Category
s e p t e m b e r / o c to b e r 2 012
Coastal Vein and Vascular Your Partners for Comprehensive Vascular Care
T H E M A G A Z I N E F OR H E A L T H C A RE PRO F ESS I O N A L S
Also in This Issue Rethinking HER Irritable Bowel Syndrome
september/october 2012
1
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Editor’s Note
Healthy Partnerships Coastal Vein and Vascular is the new name of a vascular group that has served the region for more than 40 years as Coastal Surgical Specialists. It is complemented by the introduction of Vascular Access Center, a stand-alone facility next door that is dedicated to minimally invasive diagnosis and treatment, with a vascular lab and procedure suites. In our cover story on CVV, Dr. James Chalk says most vascular patients are treated today using minimally invasive procedures. Now for CVV patients, surgery at Vascular Access Center is likely to be as uncomplicated as a regular appointment. Then patients go back to their accustomed lives, ultimately healthier and happier.
T H E M A G A Z I N E F OR H E A L T H C A RE PRO F ESS I O N A L S
Also in this issue of The Eastern Physician, we welcome a number of contributing editors. Gynecologist Andrea Lukes discusses irritable bowel syndrome in women. On the practice management front, WebChart Inc. owner Maryan Binkley writes about the electronic health record
Editor Heidi Ketler, APR
“revolution. Marketing specialist Amanda Kanaan discusses the benefits of a personal website in
Contributing Editors
combination with a practice website. Certified financial planner Paul Pittman gives pointers are
Maryan Binkley Amanda Kanaan Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Paul Pittman, C.F.P.
minimizing risk associated with retirement plans. Your medical news and insight are welcome, too. Also consider the power of advertising in The Eastern Physician. Your news and advertising can be delivered to more than 6,000 throughout the region’s medical community, increasing the likelihood of more informed referrals that lead to happier partnerships with colleagues and patients.
Photography Bill Goode Photography Creative Director Joseph Dally
With respect and gratitude,
Heidi Ketler
Advertising Sales Paget@EasternPhysician.com Info@EasternPhysician.com
Editor
News and Columns Please send to info@easternphysician.com
Contents
4 Cover
oastal Vein C and Vascular Your Partners for Comprehensive Vascular Care
DEPARTMENTS 8 Practice Management
Rethinking the EHR Revolution
9 Physician News Duke Cardiologist Joins SRMC Medical Staff
10 Women’s Health Identifying Irritable Bowel Syndrome in Women with Abdominal Pain
Cover Image: From left, William H. Bell III, M.D., R.V.T., F.A.C.S., board certified in thoracic and general surgery; Mark A. Sinning, M.D., R.V.T., F.A.C.S., board certified in vascular and general surgery; and James E. Chalk, M.S., M.D., board certified in vascular surgery.
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Subscription Rates: $48.00 per year/$6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401 Every precaution is taken to insure the accuracy of the articles published. The Eastern Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinion expressed or facts supplied by its authors are not the responsibility of The Eastern Physician. However, The Eastern Physician makes no warrant to the accuracy or reliability of this information.
11 Practice Management
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12 Your Financial Rx
Minimize Your Retirement Plan Risks
13 News
Welcome to the Area
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Cover Story
Coastal Vein and Vascular Your Partners for Comprehensive Vascular Care By Amanda Kanaan
For more than 40 years Coastal Surgical
Although some may associate the field of
just like they would for a regular appoint-
Specialists has been partnering with neigh-
vascular surgery with predominantly com-
ment and undergo an array of minimally
boring primary care physicians to provide
plex and invasive procedures, Coastal Vein
invasive procedures.
superior vascular care to the New Bern
and Vascular challenges this misconcep-
and surrounding communities. Now with
tion by dedicating an entire outpatient facil-
Coastal Vein and Vascular’s state-
the addition of a third physician, a newly
ity (called the “Vascular Access Center”) to
of-the-art Vascular Access Center
renovated office, and an on-site Vascular
minimally invasive vascular care. “Patients
is equipped for all interventional
Access Center, Coastal Surgical Specialists
sometimes think that because they were
endovascular procedures including:
is changing their name to Coastal Vein and
referred to a vascular surgeon that they
•A rteriograms and Venograms with
Vascular to better reflect their reputation as
will be scheduled for open surgery. The
one of the most comprehensive and state-
truth is that most of our patients are treated
• Endovenous Ablation
of-the-art vascular groups in the state.
through minimally invasive techniques per-
• Mini Stab Phlebectomy
formed right in our office,“ says Dr. James
• Sclerotherapy for Varicose Veins
Offering the full range of Vascular Surgery
Chalk, board certified vascular surgeon
• Long Term Venous Access
treatments, the specialists at Coastal Vein
and CVV’s newest addition.
