M a r i o n - P o l k C o u n t y M e d i C a l S o C i e t y

President’s Message | 3

Legally Speaking | 4

Tax Planning | 6

Wealth Management | 8

Emergency Planning | 10

MedAssist and Project Access Benefit | 19

Chart Notes®a p r i l 2 0 1 1

a Passion for Justice:Francine Boullosa, mpas, pa-c

By Eric Schuman, PA-C

While on a shopping trip with her mother, only ten years old, Francine Boullosa found herself bored. She felt like she’d had

enough of shopping, so she walked out of the store, thinking she was headed home. “I was a bad girl,” she explains. Attractive and blond, and appearing four years older than her age, she missed a turn and found herself walking five miles through the most dangerous part of the Bronx, New York. Leered at, propositioned, and not understanding the risk she had taken, she was lucky to make it home safely. “I did something rebellious and found myself incredibly vulnerable. From that frightening experience, I learned that when you are scared, you lose your ability to problem solve.”

Francine attributes her core value of compassion for others to the Catholic Church she attended in the Bronx. “It was an underpinning to everything that other people really mattered.” At 13, inspired by Michael Harrington’s book, The Other America, she realized that powerful ideas about the human condition often come from books. Thus, it was no surprise when she became an R.N., and later enrolled in VISTA (Volunteers in Service to America), where she was instrumental in launching a community sewing cooperative for poor black women in northern Florida. While there she learned about the Child Health Associate Physician Assistant Program at the University of Colorado – emphasizing service to disadvantaged, at risk and medically underserved populations. Continued on page 16

South Sister and Green Lakes photography by Eric Schuman

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3Chart Notes®

Older 6 MOnth CategOry

yOunger 6 MOnth CategOry

Soccer World tournament teams (under age 21) 79% 21%

Various european Professional 66 - 55% 34 - 45%

Hockey elite youth 72% 28%

nHl 62% 38%

Professional Baseball united States 55% 45%

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Marion-Polk County Medical Society

Mark Fischl, M.D.President

Scott Stice, M.D.President-Elect

Mark Gilbert, M.D.Immediate Past President

Dean Larsen, M.A., CAE Editor

Executive DirectorCorporate Secretary

Jodilou Berry Assistant Editor

In House Graphics Layout and Design

2995 Ryan Drive S.E., Suite 100Salem, Oregon 97301

(503) 362-9669FAX (503) 362-0109

e-mail: director@mpmedsociety.org website: www.mpmedsociety.org

ChartNotes® is a monthly publication.The purpose of this publication is to

provide information of interest to the local medical community. Unless stated

otherwise, opinions expressed in any article are solely those of the author

and are not necessarily endorsed by the Marion-Polk County Medical Society,

its employees, officers or directors. The editors welcome letters or articles

for publication. Deadline for submission of copy is the 15th of the

month prior to publication. Acceptance of advertising in no way constitutes

professional approval or endorsement of products or services advertised.

The Marion-Polk County Medical Society reserves the right to reject

any advertising.

Advertising rates are available from the Medical Society office.

3212

6

MessageP R E S I D E N T ' S

A few years ago I was sitting at a table with a group that

included two other doctors. The conversation turned to how much money was spent trying to influence our practice behavior. The short version is they both felt that it was a waste of money as they did not feel they were influenced. Their decisions were made on facts or data and they did “what worked best.” I posed a simple question; how do we know if we are influenced? How much time, effort and money do we spend to see how we are influenced? My questions were not about integrity but about our assumptions about how we make decisions. My impression was that they took offense at the question and the conversation moved on. So I thought I would look at some less personal and more subtle ways that humans can be influenced.

Birthdates: there are interesting studies looking at month of birth and success in varying sports. They are based on the concept of relative age within the cohorts that are intention-ally lumped together. If an age cut-off date is January 1st, then children born in January will be almost a year older than those born in December of the same cohort. If you start the

sport at age five or six there is up to 15- 20% difference in age. If you begin selecting out more apparently talented individuals around age 12 or 13 there are significant differences in developmental milestones related to puberty. Unintentionally a course can be set for future success or failure caused by factors such as increased playing time, increased practice time, more and better coaching and the psychological reward of being good at something that leads to more persis-tent effort. Conversely for those that are not as successful at a voluntary activity they are more likely to drop out. These differences are profound in European and South American foot-ball (soccer), Canadian hockey, and present, though less so, in American born baseball players. The skewing of birth month is seen through more prominently in their respective train-ing or minor leagues and is carried on into the professional ranks.

You can split the one year (same age) cohorts into two equal size groups. The first being the older six months, the second the younger six months and compare who progresses to the higher or elite levels of their sport. (See table.) If you compare

Influences By Mark Fischl, M.D.

3Chart Notes®

Continued on page 12

4

strategies, however, are ethical and highly advisable. An analogy can be drawn to tax planning. Some schemes that are called “tax planning” are nothing more than illegal and fraudulent evasions of taxes. Legitimate tax planning, however, is essential for both businesses and individuals. Similarly, legitimate asset protection planning is important for businesses and individuals, especially in our litigious society.

Doctors Need asset protectionIf you are a physician, your need for asset protection

planning is compelling. Two strong indicators of the need for and willingness to plan for asset protection

SpeakingL E G A L L Y

Continued on page 5

You Can Make It…But Can You Keep It?Asset Protection for Physicians

By Eden Rose Brown, JD – Attorney and Counsellor at LawPast Board Member of the Marion-Polk County Medical Society Foundation

My practice has recently seen an increased interest in asset protection among our local physicians. I find,

however, that although it sounds appealing, most doctors are not exactly sure what “asset protection planning” is.

lawfully protecting What’s YoursAsset protection planning is simply the process of

lawfully protecting your personal and/or business assets from creditors. It involves taking advantage of laws and legal doctrines that were actually designed to help you protect your assets.

