M AY 2 0 1 6
Skin Wellness
Dermatology Associates
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
Also in This Issue Cosmetic Vs. Medicinal Corporate Compliance
From the Editor
Healthy Balance Meet dermatologist Brooke Jackson, founder of Skin Wellness Dermatology Associates, a new practice in Durham and this month’s Triangle Physician cover story. Dr. Jackson offers a personal overview of her practice and personal passions. Professionally she brings her patients extensive training and expertise, which encompasses Mohs micrographic surgery. She reports achieving international recognition as an expert in laser treatment of those with increased skin pigmentation. She also describes herself as an educator. Dr. Jackson shares her interest in balancing career, self and family. She has had an accomplished career; she has run 10 marathons – all while raising a family. Here’s wishing Dr. Jackson continued success.
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
Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Margaret B. Boyse, M.D. Ted Gilbert Marni Jameson Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Margie Satinsky, M.B.A. Michael J. Thomas, M.D., Ph.D.
This month we offer a nice balance of contributors. Women’s health specialist Andrea Lukes discusses a new approach to treating vaginal issues that plague many women as they age. Dermatologist Margaret Boyse addresses the line between cosmetic surgery, which is superficial, and medical treatment that addresses underlying causes. Endocrinologist Michael Thomas explores the key considerations for patients with multinodular goiter.
Creative Director Joseph Dally jdally@newdallydesign.com
This month we welcome Ted Gilbert, a new contributor to The Triangle Physician. He gives an overview of top digital marketing strategies. Practice marketing consultant Margie Satinsky returns to share corporate compliance tips. Physician advocate Marni Jameson completes her two-part series on physicians uniting to protect their independence.
The Triangle Physician is published by: New Dally Design
According to Oxford Dictionary, equilibrium is “a state in which opposing forces or influences are balanced.” Within The Triangle Physician magazine we strive for a healthy balance of medical news and information that is contributed at no cost and advertising and cover story editorial that is, available at competitive rates. So the more than 9,000 readers within the medical Triangle, who receive each issue, can stay informed. This benefits all. We welcome your practice news and medical insight. Please send your submissions to info@trianglephysician.com. With gratitude for all you do,
Heidi Ketler Editor
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The Triangle Physician
Advertising Sales info@trianglephysiciancom News and Columns Please send to info@trianglephysician.com
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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4
The Triangle Physician
Table of Contents
4
COVER STORY
Skin Wellness Dermatology Associates m ay 2 0 1 6
Vol. 7, Issue 5
FEATURES
8
O P F
Practice Management
Part II: Tips for Successful EHR Implementation Margie Satinsky’s chronological steps for a smooth transition maximize the roles of staff members and vendors.
12
DEPARTMENTS
Physician Advocacy
Fed Up With Excessive Oversight, Doctors Get Organized – Part I
Marni Jameson discusses the great frustration that is causing independent physicians to join forces across the country.
10 ENDOCRINOLOGY
Differentiated Thyroid Cancer
13 DUKE RESEARCH NEWS Prostate Cancer Metastasis Site Has Direct Impact on Survival Time
14 DUKE RESEARCH NEWS Thyroidectomy Recommendation: Choose Surgeons With 25-plus Cases a Year
16 WAKEMED RESEARCH NEWS Supersaturated Oxygen Therapy Has Potential to Improve STEMI Outcomes
17 NEWS
Welcome to the Area
On the Cover: Matthew G. Kanaan, D.O., founder of Wake Sports Medicine, specializes in helping patients delay, and in some cases avoid, surgery, using traditional and cutting-edge treatment options.
May 2016
5
Cover Story
Skin Wellness
Dermatology Associates Brooke Jackson, M.D., strides with purpose
Skin Wellness Dermatology Associates “is
Dr. Jackson applies this wholesome
through the Southpoint space that is Skin
a thrilling opportunity,” Dr. Jackson says of
runner’s philosophy to her practice, too.
Wellness Dermatology Associates, her
the practice that opened just last month.
“If I need to take extra time to explain a
innovative, new dermatology practice.
“I am able to pursue all of my passions:
procedure or educate a patient about
the medical, surgical and aesthetic aspects
her skin condition, I absolutely will,” Dr.
A 10-time marathoner, Dr. Jackson knows
of dermatology, as well as some exciting
Jackson says. “My goal is quality, above all
the importance of keeping a good pace.
advances and innovations in aesthetic
else. Quality care means quality medicine,
Armed with her favorite vente Starbucks,
dermatology while staying true to the
and that takes time.”
she walks briskly but stops to appreciate
name of the practice – Skin Wellness.”
the reception area, noting the calm,
Dr. Jackson moved in 2013 from Chicago to
welcoming atmosphere and the glass wall
Like many runners, she knows when to
the Triangle area with her husband, three
that runs along a stand of green and leafy
pick up the pace and when to take her
children and goldendoodle in pursuit of a
trees and bathes the space in natural light.
time. It’s not just a racing strategy. It’s also
healthy balance of work and life. She was
She points with pride to the state-of-the-art
about staying healthy, says the board-
attracted to the area for its quality lifestyle:
laser machines in the area designed for
certified dermatologist who studied at
excellent educational opportunities and
medical-grade aesthetic treatments. Jazz
Wellesley College, Georgetown University
weather and landscape that are ideal for
music plays softly in the background.
School of Medicine, University of Chicago
outdoor activities. She loves the easy-going
and Harvard University.
pace and the diversity of her neighbors. She loves that her children can walk to school. Although she and her children miss the snow, Dr. Jackson appreciates the warmer winters. She also is well aware that with yearround outdoor activity come sun damage and its associated risks of skin cancer. Skin wellness is Dr. Jackson’s practice goal, and she says she aims to accomplish it with every patient by teaching how to manage skin conditions in the welcome, but damaging North Carolina sun. “I am primarily an educator,” says Dr. Jackson. “One of my career ‘a-ha’ moments came with the realization that, as dermatologists, we don’t cure much. Because many of the disease processes in dermatology are chronic, we spend most of our time controlling the disease. So it is important to educate patients about the nature of their conditions and exacerbating factors
Dr. Jackson has specialized expertise in laser treatment that is sensitive to the range of skin colors, including those with increased skin pigmentation.
6
The Triangle Physician
for a more successful treatment outcome.”
Dr. Jackson and her staff believe patients should leave their practice looking and feeling good.