• Ports and Dialysis Access
Angioplasty, Atherectomy & Stenting
• Central Venous Lines
and Vascular (CVV) partner with primary care for patients’ overall vascular health.
State-of-the-Art, Onsite Vascular Access Center
The Vascular Access Center is the most
“Board certified vascular surgeons are the
Although many vascular surgery practices
advanced outpatient endovascular facility
most qualified physicians to diagnose and
perform minimally-invasive procedures in
of its kind in the area, and boasts two high-
treat vascular disease. They are also the
an outpatient setting, CVV’s Vascular Ac-
tech procedure suites and separate pre and
only specialists that can offer all treatment
cess Center provides patients with an extra
postoperative recovery areas. A private,
options available for vascular conditions,
level of convenience by offering such pro-
second waiting area next to the procedure
including medical management, minimally
cedures right from the comfort of their pri-
room is dedicated for friends and family to
invasive catheter-based procedures, and
vate office. No hospital fees, no scheduling
comfortably wait for their loved ones.
open bypass surgery,” says Dr. William
limitations of off-site outpatient facilities;
Bell, board certified in vascular and gen-
patients can walk right into their freestand-
Coastal Vein and Vascular’s stand-alone
eral surgery.
ing, single story office off Neuse Boulevard
Vascular Access Center allows the physi-
care physicians to provide comprehensive
cians to conveniently and promptly schedule and perform procedures at a lower cost and without causing interruption to a patient’s continuity of care. All progress notes and results are available for both patients and referring physicians within one day of completing a procedure. These exclusive benefits allow for a more comfortable and streamlined patient experience unlike any other clinic in the area. In-Office Vascular Studies CVV also has an onsite, fully functional Vascular Lab which is performed by registered A patient undergoes a cartoid ultrasound by Coastal Vein and Vascular’s Registered Vascular Tech (RVT) in the practice’s minimally invasive vascular lab.
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The Eastern Physician
vascular technologists and supervised by physicians specifically credentialed to in-
current guidelines of antiplatelet therapy, smoking cessation, and cholesterol treatment with statins. Should the patient develop life style limiting symptoms or limb threatening wounds or ischemia, most patients will undergo an arteriogram with intervention typically consisting of angioplasty, atherectomy or stenting in CVV’s office. The majority of patients are successfully treated on an outpatient basis in this manner. With recent improvement in technique and technology, many patients Coastal Vein and Vascular’s in-office angiography suite where the physicians perform arterial and venous angioplasty, stenting and athrectomies.
who were otherwise not a candidate for open bypass surgery can now undergo minimally invasive endovascular treatment. These patients who were previously only offered an amputation now have
terpret the studies. Patients no longer need to travel to a separate
better options, many of which can be performed on an outpatient
facility, wait for the results to be interpreted and delivered, and then
basis. A small number of patients may require surgery and if so,
visit their physician’s office at a later date. This process can be con-
would be admitted to the hospital for an open bypass performed
veniently accomplished in just one visit at CVV.
by the same physician.
It is not only more convenient for patients but the physician order-
Aortic disease including aneurysms and dissections
ing the study can personally review it or be present while it is being
Any artery 50 percent larger than its native size is considered an
performed. This can often eliminate duplicate or unnecessary stud-
aneurysm. Abdominal aortic aneurysms are usually repaired once
ies. Studies performed in CVV’s office include ABI (ankle brachial
they reach greater than 5cm. Since there are some exceptions to
index) at rest and exercise, ultrasounds of the carotid, aorta, abdo-
these recommendations, it is important that patients who present
men, upper and lower extremity for veins and arteries and dialysis
with an aneurysm of any size be evaluated by a vascular surgeon.
access scans.
Most aneurysms are treated with an endovascular stent graft which usually involves an overnight hospitalization. For a minority of pa-
Comprehensive Vascular Care
tients, a traditional open repair is recommended.
The specialty of vascular surgery has rapidly evolved over the past decade to include a growing number of minimally invasive
Carotid artery disease
alternatives to traditional hospital-based surgery. Coastal Vein and
Symptomatic stenosis of 60 percent and asymptomatic stenosis of
Vascular’s fellowship trained specialists have remained at the fore-
70 percent or greater are considered for open carotid endarterec-
front of this movement to offer patients the latest in diagnosis and
tomy or carotid stenting. Both usually require an overnight hospital-
treatment options for all forms of arterial, venous and lymphatic
ization and then close post-operative lifelong surveillance.
disease. “Other specialties may treat some variation of these conditions, but we are the only surgeons who do it all,” says Dr. Mark
Lower-extremity wound/ulcers
Sinning, board certified in general and thoracic surgery.
