apartment designed for physical therapy to help children relearn various everyday skills.

A research portfolio that in 2014 consisted of 62 projects and $2.3 million in annual external funding, for a total external research funding package of $7.2 million.

Varied project sponsors include the National Institutes of Health, Patient-Centered Outcomes Research Institute, Department of Defense, State of Florida, national foundations, and leading pharmaceutical companies.

Scholarly activity reached the level of 137 publications and 223 presentations/ abstracts for 2014, exceeding 2013 performance.

Even though those statistics are impressive, there’s a key amenity that cannot be measured: Nemours Children’s Hospital is designed by families for families.

“I’m very glad we established the Nemours Family Advisory Council, comprised of Central Florida parents,” said Oxendale. “Because many of these parents have children with chronic health conditions, they have extensive experience with doctors and hospitals. These moms and dads worked with the architect and hospital leaders to help design the hospital and even interviewed finalists for positions at Nemours … more than 85 percent of physician candidates. That’s the way it should be. After all, we designed Nemours Children’s Hospital for families.”

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Editor’s Letter

The Times They Are a-Changin’ Undergoing transformative change, this industry has been tasked with fundamentally altering delivery methods and asked to meet heightened consumer expectations and increased demands for interaction and engagement.

While the above statement is certainly representative of the healthcare industry … in this case, we are actually referencing the media’s role in the dissemination of information.

The way we consume news has dramatically changed over the past decade. Yet, how, when and where we receive information is often a matter of personal choice. Some people love the feel of newsprint between their fingers. Others like to get information on their tablet. Still others want the highlights in 140 characters or less, giving them control of whether or not the topic is worthy of a click through to more information.

Recognizing our readers embody these varied preferences, Orlando Medical News is excited to announce major changes to our product. If you love the monthly paper (and we certainly hope you do), no worries … you’ll still receive it faithfully each month in the mailbox.

However, we’ve long realized the static nature of our websites left much to be desired from both an aesthetic standpoint and

the ability to adequately offer information between print cycles. Additionally, the editorial and publishing teams have looked at various solutions to quickly alert our readers to major breaking news stories and to have a platform to put important information in your hands in the immediate fashion audiences have come to require.

To achieve these goals and meet your personal expectations, we are debuting our new website this month and offering you the flexibility of following us on social media platforms to receive updates.

Knowing how many journals, magazines and e-mails you receive on a daily basis, we promise not to flood your devices with a constant stream of data. Instead, we will format key information into brief updates and breaking news alerts as warranted.

For many of you, we already have your email addresses on file so you will automatically receive an e-blast. If you aren’t currently receiving electronic notifications from us, feel free to contact me at lynne@ medicalnewsinc.com with your email address, and I’ll make sure you are added.

You can also make such a request online at www.orlandomedicalnews.com.

Our mission … as it has always been … is to make sure we get the latest clinical, business, research and regulatory news in your hands, in addition to updating you on industry events and happenings among colleagues. The new format of the website makes it easier than ever for you to see the latest information in each of these categories, find related content, and share articles on your own social media platforms. Additionally, the design was created to be scalable to desktop, tablet and smartphone formats.

As Bob Dylan aptly noted – The Times They Are a-Changin’ – and we’re excited to embrace that change with enhanced capabilities to deliver the best possible product to you in a manner that suits your busy life. We hope you enjoy the new look, flexible formats, and ability to receive industry updates in between print cycles. Please feel free to share your thoughts and comments with us. As always, we’re open to suggestions on how to continue to improve our publication and our performance.

Sincerely, Lynne Jeter Editor Lynne@MedicalNewsInc.com www.OrlandoMedicalNews.com

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Sanford-Burnham Gift, continued from page 1 ventions, and cures for patients who desperately need them. We’re profoundly grateful to Conrad Prebys for this extraordinary gift.”

At this time, Prebys’ gift will not come to Lake Nona, but to the entire institute. Exact plans for how the funds will be allocated have not yet been made, said Patrick Bartosch, a spokesperson for the Lake Nona site.

In recognition of Prebys’ contribution, Sanford-Burnham will now bear his name, along with the other institute

namesakes, T. Denny Sanford and Malin Burnham. Effective June 24, the new name is Sanford Burnham Prebys Medical Discovery Institute (SBP).

“We’re honored that Conrad Prebys’ name is now part of ours,” said Kristiina Vuori, MD, PhD, president of SBP. “He has a longstanding relationship with the institute and believes strongly in our mission. Nearly a decade ago, his first gift helped establish the infrastructure for drug discovery research. Today, Conrad’s generosity will take us even further.

We’re in the golden age of biology, where advances in molecular biology, robotics, imaging, and many other technologies allow us to ask and answer previously impossible questions. Now more than ever, we have the capacity to speed up the process of moving medical research discoveries from bench to bedside.”

SBP’s plan to form more pharma and clinical partnerships to advance translational research discoveries that will have a tangible impact on human health is critical to philanthropists like

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Prebys as they consider which organizations to fund.

“When it comes to finding cures, Sanford-Burnham is the engine that will drive innovation,” said Prebys. “I’ve been involved with the excellent researchers at the institute for many, many years.

They’re the best there is, and that excites me. If, through my support, I can shorten people’s suffering, or extend their quality of life, that would give me unlimited pleasure and joy.”

A native of South Bend, Ind., Prebys was raised in a working-class, blue-collar neighborhood, where few aspired to go to college. When he was eight years old, he developed a heart condition and was informed that he would lead a sedentary life. He focused on music as a future career choice.