As an African American, Dr. Jackson
also am able treat the diaper rash in the
The massive machines in her procedure
recognizes that many African Americans
next generation.”
rooms are lasers used for treating vascular and pigmented lesions, scars, unwanted
and other people of color believe they are protected from the sun’s harmful rays
That generational aspect is important to
hair,
discoloration,
benign
growths,
by their melanin. “Sun exposure is just
Dr. Jackson, whose late father headed
excess fat and photodamage, among other
a piece of the skin cancer puzzle, and
the pathology department at Howard
procedures. Dr. Jackson is considered an
unfortunately patients with darker skin
University in Washington, D.C. She says he
international expert in the use of lasers on
may underestimate their risk. Everyone
was an “enormous influence” on her and
skin of color, and she is very excited about
needs to practice sun-protective measures
encouraged her interest in medicine and
the advances the field.
on a daily basis, including the use of
lifelong learning. A perpetual student, she decided to pursue
sunscreen,” says Dr. Jackson, who has written several book chapters on skin
Dr. Jackson was the first African American
a second fellowship in Mohs micrographic
cancer in skin of color. “And everyone
at Harvard University to complete a
surgery and went on to establish the Mohs
should check in regularly with a board-
fellowship in cutaneous laser surgery,
surgery unit at the University of Texas MD
certified dermatologist.”
after which she taught on faculty. During
Anderson Cancer Center in Houston.
her fellowship she learned that available Dr. Jackson’s practice on Chicago’s
technology was more damaging to those
Dr. Jackson writes and speaks regularly
famous “Magnificent Mile” was diverse
with increased skin pigment and resulted
about skin health and has authored
in every way. There, she saw people of
in their exclusion from research trials she
book chapters and peer-reviewed articles
various backgrounds and ages. It’s one
was involved in. Her frustration of not
about skin cancer and laser and aesthetic
of the aspects of dermatology that she
being able to offer these patients certain
procedures, particularly in skin of color.
loves. Because of her expertise in lasers
treatment options fueled her career-long
This year she is an invited lecturer at
in skin of color, she saw patients from
interest with lasers in skin of color. “The first
several conferences and a session director
around the world. Her practice wasn’t
aesthetic lasers caused significant tissue
at a national meeting of dermatologists.
just about the acute visits but developing
damage in patients with darker skin tones,
long-term relationships too. She often saw
but now with advances in technology we
While she has excelled in these aspects
patients throughout their lives. “It is such
can treat patients of all skin colors safely.”
of her career, the work Dr. Jackson loves
an honor to have the privilege of helping
Dr. Jackson is proud to have been involved
most involves reaching out to a broader
a daughter and mother prepare for the
in clinical studies refining the parameters
audience. Her recent educational forums
daughter’s wedding, and if I am lucky, I
that now allow that to happen.
include: O, the Oprah magazine; the
May 2016
7
nationally syndicated Tom Joyner Morning
at several universities and worked in
Dr. Jackson and her husband are the
Show; and numerous appearances on
multispecialty
practice.
proud parents of eight-year-old twin girls
local television and radio shows. You can
With all the changes in medicine, she
and a six-year-old son, not to mention, that
catch her on YouTube discussing the best
is choosing once again to be in private
10 year-old goldendoodle.
foods for healthy skin or teaching men
practice, because she believes this is the
how to shave so they avoid bumps and
best fit for her and the way she wants to
“My life is very full,” Dr. Jackson laughs. “I
irritation. Whether it is skin health during
interact with her patients.
wouldn’t have it any other way.”
unwavering goal is to make sure everyone
“Each and every patient is really important
Even with a new practice and young
knows how to keep his or her skin as
to me,” she says. “I listen to them and enjoy
children, Dr. Jackson plans to train for
healthy as possible.
getting to know them, which allows me to
more races and has started to practice
tailor the treatment plan to fit their lifestyle,
yoga. She knows that running a marathon,
and that can take time.”
like running a medical practice, requires
and
private
the winter or for outdoor athletes, her
She also wants her patients to leave her
grit, planning and patience. She is ready
office looking and feeling good. “My aesthetic is a natural look,” she says.
In keeping with her closely held educa-
for the challenge, as this is “not my first trip
“When people compliment you, they
tional values and importance of overall
to the rodeo.”
should say, ‘You look great.’ They should
wellness , Dr Jackson started ChicagoFit,
not say, ‘You’ve had a procedure.’”
an organization that brought marathon
“I’m not a fast runner. I am persistent,” she
training to the South Side of Chicago. The
says. “But, you know, slow and steady gets
This is increasingly important, Dr. Jackson
first year, the program attracted 75 partici-
you to your goal too.”
says, as people stay in the workforce
pants, and within four years she had grown
longer or re-enter the workforce after some
participation to 450 new and experienced
Skin Wellness Dermatology Associates
time off. “Looking your best is always
runners. She also served on the Chicago
is located at 245 East NC Highway 54,
a confidence booster,” she says. “Who
board of Girls on the Run, a group that
Suite 202, Durham, N.C. 27713. Learn
doesn’t want that?”
teaches young girls life lessons through
more at www.skinwellnessdermatology.
sports. She is also an active member of the
com and visit the practice on Facebook:
Dr. Jackson brings experience from her
local chapter of Jack and Jill of America
skin wellness dermatology associates. Dr.
practice in a variety of clinical scenarios.
Inc., a national service organization.
Jackson can be reached at (919) 294-9440.
She has held academic appointments
Patient care is supported by a well-trained, compassionate medical team.
8
The Triangle Physician
Cosmetic Vs. Medicinal
Dermatology
Treating the Causes Rather Than the Symptoms By Margaret B. Boyse, M.D.
There are now many options for cosmetic
explain to them that we need to start
treatments outside of the traditional der-
by treating the precancerous lesions
matology clinic. Med spas and aesthetic
on their skin, which will reverse the
centers offer laser treatments to minimize
aging process and increase collagen
hair, moles, age spots, acne, wrinkles, etc.
production. As a result, the patients look younger and healthier before we
These generally are satellite campuses
even start with Botox.
owned or overseen by a single doctor who probably is not onsite. The benefit to
2. W e often have patients who approach
this sort of system is it allows the company
us wanting to get rid of their acne
to offer treatments at a slightly lower cost,
“scars” before they have recovered
but not without sacrifices.
from acne. Much of what they are seeing as red or brown marks are
Physicians should realize that cosmetic
temporary and can resolve on their
concerns are often linked to the actual
own once the acne is controlled.
health and vitality of the skin and body.
For textural changes, in other words
Aestheticians can easily overlook under-
a true scar, we can begin to treat
lying disease and treat symptoms instead
with cosmetic approaches, such as
of causes. A dermatologist, on the other
fractionated laser resurfacing.
Dr. Margaret Boyse of Southern Dermatology takes a conservative, affordable, holistic approach to determine if the simple solution is best or if she needs to apply more advanced technologies to treatment. She enjoys educating patients about prevention, building long-term relationships through excellent customer care and being a part of their lives through her medical practice. Specialties include: cosmetic dermatology, general adult and pediatric dermatology, dermatologic surgery and skin cancer.
4. P atients dealing with hair loss who are seeking transplantation might miss the
hand, understands the pathophysiology
underlying cause of the problem. The
of skin. This makes them uniquely able to
3. O ther patients approach aesthetic
hair loss could be caused by alopecia
understand and address root causes rath-
centers asking for laser treatments to
areata, lichen planopilaris, lupus or
er than endlessly hacking off branches.
minimize brown spots. Several things
any number of medical conditions,
can go wrong if we just start lasering
each requiring a different sort of
Here are four examples of skin treatments
these lesions away. Sometimes the le-
treatment.
that are addressed very differently by a
sion is a lentigo maligna melanoma.
dermatologist than an aesthetician:
Treating it like a mole or freckle can
This last example fits particularly well into
delay diagnosis for months to years.
my extended metaphor of addressing the
1. P erhaps one of the most common
Dermatologists are uniquely equipped
roots of the problems rather than cutting
concerns patients have is irregular
to recognize these often-subtle can-
down branches. Southern Dermatology
tone and texture of their aging skin.
cers and perform the needed biopsy,
understands the need for comprehensive
They normally present this problem
so treatment can begin. Often the pig-
care – care that treats causes and not
as a cosmetic concern, but the root of
mentation is the result of an inflamma-
just symptoms. The simple truth is that
their problem is often medical. Rather
tory condition that actually can’t be
cosmetic problems often have underlying
than starting with Botox or fillers, I
treated with lasers.
medical issues.