A series of non-invasive vascular testing and an evaluation performed in our office suggest if a patient needs a revasculariza-
Some of the conditions primary care providers regularly
tion procedure to improve walking, leg pain or for the potential
refer patients include:
of wound healing. Some patients can benefit from an arteriogram
Peripheral arterial disease (PAD) This can affect up to 30% of the population over the age of 70. (JAMA 2001; 286: 1317-1324) Most patients do not present with intermittent claudication; they have either atypical leg symptoms or no symptoms at all. These patients are at higher risk of death, myocardial infarction, stroke, and hospitalization rates of up to 21% per year. (JAMA 2007; 297: 1197-1206) Prevention and surveillance is the key to PAD management. Studies show the majority of patients will not need intervention but that these patients should be closely monitored with testing. Most are treated with medical management and a supervised exercise program. Their medication list should also be optimized to reflect the
State-of-the-art Vascular Access Center where the physicians at Coastal Vein and Vascular perform onsite dialysis access/PICC lines and central venous access procedures.
september/october 2012
5
A full spectrum of venous procedures are performed onsite. This begins with a comprehensive venous ultrasound. A specialized venous ultrasound is used to evaluate and develop a treatment plan for patients suffering from venous insufficiency. In appropriate candidates, laser or radio frequency ablation can be performed on the greater and lesser saphenous vein and perforator veins. Larger, superficial varicosities are usually treated in the office with a micro stab phlebectomy or sclerotherapy after successful venous ablation. All procedures are followed up with an ultrasound which The caring and experienced staff at Coastal Vein and Vascular.
can be performed onsite as well. These procedures are very successful with up to 96 percent success rate at 3 years (J Vasc Surg
with intervention typically consisting of angioplasty, atherectomy
2011; 54:146-52) and can be performed during a morning or after-
or stenting or bypass to improve the blood flow to the wound.
noon office procedure. The patient experiences minimal disrup-
Renovascular hypertension If a patient presents with severe hypertension and remains uncontrolled on four blood pressure medications, a renal artery ultrasound and possibly an arteriogram can determine if the patient can benefit from revascularization of the renal arteries. These can be performed in our office with CO2 to minimize the risk of contrast to the kidneys. Dialysis access Open AV fistulas and grafts are performed in the hospital usually on an outpatient basis. Venograms, fistulagrams with interventions such as angioplasty and stenting, and thrombectomizing a clotted access can be performed in our office.
tion to their schedule and most return to work the following day, all while avoiding an admission to the hospital. A frequently unrecognized cause of venous insufficiency and varicose veins is a proximal obstruction, which can be diagnosed in the office with a venogram and intravascular ultrasound and treated with angioplasty and stenting
Your Partners in Vascular Health Coastal Vein and Vascular partners with primary care physicians in the comprehensive management of patients’ vascular health by providing the most convenient and leading edge treatments available. Specializing in minimally invasive endovascular procedures performed at their onsite Vascular Access Center, the board certified
Deep venous thrombosis
experts at Coastal Vein and Vascular continuously strive to provide
A comprehensive ultrasound is the first step to determine if a pa-
patients with the latest in alternatives to hospital-based surgeries.
tient will benefit from percutaneous intervention to treat and re-
The physicians at Coastal Vein and Vascular strive to maintain close
move the thrombus.
relationships with the referring community. If you would like to meet the physicians, please contact the practice at (252) 638-8118.To learn
Varicose veins and venous insufficiency
more about the group, including their location in New Bern across
Cosmetic and symptomatic venous problems can be treated in-
from Carolina East Medical Center, please visit www.cvVascular.com.
office. Only symptomatic patients who fail conservative therapy are considered for invasive treatments.
Minimally-Invasive Vein Treatments for Varicose Veins and Venous Insufficiency Nearly half of the adult population suffers from undesirable and sometimes painful vein disease according to the Society for Vascular Surgery (SVS). While many patients consider varicose and spider veins to be an unsightly cosmetic issue, if left untreated varicose veins can worsen and eventually cause pain, swelling and aching in the legs as well as skin changes such as rashes, redness and sores. Previously only symptomatic patients who failed conservative therapy were considered for invasive surgical therapy at the hospital. Now nearly all venous disease can be treated as an outpatient in the office from sclerotherapy to endovenous ablation to deep venous angioplasty and stenting.
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The Eastern Physician
Coastal Vein and Vascular’s modern and well-designed patient reception and waiting area.
Practice Management
Rethinking the
EHR Revolution By Maryan Binkley
For years, experts have pointed to electronic health records as a cure for many of the problems hindering our health care system, including the inability of physicians to quickly access a patient’s history.