The turning point in his life involved an inspirational teacher who exposed him to the arts and encouraged him to further his education. He was the first of five brothers to attend and graduate from Indiana University. In 1966, Prebys co-founded Progress Construction and Management Company, a developer of real estate enterprises in California and Texas.

Recognized by The Chronicle of Philanthropy as one of the “25 Most Generous People in America,” Prebys has given more than $260 million to a variety of causes since 2005. His generosity has included capital and operating gifts to the Boys and Girls Clubs, San Diego Zoo, Old Globe Theatre, UC San Diego Music Centre, La Jolla Music Society, Scripps Mercy Hospital, Salk Institute, San Diego State University, San Diego Museum of Art, Masterpiece Theater, and SBP. Prebys previously donated $11 million to the institute, including $10 million in 2009 to support the Conrad Prebys Center for Chemical Genomics.

His investment in the ultra-highthroughput chemical screening center helped establish the drug discovery platform that’s critical to Sanford-Burnham’s new emphasis on advancing laboratory discoveries to clinical study and gaining commercial interest in Institute assets.

Last year, SBP received a transformative $275 million gift from an anonymous donor. Including the Prebys gift, the institute has received more than $375 million toward a $500 million, 10-year fundraising goal.

Prebys’ latest gift will help build sustainability for research and development, and further the institute’s work in its focus disease areas of cancer, neuroscience, immunity, and metabolic disorders.

Recognized for its world-class NCI-designated Cancer Center and the Conrad Prebys Center for Chemical Genomics, SBP employs more than 1,100 scientists and staff in La Jolla, Calif., and Lake Nona.

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Opportunity for Growth

Physician Associates Locates Clinic in Fast-Growing Lake Nona

By JONATHAN SCOTT

Every report that attempts to peer into the future of the Lake Nona Medical City area sees the same vision – a community that will continue to boom for decades.

That’s one of the reasons Orlando Health Physician Associates decided to open an office there this spring.

“This is a good growth opportunity for us,” Dennis Buhring, president and CEO of Orlando Health Physician Associates, explained why they located in Lake Nona.

With its attractive combination of medical research and healthcare facilities, as well as its variety of residential homes and apartments, it’s no wonder young professionals and families have been settling down in this area designed to promote a healthy lifestyle.

The community is barely 10 years old, but it has already succeeded in attracting thousands of residents. And that’s just the beginning. The 7,000-plus acre Lake Nona area is expected to “experience by far the most housing and population growth” in the Orlando region over the next 27 years, according to the City of Orlando Growth Projections Report published in June of 2014.

Buhring and others with Orlando Health Physician Associates could see

Orlando Health Physician Associates opened a new clinic in Lake Nona this spring. for themselves what was happening in Lake Nona.

“We saw this as an underserved area,” Buhring explained. “When we took a look at our zip code population to see where people were coming from, we were seeing a lot of people coming from that area. So it just made a lot of sense for us to open an office there.”

Orlando Health Physician Associates relocated physicians and staff from its Vista Lakes office on Chickasaw Trail to the Lake Nona location. But when they moved, they found some space they could rent that is closer to the residential area than the Medical City area. The new office is located at 9679 Lake Nona Village, on Narcoossee Road between the entrances to the Lake Nona Golf and

Since opening its new office in Lake Nona earlier this year, Orlando Health Physician Associates has already had to expand its staff to serve this fastgrowing community.

Country Club and NorthLake Park.

“The clinic is located more in the residential area and has very easy access,” Buhring added. “It’s very visible. Our preference is to be closer to the residents in a residential community.”

Orlando Health Physician Associates, one of the largest multi-specialty healthcare groups in Central Florida, opened its office in Lake Nona with three physicians: Alix Casler, MD; Daniel Goddard, MD; and Norman Lamberty, MD and two nurse practitioners offering pediatrics, adult medicine and obstetrics and gynecologic services.

“We’ve found out that what has worked well with us is to have offices that offer a variety of services,” he noted. “So we have obstetrics and gynecology and

pediatrics and then we have adult medicine. That works so well for everybody because we can take care of the many needs of our families.”

Within months, this formula at the Lake Nona clinic has proven to be a prescription for success. As the Lake Nona Medical City community continues to grow, Orlando Health expects to grow right along with it.

“The growth has exceeded our expectations,” Buhring said. “We will continue to watch the demand,” he said. “I think one of the things that is really important when you have obstetrics and gynecology, pediatrics and adult medicine, is to make sure you have ample availability. I think right now we are meeting the demand, but as demand keeps growing, we can see this office expanding.”

When securing their office space in Lake Nona, representatives of Orlando Health Physician Associates were given the right of first refusal for some additional space that is adjacent to its existing clinic - if the need arises.

“At the moment there are no definitive plans to expand,” Buhring explained. “But if the demand keeps going as it has initially, we will add additional providers there.”

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Asset Protection for Doctors Made Easy Safe From Creditors and Probate, Security, Diversification, Guaranteed Income For Life, and Guaranteed Death Benefit

By SCOTT L. OLSON

What investment offers 100 percent protection from creditors (lawsuits)? What investment also offers guaranteed income for life? ... guaranteed increases in future income?... guaranteed increase in death benefit?... unlimited growth potential, while locking-in gains, for future income for life, and spouse’s life?

Perhaps the most popular financial product for asset-protection planning in Florida is annuities - which, in Florida are exempt from creditors.

You could have $100 million in annuities in Florida and have 100 percent protection from creditors.

Florida also offers State Guarantee Protection of up to $100,000 of annuity value and $300,000 of death benefit.

Annuity owners in good company Ben Bernanke’s largest investments are variable annuities. Alan Greenspan receives a $3,000 monthly annuity check.

