The Message April 2011

messagePHYSICIAN ASSISTANTS

OUR VERSATILE, VITAL COLLEAGUES By Brad Pope, MD

SCMS President

Healthcare Reform, Integrated Practices and Physician Assistants:

What are the Opportunities?

Models of Physician-PA Teams

T HET HE

A M O N T H L Y N E W S M A G A Z I N E O FS P O K A N E C O U N T Y M E D I C A L S O C I E T Y – A P R I L 2 0 1 1

April SCMS Message Open2

April SCMS Message Open3

T A B L E O F C O N T E N T S

Physician Assistants - Our Versatile, Vital Colleagues 1

Healthcare Reform, Integrated Practices and Physician Assistants 2

Models of Physician - PA Teams 5

MEDEX Northwest Program Continues to Excel in Physician Assistant Training 6

Getting a Handle on Chronic Opioid Therapy, New Rules to Come in June 7

In the News 7

Guideline for Prescribing Opioids for Chronic Non-cancer Pain 9

Resources for Physician Assistants 9

The Future of Health Care 9

10 Healthcare Reform Market Changes Affecting Physicians 11

Karry Home a Kindle Kontest 11

"On Becoming A Doctor" 16

A Physician Perspective on the Beacon Community Project 17

Project Access Update 17

The Physician Pipeline Really Works! 19

FYI 19

CME Schedule 20

Continuing Medical Education 20

Other Meetings and Conferences 20

Physicians 21

Classifieds 22

Positions 23

“The besT way To cheer yourself up is To Try To cheer somebody else up." mark Twain

2011 Board of TrusteesBrad Pope, MDPresidentTerri Oskin, MDPresident-ElectAnne Oakley, MD Vice PresidentDavid Bare, MDSecretary-TreasurerGary Knox, MDImmediate Past President

Trustees:Keith Kadel, MDMichael Cunningham, MDPaul Lin, MDRandi Hart, MDGary Newkirk, MDCarla Smith, MDRob Benedetti, MDAudrey Brantz, MDLouis Koncz, Jr PACDavid McClellan, MD

Spokane County Medical Society Message

Terry Oskin, MD, EditorA monthly newsletter published by

the Spokane County Medical Society The annual subscription rate is $21 74

(this includes the 8 7% tax rate)

Advertising Correspondence Quisenberry Marketing & Design Attn: Jeff Akiyama 518 S Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 jeff@quisenberry net

All rights reserved This publication, or any part thereof, may not be

reproduced without the express written permission of the Spokane County Medical Society Authors’

opinions do not necessarily reflect the official policies of SCMS nor the Editor

or publisher The Editor reserves the right to edit all contributions for clarity and length, as well as

the right not to publish submitted articles and advertisements,

for any reason Acceptance of advertising for this publication in

no way constitutes Society approval or endorsement of products or

services advertised herein

April SCMS Message 1

Physician Assistants – Our Versatile, Vital ColleaguesBy Brad Pope, MD

A few weeks ago my colleague Dave Blomgren, PA-C, retired from a Veradale medical center I had worked with Dave for many years when he and I were part of a practice that included four family medicine doctors Dave had also worked in internal medicine and pediatrics, and then received specialized education in orthopedics and sports medicine

Working with Dave allowed for tremendous synergy in our practice For one thing we recognized our limitations, and Dave was our in-house, go-to person for orthopedic patients In our absence, he covered our patients and we knew they were taken care of well When we had patients who required frequent follow-up, Dave was there to tag-team in the care There’s no question—working with Dave helped us provide the best care to our patients

This month’s the Message explores the vital contributions of physician assistants (PA) in our healthcare system We are pleased that many PAs are part of SCMS’s membership and we welcome even more

Physician assistants are critical to having a high functioning care system, and they will become increasingly important as their talents and training are used in new ways In addition to their traditional services, some PAs are being tapped as health coaches, specialists in ambulatory procedures and case management roles in chronic disease management In some systems they already play a role in managing populations with patient care registries and reaching out to patients for prevention and chronic disease management

In my organization physician assistants now perform varicose vein procedures as primary proceduralists in the surgery clinic and practice in interventional radiology Clinic leaders are exploring how to leverage PA skills to support obstetrical care

PAs contribute to better outcomes in chronic illness by doing patient teaching, leading support groups, and creating interactive care plans for depression, asthma and hypertension

They also bring another benefit that’s priceless: that is, the PA can sometimes cement a therapeutic relationship with a patient when a physician can’t Sometimes it’s because the patient feels more comfortable opening up to the PA or the PA can give more time Whatever the reason, for care to be patient-centered we need all kinds of providers to serve an increasingly diverse community The PA role will continue to evolve and be defined by the patient population’s unique needs and the strengths of every practitioner on the healthcare team We all face this exciting future and I personally look forward to working with physician assistants even more in the future

On other fronts

Now here’s a quick update of our activity last month

Project Access: We have been introducing the new director, Lee Taylor, to our community Lee recently participated in a statewide meeting with other Project Access directors and visited King County to learn about operational best practices and approaches for long-term success Watch for updates from Lee

Spokane Prescription Opioid Task Force: Our Executive Committee continues to support the task force to educate the community about the issue and promote best practices in physician prescriptive behavior The most recent meeting occurred on March 16 Thanks to all who attended the WSMA CPIN “Strategies for Chronic Pain Management in Primary Care” CME program after the March Board of Trustees’ meeting