May 2016
9
Endocrinology
Multinodular Goiter By Michael J. Thomas, M.D., Ph.D.
Multinodular goiter is a common finding in
Infrequently a multinodular goiter can
patients with advancing age. As the name
become so massive that it begins to extend
implies, the features of this condition
substernally and surgical intervention is
include multiple nodules (usually benign)
advised to avoid impinging cardiac output,
in the setting of a large thyroid (i.e., goiter).
if the goiter abuts the great vessels of the heart or compromises lung volume.
The etiology of this condition is complex but may include genetic factors, nutri-
Thyrotoxicosis
tional/dietary factors (namely iodine) and
Patients usually initially develop sup-
gender.
pressed TSH, and over time this may become more pronounced, leading to frank
Histologically, chronic low-grade hyperpla-
elevations in free T4 and/or free T3. Mild
sia is thought to precede the development
hyperthyroidism is often subclinical, and
of benign colloid nodules. Thyroid func-
may persist in a borderline state for many
tion is typically normal at the outset but
months or years but usually eventually
may gradually become thyrotoxic (hyper-
become progressive. Sometimes iodinat-
thyroid) if these nodules develop autono-
ed contrast dye, such as that given for a
my. When this occurs it is termed “toxic
computed tomography scan or cardiac
multinodular goiter” and may eventually
catheterization, can trigger iodine-induced
require treatment.
hyperthyroidism in these patients.
At least three key issues need to be
American Thyroid Association guidelines
considered in patients with multinodular
recommend treating nearly all individuals
goiter.
who have frank elevations in free T4/free
Dr. Michael Thomas graduated from the School of Medicine at West Virginia University in Morgantown, with medical and doctorate degrees in pharmacology and toxicology. He completed post-graduate medical training at Barnes Hospital at Washington University in St. Louis, including his internship, residency and fellowship in endocrinology. Dr. Thomas established Carolina Endocrine, P.A., in the summer of 2005. He was previously a faculty member in endocrinology/medicine at Washington University, the University of Iowa and the University of North Carolina at Chapel Hill. Dr. Thomas is board certified in internal medicine and endocrinology and is licensed to perform endocrine nuclear medicine procedures and therapies at Carolina Endocrine. He is a fellow of the American College of Endocrinology and has completed Endocrine Certification in Neck Ultrasound.
T3 and any patient over the age of 65 with a
sometimes makes it challenging to distin-
Compressive Symptoms
TSH greater than 0.1. Also, any individuals
guish benign nodules from malignant nod-
These symptoms include neck fullness, dys-
with a history of cardiac disease or those
ules. There is a slightly higher risk of iden-
phagia, dysphonia or infrequently, stridor,
suspected of having other potential com-
tifying thyroid malignancy in this setting,
facial edema or tracheal deviation causing a
plications of hyperthyroidism (e.g. osteo-
though at least some of this may be due
restrictive lung disease pattern. Pemberton’s
porosis, psychiatric disorders) should be
to selection or observer bias. Thyroid ul-
sign is the development of facial edema af-
considered for treatment.
trasound may not accurately predict which nodule(s) is malignant or benign, although
ter holding the arms above the head for 30 seconds and suggests thyroid impingement
Radioiodine therapy or surgical therapy
certain sonographic features can heighten
on the great vessels in the neck.
is usually the preferred treatments. Anti-
or lessen the suspicion for malignancy.
thyroid drugs, such as methimazole, Massive goiter is best managed surgically
can also be used on a short-term basis,
Thyroid nodule size, long thought to be a
with a subtotal or total thyroidectomy.
but because the underlying nodules/
risk factor for malignancy, actually carries
Non-surgical candidates can sometimes be
hyperthyroidism never goes into remission
little impact on whether a particular
treated with radioiodine ablation, although
(unlike some cases of Graves’ disease) this
nodule is likely to be malignant or benign.
the results on goiter shrinkage are variable
is usually viewed as a temporary measure
If in doubt, thyroid fine needle aspiration
depending on iodine uptake and dose of
to a more definitive treatment.
(FNA) biopsy can accurately determine whether a nodule is likely to be malignant
I-131. Sometimes, cosmetic concerns are also a consideration in the decision to
Neoplasia
proceed with surgical intervention.
The presence of widespread nodular hyperplasia throughout the thyroid gland
10
The Triangle Physician
or benign. If a patient has thyrotoxicosis, a thyroid
Endocrinology
BE WELL.
nuclear medicine scan can identify hyperfunctioning (autonomous) nodules, which are termed “hot” nodules on thyroid scan. Nearly all “hot” nodules are benign hyperfunctioning
thyroid
adenoma,
whereas “cold” thyroid nodules carry ~20% risk of malignancy. Usually thyroid nuclear scans are of
Take control of your health. Take control of your life. We can help.
limited value in the setting of normal thyroid function tests, often confirming the findings on ultrasound; and if there is a question about whether a nodule is malignant in this setting, an ultrasoundguided FNA biopsy is more cost-effective, specific and sensitive to perform, than it is
Asheville Cary Chapel Hill Concord Durham Raleigh Wake Forest Wilson
to obtain a thyroid scan in a patient with
Carolina Partners
normal thyroid function tests. Asymptomatic euthyroid patients can be followed clinically and sonographically for signs of growth (compressive symptoms) or the gradual development of thyroid dysfunction or suspicious growths.
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Practice Management
Eight Corporate Compliance Tips Margie Satinsky, M.B.A.
Corporate compliance with federal and
programs under a corporate compliance
state laws is a must, not an option, in a
officer. In other practice settings, there is
well-managed medical practice. Here are
no such position and responsibility and ac-
eight practical suggestions for developing
countability are vague. We think it makes
a compliance program that meets industry
sense to start by centralizing responsibil-
standards.
ity for corporate compliance, then delegating responsibilities appropriately. For
1. Be Proactive, not Reactive
example, in many practices, the practice
The purpose of a corporate compliance
manager is the corporate compliance of-
program is to prevent violation of federal
ficer. He/she may retain responsibility for
and state laws. A comprehensive program
HIPAA Privacy and Security and delegate
is both a good strategy for avoiding prob-
responsibilities for OSHA, CLIA and cod-
lems and a good defense against com-
ing/billing compliance to members of the
plaints and possible external investigation.
clinical and billing staffs.
Make sure your compliance program positions you well and is not something you
3. Obtain Commitment and
address in a hurry when a problem arises.
