m ay 2 0 15
Wake Radiology
Independent and Unwavering in Commitment to Excellence
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
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COVER STORY
6
Wake Radiology Independent and Unwavering in Commitment to Excellence
m ay 2 0 15
Vol. 6, Issue 4
DEPARTMENTS
FEATURES
14
Womenâ&#x20AC;&#x2122;s Wellness
7 Reasons Hospital-Physician Mergers Hurt Health Care Marni Jameson Counts the ways, includ-
9 Practice Spotlight
18 UNC News
Mastectomy Is Still Choice Even
Cary Gastroenterology
Revisiting HIPAA Compliance
ing decreased competition, quality and
12 Gastroenterology
choice and increased cost.
How the Internet Can Hinder the
16
Doctor-Patient Relationship
Gastroenterology
Paradigm Shift: Replacing Lost Volume Is Key to Taking Years Off Aging Skin Dr. Margaret Boyse says dermal fillers are more effective than facelifts in restoring youthful facial qualities.
13 Womenâ&#x20AC;&#x2122;s Health Understanding Options for Fibroids
17 Autism Society of North Carolina Accessing Services Guide Is Free and Part of Online Empowerment Series
COVER PHOTO: From Left, Lyndon K. Jordan III, M.D., and Richard J. Max, M.D., review images.
2
The Triangle Physician
When Breast-Conservation
10 Practice Management
Surgery Is Option
19 DUKE NEWS - Changes in the Adolescent Brain on Alcohol Last Into Adulthood
- 2015 Editorial Calendar
20 NEWS Schaaf Awarded Highest Governor Honor
21 News
Welcome to the Area
From the Editor
Unwavering Commitment Wake Radiology arrived as a pioneer in 1953 and through the years has sustained
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
its commitment to serve patients as an integral part of the health care team. Now, 20 offices and nearly 50 radiologists strong, it continues its mission to provide specialized medical imaging as a local, independent, physician-owned practice. In this month’s cover story, you’ll gain insight into the strides Wake Radiology has made. From the first catheter angiography in the 1960s to one of the first to introduce three-dimensional mammography, it is “constantly leveraging new technologies to better serve the patients and physicians….” This month’s contributing editors demonstrate their unwavering commitment to patient care by taking the time to share specialized insight. Dermatologist Margaret Boyse enlightens readers on a safer and more effective medical process for preserving one’s youthful appearance, a characteristic that is highly valued. Also in this issue of The Triangle Physician, there are cautionary notes.
Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Margaret Boyse, M.D. Douglas Drossman, M.D. Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Marni Jameson Margie Satinsky, M.B.A. Creative Director Joseph Dally jdally@newdallydesign.com
Advertising Sales info@trianglephysiciancom News and Columns Please send to info@trianglephysician.com
Gastroenterologist Douglas Drossman addresses how information from the Internet might impact the doctor-patient relationship, as well as care. Marni Jameson, who advocates for independent physicians, talks about the ways mergers can hurt health care. Practice management consultant Margie Satinsky discusses the challenges of HIPAA compliance. The Triangle Physician represents an unwavering commitment to the more than 9,000 within the Triangle medical community. The magazine serves this select audience by providing a cost-effective medium for sharing medical news, information and insight, which we welcome at no cost. Advertising rates are competitive. Please send information and inquiries by e-mail to info@ trianglephysician.com. Many thanks to all those who support the monthly production of The Triangle Physician, which includes you. Thanks for reading. With gratitude for all you do,
Heidi Ketler Editor
4
The Triangle Physician
The Triangle Physician is published by: New Dally Design 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 Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.
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Cover Story
Wake Radiology
Independent and Unwavering in Commitment to Excellence Lyndon K. Jordan III, M.D., leans forward
The advances in medical imaging – which
another costly procedure, so it’s important
as the monitor comes to life. The Wake
allow physicians to see inside the body with
we get it right – and get it right the first time.”
Radiology physician closely examines the
greater clarity than ever before – have given
black-and-white images, looking for signs of
radiologists an increasingly important role
Dr. Jordan is one of nearly 50 radiologists at
injury to the ligaments and tendons around
in the care of the patient. Physicians now
Wake Radiology who collectively perform
the knee of his patient, a local high school
rely on images to identify and diagnose
nearly 600,000 procedures a year. Each one
basketball coach.
medical issues more often and at an earlier
is a specialist. Not just in the field of radiol-
stage.
ogy, but in a very specific type of radiology.
stark medical images in a small, darkened
“There’s a renewed emphasis on medical
“Our level of specialization is unique in
room that is purposefully tucked away in a
imaging today. We’re often involved early in
private practice, and it allows us to better
quiet corner of the Wake Radiology office.
the care of the patient and may offer the first
serve patients,” Dr. Jordan says. “Identify-
The specially designed reading room allows
insight to diagnose the problem,” says Dr.
ing subtle abnormalities requires a carefully
physicians like Dr. Jordan to focus on ana-
Jordan, president and managing director of
trained eye. A physician who spends his or
lyzing and interpreting medical images in a
Wake Radiology, the Triangle’s largest out-
her entire career studying specific kinds of
space free from distraction. The task at hand
patient provider of medical imaging. “We
images knows precisely what to look for
is too important.
realize that our interpretations often deter-
and is better equipped to accurately diag-
mine whether a patient needs surgery or
nose a problem.”
A radiologist, Dr. Jordan is surrounded by
He says the same is true for all radiology subspecialties, whether it’s breast imaging, neuroradiology or orthopedic/sports imaging. To leverage that expertise, Wake Radiology is structured around small teams of subspecialists that allow each physician to work in the field they know best and, when necessary, collaborate with others who have subspecialty experience. Wake Radiology physicians are members of the American College of Radiology and use imaging protocols to improve patient outcomes and better control health care spending. Dr. Jordan, a musculoskeletal radiologist who specializes in sports imaging, reviews computed tomography scans, magnetic resonance imaging scans, ultrasounds and Xrays. Like a pilot running through a pre-flight checklist, he carefully scans the images for All Wake Radiology computed tomography scanners are equipped with dose-reduction software.
6
The Triangle Physician
dozens of potential medical conditions that
may only be seen through sophisticated
in the past 20 years, two years ago and has
share them to consult with fellow radiolo-
medical imaging.
upgraded equipment in 80 exam rooms to
gists and collaborate with referring physi-
provide patients with more modern imaging
cians.
But as Dr. Jordan studies the images of
technology. A Spirit of Collaboration
knees, hips, shoulders and elbows, he sees beyond the bones and joints on the screen
“When I trained, images were still being spit
The physicians at Wake Radiology are ex-
before him – he always sees a patient. It
out on film and viewed on a light box,” Dr.
perts in reading medical images, but they
might be a neighbor who tweaked a previ-
Jordan says. “The advances we’ve seen in
are also an integral part of a patient’s larger
ous injury, a college athlete who took a nas-
the field of radiology in the past 20 years
health care team. The radiologists collabo-
ty spill during practice or an elderly patient
are astounding, and Wake Radiology is con-
rate with a patient’s primary physician to de-
suffering from joint pain.
stantly leveraging new technologies to bet-
termine the most appropriate imaging tests,
ter serve the patients and physicians who
discuss the results and help determine the
place their trust in us.”
best course of treatment.