“Asset protection” sometimes has a bad connotation due in part to illegal offshore tax haven schemes and other questionable planning techniques. Many asset protection

5Chart Notes®

Legally Speaking . . . continued from page 4.

are having wealth and having a high income. Doctors usually have both of these indicators, and that can make you a target.

Another strong indicator of the need for asset protection is being in a profession whose members are more likely than average to be sued. Here, again, we find doctors (along with insurance professionals, financial advisors, and yes, lawyers). Nearly 100% of neurosurgeons, cardiovascular surgeons, and OB-GYNs will be sued at least once during their careers, as will 90% of general surgeons and radiologists. In fact, each year, 50% of the U.S. neurosurgeons, and 33% of U.S. orthopedic and trauma surgeons and emergency room (ER) physicians are sued. Other types of doctors are also sued far more often than those in other professions. Being sued is a very personal and painful experience.

Planning Tip: We live in a victim-oriented society, and doctors are viewed as a deep pocket that can afford to pay for an injury.

Doctors GenerallyIn my experience, doctors are caring and intelligent

people whose personality and training is to be trusting and non-confrontational. Sometimes that trusting nature gets you into trouble, as when you fall prey to pitches for risky planning or what turns out to be a risky investment.

As a doctor, you have sacrificed years of your life and have made heavy financial sacrifices to get where you are. You want to protect the wealth you have accumulated from being stolen or taken from you and your loved ones. It is important to the planning process, however, to understand that there is more to asset protection than protecting against a malpractice claim. Although a lawsuit is what doctors fear first and foremost, in reality, physicians lose more wealth through divorce, poor investments or bad tax planning, than through a malpractice claim. Good asset protection addresses all your known risks, not just what appears to be the most obvious.

Begin with the Foundational planning As physicians, you are no different from other

professionals in the probability that you may have done some basic, traditional estate planning. It is likely, however, that your estate plan is out-of-date, particularly with how rapidly tax laws and societal norms have changed over the past decade. While asset protection may be your “hot button” issue, you must also review your foundational planning to make sure that documents are proper and up to date, there is adequate life insurance, and that you

have established and implemented an appropriate wealth accumulation plan.

Build the proper Structures and EntitiesAfter you have reviewed and updated your foundational

planning, next you should make sure that you have the proper structures in place for your practice. A good practice structure typically includes at least the following:

• Professional corporations

• Subchapter S elections

• Shareholder agreements

• Segregation of assets

Next, to reduce your liability exposure, consider segregating your professional assets as follows:

1. Place the real estate in a limited liability company (LLC) and lease it to your professional practice or business;

2. Place the office and medical equipment in an LLC and lease it to your professional practice or business; and

3. Create a separate liability-protected entity to provide business or practice functions and operations other than the actual medical treatment.

Continued on page 11

6

Individual tax planning often focuses on the income tax and often times involves a single year or maybe two

but rarely more. The current (for 2010-2012) individual federal tax rates range from 10% to 35%. As the type of tax implies the focus is on income (less certain allowed expenses, adjustments, deductions, and exclusions) or earnings.

Estate tax planning, also an individual phenomenon, has a different focus. Your estate is made up of the assets you managed to keep or accumulate over your lifetime. The focus here is on assets minus liabilities, or net worth. The Federal estate tax rate is 35%, however the first $5 million of net worth is exempt. Also, a surviving spouse gains the late spouse’s unused exemption amount. The tax rate, exemption amount, and exemption portability are applicable through 2012.

For many individuals, the individual income tax return is the closest they come to having a personal financial statement. Remember, the individual tax return involves income and expenses, not assets and liabilities. By contrast, a personal financial statement generally is a single statement; a statement of financial condition, or a balance sheet capturing the assets and liabilities and calculating the individual net worth as of a certain date. So, what we can learn about a person’s net worth by reviewing the individual tax return?

I recently analyzed an individual tax return of a new client to determine if estate planning might be warranted given the new estate tax rates and exemption amount. Here is what I saw and what led me to believe about this person’s net worth:

Form 1040, line 7 – Wages, Salaries, Tips, etc: This person was retired so no entry here. Had there been wages I would have asked about employer sponsored benefit plans that might provide a death or retirement benefit; group life insurance or retirement plan asset.

Form 1040, lines 8 and 9 – Interest and Dividends: this person earned $82,000 of taxable interest, no tax-exempt interest, and no ordinary dividends. To estimate the value of the asset that is generating this income I looked to the Schedule B of Form 1040 and noted that it was bank and US Treasury interest. Therefore, I estimated the earnings rate at 2% and divided the $82,000 by 2% to arrive at an asset value of $4,100,000.

Form 1040, line 12 – Business Income: There was no entry on the return I was analyzing. If there is a number on this line, consider the need to have a business valuation performed. Without a valuation I might use a multiplier of 10 times adjusted net income to arrive at an initial estimate of value. Also, there could be a retirement plan asset to consider.