The Obama administration proposed special benefits for retirement plan investors who invest in annuities offering guaranteed-income-for-life. The U.S. Treasury

encourages annuities, which allow for retirees to receive a steady stream of income for the duration of their lifetimes.

O.J. Simpson’s advisors put his life savings into annuities and had him move to Florida where annuities offer unlimited protection from creditors. Many annuity investors on the wrong side of nasty lawsuits were relieved that their annuities were protected from creditors, while unfortunately their other investments were not.

Even with brilliant advisors, if you don’t own annuities or haven’t spent tens of thousands for irrevocable trusts, you could lose your life savings to lawsuits.

Why do wealthy investors buy annuities?

Studies show the biggest fear of the wealthy is running out of income. Fixed and Variable annuities offer many guaranteed-income-for-life options.

According to MarketWatch.com, millionaires with $1 to $5 million net-worth’s own 22 percent of all variable annui-

ties and 20 percent of all fixed annuities.

Taxpayers with $100,000 to $1 million in assets own 15 percent of all variable annuities and 17 percent of all fixed annuities. Fixed, Indexed or so-called “so-called Hybrid” annuities do not offer the growth potential of variable annuities.

At least one variable annuity is designed specifically to be owned in trusts to reduce trust income-tax.

Trust tax rates climb to the maximum rate of 39 percent at only $12,300 of trust income, which could be deferred for generations with the right annuity.

LIMRA estimates investors will buy about $150 billion in variable annuities in 2015, and about $100 billion into fixed and indexed annuities. All annuities combined average about $250 billion in annual investments.

Here are a few benefits of annuities not offered by other investments; • Guaranteed Income for Life - even if annuity value falls to zero, • Creditor Protection – if you get sued you can’t lose your annuity, • Guaranteed Increases in your future income, • Tax-Deferral - can help reduce income-tax on social security and Medicare Part B premiums, (CONTINUED ON PAGE 11)

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Asset Protection for Doctors Made Easy, continued from page 10 • Control of when, and how much income you want, • Tax-free fund exchanges, • Free from Probate – pass directly to beneficiaries at death without the cost, delays and publicity of Probate, • Safety – Backed 100 percent by issuing companies, • Liquidity –10 to 12 percent annual free withdrawals. A few variable annuities offer immediate liquidity for a small extra fee, • Annuitization can eliminate need for RMDs, • Long-Term Care riders; • Backed by state insurance departments.

Annuities are less expensive than not having guarantees in a market crash Annuity Guarantees come with a cost, but what’s more expensive – paying a few percent annual fee to guarantee your income for life, and your spouse’s life, with a death benefit for heirs; or not paying the fee and possibly losing half, or more, of your life savings like in the last two crashes?

Why do so many investors at all income levels and risk categories buy annuities?

While the main reason many investor’s choose variable annuities may be the guaranteed income for life, or the guaranteed minimum death benefit, which

granted could be worth a lot, but when it comes to investment performance don’t tune out stellar returns of some VA’s.

A few variable annuities offer great performance According to Morningstar there are thousands of VA subaccounts which have outperformed the S&P500 stock market index.

There are 2,184 VA funds which have beat the S&P 500 over all time periods. There are 84 VA separate accounts that have doubled the S&P 500’s 15.47 percent over 5 years – while offering the ability to lock-in profits and the guaranteed income. Of course the fees for the guarantees, and locked-in benefits reduce these returns by a percent or more annually, but not enough to negate their value.

Period S&P 500

1 yr

Number of VA funds outperforming

18.86 percent, guaranteed for as long as he lives.

Many annuity owners, depending on age, receive income of 15 percent or more, mostly tax-free and guaranteed for life. The older you are, the more income you get.

A 91 year old (my father) recently wanted a safe investment paying him higher income than the bank. His anuity is paying him 19.12 percent income, paid monthly, mostly tax-free, and guaranteed for life, with no stock-market risk.

Above returns for illustrative purposes and will vary depending on costs of any riders purchased. Past performance does not guarantee future results.

Don’t buy any annuity without getting professional, experienced advice from someone with decades of practical experience, and one who is not an “agent” of one company – they may be biased.

12.73% 14,097

3 yrs 16.11% 9,310 5 yrs 15.47% 4,725 10 yrs 8.01% 17,395 15 yrs 4.15% 35,145

Fixed annuities don’t pay high enough income?

Really? A Florida client is getting 26.14 percent guaranteed income for life (NOT a typo) with an “Income Annuity” (aka, SPIA, or Pension Annuity). A famous retired attorney is receiving income of

Scott L. Olson has 37 years’ experience in Finan­cial and Estate-Planning, Wealth Preservation and Wealth Transfer.

He provides Continuing Education to Attorneys, and CPAs and has presented at the Florida Bar Tax-Section annual conference and their 1 hour CLE teleconference. This is not an offer to sell any security or in­surance product.

Variable annuities are only offered by prospectus. Securities offered through Financial West Group - member FINRA/ SIPC. Atlantic Financial Advisors, LLC, Registered Investment Advisor not FWG affiliated. Scott can be reached at Scott@ AtlanticFinancialAdvisors.com.

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11

WHO’S TENDING OUR DOCTORS?

The Plight of Physicians-in-Training Starting in medical school, stress and depression impact rising percentage of students; profession-wide, suicide claims a doctor a day

By LYNNE JETER

On the night of June 21, 2012, Greg Miday, MD, scribbled a note before settling in for a hot soak with candles flickering, music playing – and a scalpel in hand: “This is just the end of the line for my particular train,” he wrote in a goodbye note.