“We study a lot of images, but we never forget that each image belongs to a person. That image represents a woman worried about a new lump, a parent concerned about a child’s fractured wrist, a friend experiencing unexplained pain,” he says. “There’s a person behind every one of the images we review and we always remember that, even if we never meet the patient in person.” The Art of Imaging Medical imaging has come a long way since Albert M. Jenkins, M.D., founded Wake Radiology and opened the Triangle’s first outpatient imaging office in Raleigh’s Cameron Village in 1953. The tiny office featured one general purpose X-ray machine and had the ability to see up to 10 patients a day. Private radiology practices were rare at the time, but Wake Radiology was a pioneer.
Medical images are available immediately and can be accessed by referring providers on any mobile device via PACS (picture archiving and communications system).
Through the years, it has consistently raised the standard of radiology care in the Tri-
One advantage of Wake Radiology’s invest-
“We embrace that type of interaction,” Dr.
angle by introducing new imaging technolo-
ment in new software and equipment is the
Jordan says. “We want physicians to know
gies and techniques to the market – from
ability to capture high-resolution images us-
that they may contact us anytime to answer
the first catheter angiography in the 1960s
ing the lowest possible dose. All CT scan-
questions, review clinical information and
to the first cardiac MRI in the 1990s.
ners, for example, are equipped with dose-
discuss guidance on any additional testing
reduction software. In addition, the practice
that is necessary.”
As medical imaging has advanced from
follows rigorous CT dose compliance and
industrial X-rays to low-dose film to digital
quality control standards that go above and
Wake Radiology established telephone ho-
imaging, Wake Radiology has always led the
beyond the standards set by the American
tlines several years ago that connect physi-
way. That commitment to cutting-edge tech-
College of Radiology.
cians directly with radiologists in the reading rooms to discuss imaging results. And a
nology and high quality imaging continues The move to digital, computer-based imag-
new smartphone application will soon en-
ing forever changed the practice of radiol-
able referring physicians to connect with a
Wake Radiology introduced three-dimen-
ogy. Images are clearer, sharper and more
radiologist at the push of a button. The app
sional mammography, hailed as the biggest
detailed. And it’s possible to collect more
also will allow physicians to access patient
advancement in breast cancer screening
images, more quickly and immediately
images anywhere on a secure connection.
today.
may 2015
7
“It’s More Than A Job…
Hunter credits Wake Radiology with saving
While the practice has grown considerably
It’s A Calling”
her life. She didn’t have a family history of
in the past 62 years, it remains local, inde-
Susan Bradsher has been part of the Wake
breast cancer, but she knew the statistics:
pendent and physician owned.
Radiology team for nearly 30 years as one
One in eight women in America is diag-
of the Raleigh MRI front desk staff. But now
nosed with breast cancer and it kills nearly
With that independence comes an unwaver-
Ms. Bradsher brings a unique perspective
40,000 women a year.
ing commitment to serve the Triangle, Dr. Jordan says.
to her work. When the practice introduced 3-D mammography in 2013, Wake Radiology
She insisted on a 3-D mammogram and says
suggested that employees like her try the
it’s the best decision of her life. Her radiolo-
Wake Radiology demonstrates its commitment
new technology.
gist at Wake Radiology spotted a question-
by supporting local charities and health care
able shadow and later determined she had
causes. By investing in talented physicians and
She agreed, and her 3-D mammogram de-
breast cancer. Her primary physician was
caring support staff. By adopting cutting-edge
tected a tiny spot that raised concerns. A
astonished the cancer was detected, saying
technology that allows it to capture the perfect
diagnostic mammogram, breast MRI and
a traditional mammogram would have nev-
images. By doing whatever it takes to best
biopsy revealed the 49-year-old had an ag-
er caught it. The cancer would have likely
serve Triangle physicians and their patients.
gressive form of breast cancer. It’s likely the
continued to grow for another year and re-
cancer would not have been detected with
quired a much more aggressive treatment.
Wake Radiology. No one sees you like we do. www.wakerad.com • (919) 232-4700
a traditional mammogram. Serving the Triangle Since returning to work, Ms. Bradsher has a
Today, Wake Radiology sees thousands of
new outlook. “I believe we go through things
patients a day. It serves the Triangle from 20
•Body Imaging / MRI
like this for the people who come behind us.
offices that stretch from Raleigh, Cary and
•Breast Imaging / MRI
I have walked the road that some of our pa-
Chapel Hill to Fuquay-Varina, Garner, Mor-
•Interventional Radiology
tients are about to go down,” she says. “It’s
risville, Smithfield and Wake Forest. In addi-
•Neuro Imaging
more than a job now. It’s a calling.”
tion, it provides radiology services at region-
•Orthopaedic & Sports Imaging
Mary Leigh Hunter is one of those pa-
al hospital systems, including WakeMed
•Pediatric Imaging
tients who followed behind Ms. Bradsher.
Health & Hospitals, Maria Parham Medical
•PET-CT
A 69-year-old grandmother from Cary, Ms.
Center and Franklin Medical Center.
•Vein Therapy
Imaging Subspecialities
Three-dimensional mammography, the biggest breakthrough in breast cancer screening in the past 20 years, has been offered at Wake Radiology since 2013.
8
The Triangle Physician
practice
spotlight
Women’s Wellness
Cary Gastroenterology Opens Women’s Center for GI Health Doctors Juliana Miller and Shannon Scholl, along with an all female staff, provide care for women in the Women’s Center for GI Health, a Division of Cary Gastroenterology. Both physicians are Board Certified in Gastroenterology and have a special focus on women’s health issues and additionally, Dr. Scholl has special training in liver disease. The Center is centrally located, not far from Rex Hospital. The physicians of Cary Gastroenterology recognize that women’s GI issues are unique and that women express their symptoms differently than men, which prompted the opening of the Women’s Center. Many women experience digestive health issues that negatively impact their lives, but are embarrassed to discuss them with their physicians. The Women’s Center provides them an environment to discuss these intimate issues comfortably with their physician. Drs. Miller and Scholl are also cognizant of the need for special care in colon screening of women due to anatomical differences, often
from child bearing or other gynecological issues. They continually exceed national endoscopic quality measures for colonoscopy for women. Having served the Triangle community since 1986, Cary Gastroenterology’s physicians enjoy Tier 1 status with Blue Cross Blue Shield and more importantly rank substantially higher than the standard in their Adenoma Detection Rates (ADRs.). National benchmark standards show that 15% of women should have an adenoma discovered and removed during colonoscopy, Cary Gastroenterology’s physicians have an ADR rate of 34% in their female patients. Recent studies show that physicians with higher ADR’s prevent more colon cancers. Drs. Miller and Scholl provide endoscopy services in three state-of-the-art, fully accredited ambulatory surgery centers, utilizing IV sedation to ensure a comfortable experience. These endoscopy centers offer a relaxed environment, individualized care, and reduced costs compared to hospital-based procedures. They also perform procedures and see patients at WakeMed Cary.