Legislative Advocacy: Dr Anne Oakley, vice president, and Dr Terri Oskin, president elect, have just returned from a trip to Washington D C as part of our delegation to advocate for physician issues with our federal legislators Each year SCMS attends the AMA National Advocacy Conference and ensures that a contingent of Spokane physicians is visible and heard on Capitol Hill

Locally, Dr Gary Knox and SCMS CEO Keith Baldwin met with Spokane County representatives, as have many other community stakeholders, to talk about implementing a regional approach to health reform by creating a multi-county healthcare authority They discussed what a regional health authority is and how it differs from an accountable care organization, as well as what the role would be for payer and provider communities The objective is to better meet the needs of low-income residents in our area with mental health, substance abuse, developmental disability, housing and other services Our SCMS treasurer and secretary, David Bare, MD, represented our group with Keith Baldwin at the citywide meeting We’ll keep you informed as the initiative progresses

Medical School: Dr Knox and Keith Baldwin were also invited to provide input as members of the Medical School Steering Committee’s to the strategic plan The plan was developed with the assistance of Tripp-Umbach, a consulting firm hired by Greater Spokane Incorporated, to assess the economic impact of having a four-year school in Spokane We look forward to reporting the results of the strategic planning process

SCMS Informatics Committee: Dr Jeffrey Collins, chief medical officer, and Frank Otto, CIO, for Providence Sacred Heart Medical Center, spoke to the Informatics Committee in March about making electronic medical record/ HIE (Health Information Exchange) decisions The group discussed lessons that can be passed along to other physicians in the community This continues to be a hot topic

PET-CT Use: SCMS acted as the convener for a meeting with Jeffery Thompson, M D , medical director for DSHS, Medicaid and physicians (Radiologists, Oncologists and others) who use PET-CT to support their treatment regimen primarily for cancer patients It is hoped that convening this type of meeting supports our members in their pursuit of quality care for their patients

I hope that spring finds you well As always I enjoy hearing from you if you have a comment or idea to express You can reach me at pope b@ghc org or 509-241-7370


Healthcare Reform, Integrated Practices and Physician Assistants: What are the Opportunities? By Steven Meltzer, PA-C Director of MEDEX Outreach and Eastern

Washington Education Programs and Theresa Schimmels, PA-C

Dermatology, Rockwood Clinic

Washington state, and the Spokane region in particular, is moving ahead with many elements of the Patient Protection and Affordable Health Care Act of 2010 In fact, our region may be very well positioned to take advantage of several aspects of the health care reform act because of our experience in team-based care and patient-centered care

For Physician Assistants and their employers, the following are some of the elements of the reform act that are relevant:

• Increases funding for PA education programs and faculty loan

repayment options through re-authorization of USPHS Title VII

Health Professions Programs

• Fully integrates PAs into new programs such as the medical

home model and independence at home program, allowing for

PAs to participate in home-based primary care teams

• Provides a 5 year, 10% bonus for select primary care codes

furnished by PAs, providing at least 60% of all services are

qualified as primary care as determined by the Secretary of

Health

• Allows PAs to order skilled nursing facility care for Medicare

beneficiaries (effective 1/1/2011) 1

The physician-PA team, by its original design, is perfect for the new models of health care

In the many communities with small solo or group family medicine practices, the team approach provides for greater flexibility in scheduling, appropriately sharing the patient load depending on the education and skills of the PA The implementation of electronic medical records helps to simplify communication between providers The recent joint policy statement of the AAFP and AAPA (Feb 2011), notes that “the physician-PA team is effective because of the similarities in physician and PA education, the PA profession’s commitment to supervised practice, and the efficiencies created by utilizing the strengths of each professional in the clinical setting ” 2

The next hurdle is numbers: every federal or professional association study completed in the past decade has reported a significant projected shortage of health care professionals This includes nurses at every level, allied health providers such as pharmacists, physical therapists and more, as well as physicians

and PAs/NPs Although some would argue there is more a distribution problem versus a number problem, it’s clear that the growing bubble of aging “Boomers” and the overall increase of population nationally will drive the need for greater numbers of providers

The Association of American Medical Colleges report on physician supply and demand released in June 2008 noted that even with projected increases in medical school graduates over the next two decades, the U S would still be short adequate physicians, particularly in primary care This report was one of the first to recognize PAs and NPs in their calculations noting there are currently approximately 75,000 practicing PAs and 140,000 NPs Projecting almost 46% growth in those numbers by 2025, some scenarios suggest PAs and NPs could play a vital role in maintaining or increasing access to primary care services 3

Although the number of physicians and surgeons is expected to increase by 14 percent in the next decade, registered nurses and physician assistants, for example, are projected to grow by 23 percent and 27 percent, respectively 4 This becomes an important point since academic medical centers will not be able to bring many additional medical schools, residencies and necessary teaching facilities on line quickly enough Even with the relative expansion of medical school admissions over the past few years, the numbers are still too small to make a significant difference in meeting future needs

What does make sense, then, is utilizing PAs within the physician-PA team in the most effective manner Recent data from the 2009 Medical Group Management Association annual survey, shows that for every dollar collected for services provided by a PA, the practice paid only $ 36 for PA compensation 5 That’s a significant increase of revenue for any practice! And yes, although it does mean a little more time and effort to appropriately supervise the PA, over time this becomes a smaller part of the relationship as the physician becomes more comfortable with the Physician Assistant’s knowledge, skills and ability to appropriately manage patients within the practice

Where is the Physician Assistant profession headed?