Form 1040, lines 15 and 16 – IRA distributions and Pensions and Annuities: IRA distributions are generally indicative of Required Minimum Distributions (RMD) and an asset that will be part of the estate. Pensions and Annuities could be arrangements that will cease at death and therefore don’t result in an estate asset. The return I evaluated had $64,000 as an IRA distribution and the person was 72 years old. An RMD is calculated

PlanningT A X

Your Income Tax Return as an Estate Planning Tool

Continued on page 7

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by dividing the asset value by a life expectancy number from the uniform life table based on the person’s current age. For age 72 the factor is 25.6. Therefore if $64,000 is the RMD, the asset had a value of $1,638,000.

Form 1040, line 17 – Rental real estate, Royalties, Partnerships, S corporations, Trusts, etc.: the return I evaluated had no entry on this line. Amounts recorded here point to a variety of assets including real estate, natural resource interests, closely-held businesses, and assets held in trust. Significant work may be necessary to determine value of these assets and various other professionals may be utilized to estimate these.

Form 1040 Schedule a, line 6 – Real Estate Taxes: amounts recorded here indicate ownership of real estate. Generally the primary residence and possibly a second or vacation home. The return I evaluated indicated $9,900 had been paid that year for real estate taxes. These taxes are determined by applying a tax rate per thousand of value. Oregon laws generally allow $15 per thousand for operating levies and additional amounts for retirement of bonded debt. Using this information the asset value is estimated at $500 - $650,000.

Form 1040, Schedule a, lines 10 and 11 – Home Mortgage Interest: home mortgage interest indicates there is debt and a liability to consider in arriving at net worth. The return I evaluated had no entry on these lines. Considering today’s home mortgage interest rates (3-5%), work backwards to the liability amount by dividing the interest paid amount by the interest rate.

In conclusion, by evaluating seven lines on the individual tax return, I was able to estimate net worth as follows:

Cash and investments $4,100,000Individual retirement account 1,638,000Primary residence 575,000

net wOrth $6,313,000

Since this amount exceeds the $5,000,000 exemption amount, I plan to have an estate planning discussion with this individual and include legal and investment advisers. A round table discussion with all of your advisors is an excellent way to devise and implement and estate plan. Doug Parham, CPA is a partner with the firm of Boldt, Carlisle & Smith LLC, Certified Public Accountants, which serves clients throughout the Willamette Valley and around Oregon from offices in Salem, Stayton, and Albany. He can be reached at (503) 585-7751 or at dparham@bcsllc.com. For more information please see www.bcsllc.com.

Tax Planning . . . continued from page 6

8

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Continued on page 9

By Ron Kelemen, CFP® — The H Group, Inc. Independent Wealth Management Solutions™

Board Member, Medical Foundation of Marion and Polk Counties

ManagementW E A LT H

Investing in Gold, Oil, and Other Commodities

Over the past few years, commodities have caught the eye of the investing public and institutions.

And now with gold reaching new highs and oil prices spiking as a result of events in Libya, interest is even greater. All of a sudden, we’re being told to buy gold and oil—and at near record highs, by the way.

But gold and oil aren’t the only commodities traded, and others have certainly outperformed them in 2010. As you can see by the chart, the spot price for gold increased 29.5% and heating oil increased by 20.1% But you would have made more money investing in cotton (+91.5%), corn (+51.7%), or wheat (+48.7%).

Commodity prices react to the basic economic principles of supply, demand, and perception of future supply and demand. For example:

• Economic growth in emerging nations can increase the demand for industrial metals, such as copper. Some governments hoard copper to meet perceived demand, and prices rise.

• Or, the U.S. government requires ethanol to be added to gasoline. Thus, more corn is needed and the government offers subsidies to corn growers to increase production. Too much corn gets planted, and prices fall.

• Or, people think there will be an oil shortage so they bid up the price of oil futures in anticipation of a shortage. The same with gold.

So, how does one invest in them? The most common way is in a commodity mutual

fund or exchange traded fund (ETF). You can purchase ETFs that track just one commodity, such as gold, or a whole basket. Given the leverage that commodity funds employ, a basket of different commodities is less volatile than a single commodity fund. Some of these diversified funds track a specific commodity index. Some indexes might be weighted more toward energy; others more toward metals; or some equally weighted among many different commodities.

returns (including losses) are generated three ways:1. The spot return. This is the change in price of the

commodity’s spot price.

2. Roll yield. This is the change in price of the underlying commodity futures contracts between the purchase price and the spot price at the settlement date (when the contract expires).

3. The collateral return. Futures contracts are highly leveraged, often 90%. They require only a small deposit. The rest is collateral typically Treasury Bills or other bonds. The collateral return is the interest earned on those bonds. This is an important source of return for many commodity funds and why their returns over the

9Chart Notes®

past decade have closely tracked those of intermediate term bonds.

Beware of the “Contango” Trap. Rather than take delivery of a full tanker of oil or a

silo of wheat when a commodity futures contract expires, fund managers sell their existing contracts and buy new ones. (See Roll yield above). But when contracts for future delivery of a commodity are more expensive than near-term contracts for it, the fund must absorb the cost of paying for a higher-priced contract, thus creating a loss for its investors. That’s basically happening in early March with oil futures. Traders call it a “contango trap.” Therefore, you could lose money even if a commodity’s spot return increased.