3100 Duraleigh Road, Suite 309, Raleigh 27612
The Women’s Center for GI Health is the first separate all female GI office to treat women in the Triangle, setting itself apart not only by focusing solely on women; but by incorporating advanced treatment modalities and diagnostic testing with such services as nonsurgical hemorrhoid banding, capsule endoscopy and on site anorectal manometry. As a full service outpatient practice, the Women’s Center treats disease and disorder such as IBS, celiac disease, gluten intolerance, Crohn’s disease and Ulcerative Colitis, while ensuring comprehensive treatment options resulting in best outcomes. Patients referred to the Women’s Center for GI Health receive the most up-to-date care available and referring physicians always receive comprehensive information back regarding their patient. Immediate appointments are available for patients being referred for an emergent issue. Providing exceptional GI care for women by women is the goal of the Women’s Center for GI Health.
919-787-1644 • carygastro.com/womenscenter
may 2015
9
Practice Management
Revisiting
HIPAA Compliance By Margie Satinsky, M.B.A.
The Health Insurance and Portability Act has
pliance with the original Privacy and Secu-
required Covered Entities to comply with the
rity requirements doesn’t guarantee compli-
requirements of the Privacy and Security
ance with more current requirements.
Rules since 2001 and 2005, respectively. We’ll point out two of the major changes in Our experience includes training more than
HIPAA requirements. One is the definition
100 medical practices and business associ-
of a “breach,” i.e. the unauthorized use or
ates on both rules. We’re repeatedly struck
disclosure of protected health information
by the inconsistencies that we see. Some
(PHI). The Omnibus Final Rule spells out
organizations approach Health Insurance
four questions to ask to determine breach
and Portability Act (HIPAA) compliance
occurrence and sets forth the specific steps
thoughtfully, carefully and correctly; others
to be taken in the event of a breach.
Margie Satinsky, MBA, is President of Satinsky Consulting, LLC, a Durham, NC consulting firm that specializes in medical practice management. She’s provided HIPAA compliance consultation to more than 100 Covered Entities and Business Associates. Margie is the author of numerous books and articles, including Medical Practice Management in the 21st Century. For additional information, go to www.satinskyconsulting.com.
take the easiest and least expensive way out. A second change, issued in 2009 and clari-
uses PHI in order to carry out the services
Let’s start with three erroneous assumptions
fied in 2013, has to do with patients’ rights.
that it performs on behalf of a Covered En-
that we encounter most frequently:
Patients now have the right to pay in full for
tity. Examples are your information technol-
a service and ask that PHI not be disclosed
ogy software vendor or billing company.
1) Having a Notice of Privacy Practices (NPP) and Business Associate Agree-
to an insurer. They also have the right to re-
ments (BAA) constitutes HIPAA com-
quest that a Covered Entity provide their PHI
Business Associates have much greater li-
pliance.
in electronic format.
ability than they had when HIPAA went into
2) Completing risk analyses for both the
effect, and they’re now liable for most of the
Privacy and Security Rules is all that
Notice of Privacy Practices
same civil and criminal penalties that apply
needs to be done.
The Notice of Privacy Practices (NBPP) that
to Covered Entities. Moreover, in 2013, CMS
Covered Entities must make available to pa-
introduced a new concept, called “Agent”
tients is a good place to start. If you created
(i.e. subcontractor).
3) Compliance audits don’t target small practices.
an NPP in 2001 and never updated it, you’re HIPAA compliance may be much more
non-compliant. If you have a new NPP and
Depending on how work is done, some
complex than what you have incorrectly as-
didn’t inform patients about the changes,
Business Associates outsource aspects of
sumed!
you’re non-compliant.
the work they do for Covered Entities to
Changes in HIPAA Privacy
There are efficient ways to notify patients
able. If you put Business Association Agree-
and Security
about changes. You can send a letter by
ments (BAAs) into effect in 2001 and never
HIPAA has evolved since the passage of
mail and/or by email. You can and should
updated the language, you’re non-compli-
the initial Privacy and Security Rules. One
inform patients when they come to the of-
ant. If BAAs don’t have agreements in place
change occurred in 2009 with the passage
fice, giving them the opportunity to review
with agents, you’re non-compliant.
of the HITECH Act, part of the Affordable
the revised document.
third parties, i.e. agents. Agents, too, are li-
Care Act (ACA). The most recent change oc-
Use of Risk Analyses to Determine
curred in 2013, with the passage of the Om-
Business Associate Agreement
Current Compliance Status
nibus Final Rule. The Centers for Medicare
The concept of the Business Associate has
Both the Privacy and Security Rules require
and Medicaid Services (CMS) issued the
been part of HIPAA since the outset, but
using a Risk Analysis (also called “gap”
rule in March 2013, requiring compliance by
there have been major changes. A Business
analysis) to determine what compliance re-
Sept. 23, 2014 (with some exceptions). Com-
Associate is an organization that routinely
quirements have been addressed and what
10
The Triangle Physician
compliance requirements should be ad-
Next Steps for
its attestation to HIPAA compliance wasn’t
dressed going forward. We repeatedly see
Enhancing Compliance
valid.
that Covered Entities and Business Associ-
Here are suggestions for enhancing HIPAA
ates assume that answering the questions
Privacy and Security Rule compliance in
Next, use your assessment to determine
constitutes compliance; it doesn’t.
your practice. Start with an honest assess-
what needs to be done. Finally, get the job
ment of what you have in place and where
done in a way that recognizes your staff’s
The questions are just a starting point. You
you’d like to be. Although compliance with
competence and availability.
need to keep going, listing what needs to be
the requirements of Meaningful Use (MU)
done, the responsible party and the time-
are by no means the only reason to be
We have a strong opinion on what works
frame. Most important, use the lists to take
HIPAA compliant, the connection between
best – i.e. collaboration between an individ-
action steps.
HIPAA and the MU requirements is real
ual within the practice designated with the
and important. More than one practice that
responsibility for HIPAA compliance and an
HIPAA Privacy and
thought it met the MU requirements found
external expert.
Security Policies and Procedures
its financial incentive taken back because
Both the Privacy and Security Rules require Covered Entities and Business Associates to have policies and procedures (P&Ps). Realistically, busy medical practices find it hard to devote time to the creation of P&Ps. We think it’s not necessary to reinvent the wheel. A more reasonable approach is to customize a sample P&P to your particular situation. Privacy and Security Rule Similarities and Differences The Privacy and Security Rules have both similarities and differences. Both require a designated individual to take responsibility. In some organizations, the Privacy Official and the Security Official are different individuals; in other cases one person handles both Rules. Both Rules require a Risk Analysis, written P&Ps and annual workforce training. Let’s talk about differences. The Privacy Rule is administrative, and the requirements are straightforward. The Security Rule contains administrative, technical and physical components. There’s a distinction between requirements that you must meet and items that you must “address.” The address approach gives you options, with the expectation that you will use good judgment. Here’s an example. The Security Rule speaks to the security of your physical facility, but it doesn’t require installation of a particular alarm system. The choice is up to you. Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
may 2015
11
Gastroenterology
How the Internet Can Hinder the
Doctor-Patient Relationship By Douglas Drossman, M.D.