Support from Very Top
Margie Satinsky is president of Satinsky Consulting L.L.C., a Durham consulting firm that specializes in medical practice management. She has helped many physicians start new practices, assess the wisdom of affiliating with a larger health care system and improve their current practices. Ms. Satinsky is the author of numerous books and articles, including Medical Practice Management in the 21st Century. For more information, visit www. satinskyconsulting.com.
Compliance with external legal require2. Understand Scope and Organize
ments only works if the entire practice is
information. They refused to require the
Program Appropriately
on the same page. Make sure the owners
use of secure user names and passwords
Corporate compliance means different
understand the importance and scope of
to view a computer screen. Everyone who
things to different practices. Some practic-
corporate compliance.
walked down a major corridor could eas-
es limit corporate compliance to the risk
ily see protected health information (PHI)
areas identified by the Office of Inspector
Not long ago the practice administrator
by looking to the right. In addition, one
General (OIG). We prefer a broader defini-
of a large practice in North Carolina re-
particularly resistant owner prided himself
tion. Our list includes: coding and billing,
quested our help with HIPAA compliance.
on the huge piles of paper medical re-
the provision of reasonable and necessary
An out-of-state management company
cords he kept on a desk in a room that was
services, appropriate documentation of
had responsibility for HIPAA but had not
visible and accessible to all. The practice
care in the medical record, completion of
provided adequate support. The admin-
administrator could only do so much be-
the CMS-1500 form, attention to improper
istrator knew that her practice was plac-
cause everyone wasn’t on the same page.
inducements/kickbacks/self referrals, re-
ing itself at great risk. Having previously
tention of medical and business records,
worked for a large health care system that
4. Know the Relevant Federal and
Health Insurance Portability and Account-
had compliance and risk management de-
State Laws
ability Act of 1996 (HIPAA) Privacy and
partments, she herself had never directed
One of the most important aspects of cor-
Security, Occupational Safety and Health
a compliance effort. During the course of
porate compliance is the understanding of
Administration (OSHA) and Clinical Labo-
the project, the practice accomplished a
federal and state laws that impact the run-
ratory Improvement (CLIA), if relevant.
great deal, but the administrator hit the
ning of a medical practice. At the federal
proverbial stonewall.
level, the most important statutes are the
Depending on a practice’s definition of
False Claims Act (FCA), the Civil Monetary
corporate compliance, both organiza-
The practice owners refused to take the
Penalties Act, the Stark Self-Referral Pro-
tion and delegation of responsibility vary.
steps necessary to protect the visibility
hibitions, the Anti-Kickback Act of 1986,
Some practices centralize all compliance
of computer screens with patient-specific
HIPAA, OSHA, and CLIA. Depending on
12
The Triangle Physician
quirements and internal operations. 7. Train the Workforce Once the Corporate Compliance Program is in place, make sure every workforce member understands the components. Create a structured training program and repeat it annually. Incorporate compliance into the orientation for all workforce members, including clinicians. In between formal training sessions, encourage workforce members to collaboratively discuss issues and concerns without fear of penalty. Make compliance an ongoing process, not a once-a-year event. the location of the practice different state
6. Develop Written Policies and
8. Marry Corporate Compliance
statutes apply.
Procedures
with Human Resources
Documentation is critical. For each aspect
Make corporate compliance an integral
It’s critical not only to know which laws
of corporate compliance, develop written
part of the practice’s human resources
apply, but also to remain up-to-date on
policies and procedures. Specify the pur-
program. Include corporate compliance
changes. HIPAA is a good example. The
pose, responsibility, accountability, proce-
requirements in job descriptions and dis-
law was passed in 1996. Although many
dures, monitoring and enforcement. Date
ciplinary procedures, reminding each
of the provisions of the original Privacy
the creation/revision of the policy and
workforce member of the obligation to
and Security Rules have remained intact,
procedures and review it regularly to make
support a culture of compliance as well as
both the 2009 Affordable Care Act and the
sure it remains compliant with external re-
to meet job expectations.
2013 Omnibus Final Rule made important changes. The definition of a breach has changed, and now Business Associates and Agents (i.e. subcontractors) as well as covered entities are liable. 5. Start with a Risk Analysis – and
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Physician Advocacy
Critical Condition:
Doctors Link Arms to Save Profession – Part 2 By Marni Jameson
All across America a movement is afoot that
the hospital, has opted out of Medicare and
is unlike any other. Doctors, who are fed up
out of contracts with “payors who give me
with the intrusion of government overreach
nothing but administrative headaches and
and corporate acquisitions, are speaking out
low reimbursements,” she said. “I got tired
and joining forces to protect their profession.
of playing ‘how low can you go.’ When you cut out the middleman, it’s much more
To survive, they are creating membership
affordable for patients.”
groups to fight the regulations crippling
Marni Jameson is the executive director for the Association of Independent Doctors. You may reach her at (407) 571-9316 or marni@aid-us.org. Visit www.aid-us.org for more information.
them and the pressure to succumb to
American College of Private Physicians
hospital employment.
While AAPS helps liberate doctors from
by overreaching government and corporate
the tyranny of third-party payers, the new
entities,” said Dr. Strickland. “Let My Doctor
The Association of Independent Doctors
American College of Private Physicians
Practice is a movement to restore the voice
(AID), a trade association that started in Flor-
(ACPP) helps them navigate the waters of
of the doctor to the practice of medicine.”
ida three years ago to enlighten consumers,
direct practice or concierge medicine.
businesses and lawmakers about the impor-
That means working to stop the intrusion
tance of supporting independent doctors,
Two years ago, AID executive board member
into the doctor-patient relationship by third
has grown like wildfire, spreading coast to
Thomas W. LaGrelius, M.D., a concierge phy-
parties, “fighting ‘Meaningful Use,’ which is
coast. It is working together with these other
sician practicing in Torrance, Calif., formed
a degradation of the medical record, and not
groups that are fighting for the same cause:
ACPP. “This group picks up where the AAPS
letting health insurers dictate care options
leaves off, helping members navigate the
over doctors’ recommendations,” Dr. Strick-
Association of American Physicians
day-to-day running of a concierge practice,”
land said.
and Surgeons
said Dr. LaGrelius, who estimates that 10,000
Although the Association of American Physi-
United States doctors are working this way in
Remarkably, while associations in the same
cians and Surgeons (AAPS) has been around
some fashion.
industry often compete for members, the op-
since 1943, lately it has taken a new tack.
posite here is true. Rather than elbow each
When I attended the AAPS annual meeting in
“We want to help doctors take back control,”
January in Orlando, the day focused entirely
he said.
on the topic of opting out of Medicare and
other out, we link arms. I’ve been a guest on Dr. George’s radio show,
Medicaid and even from some insurance
Let My Doctor Practice
Medicine on Call. I will deliver the opening
plans, so patients pay directly for services.