Maryan Binkley is the owner and president of WebChart Inc. WebChart specializes in providing webbased, total medical data documentation solutions for physician practices, surgery centers and hospitals. Ms. Binkley graduated from nursing school in 1968 and began her career in a physician practice in the Washington, D.C., area. In 1974 she earned a bachelor’s degree in business administration. Ms. Binkley has worked in health care since 1968 in both clinical and administrative positions, providing her working knowledge of the challenges facing physicians and staff in today’s rapidly changing environment. Contact Maryan at maryan@webchart.biz, office: 336-463-4198, cell: 336-408-4209 or at her website at www.webchart.biz.
In terms of making information more readily
of checkboxes for each patient they see.
available, new federal incentives to subsidize
The required computer interaction limits
the upfront costs of electronic health records
their mobility, and if the computer is in
(EHRs) are a welcome development. A
the exam room, their interaction with the
recent report projects a robust 12 percent
patient, causing dissatisfaction from both
growth rate for such systems over the next
parties. Physicians who use front-end voice
few years. After a notoriously slow start for
recognition fare only marginally better, as
the technology, four of every 10 physicians
they’re required to immediately correct
now utilize EHRs at their hospital or office.
anything the software misinterpreted.
Of course, adopting electronic records is only
The quality of the document can also suffer.
When the transcriptionist types the note
step one. The real key to improving patient
The physician becomes the only set of
into the system, the software automatically
outcomes and gaining efficiencies lies in how
eyes looking at information going into the
parses the document for discrete data,
EHRs are implemented. Clearly, the industry
record, making it harder to detect crucial
which is automatically uploaded to the
is still finding its way in this regard. Last year,
mistakes. When it comes to reviewing patient
appropriate field of the EHR. The provider
a study of more than 2,700 family physicians
information, because the information was
receives all of the structured data needed
found that only 49 percent were satisfied in
entered into a one-size-fits-all template,
to meet Meaningful Use requirements, but
whole with their system.
practitioners no longer have a narrative note
also retains access to the note in narrative
they can look to for a clear understanding of
form. Further enhancing the documentation
what previous medical personnel observed.
process, mobile applications are becoming
While there’s no silver bullet to improving
increasingly robust and look to be a viable
the EHR experience, providers often benefit
means to simplifying a clinician’s workflow.
from taking a clear-eyed look at what these
EHR users do well by playing to the
systems can deliver. Many facilities discover,
technology’s strengths. For a number
only after an expensive rollout, that electron-
of forward-thinking facilities around the
Efforts to improve interoperability within the
ic charts aren’t actually a panacea for their re-
country, this has meant integrating their EHR
industry continue to advance, suggesting
cord-keeping challenges. For instance, while
with other software programs and building
a bright future for such interfacing. What’s
physicians appreciate the ability to call up
synergies between them. One promising
becoming more apparent is that EHRs are not
patient data instantaneously, many are unen-
trend involves hospitals and clinics linking
the solution to inefficiencies in health care,
thused about not only how that information is
transcription management software with their
but rather part of the solution. The sooner
initially captured, but also how it’s presented.
EHR system, creating a “hybrid” solution.
providers realize this, the quicker we’ll see
Doctors who were previously able to quickly
With the help of a software technology known
dictate their exam notes into a phone system
as “discrete reportable transcription,” doctors
or digital recorder now have to log into a
can realize the benefits of EHRs without
For more information call (866) 953-2828 or
computer and scroll through extensive lists
giving up their ability to dictate patient notes.
visit online at webchart.biz.
the real information revolution we’ve been
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The Eastern Physician
waiting for.
Physician News
Duke cardiologist Joins SRMC Medical Staff “Working with SRMC and Duke together will allow me to accomplish a longstanding ambition to improve the health status of the people of Robeson County, and provide advanced cardiovascular care to our community.” – Mathew S. Cummings, M.D.
and cardiovascular diseases and is board eligible in interventional cardiology, all by the American Board of Internal Medicine. His
areas
of
special
interest
within
cardiology include the treatment of coronary artery disease and coronary artery stent implantation, as well as the treatment of complex
peripheral
vascular
disease,
including carotid artery stenosis, upper- and lower-extremity disease, and renal artery
L
umberton native Matthew S. Cummings,
Dr. Cummings completed a fellowship in
stenosis.
He also specializes in invasive
cardiovascular diseases at the University of
management of venous thromboembolism
Center,
Kentucky in Lexington, Ky., in 2011 and in
and acute pulmonary embolism.
providing care through the Southeastern
advanced interventional cardiology at Ohio
Heart Center managed by Duke Medicine.
State University in Columbus, Ohio, in 2012.