These days patients increasingly take to the
On the positive side, with a good patient-
Internet for health information to find sup-
provider relationship, the relationship is a
port from other people who share similar
partnership not a confrontation. The patient
health conditions or experiences and to
can bring ideas from the Internet, and the
research health care providers via online
provider puts it in perspective.
review sites. Here are some examples of how a doctor While the Internet can empower patients to
might respond positively: “Yes you have
take a more active role in their health, it may
pain that seems like pancreatic cancer, but
also do more harm than good. The endless
a year ago the computed tomography scan
amount of information available makes it
was negative; if you had pain from cancer, it
difficult for patients to know which sources
would have been seen at that time. Let’s focus
are credible, whether the information is
on managing your functional gastrointestinal
scientific or even relevant and accurate for
pain.” Or if the physician is not sure, “Let’s
their particular health condition.
consider this and other possibilities further.”
Let’s consider scenarios where a patient’s
From the physician side there may also be
online hunt for information can challenge
problems.
both the patient and the provider. Clinicians are forced to spend more and
Dr. Douglas Drossman graduated from Albert Einstein College of Medicine and was a medical resident and gastroenterology fellow at the University of North Carolina. He was trained in psychosomatic (biopsychosocial) medicine at the University of Rochester and recently retired after 35 years as professor of medicine and psychiatry at UNC, where he currently holds an adjunct appointment. Dr. Drossman is president of the Rome Foundation (www.theromefoundation.org) and of the Drossman Center for the Education and Practice of Biopsychosocial Care (www. drossmancenter.com). His areas of research and teaching involve the functional GI disorders, psychosocial aspects of GI illness and enhancing communication skills to improve the patient-provider relationship. Drossman Gastroenterology P.L.L.C. (www. drossmancenter.com) specializes in patients with difficult-to-diagnose gastrointestinal disorders and in the management GI disorders, in particular severe functional GI disorders. The office is located at Chapel Hill Doctors, 55 Vilcom Center Drive, Suite 110 in Chapel Hill. Appointments can be made by calling (919) 929-7990.
Googling for Answers: When people
more time online with the electronic medi-
search using common symptoms (i.e., diar-
cal record (EMR), which, I believe, is more
rhea, constipation, nausea and abdominal
for billing purposes than to help the patient.
pain) the results will include a very large
Too much attention to the computer dur-
number of possibilities that takes medical
ing the office visit can take away from good
knowledge to sort out.
communication.
Self-diagnosis: With such information
Many doctors need to maintain their prac-
make a doctor look like an ogre. So one or
patients are vulnerable to “med student
tices through referrals. With specialties at
two bad reviews doesn’t necessarily mean
syndrome.” When a medical student has a
major medical centers it may come from
there is a problem.
symptom and they look it up, what do they
other specialists or primary care. But for
focus on? The worst possibility.
community doctors, they also need to rely
From the patient’s perspective they can
on their patients’ recommendations: “Dr.
judge the doctor’s interpersonal skills, but
Information overload: Some patients may
Jones… he’s the best! He really takes the
there is no good way to judge technical
run the risk of going to the doctor armed
time to listen.”
skills or the physician’s ability to diagnose
with their new Internet knowledge and may
and treat. For technical competence and
challenge the physician. “How do you know
Now there are patient evaluation sites, like
good knowledge, the patient must check
this isn’t pain from pancreatic cancer? I just
Health Grades, Vitals, etc., where patient
their training credentials and the hospitals
read about it and have those symptoms!”
evaluations of doctors are compiled. The
where they work.
good news is that if a provider consistently The physician may practice defensive medi-
gets glowing reviews, the patient can expect
Some doctors may try to encourage good
cine and order tests just to satisfy the patient
a good clinical interaction and in general
comments. There are doctors who might ac-
when it’s not really indicated or conversely
people like to give good reviews.
cede to requests to prescribe certain medi-
may stand ground and appear confrontational to the patient.
12
The Triangle Physician
cations e.g., opioids, when it might not be However, it only takes one angry patient to
medically indicated.
Gastroenterology Yes, the Internet is rapidly changing the doc-
health care providers need to be mindful of
of the physician in providing care.
the ways patients are using the Internet and
tor-patient relationship by giving patients the opportunity to assume much more responsi-
We need to urge patients to recognize the
learn how the vital role of effective communi-
bility for their own health care – and there is
ways in which the Internet can hinder their
cations can help foster a collaborative physi-
no doubt that this increased empowerment
relationship with physicians and potentially
cian-patient relationship that achieves quality
of patients is challenging the traditional role
impact the delivery of care. Additionally,
delivery of care with or without the Internet.
Women’s Wellness
Understanding Options for
Fibroids By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.
Uterine leiomyomas, or fibroids, are ex-
Treatment of fibroids largely can be bro-
traordinarily common. Some studies es-
ken into medical management and surgi-
timate that 70-80 percent of women have
cal management. Medical therapy includes
fibroids by the fifth decade of life.
hormones (both combined oral contraception and progestin treatments) as well as
As women learn that they have fibroids, we
gonadotropin-releasing hormone agonists.
emphasize that not everyone needs treat-
Further, the levonorgestrel-releasing intra-
ment. For many women – realizing how
uterine system is an option. Surgical options
common fibroids are can allay their fears.
include resection of fibroids, embolization
Many women live with fibroids and do not
of blood vessels that feed fibroids, endome-
have treatment.
trial ablation, hysterectomy and more.
When women with fibroids have symp-
Currently we are involved in a number
toms – they are typically related to 1)
of clinical trials for the medical manage-
heavy or prolonged periods or 2) bulk
ment and surgical management of uter-
symptoms (pressure, urinary frequency,
ine fibroids. Participation in clinical trials
difficulty emptying bladder).
has many benefits. First, detailed imaging of fibroids is usually done, followed by a
When symptoms are present, there are
detailed review of the patient’s symptoms.
many options for management.
Further, an endometrial biopsy may be done to evaluate a woman for cancer or
Management of fibroids involves under-
precancerous lesions.
standing the type(s) of fibroid. This can be done with a pelvic ultrasound. When
Women participating in the clinical re-
our providers perform a pelvic ultrasound,
search studies are compensated for their
we also provide an education on the type
participation. Compensation ranges from
and number of a woman’s fibroids. Once
$800 to $1,500.
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 cofounded and served as the director of gynecology for the Women’s Hemostasis and Thrombosis Clinic. She left her academic position (2007) to begin Carolina Women’s Research and Wellness Center. She and partner Amy Stanfield, M.D., F.A.C.O.G., head the Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals. Call (919) 251-9223 or visit www.cwrwc.com.
The Women’s Wellness Clinic (www. cwrwc.com) welcomes referrals of women
diagnosed, we review the prevalence and reassure the patient that fibroids are com-
A clinical trial is not always the answer, but
mon. We then review treatment based on
we are excited to offer them as options. We
a woman’s symptoms, size of fibroid, loca-
also work with radiologists, oncologists and
tion of fibroid, her age and her plans for
reproductive endocrinologists who special-
family.
ize in management of uterine fibroids.
with heavy periods and uterine fibroids. Call (919) 251-9223 to make a referral or with questions you may have regarding options for women with uterine fibroids.
may 2015
13
Physician Advocacy
7 Reasons Hospital-Physician Mergers Hurt Health Care By Marni Jameson
Every day more physicians are giving up their independent practices to become hospital employees. And who can blame them? It’s tempting. Hospitals can offer doctors more money, since hospitals get paid more for the same procedures. Plus, hospitals will take over the administration of the practice and cover staffing, billing, overhead and marketing. They will drive patient referrals into the practice, cover the costs of electronic medical records and pick up the tab for the malpractice insurance. Why wouldn’t a doctor do this? Well, because hospital-physician consolidations have many repercussions that doctors may not realize. Studies show that such mergers can negatively impact patients, doctors, communities and the nation’s health care. According to Tommy Thomas, a certified public accountant based in Winter Park, Fl., and founder of the Association of Independent Doctors (AID), here are seven of those consequences, which physicians should consider before they trade independence for employment: 1. Competition Decreases: When hospitals buy physician practices, competition dries up. It’s simple economics: Fewer independent providers competing with each other means costs go up and quality goes down. According to America’s Health Insurance Plans (AHIP), “An acquisition that eliminates significant competition between providers increases the ability of providers to lower their quality of care, abandon innovation and demand and obtain higher prices for medical care.”