Last year, Let My Doctor Practice formed
address at the ACPP annual meeting in Las
under the direction of Michael Strickland,
Vegas this September. And I sit on the advi-
Elaina F. George, M.D., an Atlanta pediatric
M.D., an Ohio internist. The group conducted
sory committee of Let My Doctor Practice.
otolaryngologist, AAPS leader and AID
a summit in Keystone, Colo., where
member, spoke at the meeting and shared
practitioners gathered to discuss strategies to
“It’s simple,” said Dr. Strickland. “We all want
her partial direct-pay model. Direct pay, she
oppose the constraints tying doctors’ hands.
to return the practice of medicine to those
says, “is the future.”
who actually practice medicine. We are sick “We believe in the sanctity of the doctor-
Tired of the red tape, Dr. George, who has
patient relationship and the autonomy to
her own surgical center so she can bypass
practice medicine without restraint imposed
14
The Triangle Physician
of being told how to practice.” Atlas is shrugging.
Practice Marketing
Top Three Digital Marketing Strategies By Ted Gilbert
Probably the last thing you thought you’d
So the first goal of search engine optimization
be when you graduated medical school was
(SEO) is to make your site as search engine-
a digital marketer. But attracting patients in
friendly as possible. Doing so involves
today’s competitive health care markets
strategic selection of keywords and phrases
means making digital marketing an integral
that prospective clients/patients likely use
part of a practice’s marketing mix.
to search for your type of business online. For example: the words “eye” or “eyes” and
Getting started on Internet marketing leaves
“doctor” in addition to “ophthalmologist.”
many feeling lost in a virtual alphabet soup of acronyms and strategies. Here are
The next goal of SEO is to push your
the top three strategies that doctors and
business’s site to the top of search results.
practice administrators must understand to
This involves appropriate – not just liberal –
effectively apply digital marketing.
use of keywords within your online content, so is easily understood by prospective and
1. Pay Per Click
existing patients and search engines, which
Pay per click (PPC) may be the most
index online sites.
familiar digital marketing strategy to most
A veteran of the life sciences industry, Ted Gilbert honed his marketing skills starting in commercial medical product launches and later was introduced to digital marketing as the operations manager of a contract testing laboratory as a way to level the playing field with bigger companies competing solely on commodity-priced testing services. After finding his niche as a successful digital marketer capable of bringing immediate and lasting change to marketing initiatives, Mr. Gilbert joined Sam IT Solutions, where he specializes in the digital marketing of medical practices of all sizes and enjoys working closely with his clients to achieve sustainable return on investment (ROI).
people. Much like the old Yellow Pages, you
3. Content Marketing
put an ad (or “banner,” in the virtual world)
For most businesses and certainly health
in a directory and hope that it attracts the
care businesses, an educated consumer is
articles. Hubspot reports that marketers
attention of people looking in your section
your best customer. That’s why 50 percent
who prioritize blogging are 13 times more
of the phone book. People notice a large
of business-to-consumer companies intend
likely to achieve a positive return on
flashy ad for your medical practice over the
to increase their content marketing budget
investment.
plain listings of your competitors.
in 2016, according to the Content Marketing Institute.
So, what’s the best content marketing
There are two things that make PPC
approach for your health care business? A
advertising better than the print ads in the
Content
strategic
mix of all three should be used to build a
Yellow Pages. You don’t pay a flat fee and
placement of valuable, relevant content that
balanced, steady lead-generation stream for
hope patients notice your ad. You pay per
will keep Internet users on, and returning
your medical practice.
click, meaning you are only required to
to, your practice’s digital site. It requires an
pay for the service when a prospective
understanding of the type of information
For quick results, PPC ads will bring
customer actually clicks on your ad. The
prospective clients/patients are seeking.
consumers to your site. Relevant and
marketing
is
the
feature also gives you the added control of
valuable content marketing, such as a
reviewing and updating your listings at any
If you have effectively selected keywords
blog or social media feed, will keep them
time.
and clients navigate to your site based
there. For long-term, sustainable returns,
on the content provided, then you are
effective SEO will ensure customers find
2. Search Engine Optimization
increasing SEO and turning curious Internet
your website.
If search engines (Google, Yahoo, Bing,
searchers into patients “organically,” or as a
etc.) can’t find your practice’s online site,
natural result.
To learn more about how these marketing
your prospective patients won’t find it either.
strategies work or how Sam IT Solutions can Content marketing could be in the form
help you attract and retain patients, send an
of e-mails, Facebook posts or blogging/
e-mail to Ted@SamITSolutions.com.
May 2016
15
Women’s Health
Solution for Improved Feminine Life By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.
The Women’s Wellness Clinic is one of the
How Does FemiLift Work?
first in North Carolina to offer FemiLift, a
FemiLift uses the thermal heating and
minimally invasive, outpatient laser solu-
micro-ablation of the carbon dioxide
tion for vaginal health issues.
fractional laser, the gold standard in skin resurfacing. The energy waves applied to
Aging, childbirth, weight fluctuations and
layers of vaginal tissue stimulate collagen
hormonal changes are among the causes
regeneration, contracture of elastin fibers,
of damage to vaginal tissue and the pelvic
neovascularization and improved vaginal
floor, which can alter the mucosal tone
lubrication.
of the vaginal wall. These physiological changes can lead to such conditions as
FemiLift is performed in our office. There
stress urinary incontinence, vaginal atro-
is no anesthesia and little-to-no downtime.
phy, dryness and recurring infections, all
The laser is precisely delivered, so sur-
of which can affect sexual functioning and
rounding tissue is not impacted, speeding
routine activities, causing pain, discomfort
up recovery time.
and embarrassment.
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.
disappearance of small lesions associated with low estrogen and an increase in vaginal secretions. Safety and Treatment Strategy When I counsel women on this new, elective procedure, I emphasize how safe it Many women believe these conditions are
Patient Satisfaction
is. Safety is enhanced by proper training,
normal and simply accept them. Others
Recently, a woman in her mid 50s com-
thorough understanding of the technology
seek out treatment options that have in-
plained of vaginal dryness and discomfort
and procedural expertise.
cluded vaginal lubricants, such as Replens
with intercourse. She was using low-dose
and Lubrin, and hormonal replacement
HRT. There are reasons why she did not
There are almost no side effects and the
therapy (HRT).
want to increase her dose. She also didn’t
benefits can be life changing.
want to use vaginal estrogen. We recommend three treatments, with ap-
FemiLift is an alternative that enables med-
proximately four to five weeks in-between.
ical practitioners to treat various feminine
She underwent FemiLift with little-to-no
indications, restoring vaginal tissue to a
pain. On follow up she expressed subjec-
more youthful state. Women report an al-
tive improvement in function and overall
More Information
most immediate return to normal activity,
satisfaction. On physical examination, she
More information can be found at www.femi-
including sexual intercourse.
had objective improvement in the color of
lift.com. Our clinic is offering free, 15-minute
the vagina, mucosal appearance with the
consultations regarding the procedure.
16
The Triangle Physician
Duke Research News
Anti-Cancer Approach Seems to Attack Cancer Cells and Not Other Cells
Edward F. Patz, Jr., M.D.