A small allocation of a basket o f commodi t i e s c an o f t en help a portfolio because many commodities tend to move in opposite directions from stocks and

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Wealth Management . . . continued from page 8

bonds. And in an inflationary environment, they tend to do well. But you can get too much of a good thing, so use them sparingly and avoid single commodity ETFs. Ron Kelemen is an independent CERTIFIED FINANCIAL PLANNER™ with 29 years of experience, and is listed by Medical Economics magazine as one of The 150 Best Financial Advisors for Doctors. He was also admitted to the MD Preferred Financial Advisor Network. He offers fee-only investment management and wealth management advice through The H Group, Inc., one of the largest independent registered investment advisory firms in the Northwest. Waterplace Building, 500 Liberty St. SE, Suite #310 · Salem, OR 97302 · (800) 285-6240 · website: www.PlanningVisionProcess.com

-20.9 uS natural Gas

Cotton 91.5

Corn 51.7

Wheat 48.7

Gold 29.5

Heating oil 20.1

Sugar 19.2

aluminum 10.8

-40 -20 0 20 40 60 80 100

2010 percentage Change in Spot prices of Selected Commodities

1010

PlanningE M E R G E N C Y

Declaration of Emergency – Who Ya Gonna Call?

By Sheila Sund, M.D.

Another tragic natural disaster, this time in a “prepared” country like Japan, and emergency preparedness (or

lack thereof ) is suddenly in vogue again, at least for a little while. Yet despite preparation, government

response to a disaster often seems slow and uncoordinated. Just days before the Japan earthquake, I spent an hour with John Vanderzanden, Marion County

Emergency Management, discussing current preparations and emergency response coordination.The key words are “local control”.

Although tempting to blame Wash-ington for inadequate response (think

FEMA and Hurricane Katrina), disasters are considered local events and emergency

operations are commanded at a city or municipal level. If a city needs help, they issue a declaration of emergency and request assistance from the county, which in turn can declare a state of emergency and request assistance from the state. If recovery is beyond the combined resources of both state and local governments, the governor must formally request assistance from the president before FEMA will step in. In fact, by definition, an emergency is a dangerous event that can be handled by city and county resources alone, whereas a disaster demands a crisis response beyond the capability of local governments.

Command remains at the local level. The local govern-ment specifies what resources and assistance they want and need, which might range from simple supplies to deploy-ment of the National Guard. County, state, and federal agencies help primarily with supply and coordination.

Continued on page 22

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11Chart Notes®

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“What did you say?”

Crystal is 22 years old and wears hearing aids. “I was missing so much of what people were saying.”

Genetic hearing loss can affect anyone, young or mature. If your patient is having trouble hearing, we can help. Onsite Otolaryngology (ENT) M.D.s. Diagnostic evaluations. Hearing aid services. Medical help without sales pressure.

Planning Tip: You need asset protection planning to protect both your medical practices (including assets such as equipment and real estate) and your personal assets (such as homes, investments, etc.).

advanced planning adds Greater protectionsWith the basic asset protection structures in place, consider more advanced

estate planning including (in increasing order of need and complexity):

• Tax exemption and marital planning

• Liability-protected entities for investment assets

• Domestic and/or offshore self-settled asset protection trusts

• Advanced estate planning strategies to reduce estate tax liability and shift wealth to younger generations.

Planning Tip: If you are in a long-term, stable marriage, one effective option is to transmute (i.e., convert) your separate property or jointly held interests into the separate property of your non-physician spouse, and to make sure you have adequate umbrella insurance to cover his or her general negligence. While effective, this strategy must be done carefully, so that the non-professional spouse is not unfairly and unintentionally enriched if you divorce.

Be Smart. Be proactiveWhether you are actively practicing or retired, as a physician, you remain a

target. It is critical to organize your assets in advance – to minimize liabilities, guard against risks, and to protect your medical practices – as well as your personal property and investments – from predators, creditors, lawsuits and divorce.

Upcoming asset protection Workshop Want to learn more about the latest asset protection issues and strategies?

Then join your colleagues on Thursday, May 26th for “Just What the Doctor Needed: Asset Protection for Physicians”. Presented on behalf of the Medical Foundation of Marion & Polk Counties, this two-hour, fast-paced workshop will introduce you to some of the fundamentals of asset protection planning so you can begin making wise choices to protect yourself,

your practice, and your loved ones. Call the Medical Society at 503-362-9669 for more information, or see the notice in this issue of ChartNotes®.

This article is a publication of the Law Office of Eden Rose Brown. Our purpose in publishing this article is to inform our readers, clients and friends of recent legal developments. It is not

intended, nor should it be used, as a substitute for specific legal advice as legal counsel may only be given in response to inquiries regarding particular situations.

Attorney Eden Rose Brown is dedicated to providing comprehensive, highly personalized, counsel in wealth preservation strategies, asset protection, family legacy design, and estate, tax and charitable planning. She holds the highest standards

of scholarship, client service and lawyer accessibility. Eden has been honored as an Oregon Super Lawyer by her peers, and Worth magazine has twice selected her as one of the Top 100 Attorneys in the United States. Eden is a past director of the Marion-Polk County Medical Society Foundation, Willamette Humane Society, and the Chemeketa Community College Foundation. The Law Office of Eden Rose Brown is located at 1011 Liberty Street SE, near downtown Salem, with additional offices in Bend and Portland. Phone: (503) 581-1800 Email: Eden@EdenRoseBrown.com. Web: www.

EdenRoseBrown.com

Legally Speaking. . . continued from page 5

12

President’s Message . . . continued from page 3

the one month before and the one month after the age cut-off dates the differences are more extreme. External influences are affecting life choices in subtle but persistent ways. There is some data that this can have an effect early in academic pursuits but it is not as easy to measure or as clear cut that these changes persist. For what it is worth there are more MDs in Marion-Polk counties born in July and August than any other month. I thought it would be September and October. September 1st is the usual cut-off date for school attendance.