Dr. Cummings and his wife, Angela Guinn,
He is board certified in internal medicine
reside in Lumberton. He is the son of Physician
M.D., has joined the medical staff of
Southeastern
Regional
Medical
He is affiliated with Duke
Assistant Earl Cummings, and
Cardiology
Amelia Hunt, a registered nurse,
of
Lumberton,
both of Lumberton.
located at 2936 N. Elm Street, Suite 102 on the campus of Biggs Park Mall. Later this year,
“Above all, I feel very fortunate to
he will also treat cardiology
be home in the company of my
patients two days each week in
loving family and many friends,”
Pembroke at an office located
said Dr. Cummings. “Working
within Southeastern Urgent Care
with SRMC and Duke together
Pembroke, which is located at
will allow me to accomplish
812 Candy Park Lane.
a longstanding ambition to improve the health status of the a
people of Robeson County, and
bachelor’s degree from UNC
provide advanced cardiovascular
Pembroke in 1998 and his
care to our community. I am
medical degree from the Brody
humbled by this opportunity,
School of Medicine at East
and look forward to rekindling
Carolina University in Greenville,
old friendships and fostering
N.C., in 2004.
He completed
new ones. After being away for
his internal medicine residency
many years, it’s great to finally be
at East Carolina University/
home!”
Dr.
Cummings
earned
Pitt County Memorial Hospital in Greenville, N.C., in 2007,
For more information or to
serving as chief resident in the
schedule an appointment
department of medicine there
with Dr. Cummings,
from 2007-2008.
call (910) 671-6619.
september/october 2012
9
Women’s Health
Identifying
Irritable Bowel Syndrome in Women with Abdominal Pain By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.
Abdominal pain is often multifactorial in
There are four types of IBS characterized
women, and health care providers should
by bowel habits: chronic or recurrent diar-
also consider a bowel etiology.
rhea (IBS-d), constipation (IBS-c), mixed (IBS-m) or unspecified (IBS-u). All types
Irritable bowel syndrome (IBS) affects as
have associated abdominal pain or dis-
many as 15 percent to 20 percent of ado-
comfort.
lescents and adults, presenting most commonly in young women. In fact, IBS affects
To diagnose IBS, a complete medical his-
about twice as many women as men.
tory and physical is needed. Symptoms must have started at least six months prior
IBS is a term encompassing abdominal pain
and must have occurred at least three days
and changes in bowel function that have no
per month for the previous three months.
diagnosed causes. It is not a disease, but a group of symptoms that occurs together (di-
IBS can have a significant impact on the
gestive.niddk.nih.gov/ddiseases/pubs/ibs).
patient’s quality of life, particularly when a patient presents with overlapping GI dis-
The changes in bowel function with IBS
orders that may exacerbate IBS symptoms,
include diarrhea, constipation or both. In
such as malabsorption of dietary sugars.
addition, there may be cramping, passing
However, IBS is not life-threatening, does
of mucous, rectal bleeding, bloating, back
not worsen if untreated, and does not pre-
pain, insomnia not related to other symp-
cipitate more serious diseases or disorders.
After earning her bachelor’s degree in religion from Duke University (1988), Dr. Andrea Lukes pursued a combined medical degree and master’s degree in statistics from Duke (1994). Then, she completed her ob/gyn residency at the University of North Carolina (1998). During her 10 years on faculty at Duke University, she co-founded and served as the director of gynecology for the Women’s Hemostasis and Thrombosis Clinic. She left her academic position in 2007 to begin Carolina Women’s Research and Wellness Center, and to become founder and chair of the Ob/Gyn Alliance. She and partner Amy Stanfield, M.D., F.A.C.O.G., head Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals for management of heavy menstrual bleeding. Call (919) 251-9223 or visit www. cwrwc.com.
toms, heart palpitations or urinary problems. Some patients report suffering ex-
More dangerous conditions must be ruled
of IBS. Stress reduction, particularly during
treme urgency with their bowel movements,
out in any diagnosis of IBS. A colonoscopy
meals, is encouraged, and changes in diet
while others report having up to 20 bowel
can rule out colon cancer, particularly if the
appropriate to the symptoms (such as add-
movements a day. Symptoms are often re-
patient has a family history of the disease,
ing more fiber to a constipated patient’s
ported as being worse after eating, during
and inflammatory bowel disease (Crohn’s
diet) are recommended. Large meals can
stressful times or during menstruation.
disease), which also may present similar
exacerbate symptoms, so smaller meals
symptoms as IBS. A pelvic ultrasound can
are recommended. A low-fat/ high carbo-
The causes of IBS are not well understood,
help identify ovarian cysts, and blood tests
hydrate (pasta, rice, whole-grain) diet may
but may be caused by brain-gut signal
can rule out Celiac disease and food aller-
help.
problems, gastrointestinal (GI) motor prob-
gies. Other tests for diagnosis of IBS are
lems, hypersensitivity, mental health prob-
not needed. However, a stool test, lower
Pharmacologic options for IBS include fib-
lems, bacterial gastroenteritis, genetics and
GI series and sigmoidoscopy or colonos-
er supplements, laxatives, antidiarrheals,
food sensitivity. The discomfort associated
copy may be indicated for symptoms that
antispasmodics, antidepressants and lubi-
with IBS is believed to result from abnor-
include fecal bleeding, rectal bleeding,
prostone (Amitiza). Further, providers
malities of muscular contractions or of the
weight loss, anemia and a family history of
should consider the benefits of probiotics.
sensory or motor nerves within the bowel,
colon cancer or IBS.