14
The Triangle Physician
2. Quality goes down: Hospitals track how many patients their doctors admit and how many tests they order. Employed physicians’ employment contracts can depend on their numbers. This pressure results in employed physicians ordering more unnecessary tests and procedures, which not only drives up health care costs but also can put patients in harm’s way. “Consolidation of providers results in a welldocumented record of harm to consumers with price increases of 20 percent to 40 percent after consolidation,” according to AHIP. 3. Patients have less choice: Employed physicians are expected to refer to other doctors employed by that hospital and to order tests through hospital-owned facilities, regardless of whether those doctors or facilities are the best or most cost effective. Patients unwittingly get into the funnel, going only to hospital-owned entities, which costs them more. 4. Costs increase. In a large study, the Medicare Payment Advisory Commission (MedPac) confirmed that hospitals charge more than independent doctors for the same procedure – sometimes several times more. For instance, a heart catheterization in a freestanding center costs around $1,100, while the same procedure costs $4,000 in a hospital outpatient setting. “The disparities create incentives for hospitals to buy physician practices, which drives costs up for everyone: Medicare, private insurance companies, employers, employees and patients,” the 2013 MedPAC report concluded. A study published in the Journal of the American Medical Association (Oct. 22, 2014) further substantiated the higher costs. The California study, which included 4.5 mil-
Marni Jameson is the executive director for the Association of Independent Doctors. You may reach her at (407) 865-4110 or marni@aid-us.org. lion patients seen between 2009 and 2012, found a significant difference in the mean inpatient costs when comparing patients of independent doctors, of doctors employed by a hospital and of doctors employed by a multi-hospital system: • Independent doctor: $3,066 • Hospital-owned doctor: $4,312 • Multi-hospital-system-owned doctor: $4,776 It adds up. “If hospital facilities charged the same as independent doctors for the same services for 66 groups of services, taxpayers would save $900 million a year in Medicare costs,” said MedPAC. Imagine if insurance providers also brought their contracted rates with hospitals in line with their reimbursement rates for private practitioners. 5. Communities lose jobs. Independent practices are small businesses. Small businesses create about 65 percent of our nation’s new jobs and are vital to the market dynamics of healthy communities. When independent doctors sell to hospital systems and become employees, the hospital assumes staffing and that often means loyal office workers lose their jobs. 6. Taxes go up: When a nonprofit health system acquires an independent physician’s practice, overnight that practice goes from
supporting the community through paying property, tangible and sales taxes to paying no taxes. We all pay for that. 7. Job satisfaction and security go down: Employed doctors often find the best year of employment is the first one. After that, contracts often get worse, if they get renewed at all. Remember, employed physicians’ jobs, salaries and benefits can depend on their numbers. Most physicians usually have to sign as a condition of employment a non-compete agreement if they leave, so some aren’t allowed to practice in the area again for a specified period of time. The risk of not signing the agreement is that their contracts won’t be renewed.
55 Vilcom Center Drive Boyd Hall, Suite 110 Chapel Hill, NC 27514
Drossman Gastroenterology PLLC a patient-centered gastroenterology practice focusing on patients with difficult to diagnose and manage functional GI and motility disorders. The office is located within the multidisciplinary health care center, Chapel Hill Doctors. Dr. Douglas Drossman is joined by physician’s assistant, Kellie Bunn, PA-C. Appointments are scheduled on Tuesday and Wednesday and most laboratory studies are available.
919.929.7990
www.drossmangastroenterology.com
Drossman Gastroenterology
Most physicians don’t want to be part of the fallout that occurs when hospitals acquire them, but many also feel they don’t have a choice. We think they do. The Association of Independent Doctors is a fast-growing, national nonprofit organization designed to help independent doctors stay that way. Since it was established in April 2013, the association has grown to include members in eight states. “We fight a fight that doctors have neither the time, means nor clout to pursue,” said Mr. Thomas.
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By organizing physicians in the fight to stay independent, AID communicates to patients, insurance providers and government representatives the important reasons why our health care system needs physicians to remain independent. For more information, go to www. aid-us.org. Next month Ms. Jameson will look at a high court’s decision in an anti-trust case involving the purchase of a large medical practice by a major health care system. The verdict is being felt nationwide.
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Dermatology
Paradigm Shift
Replacing Lost Volume Is Key to Taking Years Off Aging Skin By Dr. Margaret Boyse, M.D.
Virtually everyone over 40 or 50 is losing fat in the facial fat pads of their cheek and under eye areas, making us look tired and old whether we feel that way or not. During the last 10 years there’s been a paradigm shift in the way anti-aging experts view aging. For a long time, the view was that gravity pulled everything down, and the answer was a facelift that cut that sagging skin and lifted it upwards. The new view is that gravity is secondary to the real issue – which is volume loss. A youthful face has an ample amount of volume, creating a surface that reflects light in a pleasing way. A youthful face reflects light at the
Dr. Margaret Boyse practices at Southern Dermatology. After earning her medical degree from the University of Texas, she completed her internship at Walter Reed Army Medical Center and residency at the University of Michigan. Special interests include: general adult and pediatric dermatology, dermatologic surgery, cosmetic dermatology and skin cancer. She is a member of the American Academy of Dermatology and North Carolina Medical Society. For more information, visit www.southernderm.com.
top of the brow, the middle of the nose, cheeks, upper lip, chin and ear lobes, giving the skin a soft, luminous quality. How the face reflects
Volume is lost in the face as we age: the skin, soft tissue and the
and shadows the light really is what gives us an idea of its age.
craniofacial skeleton, which is the supporting structure of the skin. To complicate matters even more, each layer loses volume at in-
Start looking at young faces, and you can see for yourself how they
dependent rates in each individual. So our skin does all the same
reflect light outwards.
things as we age, but there’s a very individual stamp on it. Replacing lost volume where each individual needs it is the key. My patients see wonderful results from dermal fillers, such as Juvéderm® Voluma, Restylane® and Perlane. Dermal fillers injected underneath the skin do a very effective job of lifting the skin back into place, softening wrinkles and filling creases by restoring the volume that’s lost due to aging. I am proud to be one of the few physicians in the area that uses
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very flexible. There are fewer entrance pokes than with needles. And most importantly the risk of a vascular catastrophe is almost eliminated. Taking years off aged skin obviously doesn’t require a facelift in today’s environment. These dermal fillers can replace volume to restore youthful skin with little downtime.