A little list of subtle things that can affect our decision making. A warm drink: A simple study showing that a person handed a warm, as opposed to a cold drink, they do not take a sip, will cause to the subject to think more of a person they meet for the first time. The act of writing a random but higher number on a piece of paper influences the average bid for an item in an auction. People were asked to write the last two digits of their social security numbers as an identifier on their bidding sheet. Higher numbers associated with higher bids. Holding an item, including money, in hand as opposed to seeing the item in front of you decreases your willingness to risk it in a wager even if the odds are obviously in your favor. It also increases what

you are willing to pay for the item in an auction. This concept relates to humans being generally loss averse. We are more upset at losing $10 than the reward we feel for getting or finding $10. If you question this then ask why your retirement money, and your taxes, are taken out of your pay before you put it in the bank (possess it). A simple study in JAMA showed that when residents were reminded of the sacrifices they made to obtain their education the perceived acceptability of getting a gift from a drug rep increased from 22% TO 48%.

It is common knowledge that our prescribing patterns are available to drug companies. When I started out in private practice, I was in Moses Lake, Washington. There were four other internists in our group and I think one or two other internists in town. One day I had some cancellations and I saw a drug representative and I told him I had time to sign for his samples. He told me he could not talk to me as I was not on his list. I thought I must be at the low end of the totem pole if the drug reps will not talk to me. Then it dawned on me. I was in the placebo group. There were six internist and three pharmacies in Moses Lake. I was in the middle of a little study to see how drug reps influenced prescribing patterns in Moses Lake. I asked the drug rep if this were true and eventually he did acknowledge it.

I think we must acknowledge there are individuals that study decision making and how to influence it, and this knowledge can be used by those who try to influence us politically, socially, financially or in our case professionally. Our best defense is to be aware of the possibility of bias in what is being told to us. We can do this by being aware of what the motivation is of the presenters and be cautious as to our own baseline. It is not a matter of character as much as a matter of trying to filter, as evenly as possible, an insurmountable amount information. If we do not make an effort to look for bias then we are open to being intentionally misled. If we do not filter carefully we are left open to the subtlety of selection bias. This happens when we pick out or are shown information supporting only one side of an argument. A good habit is to be as critical of information or studies that agree with what you already think as you are with studies that challenge what you believe. The goal is to direct our own learning and be very particular about our trusted sources of information. In doing so we can be more confident our decisions are made from the best available facts.

Next month I am going to try and recruit some cyclists. This March was simply not the inspiring weather for which I have been waiting.

12

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13Chart Notes®

Continued on page 15

Recent data from the Oregon Healthy Teens survey shows hookah use is on the rise among middle and

high school students, while other forms of tobacco use are declining. Specifically, hookah use among teens is rising significantly faster among girls and in counties with hookah lounges (see figure below); here in Marion County, three hookah lounges have opened within the last year.

Although hookah is a hot topic, few people know what it actually is. A hookah is a water pipe used to smoke shisha – a moist, flavored leafy tobacco. There are many misperceptions surrounding hookah, especially among young people. Many people believe that because a water pipe is used, the smoke is cooled and toxins are removed. Studies tell us a much different story.

The World Health Organization (WHO) and the Centers for Disease Control and Prevention have found that hookah smoke contains many of the same carcinogens as cigarette smoke, and according to Shihadeh’s 2004 article

HOOkAHBy Amanda Lynch, Marion County Tobacco Prevention and Education Program

HOT TOpIC

14

A P R I L

O F E V E N T S

D E C E M B E R

A U g U S T

Medical/Legal Golf Tournament

J U N E

New Student Welcome Dinner

S E P T E M B E R

Annual Poinsettia Sale Begins

Annual Speed Referral Event

New Physician and Physician Assistant Dinner

O C T O B E R

Mini-Internship Program

Political Mixer

2 0 1 1

Annual Education/ Scholarship Dinner

with Speaker Tierney CahillAuthor of: Ms. Cahill for Congress

7th Annual Benefit for Medassist and Project Access

with Henry Winkler and Marlee Matlin

4/15/11

4/28/11

6/18/11

8/26/11

9/15/11

9/23/11

10/17 – 10/19/11

10/28/11

12/4/11Annual Holiday Carousel Event

15Chart Notes®

B O A R DBusiness

BUS_CARD 3.5” x 2” July 2010

Benny Won, CFM Assistant Vice President, Financial Advisor(503) 362-9556 • (800) 475-76061255 Lee Street, S.E., Salem, OR 97302http://fa.ml.com/benny_wonMerrill Lynch Wealth Management makes available products and services offered by Merrill Lynch, Pierce, Fenner & Smith Incorporated (MLPF&S) and other subsidiaries of Bank of America Corporation. MLPF&S is a registered broker-dealer, member SIPC.Investment products:

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Are Not FDIC Insured Are Not Bank Guaranteed May Lose Value

in Pharmacology, Biochemistry and Behavior and the WHO, an hour long hookah smoking session exposes a person to the equivalent of the amount of smoke produced by 100 cigarettes. Shisha tobacco does contain nicotine and users can become addicted. Regular hookah smokers also put themselves at risk for many of the same life-threatening health conditions caused by smoking cigarettes or cigars, such as heart disease and lung cancer. In addition, according to the American Cancer Society, hookah smoking has been associated with aspergillus, a fungus that can cause serious lung infections, and helicobacter, which can cause stomach ulcers.