The following morning, his body was discovered, major arteries severed.

Miday, 29, an instructor of medicine for the Washington University School of Medicine (WUSM) and a hospitalist with Barnes-Jewish Hospital, was days from beginning an oncology fellowship when he committed suicide. In his obituary, his parents – both MDs – wrote: “With all his talents and accomplishments, he struggled in a world that didn’t fully understand him.”

“Greg knew it was a career killer to ask drome disorders, cautioned Stuart Slavin, for (mental health) help,” said his mother, MD, MEd, director of curriculum for Haunting Actions Karen Miday, MD, a psychiatrist from Saint Louis University School of Medicine, Because of their intrinsic knowledge of Ohio. “At the end, he must’ve felt there where he successfully implemented promedicine, suicide success rates are alarmwas no way out.” gram changes to improve the wellbeing of ingly high among medical professionals.

Every day, a medical student or doctor medical students and received a national Nearly every physician knows of colleagues calls it quits in the most permanent way. teaching award for restructuring medical who took their own life.

Because of the stigma surrounding education.

Many remain haunted by their acmental health issues, medical students re“Maladaptive perfectionism is always tions. main wary of seeking help. setting the bar so high for yourself that Jay Bitar, MD, “We must see change to de-stigmatize you’re continually disappointed,” explained FACC, an interventional mental illness,” said Miday. “From the Slavin. “Imposter syndrome is the belief of cardiologist at Cardiolbeginning, medical students should be albeing incompetent despite overwhelming ogy Care Center in Lake lowed to seek help if they’re struggling. Unobjective evidence to the contrary. Both Mary, Fla., recalled an fortunately, medical people seem to be the maladaptive perfectionism and imposter intern – Brent Branham, most judgmental when it comes to mental syndrome are particularly risky when mediMD – from Detroit, Group Benefits illness.” cal graduates are starting residency. All of a Mich., who committed Dr. Jay Bitar Colin West, MD, PhD, co-director of sudden, they have their MD, they’re writsuicide in 1985. the Mayo Clinic Department of MedicineLife Disability Insurance ing& orders and making decisions for which “On the night Dr. Branham was on Physician Well Being Program, told The they may feel terribly unprepared. They’re call (alone), he’d start having anxiety as my New York Times: “If this is the way that stuInvestments & Asset Protection terrified of doing something wrong. Both time to leave approached,” said Bitar, then dents view each other – survival of the fitcan be setups for emotional distress and Branham’s rounding resident on the infectest – how do they view their patients who potentially suicide. Preparation The fear of being ‘distious disease floor of a medical complex in Retirement are depressed or struggling with mental illcovered’ or disappointing those who have downtown Detroit. When Branham’s oneness?” supported you along the way … suicide is month rotation ended without incident, Tax Strategies Medical students are prone to malsadly an out as having potential advantages Bitar wrote a favorable evaluation. adaptive perfectionism and imposter synwhen you’re desperate.”

Two months later, as he was about to

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take night call on another medical floor, Branham had a meltdown at the nurses station. A psychiatrist called to evaluate Branham determined he wasn’t suicidal and recommended the night off, calling for further psychiatric evaluation.

Branham didn’t return home that night. Instead, he checked into a hotel room, injected himself with insulin he’d stolen from the hospital, and lapsed into a hypoglycemic coma.

“The next morning, when the hotel maid found him unconscious, he’d already sustained permanent brain damage,” lamented Bitar. “He lived for a few months in a vegetative state before succumbing.”

Over the years, Bitar has wondered what went wrong, how the signs were missed, who was to blame, and if actions could have been taken to positively impact Branham.

“Each one of us has a Brent Branham inside,” said Bitar. “The system is quick to weed out physicians who cannot survive long, sleepless nights, withstand the pressure, and take abuse from senior staff … with pride. The system of residency training doesn’t address collateral damage like the physician’s marriage getting destroyed, or when the children become neglected, or when the physician’s physical or mental health is permanently degraded.”

After hearing about a nearby physician who committed suicide, Pauline Chen, MD, wrote in The New York Times that his death came up repeatedly in conversations for days afterward.

“It wasn’t the details of his life that haunted us; it was the details of his death,” she noted. “He’d locked himself in a room in the hospital, placed a large needle in his vein and injected himself with a drug that so effectively paralyzed his muscles, he was unable to breathe. Or call for help.”

Pam Wible, MD, a family physician from Oregon and a national voice for physician suicide prevention, pointed out the ripple effects of such tragedies. A year after Kaitlyn Elkins, a third-year medical student at Wake Forest School of Medicine, died by asphyxiation due to helium inhalation, Wible attended the funeral of Kaitlyn’s mother, who chose the same method to end her life.

Miday was so devastated by her son’s suicide that “the first year after Greg died, I don’t think I could string three words together,” she said.

Wible admitted: “Many of us have considered suicide, but we’re so resilient that we smile and head back into the next room to see the next patient.”

Seeking Solutions Missouri jumped ahead as arguably the first state to introduce legislation aimed (CONTINUED ON PAGE 16)

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WHO’S TENDING OUR DOCTORS?

Missouri Leads States on Medical Student Well-Being Advocacy Proposed State Legislation Could be Model for Proactive Mental Health Measures at Medical Schools Nationally

By LYNNE JETER

On an unusually chilly spring day, a fourth-year medical student in northern Missouri completed his mission with such surety that only dental records could identify his remains.