There are currently 154 accredited programs nationally, five within the WWAMI-0 region The MEDEX program at the University of Washington (UW) is the second oldest program in the nation and has campuses in Seattle, Yakima, Spokane and Anchorage, AK In Spokane, we are fortunate in that the UW anticipated a primary care and healthcare provider shortage in eastern Washington and opened the MEDEX Spokane satellite in 1997 The Spokane program now awards a Master’s Degree, graduating an average of 24 students per year Approximately 110 students are admitted each year to the combined Seattle program and satellites MEDEX Spokane joined the Riverpoint campus in 2008 and is proud is be part of the expanding “Academic Health Sciences Center”

Over the past fifteen years, the PA profession has shifted to the Master’s Degree, putting it at parity with most of the other allied

1O

The Christ Clinic / Christ Kitchen20th Anniversary Celebration

April 286:30 – 8:30 p.m.

The Lincoln Center

For more information call (509) 325-0393


health professions Although there has been some discussion at the national level about the entry-level doctoral degree, there has been less than enthusiastic support PAs who are interested in advanced degrees often pursue such degrees in leadership, business or education with the idea of teaching, research, advocacy or administration

The only doctoral program currently operational is the U S Army program in Texas, which partners with Baylor University Students do their clinical program at multiple military bases including Madigan Army Medical Center in Tacoma Started in 2008, the Army now has programs in both emergency medicine and orthopedics which it hopes will encourage greater retention

Physician Assistants practice in virtually every area of medicine, with 35-40% in primary care The largest cohort is in Family Medicine with 25%, followed by general internal medicine (17%), emergency medicine (10%), orthopedics (10%), pediatrics (4%), general surgery (3%), and all other surgical specialties (13%) 6

Hot areas for growth include hospitalist services, dermatology, gastroenterology and various surgical subspecialties PAs have been highly visible in orthopedics for some time and continue to be a significant benefit to those practices

Because PAs are linked directly to physicians, we see the same skewing toward specialty practice over the past three decades Overall, the MEDEX program has one of the highest rates of all PA schools graduates choosing primary care (54%), but with declining numbers of family medicine physicians, that may change over time The lesson, therefore, is that both MD and PA professions need to enhance applicant pools and direct training toward primary care thus reinforcing the benefits of primary care practice

In addition, interdisciplinary education and clinical training will provide new opportunities for learning effective communication, utilization and practice development Several new federal funding streams are being directed toward such interdisciplinary models and the WWAMI region is very well positioned with multiple residency programs and WWAMI sites available to support students

So what have we learned?

No one has been able to quantify just what impact health reform will have on the profession But with an estimated 32 million more Americans acquiring health insurance within a few years, the recently passed federal health reform law means the demand for health care providers in general is likely to grow

With the current medical home model pilot projects in Washington state, and projected new projects to include more rural practices and communities, Physician Assistants can play a vital role Helping to implement medical home models by assuming a greater role in managing chronic disease patients to improve outcomes, opening additional schedule slots to increase access, extending care via home visits and/or extended clinic hours and participating in physician-PA “pods” within a practice are just some examples

Such approaches are being used successfully across the country to

expand the reach of primary care practices and improve the health of

the community With emphasis on the Physician-PA team approach

to patient-centered care, the opportunities continue to expand

Join the Physician-PA Team!!

1 AAPA Overview of New Health Insurance Reform Law, April 2010 www aapa org/advocacy-and-practice-resources/federal-advocacy/federal-legislative-fact-sheets Accessed March 7, 2011

2 Family Physicians and Physician Assistants: Team-Based Family Medicine, February 2011 www aapa org/advocacy-and-practice-resources/federal-advocacy Accessed March 8, 2011

3 Dill MJ, Salsberg ES The Complexities of Physician Supply and Demand: Projections Through 2025 Center for Workforce Studies, November 2008, AAMC, pp65-67

4 United States Bureau of Labor Statistics (BLS) www statehealthfacts org/profileind jsp?ind=440&cat=8&rgn=49 Accessed March 7, 2011.

5 Medical Group Management Association Physician Compensation and Production Survey: 2010 Report Based on 2009 Data July 2010

6 American Academy of Physician Assistants National Physician Assistant Census Report: Results from AAPA’s 2009 Census www aapa org/about-pas/data-and-statistics/aapa-census/2009-data Accessed March 9,2011



Models of Physician-PA Teams

Family Medicine Spokane Residency Program

By Gary Newkirk, MD, Dale Petersen, PA-C and Barry Linehan,

PA-C

Dale Petersen PA-C and Barry Linehan PA-C are an integral part of

the faculty at Family Medicine Spokane (FMS), a community-based

Family Practice Residency Training Program in eastern Washington

The mission of FMS is to “educate and train quality, compassionate

and competent family physicians to practice in the underserved

rural and urban regions of the Pacific and Intermountain West ”