Despite these health effects, use among young people continues to rise. Not surprisingly, this rise could be based on marketing and perceptions by youth. A common misconception among young people is that hookah smoking presents no risk of becoming addicted and there are no health effects. In fact, a teen’s comment in a focus group facilitated by the Oregon Health Authority was “If it isn’t safe to smoke hookah, why didn’t anyone ever tell us?” For this reason, the Marion County Health Department’s Tobacco Prevention and Education Program (TPEP) has taken strides to educate the community and

raise awareness about the health effects of hookah smoking.

Adults must be vigilant in order to protect our young people from this dangerous activity. Physicians: be sure to ask all patients if they use tobacco and if so, what type. If a patient does use tobacco, assess readiness to quit and refer them to the Oregon Tobacco Quit Line (1-800-QUIT NOW) if needed. Parents: talk to your kids. Ask them what they know about hookah and provide them with facts. Community members: be aware of businesses opening in your neighborhood. Call your legislators if you are concerned. Everyone: get the facts. Being educated and spreading awareness will go far in protecting the health of our young people and our entire community.

For more information about hookah, please contact Emily de Hayr or Tonya Johnson at the Marion County Health Department (503) 566-2901.

Hot Topic: Hookah . . . continued from page 13.

16

Hired in 1979 as a pediatric physician assistant at Kaiser Permanente in Salem, she frequently found herself with a patient panel reflecting the highest numbers of OHP/Medicaid patients in the region. “I think my work with the poor in Florida made me realize that something as seemingly trivial as a stolen purse can take a disadvantaged person years to recover from. For someone with limited income, no personal transportation, and a lack of assertiveness, it can be overwhelming and seem hopeless. I’ve learned not to make assumptions that something I might perceive as easy is necessarily easy for someone else.”

Francine treasures the trust she develops with families and has served as the primary care provider for as many as 3 generations of children. She can be found in the nursery at Salem Hospital 4-5 mornings a week, evaluating and discharging up to 300 Kaiser newborns a year.

Francine is well known for going to extraordinary lengths to help families in need. She decries her lack of time to perform volunteer work, but makes up for it with personal involvement with families in distress. She

cites the example of a 19 month old patient diagnosed with a potentially fatal renal carcinoma whose parents were burdened with the realities of sustaining their employment while ferrying their daughter to radiation and chemotherapy. “I told the parents I would do anything they needed – shop for food, watch the other kids or scrub the floors. “ (She did all three.) After the child went into remission, her 30 year old mother was diagnosed with a devastating cancer which had already metastasized.

Once again, Francine spends days off supporting the family through a second crisis. “I’m happy to have made them part of my extended family. It may sound trite, but you really receive much more back than you give. It has truly enriched me to be there for them, and my commitment will continue as long as I’m able to sustain it.”

Asked about significant changes in pediatrics during the 35 years of her career, Francine cites the evolving need for primary care pediatricians, PAs and nurse practitioners to treat psychiatric disorders such as autism, major depression, anxiety and attention deficit disorder. To that end, she enrolled in a yearlong mental health fellowship program through Arizona State University she is completing this spring. In 2002 she enrolled in the University of Nebraska School Of Medicine’s Master’s program for PAs, and did groundbreaking research which predicted the consequences of the obesity epidemic among children and teens. Her findings were incorporated into initiatives Kaiser Permanente rolled out in years that followed, including training teams of pediatricians and

A Passion for Justice . . . continued from page 1.

Continued on page 17

Francine at The Steens • photography by Eric Schuman

17Chart Notes®

family practice providers how to counsel families regarding obesity, and developing computer tools which have resulted in a systematic approach by pediatric providers to prevent diabetes in children.

Francine’s career has taken some interesting turns. In 1991-92 she served as Health Policy Fellow for the American Academy of Physician Assistants, working in then Rep. Ron Wyden’s office on Capitol Hill. She was involved in efforts which resulted in granting the state of Oregon a waiver to launch the Oregon Health Plan. As a staff member, she met with constituents, answered correspondence, prepared for hearings and press events.

As an adjunct faculty member at the OHSU Physician Assistant Program, in 2008 Francine was named “Preceptor of the Year” for a second time. She was named Oregon Physician Assistant of the Year in 2000 and has lectured on pediatric topics at the Oregon Society of Physician Assistants annual conference, and recently at a medical meeting in Alaska on the topic of neonatal jaundice.

Francine treasures her relationships with PA students and enjoys serving as a mentor to young people, but it was truly a surprise when her youngest daughter Anna decided to pursue a career in medicine after completing an undergraduate degree in social sciences. Torn between medical school and PA school, she finally decided on PA studies and was admitted to OHSU (to a class of 38 among 900+ applicants) and the University of Colorado PA program where her mother matriculated in 1973 – both at the age of 24! Despite her mother’s disappointment, Anna chose Colorado, where she begins a 3 year program in June.