A research team from
One of the features that separated these
Once the antibody for CFH was identi-
Duke Health has devel-
patients from those who had more lethal
fied, Dr. Patz and colleagues sought to ex-
oped an antibody from
tumors was the presence of antibodies
plore how this immune response could
the body’s own immune
against a protein called complement fac-
be optimized as a cancer therapy. Critical
system that preferential-
tor H, or CFH, which protects cells from
to that effort, according to the press ad-
ly attacks cancer cells.
an immune system attack, according to a
visory, was finding a way to produce an-
Duke Health press advisory,
tibodies that recognized the exact-same part of CFH as the autoantibodies made
The antibody works by targeting a natural defense mechanism that cancer tumors
CFH works by preventing activation of an
by the early-stage cancer patients. This
exploit.
important immune response. It inhibits the
assured the antibodies would have a par-
deposit of a complement C3b protein on
ticular affinity for cancer cells.
Cells in the body essentially use a home
the cell surface. Complement C3b initiates
security system that relies on certain pro-
the degradation of the cell membrane,
Dr. Patz and colleagues pooled the white
teins to protect the cell surface and keep
which eventually leads to cell death.
blood cells from CFH antibody-producing
it safe. These proteins help the cell avoid injury and even death from unwanted activation of the immune system. In a paper published online May 5 in Cell Reports, the Duke team describes the workings of a cancer-fighting antibody they discovered, developed and tested in cell lines and animal models. The
A new angle on battle against cancer A protein in the body called complement factor H, or CFH, helps protect the body’s cells against an immune system attack.
rived antibody developed as an anti-cancer therapy, which is very different from other immunotherapy approaches,” said
CFH protein
...taken away... More people whose cancer had not spread, had a specific antibody that works against the CFH protein. Since CFH protects cells, having an antibody that disables this layer of protection, can allow cancer cells to be destroyed.
People whose cancer spread.
People whose cancer did not advance beyond stage 1.
Scientists cloned the antibody from the patients
senior author Edward F. Patz, Jr., M.D., the James and Alice Chen professor of ra-
CFH does this by blocking another protein (C3b) from penetrating the cell surface and instigating cell destruction. Cancer cells exploit this cell protection.
cell surface
cancer cell’s defense system and then
“This is the first completely human-de-
C3b
A layer of protection...
antibody dismantles a specific part of a employs several mechanisms of attack.
C3b
Anti-CFH using a process that would ensure the antibody antibodies only affect cancer cells.
CFH protein
diology and professor in the Department of Pharmacology and Cancer Biology at Duke.
The antibody disabled CFH, allowing the protein (C3b) to initiate cell destruction.
...may lead to the body’s ability to effectively destroy cancer cells.
C3b
The cloned antibodies were tested on human cell tumor lines and in mice. The antibodies caused tumor death and inhibited tumor growth. Since only cancer cells are attacked, this represents a promising new treatment approach.
Dr. Patz and colleagues include principals from the Duke Human Vaccine Institute, who have been advancing the development of antibodies for an HIV vaccine.
C3b cancer cell surface
They started their cancer-fighting pursuit with the observation that some lung can-
The damage to the cell also triggered a cascade of other cells that created a beneficial immune system response.
inflammatory cells
cer patients have early-stage tumors that never progress to advanced disease.
Alisa Weigandt for Duke Health
May 2016
17
Duke Research News cancer patients and then isolated and
effects. The antibodies also appeared to
side effects to achieve tumor control,” Dr.
cloned the antibody genes from single
trigger an additional adaptive immune
Patz said. “We believe we can modulate
immune cells that make the specific an-
response when the damaged cells sent
the immune response and let the body’s
tibodies.
signals to recruit an army of lympho-
own immune system take over to either
cytes, creating a potentially more lethal
kill the tumor or keep it from growing.”
According to Duke Health, this was an
systemic attack. In addition to Dr. Patz, study authors
efficient process that enabled the researchers to produce mature antibodies
“We believe it might be this additional
include Ryan T. Bushey; M. Anthony
that recognized the same region of CFH
cellular response that could potentially
Moody; Nathan Nicely; Barton F. Haynes;
targeted by the original patient’s immune
have the most profound impact on can-
S. Munir Alam; Stephen T. Keir; Rex C.
systems – therefore leading to the attack
cer outcomes long term,” Dr. Patz said,
Bentley; Kingshuk Roy Choudhury; Eliza-
of cancer cells, not healthy cells.
noting that further tests would be re-
beth B. Gottlin; Michael J. Campa; and
quired to understand the full potential of
Hua-Xin Liao.
The researchers then tested the antibod-
the approach. The study received funding from the LUN-
ies in multiple cancer cell lines, including lung, gastric and breast cancers, in
“This could represent a whole-new ap-
Gevity Foundation, the Department of De-
lab dishes and in tumors in living mice.
proach to treating cancer, and it’s excit-
fense (W81XWH-13-1-0189), the National
They found that the antibodies caused tu-
ing because the antibody selectively kills
Institutes of Health (UL1TR001117) and
mor cell death without any obvious side
tumor cells, so we don’t have significant
the Duke Translational Research Institute.
Breast Cancer Expert Named to TIME’s 100 Most Influential People Shelley Hwang, M.D.,
treated, according to a Duke Health press
chief of breast surgery
advisory.
conservative approach to DCIS. “Shelley is an exceptional surgeon-
at the Duke Cancer been
Dr. Hwang’s research and advocacy
scientist, who is, through elegant and
named one of TIME’s
for a more informed approach to
focused investigation, redefining our
100
DCIS
could
understanding of breast cancer,” said
include lumpectomy and/or ongoing
Allan D. Kirk, M.D., Ph.D., chairman
surveillance
aggressive
of the department of surgery at the
One of the world’s foremost experts in
radiation or mastectomy – has helped
Duke University School of Medicine
early-stage breast cancers, Dr. Hwang
spur
and surgeon-in-chief at Duke Health.
has become an international leader
has been a voice for women who are
“However,
calling for research to guide treatment
diagnosed with DCIS to receive the best
the
for ductal carcinoma in situ (DCIS), in
treatment available while sparing them
understanding she brings to each of her
which abnormal cells are detected in the
unnecessary procedures that don’t help
patients. She sets the standard for other
lining of a milk duct, but haven’t spread
or may even cause harm.
surgeons to follow.”
Dr. Hwang and fellow breast cancer
Dr. Hwang’s work in the operating
DCIS is the most common form of
surgeon Laura J. Esserman, M.D., MBA,
room and in the lab has focused on
noninvasive breast cancer in the United
of the University of California, San
the evolutionary basis for how breast
States, and accounts for about 20 percent
Francisco, share the honor in TIME.
cancer progresses. Her lab also is
of all new breast cancer cases diagnosed
Musician Melissa Etheridge, who is
working to identify common biomarkers
from
Institute, Shelly Hwang, M.D.
most
has
influential
people for 2016 as a pioneer in her field.
treatments
–
which
instead
international
of
discussion.
She
her
genuine
strongest empathy,
trait care
is and
to other tissues.
But
a breast cancer survivor and activist,
of cancer progression that in the future
doctors are divided on how some
provides comments for TIME about
could lead to clues in preventing the
patients with low-risk DCIS should be
these two top-100 winners and their
disease. In addition, Dr. Hwang serves
18
mammogram
The Triangle Physician
screenings.