Dale Petersen, PA,C, Gary Newkirk, MD and

Barry Linehan, PA-C

Barry and Dale manage the day-to-day patient flow in the clinic,

ensuring that residents have every opportunity to practice their

trade by serving a vulnerable urban patient population that is

medically undeserved The PAs also provide patient care, working

directly with the residents as an important part of an integrated

healthcare team They deliver formal training programs for the

residents on topics such as ambulatory care

Dale brings with her considerable experience as a PA focusing on women’s health care and OB/GYN, training residents on prenatal care She also oversees and coordinates our follow-up management of surgical cancer screening Barry brings an MBA to the table and has helped implement an Open Access system that meets the unique and diverse needs of a residency training program The results include decreased waiting time to see a provider, increased patient-provider continuity and a 50% decrease in the appointment no-show rate All provide valuable educational opportunities for our family medicine residents

Dr Gary Newkirk, FMS Program Director, remains a strong proponent for the role of PAs in providing direct provider services as well as being an integral part of the educational experience of our residents Both of the FMS PAs are residency faculty with clinical appointments through the University of Washington Department of Family Medicine The overwhelming majority of our graduates will leave the program and work alongside PAs Training together is a compelling advantage

Rockwood Clinic – Urology

By Louis Koncz, PA-C

Lou Koncz, PA-C has worked as a Physician Assistant in Urology for 19 years at the Rockwood Clinic In thinking about the relationships between physicians and PAs in Rockwood, he notes: We have 46 full and part-time Physician Assistants at the clinic They are working in several areas within the clinic including Family Practice, Pediatrics, Internal Medicine, Dermatology, Endocrinology, Nephrology, Orthopedics, Otolaryngology, Urology, Urgent Care and Anticoagulation PAs provide quicker access to care, the ability to see work-ins and are able to help a practice grow Working with PAs allows physicians, especially in the surgical subspecialties, to see the more complex patients as PAs see less complex cases and follow-ups Assisting physicians in surgery frees up another surgeon who can be seeing patients or be in surgery on another case PAs also provide increased income to the practice with less overhead, including salary

Continued on page 6

FPO


Continued from page 5

At the Clinic, PAs are an integrated part of the health provider team Recently a PA was placed on the Board of Directors as a full voting member The Clinic recognizes the valuable services that PAs provide and seeks their input for positive changes to improve patient care

It has been shown in numerous studies that PAs are accepted by patients and provide excellent care The benefits of a PA as part of the medical provider team are becoming more recognized as the need for providers continues to increase especially in the new medical models which are being implemented

MEDEX Northwest Program Continues to Excel in Physician Assistant TrainingPaul G. Ramsey, M.D.

CEO, UW Medicine

Executive Vice President for Medical Affairs and

Dean of the School of Medicine,

University of Washington

As health-care reform increases access to health services in the

coming years, the demand for physicians, physician assistants

and nurse practitioners will increase Increased focus on

interprofessional training and efficient teamwork also will be

needed to improve the quality and safety of health care

Interprofessional training has long been a focus at UW Medicine,

as evidenced by the MEDEX Northwest Program, located within

the School of Medicine, that trains physician assistants (PAs) The

west coast version of the PA role was first developed in Seattle

through the MEDEX Program Ruth Ballweg, division director and

program director and a graduate of the MEDEX program, has

done a superb job leading the program since 1985

MEDEX began in 1969 as a joint project of the UW School of

Medicine and the Washington State Medical Association The

first eight MEDEX classes were exclusively military corpsmen

The program still requires significant medical experience as

a requirement for admission, although student backgrounds

now include emergency medicine, nursing, allied health, and

other categories of medical personnel Forty-two years later,

the program has graduated 1,800 PAs, almost all of whom are

working in the WWAMI region

The MEDEX Program originally was designed to support rural

physicians and to increase health-care access in the region

Currently, about 50 percent of the program’s graduates work

in primary care and the remainder work in specialties Within

the UW Medicine Health System, PAs are employed in all of our

clinical sites and virtually all specialties

Continued on page 14


Getting a Handle on Chronic Opioid Therapy, New Rules to Come in JuneBy Tom Schaaf, MD