Asked what sustenance she receives and what nurtures her soul, there isn’t a moment’s hesitation as she cites outdoor pursuits like hiking, camping and kayaking – visiting places like The Steens, Borax Hot Springs in eastern Oregon and Green Lakes in the 3 Sisters wilderness. Her pride and joy (“Westy”) is a recently purchased 1986 Westfalia Camper. “I live frugally so I can support my children and their growing families. My vacations are inexpensive, but the joy I feel in the wilds of the Northwest is priceless.” Although she tore an ACL 30 years ago and has 2 blown meniscuses on the same knee, she basks in completing at least one 10 mile, 1500 foot elevation gain hike in the Cascade mountains each year. Asked why she didn’t have the ACL repaired, she explained, “After the orthopod drained the fluid, I could walk without pain. I was on the surgery schedule, but you have to understand that for my patients, deciding when to start rice cereal is

a big decision, and I felt a little like that about surgery, so I never had it done. “

An avid reader, her current favorite author is Tony Judt, whom she calls “the new Michael Harrington.” “Judt articulates the importance of society existing for community, and he believes what’s good for society and community is good for the person. The imbalance I see

A Passion for Justice . . . continued from page 16.

“Westy”

Continued on page 18

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around me is people believe what’s good for them is what matters instead of what’s good for someone else.” She shares her love of books with women at a monthly book club she founded in 2001.

Asked to comment about the unique relationship between PAs and their supervising physicians, Francine cites the importance for PAs “… to maintain our roots, connected to physicians who anchor the care we provide. I’ve always benefited from a strong relationship with a supervising physician. I can ask his help and input at any time. That’s extremely important to me, and his knowing I will never hesitate to ask is very important to him. “When I mentioned earlier that frightening situations (like being lost in the Bronx) cloud the ability to reason, it makes me think of difficult and challenging cases in my practice. Those are the times the relationship with my supervisor is most important. Sometimes I think PAs have it easier than physicians because we have that relationship built into

the framework of our profession. I w o n d e r i f physicians find it as easy as PAs to find help when they need it.”

“ I ’m s o m e -times disturbed by trends I see when PAs are used to provide episodic care rather than continuity of care. Many of us are capable of and want enduring relationships with our patients as well as the physicians who are our collaborative partners.”

Francine Boullosa’s 35 years in practice serve as a model for any young person choosing medicine as a career. Not everyone has the commitment and courage to follow their heart. In Francine’s case, it was the only real choice.

A Passion for Justice . . . continued from page 17.

Please contact us if you have any questions or wish more information about these programs.

MedAssist program project Access program Shirley Sproule – 503 561-6042 Barbara Halsey – 503 561-6074Sabrina Lane – 503 561-6043 Trisha Martin – 503 561-6071

MedAssist & Project Access Programs Updates for 1/1/11 to 3/8/11

amount of Donated Medications & Medical ServicesMedassist Medications $ 1,157,770Participating Project access Providers 1,084,528PhrMa 245,459Ph tech 13,159

tOtal $2,500,916

Medassist program:Forty-nine patients were enrolled in MedAssist for the period 2/7/11-3/7/11. Currently, there are approx. 1,353 active MedAssist clients between all the MedAssist offices. Offices are located in Salem, Woodburn, Stayton and Dallas.

project access program:Thirty-eight patients were enrolled in Project Access for the period 2/7/11-3/7/11. Since the beginning of the program in April 2009, 903 patients have been enrolled in Project Access.

Thank Youto all our providers for your support in making the MedAssist and Project Access programs a huge success!

OvEr 300 prOviDErS arE parTiCipaTiNG iN ThE prOjECT aCCESS prOGraM.ThE SpECialTiES iNClUDE: Allergy, Anesthesiology, Cardiac Surgery, Cardiology, Dermatology, Endocrinology, ENT, Gastroenterology, Hematology/Oncology, Pulmonary & Critical Care, Family Practice, General Surgery, GYN, Ophthalmology, Orthopedics, Pathology, Pain Management, Plastic Surgery, Podiatry, Physiatry/Rehab, Nephrology, Neurosurgery, Radiation Oncology, Radiology, Rheumatology, Urology and Vascular Surgery.aNCillarY prOviDErS iNClUDE: Salem Health [Salem Hospital & West Valley Hospital], Santiam Hospital, Silverton Hospital, Northbank Surgery Center, Willamette Surgery Center, River Road Surgery Center, Salem Laser & Surgery Center, Mission Medical Imaging, Salem Radiology Consultants, Diagnostic Imaging of Salem, Salem Hospital Rehabilitation, Hope Therapy Services, PT Northwest, Capital Physical & Hand Therapy, Willamette Health Partners and PH Tech.

Francine Boullosa and daughter Anna Christenson

19Chart Notes®

7th Annual BenefitFriday, April 15, 2011

Salem’s HistoricElsinoreTheatre

Doors Open at 6 pmTickets are available at

the Elsinore Theatre box office (503-375-3574) or

TicketsWest locations.

MEDICAL FOUNDATIONOF MARION & POLK COUNTIES

A benefit for medAssist & project Access

“Anything is possible if you follow your dreams.”

An evening of moving stories about overcoming adversity, humorous anecdotes, and inspirational life lessons

about believing in oneself.

Drs. Bud and Selma Pierce

Platinum Sponsors

SILVERTONHOSPITAL

TM

Dr. & Mrs. Steven A. LaTulippe

Board of directors

presented bY

H E n r y W i n k l E r M A r l E E M AT l i n

Silver Sponsors

Gold Sponsors

Drs. Robert C. Buza, Julie E. York & Magdalena Benasiak • Cascade Cardiology • CB|Two Architects + ConstructionC&R Remodeling • Diagnostic Imaging of Salem • The Doctors Company • The H Group, Inc. • Kaiser Permanente

Sue & John Miller • Radiation Therapy Consultants, P.C. • Saalfeld Griggs, P.C. • Salem Radiology Consultants C.S. and Angela Sheffield • Dr. Scott & Mrs. Jeanine Stice • Willamette ENT & Facial Plastic Surgery, LLP

Willamette Valley Radiology, Inc & Mission Medical Imaging

Bronze Sponsors

me!Eat healthier.