16
The Triangle Physician
Autism Society of North Carolina
Accessing Services Guide
Is Free and Part of Online Empowerment Series
The Autism Society of North Carolina re-
nosed with ASD in North Carolina, accord-
education and services to directly improve
cently released the “Accessing Services”
ing to a prevalence study of eight-year-old
the lives of individuals affected by autism.
toolkit, the sixth in a series designed to
schoolchildren conducted by the Centers
empower parents and caregivers of indi-
for Disease Control and Prevention.
For more information, call (800) 442-2762 or visit www.autismsociety-nc.org.
viduals with autism spectrum disorder. For more than 45 years, the Autism Society The free guide helps inform parents and
of North Carolina has provided advocacy,
guardians of children and adults on the autism spectrum about the kinds of services and supports that may be available in North Carolina and how to obtain them. The “Accessing Services” toolkit covers such topics as individualized education programs (IEPs), bullying and advocacy and is available on the Autism Society of North Carolina (ASNC) website, www. autismsociety-nc.org. The toolkit series was researched and written by ASNC’s autism resource specialists. They include parents of those with autism who now work with families in need of support; licensed psychologists and certified analysts from the ASNC clinical team and leaders in ASNC’s advocacy and services departments, who are knowledgeable about North Carolina law and the services system. ASNC plans to introduce more toolkits on a variety of topics in coming months. Background Autism Spectrum Disorder (ASD) is a lifelong developmental disability that typically appears during the first three years of life. As many as one in 58 children may be diag
may 2015
17
UNC News
Mastectomy Is Still Choice Even When Breast-Conservation Surgery Is Option No approved targeted therapies exist to
tients and their surgeons made this choice.
growth of new blood vessels – to the stan-
treat triple-negative breast cancer, but new
Previous studies have found that for those
dard regimen of chemotherapy given to
chemotherapeutic treatment strategies are
who are eligible for breast-conserving sur-
patients with triple-negative breast cancer.
helping shrink tumors so less breast tissue
geries such as a lumpectomy, the rate of
The team found a trend suggesting that the
needs to be removed during surgery.
survival for patients who chose to have a
addition of one or both drugs increased
lumpectomy is the same as for those who
the number of patients eligible for breast-
New research led by Brigham and Wom-
chose to have a mastectomy. A study by
conserving therapy. Forty-two percent of
en’s Hospital in collaboration with the
von Minckwitz et al. found that in a popu-
185 women who were not initially candi-
University of North Carolina Lineberger
lation from Germany, nearly 75 percent of
dates for breast-conserving therapy were
Comprehensive Cancer Center finds that
patients underwent breast-conserving ther-
considered to be eligible after receiving
breast-conserving therapy – or the removal
apy for similar type tumors, much higher
drug treatment. And breast-conserving
of less breast tissue via a lumpectomy –
than the overall breast-conserving therapy
therapy was successful for 91 percent of
was successful in more than 90 percent of
rate of 47 percent reported in the current
the 53 women who chose it.
the women who became eligible for this
study. “In triple-negative breast cancer patients,
procedure after treatment with chemotherapy. Despite these findings, 31 percent who
“In general, if possible, we try to offer
we continue to increase the complete
were eligible for breast-conserving therapy
breast-conserving therapy as a preferred
pathologic response rate with our new
chose to have the entire breast removed
option for women with early stage breast
drug combinations,” Dr. Ollila said. “On
via mastectomy.
cancer,” said corresponding author Mehra
our trial, more patients were eligible for
Golshan, M.D., director of Breast Surgi-
breast preservation. Despite these advanc-
The complete manuscript of this study and
cal Services at Dana-Farber/Brigham and
es, more patients chose mastectomy as
its presentation at the American Surgical
Women’s Cancer Center. “One of the rea-
their surgical procedure. The reasons for
Association’s 135th annual meeting in April
sons we use chemo first is to potentially al-
this paradox need to be further explored.”
is anticipated to be published in the Annals
low women who originally needed to have
of Surgery pending editorial review.
the entire breast removed because of more
Dr. Golshan and his colleagues note that
advanced disease to now be eligible for
they did not study specific patient or sur-
“We’ve shown that
breast-conserving therapy. We see though
geon factors, such as fear of cancer re-
we can offer breast-
that a significant number of patients who
currence or whether a patient harbored
conserving
were eligible still ended up deciding to
mutations in genes such as BRCA. Future
have their breast removed.”
studies could shed light on how these vari-
therapy
to more women using
ables impact the choice between mastec-
these drug combina-
tomy and breast-conserving therapy.
tions, and if they con-
“We don’t have an answer for why this is
vert, we’re really suc-
the case, but we hope that this work en-
cessful,” said senior
courages more patients and clinicians to
Research reported in this publication was
author David Ollila, M.D., James and Jesse
think about why this is happening and
supported by the National Cancer Insti-
distinguished professor of surgery at UNC
what we can do to address this,” said Dr.
tute of the National Institutes of Health
School of Medicine, co-director of the UNC
Golshan, who is also director of Breast Sur-
under Award Numbers U10CA180821 and
Breast Program and a member of the UNC
gical Services at the Susan F. Smith Center
U10CA180882 (to the Alliance for Clinical
Lineberger Comprehensive Cancer Center.
for Women’s Cancers at Dana-Farber Can-
Trials in Oncology), CA180888 (SWOG),
“We have more and more women eligible
cer Institute. “It’s a work in progress.”
U10CA180791, and U10CA180867. This work
David Ollila, M.D.
was also supported in part by grants from
for breast preservation, and still we saw more than 30 percent of women choosing
The new study examined the impact of
the Breast Cancer Research Foundation
mastectomy.”
adding carboplatin – a platinum-based
and Genentech.
chemotherapeutic agent – and/or bevaThe new work does not explain why pa-
18
The Triangle Physician
cizumab – a drug designed to slow the
Duke News
Chances in the Adolescent Brain on Alcohol Last Into Adulthood Repeated alcohol exposure during adoles-
are much less adept at memory tasks than
Importantly, the LTP abnormality was ac-
cence results in long-lasting changes in the
normal animals – even with no further al-
companied by a structural change in indi-
region of the brain that controls learning
cohol exposure.
vidual nerve cells that Drs. Swartzwelder and Risher and colleagues identified.
and memory, according to a research team at Duke Medicine that used a rodent model
What has not been known is how these
The tiny protrusions from the branches of
as a surrogate for humans.
impairments manifest at the cellular level
the cells, called dendritic spines, had ap-
in the region of the brain known as the hip-
peared lanky and spindly, suggesting im-
The study, published April 27 in the jour-
pocampus, where memory and learning
maturity. Mature spines are shorter and
nal Alcoholism: Clinical & Experimental
are controlled.
look a bit like mushrooms, refining cell-tocell communication.