In most of our practices, we see patients who need medication to

manage chronic noncancer pain

Yet for many doctors, prescribing opioid drugs to patients

poses a dilemma We know the inherent risks to prescribing

narcotics—that patients become tolerant and may require more,

which can lead to overdose Washington State has one of the

highest rates of overdose death in the country From 2003 to

2008 the state death rate from prescription pain medication

increased 90 percent Poisoning is now the state’s leading cause

of unintentional injury—more than vehicle accidents

Perhaps we’ve seen a patient who was manipulative about their

medication because of a chemical dependency It’s hard not to

be conflicted after a few of these experiences

We, the medical community, want to give our patients the best

treatment safely, but we are not consistent in how we handle

the issue Some of us prescribe without reservation, never

challenging the patient Others won’t prescribe at all

Beginning in June 2011, Washington’s Department of Health will

require five professional boards to uniformly apply new rules to

manage non-cancer chronic pain Washington’s Medical Quality

Assurance Commission represents physicians; the others boards

represent nursing, osteopathic medicine, podiatry, and dentistry

See MQAC proposed rules at http://www doh wa gov/hsqa/

Professions/PainManagement/files/pmrule pdf

Our approach

Six months ago Group Health deployed a Chronic Opioid

Therapy (COT) process that’s intended to be compassionate while

maintaining barriers to abuse Our doctors use it throughout our

medical centers Our first step was to remove judgmental and

paternalistic language from our care—from “drug-seeking” to

“pain contracts ” It’s easy to label a patient—and hard to remove

one once it’s there

We now flag patients in our electronic medical record’s problem

list as being on COT It’s a neutral, non-judgmental term We also

include a brief description in the problem list of why the patient is

on the medication and its limits, so a doctor can view at a glance

whether the patient is being managed

Developing the treatment plan with the patient is key Our

doctors use a template for the treatment plan that includes

patient specific goals for their therapy as well as standard

information about the risks of the narcotic, given the condition

The plan clarifies the number of refills, where they will be filled

and the actions needed to stay safe

We’ve lowered the temperature on tense discussions with

patients In our system, the patient gets the same message

everywhere they go—in primary and urgent care, pharmacy, etc

Each patient is also assigned a risk level based on morphine

equivalent dose and behavior issues, which clarifies how often

we’ll see the patient and how often they will get a urine drug

screening We explain that even behaviorally low-risk patients

may be taking high doses, so we screen consistently for everyone

In six months, our primary care teams have updated problem-

list fields and created new care plans for high-risk patients We’ll

adjust the program to conform with the new rules

In 2009, the Group Health Research Institute completed a

study of nearly 10,000 patients who received multiple opioid

prescriptions for common chronic pain conditions like back pain

and osteoarthritis Patients who received higher opioid doses

were nine times more likely to overdose than were those receiving

low doses Still, most of the overdoses occurred among patients

receiving low to medium doses, because prescriptions at those

levels were much more common

This is an issue that requires everyone’s attention To learn more

about our COT Program, please contact me at (509) 241-7669 or

Schaaf t@ghc org

***************

Tom Schaaf, MD, is the assistant medical director for Group

Health Cooperative’s Eastern Washington/North Idaho District.

Board-certified in Family Medicine, Dr. Schaaf has practiced at

Group Health in Spokane since 1992, and founded its hospitalist

program in 1997.

In the NewsLouis Koncz, PA-C was recently elected the 2011 – 2012 President Elect of the Washington Association of Physician Assistants Louis is the PA representative on the SCMS Board of Trustees He graduated from the University of Utah in 1992 and works at the Rockwood Urology Center

Jan Martinez was awarded the 18th annual Sister Peter Claver Award by Providence Sacred Heart Medical Center and Children’s Hospital Martinez created Christ Kitchen, which helps women gain skills and work experience Christ Kitchen is a ministry of Christ Clinic, a non-profit medical clinic serving the needs of Spokane's working poor

April SCMS Message 8P e r s o n a l i z e d OB C a r e . R i g h t H e r e .

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To schedule a tour of The Birthing Center and Special Care Nursery at Valley Hospital, call (509) 473-5475. To find an OB physician based in the Valley, visit www.spokanevalleyhospital.com/physicians.

When it comes to your special delivery, we’ve got you covered.

53203_VHMC_OB_7_5x10c.indd 1 1/14/11 5:01 PM


Guideline for Prescribing Opioids for Chronic Non-cancer PainPrescription opioid abuse is a growing problem in our community During the last decade, opiate-related poisonings in Spokane County increased 102% for Emergency Department visits, 213% for hospitalizations and 25% for deaths

Researchers from the University of Washington are surveying healthcare providers in our community to evaluate the diffusion and acceptance of the Washington State’s Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain The Spokane County Medical Society and the Spokane Regional Health District support this effort and encourage your participation

Participating in this evaluation will help strengthen knowledge about how to prevent accidental overdoses from opioid prescriptions It is important to have as many providers participate as possible to accurately reflect provider practice The Spokane Regional Health District and community partners can use this information to guide prevention efforts, working in partnership with the medical community

The survey typically takes less than 20 minutes to complete and is located at http://www surveymonkey com/s/8SR9SQV

Participation is voluntary and responses are anonymous There will be no benefit to the respondent for participating in this research, but it will help efforts to improve Washington State’s Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain.

If you have questions about this survey please contact Kathleen Egan at (206) 685-7194 or email her at katbegan@uw edu

Resources for Physician AssistantsBy George McAlister

Health Information Resources Director

Physician assistants provide physician-directed patient care in all medical and surgical settings To help support your clinical practice, areas of interest, and special expertise, we have created an ongoing resource category within Medicor (http://spcmsmedicor org) for physician assistants Over 40 resources have recently been added, including selected PA-centric websites, academic and professional associations, state boards, directories, scope of practice competencies and other specialized resources The new “Physician Assistants” collection of resources can be found within the Medicor library information portal under the following menu headings: Find Resource>Category>Physician Assistants Or enter this URL in

your browser’s address window: http://tinyurl com/4aqydq4 As always, we welcome your additions to this ever-growing list of authoritative information – Please contact George McAlister at 509-325-5010, george@spcms org, for more information

“The Future of Health Care”By Keith Baldwin, CEO, SCMS

Greater Spokane Incorporated in partnership with the Journal of Business invited the community to peer into the future on a snowy Thursday morning, February 24, 2011 They invited a diverse panel of individuals to discuss two general topics The Business of Health and Factors Driving Change and Innovation and Solutions to Deliver Quality Health Care and Reduce Costs The panelists included Dr Maxine Hayes, WA State Health Office, DOH; Heidi Alessi, Attorney, K&L Gates, LLP; Jan Wigen, Employee Benefits Principal, Mercer Health & Benefits; George Iranon, CEO, Career Path Services; Brian Kingsbury, District Manager, Safeway, Inc ; Dr Tom Schaaf, Assistant Medical Director for E WA and N ID, Group Health Cooperative; Dr Ronald Inge, VP & Dental Director, WA Dental Service; Jac Davies, Director of Beacon Community of the Inland Northwest (BCIN); Dr Lisa Shaffer, President, Signature Genomics from PerkinElmer and Dr Ken Roberts, Director, WWAMI/WSU Spokane