IMove right.

MAR

ION

COUNTY

20

It’s time to lace up your tennis shoes and join the efforts of Senator Winters, and Senator

Courtney, Dr. James Lace, Dr. Doug Carney and the I Love Me—Marion County task force to reduce the incidence of obesity and diabetes in Marion County. Their efforts were officially launched last month with a community walk from the Capitol steps, and are fully supported by the Medical Foundation of Marion & Polk Counties and the Medical Society.

The Medical Foundation will act as the 501c3 for the community efforts of I Love Me—Marion County with representation of members (Dr. James Lace and Dr. Doug Carney) on the initial committee created jointly by Senator Winters and Courtney last fall. The Senators hope the I Love Me—Marion County campaign will build the synergy needed to combat the rising tide of diabetes projected in our county linked to above

average rates of adult and pediatric obesity.

By Jeanine Stice, MPH, RD

21Chart Notes®

Beyond the message of self-care inherent in the I LOVE ME logo is sound research. In a recent article from the New York Times on self-compassion, University of Texas Psychologist Kristin Neff noted, “Self-compassion is really conducive to motivation. The reason you don’t let your children eat five big tubs of ice cream is because you care about them. With self-compassion, if you care about yourself, you do what’s healthy for you rather than what’s harmful to you.” Hence, I LOVE ME is a message of motivation to move right and eat healthy.

Beyond the walk from the Capitol steps, Salem Health CHEC Health Educator, Kristin Jordan and the I LOVE ME team developed action cards that can be used in coordination with medical body mass index screenings. Three cards were developed citing specific steps patients can take to improve their health: Just Right, Hold Steady, and Lose a Little.

“Just Right” targets people whose BMI is in the normal range and includes current Center of Disease Control recommendations for maintaining a healthy weight.

“Hold Steady” targets children who’ve not completed their growth and are overweight whose goal to maintain their weight so their height can catch up and lower the BMI to the healthy range.

“Lose a Little” targets children who’ve completed their growth and development, as well as adults who are overweight, the message being to lose 10% of their body weight to improve their health.

The action steps on the cards are similar in to the steps recommended state wide through the WIC program to improve public health: Eat at least five fruits and vegetables a day, limit screen time and computer time to 2 hours or less on most days, partici-pate in at least 60 minutes of activity a day unless restricted for health reasons, and limit sweetened beverages at meals and snacks.

22

St. Patrick’s Day this year was not just about wearing green, kissing the Blarney

Stone and a “Wee Bit O’Luck,” it was also the annual OMA Day at the Capitol.

Over 60 physicians attended the event (seven from Marion and Polk counties),

meeting one-on-one with their legislators and participating in discussions with

leadership from both the House and the Senate.

Day at the Capitol

Kirk Walker, M.D. (sitting, second from left)

Keith White, M.D.

Emergency Planning . . . continued from page 10.

In their own words, “FEMA’s mis-sion is to support our citizens and first responders to ensure that as a nation we work together to build, sustain, and improve our capabil-ity to prepare for, protect against, respond to, recover from, and miti-gate all hazards.” Bottom line - if you are concerned about emergency preparedness and response, look no further than your own backyard.

Locally, we’ve made progress but there’s a long way to go. Marion County has a Natural Hazards Miti-gation Plan and Emergency Opera-tions Manual updated in 2010 (fasci-nating reading). They have a resource

list of organizations and businesses that could help in an emergency, including obvious ones like the Red Cross, and less obvious ones like John Deere (tractors!). They list hospitals, but not clinics or ambulatory surgery centers. There is a radio system for all county public safety agencies, but un-fortunately, city and county systems cannot talk to each other.

There is no real way to assess lo-cal preparedness because so much depends on individuals, agencies, and businesses, not government. Are buildings retrofitted to be seismically safe? Do businesses have emergency plans, both to keep employees safe

and to continue operations? How fast will grocery stores run out of food or gas stations out of gas?

If you feel inspired after watching events unfold in Japan, the basic mes-sage is the same – get a kit (emergency supplies), have a plan, and be informed. But remember citizens are the key play-ers in both disaster preparation and response. Mr. Vanderzanden’s request of us – be prepared, get trained, and please, check on your neighbors! Sheila Sund, M.D. is the Medical Director for Willamette Valley Hospice. She recently joined the MPCMS Disaster Preparedness Task Force, the Marion County Community Council for Emergency Preparedness, and the State Crisis Care Home Health/Alternate Care Site Workgroup. She can be reached at sheilas@wvh.org and welcomes any other physician who would like to help.

Bud Pierce, PhD, M.D., Representative Vicki Berger,

Mark Gilbert, M.D. and Peter Bernardo, M.D.

Endorsed by

The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts with

patient safety. In fact, we have the largest Department of Patient Safety/Risk Management of any

medical malpractice insurer. And, local physician advisory boards across the country. Why do we

go this far? Because sometimes the best way to look out for the doctor is to start with the patient.

Our medical professional liability program has been endorsed by the Marion-Polk County Medical

Society since 2006. To learn more about our program benefits for MPCMS members, call our Salem

office at (800) 243-3503 or visit us at www.thedoctors.com.

www.thedoctors.com

We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head. We make CME easy, free, and online. We do extra homework. We protect good medicine. We are your guardian angels. We are The Doctors Company.

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