We encourage providers to work with gastroenterologists to establish the best model
leading to pain or dysfunctional reflexes. Imbalances of neurotransmitters, particu-
Treatment of IBS usually involves encour-
of care for women with IBS-related abdomi-
larly serotonin, may also contribute.
aging the patient to avoid the aggravators
nal pain.
10
The Eastern Physician
Practice Management
New Marketing Trend:
Personal Doctor Websites By Amanda Kanaan
If you are part of a larger medical group, then
Nearly 85 percent of patients now turn to
your practice most likely has a website. How-
the internet for information on their ailments
ever, a growing number of physicians are
and their physicians. These “e-patients” are
now creating websites to market themselves
empowered, knowledgeable and expect and
individually. Although it’s important that the
demand a far higher level of service and
community be familiar with your practice
resources from their health care providers.
name, the most successful physicians I’ve
Physicians who are able to capitalize on this
worked with also understand the benefit of
new “e-patient” revolution stand to gain the
personal branding.
greatest benefit through a savvy online marketing strategy.
Medical practice websites often include a section called “meet the team” or something
Here are the top ways in which a personal
similar. Each team member’s page usually
website may be beneficial:
includes a name, bio and headshot.
1. T o establish a personal brand and
However, this isn’t enough information for
2. If your clinical interests are different
respected reputation patients to really connect with you or to establish a reputation within your field. By designing a personal website just for you (e.g. “www.drbrown.com”), this gives you the ability to include all the information necessary to establish your brand – that is, what differentiates you among your peers.
than your partners 3. If you have a new skill that you want to market 4. To offer your services for speaking engagements
Amanda Kanaan is the president and founder of WhiteCoat Designs, a North Carolinabased marketing agency catering specifically to physicians. WhiteCoat Designs offers doctors affordable marketing solutions to help them grow their practices. Services include website design, search engine optimization (SEO), social media management, online reputation monitoring, brochure and collateral design, branding makeovers and physician liaison services to build patient referrals. Ms. Kanaan can be reached at amanda@whitecoat-designs. com or (919) 714-9885. To learn more, visit www.whitecoat-designs.com. Creating a personal website is an affordable
5. To submit yourself to the local media for interviews as an expert in your field
and effective way to build, maintain or grow your reputation in the community. Patients
6. If you are a new doctor who needs to
are researching their doctors online more
A good example of this would be an OB/
build a reputation within the vicinity
now than ever, and it’s important that your
GYN doctor who wants to establish himself
7. I f you are considering leaving your cur-
services be easy to find and provide as
as the leading robotic surgeon in the area.
rent practice at some point in the future
much information and transparency as pos-
If he solely relied on his practice website to
8. If you are trying to rank higher for cer-
sible when describing your offerings. Your
tell patients within his bio that he also offers
tain keywords in the search engines
website has seven seconds to make an im-
robotic surgery, it would take much longer to
pression on a patient. Make them count.
build his reputation. By having an individual website devoted to his robotic surgery, he can now talk more in depth about his training and qualifications, the number of cases he’s performed, photos of how the procedure works, patient outcomes, testimonials, a video introducing himself, etc. He can then use this website to promote himself in the search engine rankings, such as Google, to increase traffic to his site and attract more patients.
september/october 2012 September/October
11
Your Financial Rx
Minimize Your Retirement Plan Risks By Paul J. Pittman, C.F.P.
One of the most difficult aspects of my job
How
is helping a client understand risk. Some
investments that you offer inside your
often
are
you
reviewing
the
risk is a necessary evil for most investors
retirement plan? Are you putting funds
and not a bad thing, if properly managed.
on a watch-list? Are you removing and
Unnecessary risk is the bane of a portfolio.
replacing funds that are not in line with your investment policy statement?
I preach every day that if you do not have to take on risk to accomplish your goals,
One way to limit the risk of your employee
then don’t do it! If all of your goals can be
retirement plan is to have a qualified
met by putting your money in certificates
adviser review and oversee the plan. This
of deposits, then by all means, do it.
is the person who should be counseling
Everyone does not need to be in the stock
you and your employees.
market, but when the markets are good, everyone wants to be in the stock market.