Each panelist gave insightful information about their particular area of expertise and several themes seemed to consistently surface from the presentations and questions which followed

• The management of chronic disease must be a priority in

order to improve quality and reduce the cost of health care,

especially diabetes care, which uses about 40% of our health

care dollar

• The PPACA (health reform law) has brought some needed

improvements to the health system but it will be years before

all the rules are written and we actually have “health” reform

rather than insurance reform

• People (individuals) and employers must take more

responsibility for preventative health behaviors and employer

sponsored programs to reduce the need for expensive health

services and treatments so we will all live healthier lives



Jamie Lewis, MD Patricia Fernandez, PsyD

Phone: 509.464.6208 Fax: 888.316.1928 Spokane, Washington

Physical Medicine & Rehabilitation

Psychology

Interventional Spine

Pain Medicine

EMG/NCS

A Multidisciplinary Approach to Improving Quality of Life.A Multidisciplinary Approach to Improving Quality of Life.



• The delivery of medical care must take advantage of

technology and be patient centered in order to increase care

coordination, be timely and improve patient and provider

satisfaction

• Oral health must be considered an integral part of a healthy

lifestyle

• An adequate supply of primary care physicians, who direct the

team process of care with other health professionals, is critical

to a new model of health care delivery which emphasizes

prevention and care coordination of chronic disease

• A four-year medical school in Spokane, complemented by

numerous other health professional education offerings, is

critical to the economic success of this region and significant

improvement in health status

The panelists reinforced the need for creating an environment which incentivizes healthy behaviors by individuals and for the payment system reforms which will incentivize providers to improve the quality of care provided (value versus quantity)

In a special report on “The Future of Health Care” in the Journal of Business (Feb 24, 2011), Dr Brad Pope, SCMS President, noted the serious effects rising medical costs are having on patients, businesses and all sectors of the medical community Reversing this trend will require a transformation that will include consolidation of healthcare systems, a shift to outcome-based reimbursement and more transparency when it comes to costs, quality and service for patients “If the transformation is successful,” Dr Pope noted, “our society will enjoy healthier people and a healthier economy ”

10 Healthcare Reform Market Changes Affecting PhysiciansBy Laura P. Jacobs, MPH

While the specific regulations from the Patient Protection and Affordable Care Act (“ACA”) are still evolving, the “barometer reading” for change is clear Market place trends and healthcare reform have clear implications for physicians The pace of change will depend on specific market dynamics, private payer initiatives, and the degree of physician organization and physician-hospital integration, not to mention government action

Physicians in private practice have been faced with a series of challenges and opportunities in recent years, and some assume that “this too shall pass ” The risk, though, of ignoring market trends is to face the downside of evolution – extinction Here are the top ten ways in which these market forces, dominated by healthcare reform, affect physicians They may not all affect you now, but your radar should be scanning for “blips” of change in your market

1 Traditional payment will decline. Since the ACA did not “fix” the Medicare formula driven by the sustainable growth rate (“SGR”), there will be threats of decreases in the traditional Medicare fee schedule – this year close to 30 percent While it likely that these decreases will be periodically “patched” by Congressional action, it is unlikely that Medicare fees will increase in the near future Since many private payers link their fee schedules to Medicare rates, this means no increases for the foreseeable future For some specialties, it will mean decreases, since Medicare and some other payers are shifting dollars from primary care to specialty services – but not adding any new money to the “pot ” The only hope of “upside” will come through new payment models such as bundled payment, shared savings, and pay-for-performance


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2 EMR and connectivity are “table stakes.” With the passage of the American Recovery and Reinvestment Act of 2009 (“ARRA”), physicians have the opportunity to earn incentives up to $44,000 from Medicare for implementation of electronic medical records (“EMR”) that meet “meaningful use” criteria But after 2015, penalties are imposed if practices fail to meet these criteria Additionally, the need to be clinically integrated with other physicians and hospitals is growing due to various new payment methodologies, not to mention patient expectations Within the next few years, it will not be a “benefit” to have an EMR AND connectivity with other providers, it will be a requirement to stay in the game

3 Expect to be measured – no more “invisible man (or

woman).” The Physician Quality Reporting Initiative (“PQRI”) program was expanded in ACA, so that there are increasing incentives to participate through 2014, then the penalties for non-participation begin (sense a theme here?) Results will be posted publicly on the to-be developed “Physician Compare” website sponsored by CMS This is in addition to the data gathered by payers and other private rating websites such as HealthGrades Whether or not the measures are “right,” they will be published and available to consumers The forward-thinking physician organizations are collecting and sharing this information among physicians now to provide timely feedback and improve organization-wide performance and outcomes

4 Are you now or have you ever been an ACO? ACOs will be selected by CMS beginning in 2012 Some private payers and self-insured employers are evaluating this model as a way to reduce healthcare cost inflation and improve population health It is widely accepted that ACOs must be physician-led in order to achieve these objectives Since the infrastructure required to function successfully as an ACO is substantial, many smaller physician groups will be participate in ACOs; others will be large enough to potentially qualify as an ACO The key question for physicians to consider is: what role should/can we play in an ACO model, and what resources, leadership skills and partners will we need to successfully fulfill that role?