Research, provides new insights at the cellular level for how alcohol exposure
Using small electrical stimuli applied to the
during adolescence, before the brain is
hippocampus, the Duke team measured a
“Something happens during adolescent
fully developed, can result in cellular and
cellular mechanism called long-term po-
alcohol exposure that changes the way
synaptic abnormalities that have enduring,
tentiation, or LTP, which is the strengthen-
the hippocampus and other regions of
detrimental effects on behavior.
ing of brain synapses as they are used to
the brain function and how the cells actu-
learn new tasks or conjure memories.
ally look – both the LTP and the dendritic spines have an immature appearance in
“In the eyes of the law, once people reach
adulthood,” Dr. Swartzwelder said.
the age of 18, they are considered adult, but
Learning occurs best when this synaptic
the brain continues to mature and refine all
activity is vigorous enough to build strong
the way into the mid-20s,” said lead author
signal transmissions between neurons. LTP
Dr. Risher said this immature quality of
Mary-Louise Risher, Ph.D., a post-doctoral
is highest in the young, and effective learn-
the brain cells might be associated with
researcher in the Duke Department of
ing is crucial for adolescents to acquire
behavioral immaturity. In addition to spine
Psychiatry and Behavioral Sciences. “It’s
large amounts of new memory during the
changes in the hippocampus, which affects
important for young people to know that
transition to adulthood.
learning, colleagues of the Duke group have shown structural changes in other
when they drink heavily during this period of development, there could be changes
The researchers expected they would find
brain regions that control impulsiveness
occurring that have a lasting impact on
abnormally diminished LTP in the adult
and emotionality.
memory and other cognitive functions.”
rats that had been exposed to alcohol during their adolescence. Surprisingly,
“It’s quite possible that alcohol disrupts the
Dr. Risher and colleagues, including se-
however, LTP was actually hyperactive in
maturation process, which can affect these
nior author Scott Swartzwelder, Ph.D., a
these animals compared to the unexposed
cognitive functions later on,” she said.
professor of psychiatry and behavioral sci-
rodents.
“That’s something we are eager to explore in ongoing studies.”
ences at Duke and senior research career scientist at the Durham VA Medical Center,
“At first blush, you would think the animals
periodically exposed young rodents to a
would be smarter,” Dr. Swartzwelder said.
The researchers said additional studies
level of alcohol during adolescence that,
“But that’s the opposite of what we found.
would focus on the longer-term cognitive
in humans, would result in impairment,
And it actually does make sense, because if
effects of alcohol on brains, along with ad-
but not sedation. Afterward, these animals
you produce too much LTP in one of these
ditional cellular changes.
received no further exposure to alcohol
circuits, there is a period of time where you
and grew into adulthood – which in rats
can’t produce any more. The circuit is satu-
In addition to Drs. Risher and Swartzweld-
occurred within 24 to 29 days.
rated, and the animal stops learning. For
er, study authors include Rebekah Lyn
learning to be efficient, your brain needs
Fleming; W. Christopher Risher, Kelsey
Earlier studies by the Duke team and oth-
a delicate balance of excitation and inhibi-
Miller, Rebecca Klein, Tiffany Wills, Shawn
ers have shown that adolescent animals
tion – too much in either direction and the
K. Acheson, Scott D. Moore, Wilkie A. Wil-
exposed to alcohol grow into adults that
circuits do not work optimally.”
son and Cagla Eroglu.
may 2015
19
News The research team is part of the Neurobiolo-
The
Alcohol
ed States Department of Veterans Affairs
gy of Adolescent Drinking in Adulthood (NA-
Abuse and Alcoholism provided fund-
and the Institute for Medical Research. A
DIA) consortium, which studies the effects of
ing (U01AA019925; UO1AA020938; BX-
full list of funding sources is provided in
adolescent alcohol exposure https://www.
001271-02; DA031833; 2T32NS51156-6 and
the published study.
med.unc.edu/alcohol/nadiaconsortium).
1F32NS083283-01A1), along with the Unit-
National
Institute
of
Schaaf Awarded Highest Governor Honor Robert Schaaf, M.D., president and managing partner of Wake Radiology for 27 years, was presented with The Order of the Long Leaf Pine, one of the highest honors that the governor of North Carolina can bestow. Robert W. Seligson, executive vice president of the North Carolina Medical Society, presented the award to Dr. Schaaf on behalf of Gov. Pat McCrory during a special ceremony on April 13. Dr. Schaaf, who retires in June, was recognized for his outstanding service to the state’s medical community. A board-certified radiologist, Dr. Schaaf has served on the NC Medical Society’s board of directors since 2004 and currently serves as president of the organization. He has served on the board of directors of Medical Mutual Insurance Co., the largest insurer of physicians in North Carolina, since 1998 and was elected vice chairman in 2005. “It’s a great honor to present The Order of the Long Leaf Pine to one of our state’s most dedicated and accomplished physicians,” Mr. Seligson said. “His record of service and commitment to the state’s medical community over the past 35 years makes him well qualified to receive such an honor.” The Order of the Long Leaf Pine was established in 1963 by Gov. Terry Sanford to honor people who have demonstrated a lifetime of service to the state of North Carolina. It confirms upon the recipient “…the rank of
20
The Triangle Physician
ambassador extraordinary, privileged to enjoy fully all rights granted to members of this exalted order, among which is the special privilege to propose the following North Carolina toast in select company anywhere in the free world: “Here’s to the land of the long leaf pine, The summer land where the sun doth shine, Where the weak grow strong and the strong grow great, Here’s to “down home,” the Old North State!” Dr. Schaaf came to North Carolina in 1976 following graduation from Tufts University Medical School in Boston for a combined internship and residency in diagnostic radiology at Duke University Medical Center. He went on to serve as an assistant clinical professor of radiology at the Duke University Medical Center (1980-1990) and the University of North Carolina at Chapel Hill (1980-1992). He joined Wake Radiology in 1980 and was named president and managing partner in 1986. In addition, he served as chairman of WakeMed’s radiology department (19811984) and chairman of the radiology department at Franklin Regional Medical Center (1984-1996). In April 2004, North Carolina Gov. Mike Easley appointed Dr. Schaaf to serve on the NC Medical Care Commission, which oversees regulation of the state’s hospitals and health care facilities. He continues to serve on the commission today.
Dr. Schaaf is a fellow and member of the American College of Radiology, Radiological Society of North America, American Society of Neuroradiology, American Roentgen Ray Society, American Medical Association, North Carolina Medical Society and the Wake County Medical Society. He was appointed to the Wake Forest University Law School Board of Visitors in 2012 Business Leader Magazine named Dr. Schaaf “Medical Business Leader of the Year” in 2012.