The broker-in-charge of every plan charges a fee every quarter of every year. Are you
Take a good, long look at your financial
getting what you are paying for? How often
picture and consider the risks. I have written
is your broker-of-record contacting you and
before about allocation, diversification,
meeting with the employees?
Paul Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education. He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 4594171 and paul.pittman@pcgnc.com. Send an e-mail to receive Mr. Pittman’s Weekly Market Commentary.
If you already have a qualified retirement
redundancy, weightings, etc., etc. Just don’t employment-sponsored
Take a look at the name of the broker-in-
plan, such as a 401(k), you can also start
retirement plan, a huge risk factor every
charge of your plan. Are your employees
a cash balance plan. A cash balance plan
month.
familiar with this person? If not, then you
is a type of retirement plan that belongs to
are not getting the kind of service and
the same general class of plans known as
Fiduciary Advisors
guidance you deserve. If you and your
“qualified plans.” A 401(k) is a qualified
If you are the employer, you may have
employees aren’t 100 percent thrilled with
plan. These plans “qualify” for tax deferral
infinite and personal liability for your
this person, then you can easily replace
and creditor protection under ERISA.
retirement plan. It is important for you
him or her at any time.
to understand that compliance with
Cash Balance Plans
In a cash balance plan, each participant has
Employee Retirement Income Security
What about the risk of not putting away
an account. The account grows annually in
Act (ERISA) standards is not enough to
enough money for your own retirement?
two ways: first, a contribution and second,
overlook
your
an interest credit, which is guaranteed
protect you or properly take care of your employees.
With the economy the way it is, you have
rather than being dependent on the plan’s
no doubt asked yourself that question
investment performance.
Attorneys ask me on a regular basis to meet
when you look at your statements. Do not
with business-owner clients, who ask, “Do
let this stop you from putting money away.
For owners and partners seeking larger
I, as the business owner, have any personal
You may want to make some changes as to
tax deductions and accelerated retirement
liability with my employee retirement
where the money is placed, but definitely
savings, cash balance plans may be the
plan?” The short answer is this: yes!
make the deposit.
solution. 2006 legislation is encouraging
12
The Eastern Physician
News Welcome to the Area
Physicians
Edwin Houng, MD
Paul Edward Kelley II, PA
Nathan Gene Miller, DO
Family Medicine, Family Practice
Southern Regional AHEC Fayetteville
Cardiovascular Surgery, Emergency Medicine, Hospitalist, Internal Medicine, Thoracic Cardiovascular Surgery
120 Newcastle Dr Jacksonville
Robert James Allen Jr., MD Physical Medicine & Rehab - Pain Medicine
Cape Fear Pain Treatment Center Fayetteville
Lilian Andries, MD Internal Medicine, Hospitalist
New Hanover Regional Medical Center Wilmington
John Gerome Bertolino, MD Administrative Medicine, Family Medicine
Naval Hospital Camp Lejeune Camp Lejeune
Ajit Kumar Bisen, MD Internal Medicine
more and more professionals and successful business owners to adopt this type of plan.
Hope Mills
Miranda Elizabeth Blevins, MD Family Medicine
Davis Regional Hospital Statesville
Robert Christopher Brock, MD
A cash balance plan is a defined benefit
plan
that
specifies
both the contribution to be credited to each participant and the investment earnings
Emergency Medicine
Vidant Medical Center, GME Greenville
Ambrose John Joseph Chazhikattu, MD Internal Medicine
Wilmington
to be credited based on those
Joshua David Dobstaff, MD
contributions. Each participant
Wilmington Health, PLLC Wilmington
has an account that resembles those in a 401(k) or profit sharing plan. The plan actuary, who maintains the account, generates annual participant statements. Cash
balance
contributions
are age-dependent. The older the participant, the higher the amount. The reason for this difference is that an older person has fewer years to save toward the approximate $2.5 million lump sum that is allowed in a cash balance plan. As an example, if you were born in 1950, you can defer $150,261 into a cash balance plan plus $20,500 into your 401(k) for a total of $170,761 for that year! Few advisers are aware of cash balance plans. Make sure the one who is overseeing your portfolio risk management is.