“He was going to get it right this time,” lamented his father, who declined to have the family identified. His son, who died from a self-inflicted gunshot wound, was weeks away from earning a DO. More than 300 mourners were on hand for the premature burial of the 26-year-old, including state lawmakers attempting to push through legislation to deter the alarming rate of depressions and thoughts of suicide amid medical students in Missouri. Among them, Keith Frederick, DO, one of four doctors serving in the Missouri Legislature, and a state representative (R-Jefferson City) who proposed House Bill 867, the “Show-Me Compassionate Medical Education Act” in the 2015 regular legislative session.

By the time Frederick’s bill had churned through the legislative process and was awaiting a final look acknowledging the acceptance of a conference committee report, a Senate filibuster over a Right-to-Work vote killed it, along with a couple of dozen bills awaiting similar action during the volatile last week of session.

“This topic – a dirty little secret of medical education for decades – badly needs the light of day,” said Frederick.

“One of the biggest problems is that medical schools say, ‘we’ve got this covered,’ but they don’t.”

Even though HB 867 nearly crossed the finish line, medical school deans balked early on. As originally drafted, the bill would have established an anonymous online survey to screen medical students for depression and provided for access to immediate help through an existing 24hour hotline for students in crisis. It would have also required the state’s six medical schools – two public, four private – to conduct the screening. Results would have been made public after three years.

Strong opposition came from the Washington University School of Medicine (WUSM) in St. Louis, consistently ranked among the nation’s top medical schools by U.S. News & World Report, and world-renowned for its 124-year history of groundbreaking research.

“Washington University’s primary concern – voiced by all six Missouri medical schools – was a provision that would have required the State of Missouri to

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publish the rates of depression among MD students at each of the state’s medical schools,” said Lisa Moscoso, MD, PhD, associate dean for students affairs at WUSM. “In its earliest form, House Bill 867 would’ve required the Missouri Department of Mental Health to determine rates of depression using a state-mandated survey tool, though student participation in the survey would’ve been optional. We noted that a voluntary survey instrument would give schools an unreliable view of the scope of any mental health challenges. We also worried that a government-mandated survey and reporting process for what is unquestionably a sensitive matter would undermine the culture of trust each school strives to build with its student body.”

Frederick modified the bill while it was held for more than a month in the Social Services Committee, and then medical schools unofficially removed their opposition to the bill, which Frederick plans to pre-file this fall.

“The measure that was before the Senate in the final weeks of the session represented a reasonable approach to raise awareness about medical students’

mental health and to encourage Missouri medical schools to collaborate to identify best practices, particularly those efforts that are most effective at de-stigmatizing mental illness and encouraging students to seek support and services to cope with mental health issues,” said Moscoso.

Margaret Wilson, DO, dean of A.T. Still University’s Kirksville School of Osteopathic Medicine in Kirksville, Mo., expressed concern about “confidentiality and potential to cause stigma to students.” Since modifications have been made, “the bill meets with my school’s support,” she said.

In its final form, HB 867 dropped the requirement that medical schools undertake this study, but protected medical students and medical student organizations from interference or retribution from the medical schools when planning or conducting screening for depression or other mental health issues among medical students.

Britani Kessler, MD, immediate past president of the American Medical Student Association (AMSA), traveled from Virginia to testify before the Social Services Committee that “mental wellness” is

the organization’s most frequently clickedon website link.

“The culture of the current medical education system is that you can’t show weakness,” said Kessler. “The rigors of medical school make you sometimes think this sustained high level of stress is normal.”

The AMSA Board of Trustees has expressed interest in launching a national pilot program to survey medical students anonymously at various intervals of their educational training. To Kessler’s knowledge, Missouri is the only state to have attempted to pass legislation relating to medical students’ mental well-being.

“The purpose of the AMSA is to help pre-med and medical students learn things they aren’t taught in traditional medical education,” said Kessler. “We’re very feisty about medical education reform and making sure the social determinants of health are included.”

Frederick said more changes are needed in medical education, like national award-winning modifications made to the four-year curriculum at Saint Louis University (SLU) School of Medicine in St. Louis, Mo., to reduce the damage rather than emphasize that medical students need to learn to cope with the existing medical education structure and harshness.

“As SLU’s groundbreaking study revealed, medical education can greatly reduce the harm inflicted on medical students,” he said, “without adversely affecting achievement and board scores.”

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WHO’S TENDING OUR DOCTORS?

The Plight of 1 1486 CO Physicians-in- ORLA Training,

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at facilitating change at the medical school level. Keith Frederick, DO, one of four doctors serving in the Missouri Legislature, and a state representative (R-Jefferson City), proposed the “Show-Me Compassionate Medical Education Act” in the 2015 regular legislative session. House Bill 867 raises awareness about medical students’ mental health and encourages Missouri medical schools to collaborate to identify best practices, particularly those efforts most effective at de-stigmatizing mental illness and encouraging students to seek support and services to cope with mental health issues.

In June, the American Medical Association (AMA) launched an ambitious new initiative to address physician burnout, a step toward addressing mental health wellness in the profession. The interactive practice transformation series, AMA STEPS Forward, was developed after research revealed the overall burnout rate of U.S. physicians approaching 40 percent.

That’s “more than 10 percentage points higher than the general population, which is why the AMA is taking a hands-on approach to meeting their dayto-day concerns,” said AMA CEO James L. Madara, MD. The Accreditation Council for Graduate Medical Education requires that programs assess fatigue and burnout among trainees and provide access to confidential counseling, “but these regulations should 111486 CORPORATE BLVD, SUITE 120 1486 CORPORATE BLVD, SUITE go further to require specific strategies to 120 ORLANDO, FLORIDA ORLANDO, FLORIDA 32817-8350 promote mental health among32817-8350 all trainees,” according to an article published ucf-rec.org ucf-rec.org March 4 in JAMA Psychiatry

by Matthew Goldman, MD, of Columbia University Medical Center and New York State Psychiatric Institute and colleagues.