5 Would you like to be a pilot? The ACA calls for the funding of $10 billion to the CMS Center for Medicare/Medicaid Innovation to provide grants and lead demonstration projects to identify new delivery models and/or payment models The hope is that through incentivizing discovery, new care delivery models such as the patient-centered medical home (“PCMH”) or payment models such as bundled payment will evolve to “reduce program expenditures while preserving or enhancing quality of care ” Alert physician organizations, large and small, can participate in these demonstration projects to be at the leading edge of innovation and seize opportunities to lead the market

6 Access (when and how) matters. Providing the estimated 32 million or more currently uninsured individuals with access to health insurance will likely create or exacerbate access issues

for medical care Patients already have difficulty obtaining physician appointments within a desired timeframe in some communities Given the current shortage of primary care physicians in many markets, access to primary care is likely to be the first to be affected Only through redesigning care delivery models, implementing electronic visits (e-visits) and other electronic tools such as telemedicine, effectively utilizing a broad array of healthcare practitioners and support staff, and empowering patients to play an active role in their health will an access “meltdown” be avoided Even today, patients are increasingly expecting ready access (defined by the patient) to their healthcare providers through e-mail, portals, and, when necessary, the face-to–face visit at home Physicians who cling to the traditional office visit as the only venue for care will risk declining patient preference and limited – hence declining – patient revenue

7 Patient expectations will continue to rise. A combination of factors will result in an increase in patient expectations for healthcare services:

• The newly insured will expect to have access like anyone else

• Those with insurance may face increased cost-sharing, so will

now “shop” for the best service and quality

• The Baby Boomer generation wants to avoid looking or feeling

older, and will expect their healthcare provider to provide the

solution(s)

• There will be an increasing demand for the ability to

communicate via text, social networking, or web portal with

healthcare providers

• Disruptive innovators and innovations can change the

competitive landscape (e g Google, Walmart)

• Exploding wealth of data and health information will appear

online for the worried well, chronically ill, or recently diagnosed

patient

These factors will result in an increasingly savvy healthcare consumer who expects that their physician is responsive to their expectations Language in the ACA speaks of rewarding providers who embrace “patient-centric” processes; physicians must take stock of their practice and processes to evaluate how well they are prepared for these expectations

8 Reframing the clinical workforce. The ACA includes funds to increase training positions for primary care and general surgery, add training in preventive medicine and public health, and support training for medical homes and team management of chronic disease, among other initiatives But these will likely fall short of filling the gap of demand/capacity in many key specialties – particularly primary care In addition, the generational shift in expectations among young physicians – for employment models that provide greater security, balanced work life, and part-time options that many small private practices cannot offer – creates a dynamic in many markets where the big groups



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(or hospital-owned) get bigger, and the small practices disappear as physicians retire All this requires physicians to evaluate how their group or practice is structured for recruitment of a clinical workforce to facilitate growth and/or succession planning to meet community need This may require looking to advanced practice nurses or physician assistants as well as a re-evaluation of compensation plans, benefits, and even medical group structure

9 No relief in operating costs. Despite the fact as

previously noted that traditional sources of revenue are likely

to be constrained in the future, there is nothing in the ACA or

in economic trends that give practices any relief in day-to-day

practice expenses The ACA does little to mitigate increases

in malpractice costs, the taxes on biotech and pharmaceutical

companies are likely to increase these supply costs, and

implementing EMR requires annual maintenance fees So the

recent trends of increasing overhead costs will not likely go away

– unless practices evaluate new models of care or ways to achieve

economies This means evaluating how support staff are being

utilized (i e , are they working at the top of their qualifications in a

way that maximizes provider productivity and effectiveness)?

10 Hospital relationships matter. In recent years the

“centricity” of the hospital as the focal point of the healthcare

community has been affected by conflicting trends: on the one

hand, hospitals are the employer of physicians at an increasing

rate; on the other, there are many physicians who never set

foot in the hospital and are unaware where the medical staff

dining room is or cannot recognize key specialists other than by

name Further, many of the hopes for healthcare reform are riding

on better chronic care management, which is not a skill most

hospitals possess What the new payment models (e g , shared

savings, bundled payment, PCMH) and the “triple aim” espoused

by Dr Don Berwick of CMS (i e , “better care, improved health,

and lower costs”) require, though, is a care delivery system that

is based on collaboration between physicians, hospitals, and

other healthcare providers To achieve optimal performance

under any of the proposed payment models, whether you

are a small practice or large multispecialty practice, requires

collaborative physician-hospital relationships This will require

both hospitals and physicians to put aside old frameworks that

assume one entity “controls” the other; how these partnerships

evolve will depend on who leads innovation and demonstrates a

commitment to healthcare improvement and operates effectively

to remain financially strong

HealthLeaders Media , March 10, 2011



A two-year program, MEDEX operates four training sites —

Seattle (40 students), Yakima (20 students), Spokane (20 students)