Internal Medicine
Janie Louise Jacobs, MD Pediatrics
Premier Pediatrics Southern Pines
Satya Naga Sai Sowjanya Mantripragada, MD Pediatrics
Hope Mills Pediatrics, PC Fayetteville
Noha Mataoui, MD Family Medicine
New Hanover Regional Medical Center Wilmington
Ogheneochuko John Oteri, MD Emergency Medicine
Cape Fear Valley, Fayetteville
Rajen Sudhir Patel, MD Family Medicine
Vidant Medical Center, GME Greenville
Ashwin Viren Patel, MD Obstetrics and Gynecology
Wilmington
Jeffrey Howard Perlman, MD Endocrinology, Internal Medicine
The Regional Diabetes and Endocrinology Fayetteville
Vidant, Greenville
Azeem Elahi, MD
Steven Roger Turley, MD
Internal Medicine - Endocrinology, Diabetes & Metabolism, Sleep Medicine, Geriatric, Pulmonary Disease, Rheumatology, Gastroenterology, General Preventive Medicine
Nephrology, Internal Medicine
Zelalem Atakilt Gebreananya, MD Hospitalist, Internal Medicine
Cape Fear Valley Health System Fayetteville
Solomon Tewolde Ghebregziabiher, MD
Brook Rene Wager, MD Emergency Medicine
The Outer Banks Hospital Nags Head
Sarah Wistran Young, MD Internal Medicine
West End
Physician Assistants Kimberli Anne Alcaino Dement, PA Family Medicine
Joel Health Clinic Fort Bragg
Internal Medicine
Lauren Elizabeth Finley, PA
Village Internal Medicine Fayetteville
Family Practice
Joel Health & Dental Clinic, Fort Bragg
Anna Blair Hatchett, MD
Dale Herd, PA
Surgery, General Surgery, Surgical Critical Care
Orthopedic - Surgery of the Hand, Sports Medicine, Surgery, Adult Reconstructive, Trauma, Emergency Medicine, Family Medicine, General Practice
Abdominal Surgery, Critical Care Vidant Medical Center, GME Greenville
Justin Arman Haynes, MD
Womack Army Medical Center Fort Bragg
Emergency Medicine
Robert Allan Hodge, PA
Vidant Medical Center, GME Greenville
Franklin
Aaron Michael Scheib, PA Emergency Medicine, Surgery (general)
Fayetteville
Michael Volk Stewart, PA Emergency Medicine, Psychiatry, Geriatric
Carolina Cardiology P.A., Fayetteville
Audrey Martin Thornberg, PA Emergency Medicine, Family Medicine, Urgent Care
Carolina East Medical Center New Bern
Valorie Anne Van Houten, PA Adolescent & Young Adult Medicine, Alcohol and Drug Abuse, Allergy/Immunology, Diagnostic Lab, Cardiology, Cardiovascular Disease, Internal Medicine, Clinical Neuropathology, Clinical Neurophysiology, Critical Care Pediatrics, Critical Care Sugery
Bradleigh Rose Zito, PA
Allison L. Scott, PA Certified Family Nurse Practitioner
Duke Cardiovascular Surgery of Lumberton and Southeastern Heart Center
Vidant Medical Center, GME Greenville
Internal Medicine
Vidant Internal Medicine Washington Washington
Emergency Medicine, Family Practice, Obstetrics and Gynecology, Surgery, Pediatrics
Eastern Radiologists, Inc., Greenville
Hospitalist, Internal Medicine
Urvi D Gandhi, MD
Linda Sax, PA
Radiology
Cary
Fayetteville
Rocky Mount
East Carolina Heart Institute, Greenville
Anesthesiology
Pediatrics
Family Practice
Cardiovascular Surgery, Critical Care Surgery, Thoracic Cardiovascular Surgery, Thoracic Surgery
Nash General Hospital, Rocky Mount
Ramya Thota, MD
Shanti Priya Eranti, MD
Claudine Polley Lamanna, PA
Zaneta Yeungjoo-Chung Strouch, MD
Amira Aly El Sherif, MD
Vidant Medical Center Greenville
Greenville
Cardiovascular Surgery, Critical Care Surgery
First Health of the Carolinas Pinehurst
Lumberton
Event Tues, October 2 Village Design Group will be hosting a special fundraiser Golf Tournament (open to all golfers) at Foxfire Resort and Golf Club benefitting the Cancer CARE Fund and the Clara McLean House at FirstHealth. The format of the tournament will be Captain’s Choice The registration fee of $75 provides green fee, cart, oncourse beverages, lunch and door prizes. Nationwide Insurance and Bill Smith Ford are sponsoring a Hole-in-One Par 3 Challenge to win a car. In addition, participants may purchase mulligans, T-shirts, and raffle tickets with all proceeds going to the Cancer CARE Fund and the Clara McLean House of FirstHealth. Meadow Creek Tile and Kitchen & Bath Galleries of Southern Pines are also assisting with the event. Hole sponsors for businesses ($100 each) and memorials to cancer victims ($20 each). Please help us promote this important event, benefitting local organizations and victims of cancer. Contact Village Design Group at 910-692-1000 to register or for more information. Players can register on facebook.com/villagedesigngroup using PayPal.
september/october 2012
13
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