Depression and burnout are separate entities, some medical professionals cautioned, noting that some overlap exists.

West believes that mental health wellness begins eroding with “first-years”: “We have to assume that starting in medical school, a pipeline of experiences leads to an increased risk of suicide,” he said. “That’s where we need to start.”

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Editor’s Note: Please see series companion articles in this month’s edition: “Missouri Leads States on Medical Student Well-Being Advocacy” and “The Saint Louis University School of Medicine Experiment.”

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WHO’S TENDING OUR DOCTORS?

Medical School Answers: The Saint Louis University Experiment

Program Helps Medical Students Build Resistance to Stress, Maintain Happiness

By LYNNE JETER

Two years ago, Stuart Slavin, MD, MEd, stepped onto the podium at the Association of American Medical Colleges’ annual meeting to pick up one of the nation’s most prestigious teaching awards for his career accomplishments, most notably spearheading a plan to restructure Saint Louis University’s medical school curriculum to help students reduce stress, depression and anxiety – and to make a dent in reversing the national trend of rising medical student suicides. The revised four-year curriculum has been heralded as a national model.

“Dr. Slavin is very courageous,” said Keith Frederick, DO, a Missouri state representative who proposed legislation also aimed at reversing the trend via the “Show-Me Compassionate Medical Education Act.” “Academics were concerned about test scores going down as a result of changes, but it didn’t happen. In fact, it had the opposite effect and blew the lid off this problem.”

Slavin took an interest in medical students’ mental wellbeing soon after joining Saint Louis University (SLU) School of Medicine as director of curriculum, after a 21-year run at UCLA, where he logged 75 to 80 hours a week as a professor of pediatrics and full-time pediatrician.

“No singular event occurred to pique my interest,” said Slavin, who gave up a pediatric practice to focus on his administrative role. “I kept reading in medical education literature about problems with mental health issues among students, interns, residents and physicians. I viewed medical student mental health as my responsibility. Medical schools place a great deal of emphasis on academic outcomes … if a medical student comes out of four years with good clinical skills, has done well on all exams, but they’re depressed and suicidal, what’s really been accomplished?”

Slavin began walking the campus, talking to students about their medical school experiences. “Our students seemed really happy,” he said. “They smiled a lot, seemed pleased with administration and education. I developed good relationships with them.”

Still, Slavin wanted hard numbers.

“Trying to understand what students are experiencing traditionally hasn’t been part of the medical education culture,” he said.

In May 2008, he dispatched program evaluation questionnaires to SLU’s 175 medical students to be answered anonymously.

“I remember the day I got the survey results,” he said, shaking his head. “It was

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like a kick in the gut. It was devastating to see how many negative mental health outcomes we had in the school. Medical students are very good at hiding the pain they’re suffering. It can be very invisible from faculty and administration, and they’re hiding it from each other. I felt a sense of urgency with this problem.”

Survey results showed that, in the first year of medical school, 57 percent of students expressed moderate-to-high symptoms of anxiety; 27 percent reported moderateto-severe symptoms of depression. Similar results were found for second-year students.

They cited the volume of material, level of detail of material, and competition for grades among their greatest stressors in the first two years of the curriculum.

“I really started thinking about ways to design and implement curricular changes that would directly address these stressors and produce a less toxic educational environment,” said Slavin. “I knew if we let students get further down the road without addressing this issue, the problem would only grow worse.”

With the blessing of SLU leaders, Slavin implemented initial curricular changes in the 2009-10 academic year for the incoming class of 2013. First, a pass/ fail grading system for preclinical courses replaced the existing grading system. Second, contact hours were reduced across the first two years of the curriculum by 10 percent to allow students more time to participate in new learning communities

and longitudinal electives. Third, longitudinal electives were instituted.

“Before, electives for first- and second-year students included a half-day per week over seven weeks,” said Slavin. “In the new system, electives extended across the majority of years 1 and 2, with a halfday session every two weeks for a total of 12 days per academic year. This change allowed students more freedom to explore their interests, to create mentorship relationships with faculty and School of Medicine alumni, and to engage in service and/ or research with more continuity. We retrofitted existing electives to fit the new system and developed new electives designed specifically to take advantage of the longitudinal nature of the experience.”

Fourth, five learning communities were established – service and advocacy, research, global health, wellness, and medical education – to include students and faculty who share common interests and passions for research and/or service beyond the classroom.

“We charged the learning communities with designing and implementing new electives, developing a lunch lecture series, identifying faculty mentors, and expanding service and research opportunities,” said Slavin.

In the 2010-11 academic year for the incoming class of 2014, Slavin implemented additional curricular changes. A required resilience and mindfulness (R/M) program, spanning six hours of curricular time in the fall semester, was added to the (CONTINUED ON PAGE 19)

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Why a Sports Physical Should Take More than 10 Minutes

By CINDY SANDERS

Frequently viewed by parents and young athletes as more annoyance than necessity, it’s easy for the sports physical to devolve into automatic answers to a list of questions, a quick check of vital signs and then out the door with a signed permission slip for another year of organized activity.

But it doesn’t have to be … and really shouldn’t be … this way, stressed Chris Koutures, MD, FAAP, a board certified pediatrician and sports medicine specialist who sits on the American Dr. Chris Academy of Pediatrics Koutures (AAP) Council on Sports Medicine & Fitness.