NEWSOURCE-JUN10:Heidi
8/5/10
Page Research 1 Duke News
12:57 PM
on committees for the National Cancer Institute and National Comprehensive Cancer Network and is an advocate for cooperative group clinical trials in
Do They Like What They See?
breast cancer. Dr. Hwang is currently leading a
Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.
national study evaluating how an oral hormone blocker could treat women with low-risk DCIS that may be fueled by estrogen. She is also the principal investigator of the first large, national
Our services range from consultation, to design, to creation and implementation of strategic plans.
trial that will compare the benefits of surgery or monitoring for patients with low-risk DCIS. She and co-investigators hope the trial provides landmark data to
RADAR: BAY15001 Ad: Version 1 for low-risk breast Date: 6/15
help identify the least invasive and most effective treatments cancer.
newsource & Associates
“This an important study of more than 1,000 women that asks when it may be appropriate for women diagnosed with DCIS to omit surgery,” Dr. Hwang
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Our network of smart, creative, award-winning specialists serves the health care industry throughout the Mid-Atlantic.
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said. “We have assembled a dedicated multidisciplinary team of investigators and patients across the country to address a fundamental question about how we think of cancer and cancer treatment. I am proud that Duke and Duke Surgery provide an environment where we can address such questions.” Dr. Hwang joins a prestigious roll on the TIME list, which this year honors the activism, innovation and achievement of
artists
and
leaders
including
Christine Lagarde, Priscilla Chan and Mark Zuckerberg, Ta-Nehisi Coates, Leonardo DiCaprio, Aung San Suu Kyi and Kendrick Lamar. Dr. Hwang is the second Duke Cancer Institute physician to be named to the TIME list. In 2013 medical oncologist Kimberly Blackwell, M.D., was an honoree. A full list of this year’s TIME 100 most influential people appeared in the May 2 issue of the magazine. It is currently
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May 2016
19
WI
News Welcome to the Area
Physicians
Alexander Jefferson Craft, DO Diagnostic Radiology; Musculoskeletal Radiology; Radiology
Duke University Hospital Durham
Kendall Leonard, DO Anesthesiology
Pinehurst Anesthesia Associates Pinehurst
Benjamin Stevens Bryner, MD
Melissa Jean Fitzgerald, MD
Elizabeth Grace Jarvis, MD
Thoracic Surgery
Pediatrics
Obstetrics and Gynecology
Duke University Hospitals Durham
Eileen Tsai Chambers, MD Pediatric - Nephrology
Duke University Medical Center/ Children’s Health Center Durham
Don Clarence Chaplin, MD
Khoa Mai Nguyen, DO
Burlington
Orthopedic Surgery; Orthopedic Surgery, Adult Reconstructive
Jeffrey Cheng, MD
Triangle Orthopaedic Associates Durham
David Edgar Deleon Tolentino, DO Internal Medicine
Campbell University Lillington
Amir Aghajanian, MD Cardiology; Internal Medicine
Otorhinolaryngology; Pediatric Otolaryngology
Duke Children’s Hospital & Health Center Durham
Jason Yebin Cho, MD Child Psychiatry; Psychiatry
Duke University Hospitals Durham
University of North Carolina Hospitals Chapel Hill
UNC Hospital Chapel Hill
Kimberly Elizabeth Fryer, MD
Pediatrics
Obstetrics and Gynecology
UNC Healthcare Chapel Hill
Marame Khaled Gattan, MD Alcohol and Drug Abuse; Anesthesiology; Cardiovascular Disease, Internal Medicine; Critical Care Surgery; Critical Care-Internal Medicine; Emergency Medicine; Internal Medicine; Obstetrics; Obstetrics and Gynecology; Ophthalmology; Orthopedic Surgery
Duke University Hospitals Durham
Thaidra Ann Gaufin, MD Internal Medicine
UNC Hospitals Chapel Hill
University of North Carolina Hospitals Chapel Hill
Julien Mathieu Cobert, MD Chapel Hill
Christopher Jordan Hancock, MD
Laura Kathleen Altom, MD
Michael Kevin Dougherty, MD
Anesthesiology
Colon and Rectal Surgery; Surgery
Rex Surgical Specialists Raleigh
Arthur Wakefield Baker, MD Infectious Diseases, Internal Medicine
Anesthesiology; Internal Medicine
Gastroenterology, Internal Medicine; Hospitalist; Public Health
UNC Gastroenterology Chapel Hill
Eugenie Du, MD
Duke University Medical Center Durham
Head and Neck Surgery; Otolaryngology - Plastic Surgery Within the Head and Neck
Adam Zachary Banks, MD
UNC Dept of Otolaryngology Chapel Hill
Cardiovascular Disease, Internal Medicine
Duke University Hospitals Durham
Dane Michael Barrett, MD Otolaryngology - Plastic Surgery Within the Head; Neck
Duke Otolaryngology of Durham Durham
Megan Rebecca Barrett, MD Obstetrics and Gynecology
Duke Women’s Health Associates Durham
Ashley Nicole Battarbee, MD Obstetrics and Gynecology
UNC Maternal-Fetal Medicine Chapel Hill
Meghan Kay McPheeters Black, MD Hospitalist; Internal Medicine
University of North Carolina Hospitals Chapel Hill
Sonya Thomas Blizzard, MD Ophthalmology
Michael Sean Enslow, MD
Megan Dale Henley, MD Anesthesiology
Duke University Medical Center Durham
Aaron David Falchook, MD
Derrick John Hoover, MD
Radiation Oncology
University of North Carolina Hospitals Chapel Hill
Adolescent Medicine; Dermatology; Diabetes; Family Medicine; Family Practice; General Practice; General Preventive Medicine; Geriatrics; Urgent Care
Nicholas Craig Farber, MD
Advance Community Health Raleigh
Ophthalmology
UNC-CH Department of Ophthalmology Chapel Hill
Oluwadamilola Motunrayo Fayanju, MD
General Surgery; Surgical Oncology Duke University Hospital Durham
Duke University Eye Center Durham
The Triangle Physician
Duke University Medical Center Durham
Duke University Hospitals Durham
Gregory Daniel Brown, MD
20
Neurological Surgery; Neurological Surgery, Critical Care; Vascular and Interventional Radiology
UNC Hospitals Chapel Hill
Avni Patel Finn, MD
Duke University Hospital Durham
Erik Friedrich Hauck, MD
Diagnostic Roentgenology Radiology; Musculoskeletal Radiology; Neuroradiology; Nuclear Medicine; Nuclear Radiology; Pediatric Radiology; Vascular and Interventional Radiology
Duke Eye Center Durham Internal Medicine; Psychiatry
University of North Carolina Hospitals Chapel Hill
Ophthalmology
Julian Thornton Hertz, MD Emergency Medicine
Alicia Germaine Howard, MD Hospitalist; Internal Medicine
Catawba Valley Medical Center Hickory
Austin Archie Howard III, MD Internal Medicine