2015 Editorial Calendar June Men’s Health, Pulmonary July New Imaging Technologies, Vein Diseases, Rheumatology August Gastroenterology, Nephrology, Sports Medicine September Bariatrics/Neonatology Advances in NICU, Obstetrics/Gynecology October Cancer in Women Wound Management, Dermatology November Urology, ADHD, Austism December Sports Medicine, Otorhinolaryngology Pain Management
News Welcome to the Area
Physicians
Reid Cameron Chamberlain, MD
David Wonil Lee, MD
Craig Conover Reed, MD
Amir Homayoun Barzin, DO
Pediatrics
Gastroenterology, Internal Medicine
Duke University Hospitals Durham
Cardiology; Internal Medicine
Family Medicine
UNC Family Medicine Chapel Hill
Lars Benjamin Gardner, DO Neurological Surgery, Critical Care
Raleigh Neurosurgical Clinic Raleigh
Matthew Justin Merritt, DO Emergency Medicine
Nash General Hospital Rocky Mt
Emily Christine Valenta, DO Family Medicine
Chapel Hill
University of North Carolina Hospitals Chapel Hill
Idan Cudykier, MD
Brice Nielsen Lefler, MD
Patrick David Retterbush, MD
Emergency Medicine
Internal Medicine
Duke University Hospitals Durham
Durham VA Medical Center Durham
Dermatology
Genevieve Guenther Ricart Embree, MD
John Strudwick Lewis Jr., MD
UNC Center for Heart & Vascular Care
Orthopedic Surgery
General Preventive Medicine; Internal Medicine; Occupational; Public Health
Duke University Hospitals Durham
UNC Hospitals Chapel Hill
Sandy Junjun Li, MD
Elizabeth Eve Falchook, MD
Gynecologic Surgery; Obstetrics Gynecology Endocrinology/Infertility; Reproductive
Doctors Making House Calls Durham
Addiction Psychiatry; Child Psychiatry; Neurology/Psychiatry; Geriatric; Psychosomatic Medicine
Duke Fertility Center Durham
Christopher Michael Wozniak, DO
University of North Carolina Hospitals Chapel Hill
Eben Isaac Lichtman, MD
Family Medicine
Rex Family Practice of Wakefield Raleigh
Krista Ruth Alexander, MD
Deborah Faith Gelinas, MD Neurology/Psychiatry
Grifols Research Triangle Park
Psychiatry
Hematology and Oncology, Internal Medicine
Hematology/Oncology
Maria Emmeline Lim, MD Pediatric Ophthalmology
Duke Eye Center Durham
Duke University Medical Center Durham
Robert Thomas Harris, MD Administrative Medicine; Psychosomatic Medicine
Jose Antonio Lozano Jr., MD
Emma Longley Barber, MD
CSC, Inc. Raleigh
Duke University Hospitals Durham
Gynecology/Oncology, Surgery, Critical Care Medicine, Hospice; Palliative Medicine; Obstetrics and Gynecology
UNC Hospitals Chapel Hill
Meena Bhatia, MD
Kelly Lawson Hastings, MD
Rebecca Wertman Bialas, MD Dermatology
Duke University Medical Center Durham
Ryan Christopher Bialas, MD Anesthesiology
UNC Hospitals Chapel Hill
Edith Villette Bowers, MD Dermatology
UNC Dept of Dermatology Chapel Hill
Joseph Donald Brogan, MD Internal Medicine
Duke University Hospital Medicine Durham
Physical Medicine; Rehabilitation
UNC Hospitals Chapel Hill
Adnan Siddiqui, MD Anatomic Pathology; Clinical Pathology; Hematology Pathology
Morrisville
Mandeep Singh, MD Anesthesiology - Critical Care Medicine
Duke University Hospitals Durham
John Stephen Sullivan, MD Critical Care Pediatrics
WakeMed Health & Hospitals Raleigh Infectious Diseases, Internal Medicine
University of North Carolina Hospitals Chapel Hill
Duke University Hospitals Durham
Brittany Emma Howard, MD
Andrew Walker Mccrary, MD
Broncho-Esophagology; Facial Plastic Surgery; Head and Neck Surgery; Otolaryngology Pediatric Otolaryngology; Reconstructive Surgery
UNC-CH Department of Otolaryngology - Head and Neck Surgery Chapel Hill
Alison Kay Kalinowski, MD Obstetrics and Gynecology
Kamm McKenzie ObGyn Raleigh
Michael Raymond Kazior, MD Anesthesiology
UNC Dept. of Anesthesiology Hospitals Chapel Hill
Bryan Young Hoon Kim, MD Ophthalmology
Brian Richard Kincaid, MD
Kelly Amanda Bruno, MD Anesthesiology
Duke University Hospital Durham
Univ of North Carolina Hospitals Chapel Hill
Bradley Mark King, MD
Hospitalist; Internal Medicine; Psychiatry
Ophthalmology
Cardiology; Internal Medicine
University of North Carolina Hospitals Chapel Hill
University of North Carolina Hospitals Chapel Hill
Rajesh Kurpad, MD
Marie Masse Caldwell, MD Internal Medicine
University of North Carolina Hospitals Chapel Hill
University of North Carolina Hospitals Chapel Hill
Garjae Dayan Lavien, MD
Laura Mosby Carlson, MD
Duke Div of Urology Durham
University of North Carolina Hospitals Chapel Hill
Lee Thomas Shuping, MD
Joshua Thomas Thaden, MD
UNC Gastroenterology Chapel Hill
Maternal and Fetal Medicine; Gynecology
N.C. Childrenâ&#x20AC;&#x2122;s Heart Center Chapel Hill
Wake Med Health System - Pediatric Hospitalist Division Raleigh
Gastroenterology, Internal Medicine
Adam William Caldwell, MD
Pediatric Cardiology
Pediatrics
UNC-CH Department of Ophthalmology Chapel Hill
Philip John Brondon, MD
Pamela Sue Ro, MD
John Bryan Lykes, MD
Diagnostic Radiology; Neuradiology; Vascular and Interventional Radiology
Anesthesiology - Critical Care Medicine
University of North Carolina Chapel Hill
Hospitalist; Internal Medicine
UNC Hospitals Chapel Hill
Urological Surgery; Urology
Urological Surgery; Urology
Pediatric Cardiology; Pediatrics
Duke University Hospital Durham
Nisha Mukherjee, MD Ophthalmology
Duke University Hospitals Durham
Joseph Adam Yancey, MD Radiology: Diagnostic, Musculoskeletal, Nuclear, Pediatric, Vascular, Interventional; Neuroradiology
University of North Carolina Hospitals Chapel Hill
Carlos Armando Gonzalez, MD Diagnostic Radiology; Neuroradiology;
Univ of North Carolina at Chapel Hill Chapel Hill
Bhavini Patel Murthy, MD Preventive Medicine/Occupational; Public Health
UNC Hospitals Chapel Hill
Allison Lindsay Overmon, MD Anesthesiology; Critical Care Medicine, Hospice and Palliative Medicine, Pain Medicine
Duke University Medical Center Durham
Shelly Rae Harrell Pecorella, MD Anesthesiology
Physician Assistants Allison Kathleen Alexander, PA Emergency Medicine; Hospitalist; Internal Medicine; Urgent Care
Fuquay-Varina
Whitney Claire Andrew, PA Hematology and Oncology, Internal Medicine
Duke University Hospitals Durham
Hillsborough
Lamise Zouka Rajjoub, MD
Cardiology; Emergency Medicine/Sports Medicine; Family Medicine
Ophthalmology
University of North Carolina, Department of Ophthalmology Chapel Hill
Veena Shiva Rao, MD Ophthalmology
Duke Eye Center Durham
Reshmi Preethi Raveendran, MD Rheumatology, Internal Medicine
UNC Hospitals Chapel Hill
Thomas Vincent Recore, MD Psychiatry
Duke University Hospitals Durham
Daryl Carducci, PA Raleigh
Emily Caitlin Godfrey, PA Mebane
Reginia Everett Gurley, PA Dermatology; Family Medicine; Psychiatry
SHAE Partners Durham
Kelsey Hines, PA Dermatology; Family Medicine; Obstetrics and Gynecology; Otorhinolaryngology; Pediatrics
Durham
Clarissa Anne Urban, PA Medical Oncology
Waverley Hematology Oncology Cary
may 2015
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