Instead, he continued, providers should look at the sports physical as a prime opportunity to address important issues with children, teens and parents. “There are a host of things we can look at … both sports specific and medically in general,” he said. “Every opportunity we get to sit down with a family is a chance to educate … whether with a sports physical or routine physical.”

Koutures, who is based in Anaheim Hills, Calif., is co-author of “Pediatric Sports Medicine: Essentials for Office Evaluation” and served as medical team physician for USA Volleyball and Table Tennis at the 2008 Beijing Summer Olympics. He pointed out providers have the opportunity to not only identify and fix current problems but to delve deeper to discover and address underlying issues that could prevent or reduce the impact of future injuries or illness. “One thing that pediatricians and primary care providers do so well is anticipatory guidance,” he said.

Koutures said there are a host of reasons families rely on retail clinics for a sports physical ranging from convenience to cost to the drop-in nature of such facilities. However, he pointed out, seeing your regular provider has a value-added proposition that shouldn’t be ignored. “If we do our job right, we are providing such a higher level of care,” he said. “If you have a relationship with that family, you can look at past history. We can see a history of asthma. We can look at a growth scale and see if there’s been a tremendous amount of growth. We can see immunization records,” Koutures enumerated.

He added the long checklist of issues, ailments and conditions on sports medicine forms makes it easy to simply answer ‘no, no, no’ to everything. However,

those answers aren’t always accurate … whether by accident, oversight, or fear of being sidelined.

“You look at the sheet, and it says ‘no history of asthma.’ Really? There was an episode two years ago,” Koutures outlined an example of the benefit of going to a provider who knows a child’s history. “If you know the child has asthma, they can actually have a better sports experience because you are addressing and controlling the issue.”

He added, “Having that background knowledge is one more checkpoint to making sure we’re giving the best care we can.”

As important as it is to use the time to educate young athletes and their families about issues ranging from nutrition and hydration to concussion and overuse, Koutures said a sports physical is also a great time to listen. Particularly with older adolescents where part of the appointment is without the parent, Koutures said it’s a great time to open dialogue about alcohol, drugs and supplements and to allow kids to ask questions. “We need to take the time to educate ourselves,” he added of hearing a patient’s thoughts and concerns.

Listening, he continued, also plays an important role in an area where he believes providers could do a better job – assessing and addressing mental health issues. “It’s a silent epidemic,” Koutures noted of the number of adolescents feeling overwhelmed, anxious or depressed.

“If you get that one time a year to sit down with a family and address these things, you can make a big impact,” Koutures concluded of the sports physical.

But, he added, “That’s not going to happen in 10 minutes.”

How Much is Too Much?

“The minimum the American Academy of Pediatrics recommends is one day off a week from organized activity,” Koutures said.

Furthermore, he continued, there are additional time limits on adult-directed activity that should be considered. “If you take the age of a child, that’s the number of hours of organized activity they should not exceed in a week,” he said of recommendations based on new data. Therefore, a 12-year-old shouldn’t participate in more than 12 hours of organized sports and practices in a week. However, Koutures stressed, this time limit doesn’t apply to additional free play with friends.

Overuse “I think we’re seeing more overuse injuries,” Koutures said. In part, he thinks the increase is due to more children becoming

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one-sport athletes, which leads to repetitive motion. He added that when a child plays a number of sports, different muscle groups are engaged, and children mentally learn different movement patterns.

While physicians might not be able to change a child’s activity preferences, they can help mitigate overuse injuries through evaluation and education. “With my throwing athletes, I look at the shoulder range of motion. There are great studies that show if we can make sure they have appropriate follow through, we can reduce the risk of injury,” he pointed out.

Hydration & Nutrition Koutures noted the AAP released a statement on sports drinks several years ago. “The belief is that for most times, water is sufficient,” he said. Koutures added that a sports drink might be appropriate when exercising for over an hour, particularly if it is hot and humid, or right after an activity to replace salt and sugar.

“We like to think of hydration as being a full time job,” he continued, not-

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Addressing Common Questions & Concerns Pediatric sports medicine specialist Chis Koutures, MD, FAAP, shared insights and advice on several common questions and concerns parents might have regarding their active offspring.

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ing proper hydration doesn’t occur during the small window of practice or playing.

Instead, children should be drinking water regularly to prepare for … and recover from … activity.

He also tells young athletes to look at their urine to gauge their level of hydration. “If it’s really dark, that’s a sign of dehydration,” Koutures reminds them.

As for pre-activity nutrition, he said that somewhat depends on the child, time of day and personal preference or tolerance. Recognizing some kids really can’t eat much shortly before competition, he suggested trying fruit because of the liquids and quick energy it provides.

“The most important meal of the day isn’t breakfast, lunch or dinner,” he continued, “It’s what you eat right after you exercise. Getting some sort of protein mixed with carbohydrates in that first half hour after you exercise is essential for recovery.”

Koutures added chocolate milk has a great protein-to-carb balance. Greek yogurt and peanut butter are also good options.

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GrandRounds

WHO’S TENDING OUR DOCTORS?

Medical School Answers, continued from page 17

Applied Clinical Skills 1 course. R/M sessions, Slavin explained, focus on energy management, mindfulness cultivation, stress reduction, cognitive distortions/restructuring, optimistic explanatory styles, and character strengths.

Slavin also refined the pass/fail grading system by eliminating normreferenced exam performance data from feedback given to students.

In the 2011-12 academic year for the incoming class of 2015, SLU implemented a third set of changes. For example, after students identified the Human Anatomy course as the most demanding and challenging in the preclinical curriculum – and a major source of stress – Slavin made two changes to the course. The medical school dean instructed course directors to produce exams that yielded a higher mean score, to be consistent with other courses in the preclinical curriculum “so that fewer students would feel at risk of failing,” Slavin noted. Also, the course was moved from its traditional position as the first course in the first year to follow courses in Cell Biology and Metabolism.