University of North Carolina Hospitals Chapel Hill
Abigail Elizabeth Huang, MD Ophthalmology
Duke Eye Center Durham
Jacob Keith Johnson, MD UNC Hospitals Chapel Hill
Andrew Robert Karenz, MD Anesthesiology
University of North Carolina Hospitals Chapel Hill
Cristine Nicole KlattCromwell, MD Head and Neck Surgery; Otolaryngic Allergy; Otolaryngology; Otolaryngology - Neurotology; Otolaryngology - Plastic Surgery Within the Head & Neck; Otolaryngology, Otology-Neurology; Otolaryngology/ Facial Plastic Surgery
University of North Carolina Hospitals Chapel Hill
Harajeshwar Singh Kohli, MD Emergency Medicine
Duke University Medical Center Durham
Matthew Kirk Langman, MD Diagnostic Radiology; Radiology; Vascular and Interventional Radiology
Duke University Hospitals Durham
Lindsay Roofe Lavin, MD Pediatric - Emergency Medicine; Pediatrics
Wake Emergency Physicians, PA Cary
Wonchon Lin, MD Ophthalmology
Duke University Eye Center Durham
Sheppard Allen McKenzie III, MD Gynecology
Raleigh
Megan Ann McNamara, MD Hematology and Oncology, Internal Medicine; Hematology, Internal Medicine; Internal Medicine; Medical Oncology
Duke University Medical Center Durham
Shriti Masrani Mehta, MD Cardiology; Cardiovascular Disease; Internal Medicine - Interventional Cardiology
UNC Hospitals Chapel Hill
Brian Edward Moore Jr, MD Psychiatry
UNC Hospitals Chapel Hill
News Welcome to the Area Haley Arden Moss, MD
Elizabeth Schweighofer
Gynecology/Oncology; Obstetrics & Gynecologic Surgery; Obstetrics & Gynecology - Gynecologic Oncology; Obstetrics and Gynecology
Sandberg, MD
Department of Gynecologic Oncology Durham
Liliana Nanez, MD General Surgery; Vascular Surgery
Rex Vascular Specialists Raleigh
Venu Nemani, MD Orthopedic Surgery; Orthopedic Surgery of the Spine
Raleigh Orthopaedic Clinic Raleigh
Hien Ngoc Nguyen, MD Addictionology or Addiction Medicine; Administrative Medicine
Western Wake Treatment Center Apex
Myles Stanley Nickolich, MD Hematology and Oncology, Internal Medicine; Internal Medicine
Duke University Hospitals Durham
Sarah Elizabeth Nickolich, MD Family Medicine
University of North Carolina Hospitals Chapel Hill
Latoya Cherry Patterson, MD Obstetrics and Gynecology
Duke University Hospitals Durham
Eric Davis Pauley, MD Cardiology; Hospitalist; Internal Medicine
University of North Carolina Hospitals Chapel Hill
Richard B Phinney, MD Ophthalmology
Pinehurst
Chad Edward Pletnick, MD
Pediatrics
University of North Carolina Hospitals Chapel Hill
Jill Annette Schaeffer, MD Internal Medicine
Duke Primary Care Raleigh
Joseph John Schreiber, MD Orthopedic - Surgery of the Hand; Orthopedic, Hand Surgery
Raleigh Orthopaedic Clinic Raleigh
Sounok Sen, MD Cardiovascular Disease, Internal Medicine; Internal Medicine
Duke University Hospital Durham
Evan Samuel Shelby, MD Internal Medicine
University of North Carolina Hospitals Chapel Hill
Pediatrics
Duke University Hospitals Durham
Kaitlin Marie Ryan, MD Administrative Medicine; NeonatalPerinatal Medicine; Pediatrics
Duke University Medical Center Durham
Duke University Hospitals Durham
Monica Casey Tang, MD Allergy and Immunology; Internal Medicine; Pediatrics
Duke University Hospital Durham
Genevieve Louise Taylor, MD Pediatrics
University of North Carolina Hospitals Chapel Hill
Sandra Leta Silberman, MD Hematology and Oncology, Internal Medicine; Hematology/Oncology; Internal Medicine
VA Medical Center Durham
Jessica Son, MD General Preventive Medicine; Gynecology; Obstetrics; Gynecologic Surgery
Associates in Women’s Healthcare Raleigh
Michael Landron Soo, MD Neurology; Sleep Medicine
Durham Ophthalmology
Hospitalist; Internal Medicine
Jonathan Doo Young Yun, MD Dermatology; Diabetes; Family Medicine; Family Medicine Adolescent Medicine; Family Practice; Public Health; General
UNC Family Medicine Clinic Chapel Hill
Wenlan Zhang, MD Ophthalmology; Pediatric Ophthalmology
Duke University Durham
Gaurav Telhan, MD Physical Medicine; Rehab - Pain Medicine; Physical Medicine and Rehabilitation
University of North Carolina Spine Center Chapel Hill
Rebecca Elizabeth Traub, MD Neurology; Neuromuscular Medicine
Christopher Lawrence Weller, MD
UNC Kittner Eye Center Chapel Hill
Candice Marlow Roberts, MD
Duke University Hospitals Durham
First Health Moore Regional Hospital Pinehurst
Department of Anesthesiology at Duke University Medical Center Durham
Cary
Internal Medicine; Pulmonary Disease and Critical Care, Internal Medicine
Hospitalist
Randall Noah Stein, MD
Emergency Medicine
Eric Michael Yoder, MD
Department of Neurology, University of North Carolina at Chapel Hill Chapel Hill
Moushumi Rahman Shumi, MD
Anesthesiology; Anesthesiology - Pain Medicine
Nicholas David Reid, MD
Aparna Chandra Swaminathan, MD
Ophthalmology
Duke Eye Center Durham
Benjamin Joseph White, MD Obstetrics and Gynecology
Physician Assistants
Jennifer Lynn Beard, PA Family Medicine; Family Medicine Adolescent Medicine; Family Medicine - Geriatric Medicine; Family Practice; Family Practice/Geriatric Medicine; General Practice; Sleep Medicine
Rural Health Group Henderson
Michelle Christine Johnson, PA Gastroenterology, Internal Medicine
Kernodle Clinic West Burlington
Betsy Clifton Joyner, PA Pediatrics
University of North Carolina Hospitals Chapel Hill
Cary
Michelle Joette White, MD
Central Dermatology Center Chapel Hill
Pediatrics
University of North Carolina and NC Children’s Hospital Chapel Hill
Benjamin Marshall WildmanTobriner, MD Diagnostic Radiology; Radiology
Duke University Hospitals Durham
Jessie Peyton Wilson, MD
Stephanie Marie Knutson, PA Dermatology
James Lance McGhee, PA Orthopedic Surgery
Kernodle Clinic Burlington
Dennis Charles Polley II, PA Dermatology
Polley Clinic of Dermatology Wilson
Pediatric Infectious Diseases; Pediatrics
Rebecca Stone Ramey, PA
University of North Carolina Hospitals Chapel Hill
Family Practice
Rural Health Group-Whitakers Whitakers
Duke University Medical Center Durham
Noah Bedford Wohlert, MD
Stephanie Marie Reese, PA
Stephanie Gauder Sussman, MD
University of North Carolina Hospitals Chapel Hill
Matthew Nicholas Suberlak, MD Diagnostic Radiology
Pediatrics
University Pediatrics at Chapel Hill North Chapel Hill
Family Medicine
Pediatrics
Mebane Pediatrics Mebane
John Patrick Yeatts, MD Hospitalist
Duke University Hospital Durham
May 2016
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