Because students typically have less than three months to choose a specialty, “we allowed them more time,” said Slavin.

Slavin has continued surveying students with questionnaires, resulting in improvement every year.

“In first year students, we have it down to 8 percent (moderate-to-severe symptoms of depression),” he said. “Moderate-to-severe symptoms of anxiety are down to 23 percent in our first-year students.”

“We wanted to impact the curriculum in a completely different way to give students better coping skills and to reduce stressors in the environment,” said Slavin. “Other medical schools haven’t looked at (this issue) hard enough.”

Editor’s Note: Please see series companion articles in this month’s edition: “Missouri Leads States on Medical Student Well-Being Advocacy” and “The Plight of Physicians-in-Training.”

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U.S. News & World Report Names Florida Hospital Best in State Florida Hospital has been recognized as the best hospital for 2015-16 in Florida by U.S. News & World Report. The annual U.S. News Best Hospitals rankings, now in their 26th year, recognize hospitals that excel in treating the most challenging patients. Lars Houmann, president and CEO of Florida Hospital said they are thrilled and honored that Florida Hospital has been recognized as the best hospital in the state, and among the greatest in the country. Florida Hospital also ranked in nine specialties. Additionally, Florida Hospital’s cancer and orthopaedics programs were rated high-performing. For 2015-16, U.S. News evaluated hospitals in 16 adult specialties and ranked the top 50 in most of the specialties. Less than 3 percent of the nearly 5,000 hospitals that were analyzed for Best Hospitals 2015-16 were nationally ranked in even one specialty.

In rankings by state and metro area, U.S. News recognized hospitals that perform nearly at the level of their nationally ranked peers in one or more specialties, as well as hospitals that excel in multiple common procedures and conditions. The rankings are freely available at /health.usnews.com/ best-hospitals and will appear in the U.S. News “Best Hospitals 2016” guidebook, available from the U.S. News Store.

St. Cloud Regional Medical Center Welcomes Belinda Johnson, MD Family Practitioner Belinda Johnson, MD joined the Medical Staff at St. Cloud Regional Medical Center in July. Dr. Johnson treats a wide range of primary care conditions for children and adults and is available full-time to St. Cloud and surrounding areas, residents in Northeast Osceola County. Dr. Johnson is joining the practice of ProHealth Family Physicians, at their office located in St. Cloud, FL. A graduate of Rutgers University in New Brunswick, NJ, Dr. Johnson received her medical degree from the

Medical School at Ross University School of Medicine in Dominica, West Indies. She completed her family medicine residency at St. Joseph’s Hospital and Medical Center in Phoenix, AZ and is board-certified by the American Board of Family Medicine.

Mark Strachan Named Practice Manager at St. Cloud Physician Management Mark Strachan has been named as the Practice Manager at St. Cloud Physician Management. As the Practice Manager, Mark will direct and supervise the day-to-day functions of specific practices including Urology Associates of St. Cloud, Vascular Associates of St. Cloud, and St. Cloud Cardiology Group.

Mark joins our practices with an extensive and varied background in healthcare, most recently as the Center Operations Manager for Fresenius Vascular Care in Orlando, FL and Arlington, VA. Mark also has an extensive background in Cardiology starting as a United States Navy Corpsman and moving on to clinical and managerial responsibilities at Walter Reed Army Hospital. Mark is a valued addition at St. Cloud Physician Management. He can be reached at Mark.Strachan@ stcloudregional.com.

Megan Glass Named Marketing Director at SCRMC Megan Glass has been named as the Marketing Director at St. Cloud Regional Medical Center reporting directly to the CEO. As the Marketing Director, Megan will oversee all aspects of advertising campaigns and media communications, as well as provide leadership in community events. Megan joins St. Cloud with solid experience and proven results with healthcare marketing in Central Florida, including serving most recently as a Marketing Manager with Florida Hospital Medical Group. Megan holds a B.S. Degree in Political Science from Auburn University, and a Master’s Degree from the

University of Miami’s School of Communication. Her background includes public relations, sales, and healthcare marketing.

Megan can be reached directly at megan. glass@stcloudregional.com

Thomas R. Kelley, MD, Named Chief of Quality and Clinical Transformation at Orlando Health Orlando Health has named Thomas R. Kelley, MD, chief of quality and clinical transformation. His appointment became effective August 1. Dr. Kelley has served as the system’s interim chief of quality and clinical transformation since March 2014. He has also served as chief quality officer of Orlando Health South Seminole Hospital in Longwood since March 2012 and will continue in that role until a new appointment is made.

Under his leadership, in 2013 South Seminole Hospital became the first Orlando Health facility to install and activate digital quality boards in public areas to provide medical outcomes data directly to patients and families.

Dr. Kelley graduated from the Medical College of Georgia and completed his internship and residency at St. Vincent’s Medical Center in Jacksonville. He worked as a faculty physician training residents at Atlanta Medical Center where he developed the first continuous quality improvement council for the residency program. He also started the only free clinic to serve the uninsured people of South Atlanta and was the founder of the Georgia Free Clinic Network.

Dr. Kelley began his affiliation with Orlando Health in 2009. In addition to his leadership quality roles, he has served on several key system-wide quality workgroups and chaired the corporate VTE (venous thromboembolism) taskforce and the corporate quality and safety committee.

Medical News is pleased to provide space for press releases by providers in our Grand Rounds section.

Content and accuracy of the releases is the sole responsibility of the issuer.

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