and Anchorage (20 students) The Seattle and Spokane sites offer

a master’s degree and the Yakima and Anchorage sites offer a

bachelor’s degree

This year, MEDEX received two new federal training grants

An equipment grant is designated for purchase of additional

teaching technology for the decentralized program A nearly

$2 million expansion grant will support new training slots for an

additional 50 students over the next five years These students

will receive annual stipends to support their primary care career

plans

In addition to contributing to the U S health workforce, MEDEX

has begun working on the development and expansion of training

for PA (or PA-like) programs globally The program has hosted

medical leaders from Australia, the UK, New Zealand, Ghana,

Mozambique, China, South Africa and Canada to discuss the

potential for PA training and practice

2011 will bring significant leadership changes to the MEDEX

Program In June, Ruth Ballweg (left) will pass the program

director responsibilities for the entry-level PA program to Terry

Scott This will allow Ruth — who will continue as division

director — to focus on the broader functions of the MEDEX

program, including research, innovations in medical education,

post-graduate programs, global health projects, and the overall

expansion of PA utilization in the region Terry Scott is a highly

respected PA leader at UW Medicine, where he has served on the

MEDEX faculty and practiced at the Roosevelt Family Medicine

Clinic since 1997 Terry is a past president of the Washington

Academy of Physician Assistants and currently serves on the City

Council for Shoreline

The MEDEX Program is a superb example of an educational

program that has carefully expanded its breadth and depth

as it remained focused on serving the region I would like to

thank Ruth Ballweg and her colleagues for developing and

implementing one of the nation’s finest physician assistant

training programs, and for remaining strongly focused on our

mission of improving the health of the public

Spokane County Medical Society2010 PHYSICIAN/CITIZEN OF THE YEAR

The DEADLINE for nominations has been extended to

April 18, 2011.

Any member of the Spokane County Medical Society is eligible for nomination.

For nomination forms and further information visit the

SCMS website at www.spcms.org.


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Below is the winning essay of the 1st annual resident writing competition. The essay was written by Dorien McAbee, a second year resident with Internal Medicine Residency Spokane Program.

"ON BECOMING A DOCTOR"DORIEN MCABEE, DO

The last time I say her, and she was in a crisis – shaking, crying and telling me she no longer felt in control of her ability to

stop drinking alcohol She felt hopeless about the future, did not care if she lived or died, and looked to me with pleading eyes As

I sat in clinic listening, I was at a loss Do I reach for anti-depressants, Antabuse, refer to counseling? The tremendous amount of

trust she placed in me, to come to me for help at one of the lowest points in her life, really weighed on me Five hundred twenty five

thousand six hundred minutes…/how do you measure, measure a year/in daylights, in sunsets/in midnights, in cups of coffee /

This melody from a song crosses my mind when I sit down and think about the road I have been down to becoming a

doctor How do you measure becoming a doctor? In years of training? In number of patients? In late nights studying or in tests?

Memories swirl across my mind like flashes of light – running down the long fluorescent lighted hallway to a code, living out of a

suitcase traveling to different rotation sites, excitement of seeing a baby born, holding a patient’s hand and telling them they were

dying, the privilege I felt to be able to hold a spinal cord in my hand in anatomy lab Also a series of “firsts” – my first week in

medical school, getting my white coat, my first day of clinical rotations, my first day of residency, my first night on call, the first time

someone called me “doctor” The first time a family member was ill and everyone looked to me for answers The first time I made

a mistake The first time I saw someone die The first time I coded someone and they survived

Four months later I saw my patient again in clinic She had enrolled in an intensive outpatient counseling program and we

had gone through trails of different medication including Antabuse, Campral and Naltrexone With tears in her eyes, and a smile on

her face, she told me she had not had a drink of alcohol in ninety days, and felt like she had been given her life back She no longer

felt like she wanted to go to sleep and not wake up As she left the clinic, she put her hand on my arm, and with a waver in her

voice, told me how she did not think she was going to make it through that time She told me sincerely how much it meant to have

a doctor she trusted enough to admit she was at rock bottom and needed help

I know that in reality, a relapse is a likely hurdle in her future And I know there might be nothing medically I can offer

Receiving your medical degree unfortunately does not result in waking up the next morning and having all the answers Becoming

a doctor is a journey that never ends – every patient can teach you something I remember writing my medical school essay, about

my motivation to enter this field I talked about wanting that rewarding feeling of using my knowledge to truly change a person’s

life for the better Now, I know that despite my best efforts, some people do not improve, accept my advice, or stay compliant to

therapies But sometimes, a patient makes you stop in your tracks and reminds you to the core why you decided to do what you do

Not everyone gets better But some of them do And that makes it worth it

In Memoriam

Robert Paul Shanewise, MD

Robert Shanewise passed away at home on February 26,

2011 He was born on October 13, 1921, in Akron, Ohio Bob

graduated from Mount Union College in Ohio in 1943 and in the

fall enlisted in the Navy where he served three years In 1950 Bob

graduated from the University of Rochester Medical School in

New York and in 1955 he completed his residency at Washington

University in St Louis, Missouri

In 1955 Bob and his family moved to Spokane where he

began a practice as an orthopedic surgeon that lasted until 1998

From 1975 until 1996 Bob volunteered for Orthopedic

Overseas working in many third world countries The last

ten of those years were spent in Ethiopia helping to develop an

Orthopedic training program at the Black Lion Hospital in Addis

Ababa He also served as the Director of Volunteers for Ethiopia

in Orthopedic Overseas After retiring from his practice, Bob and

his wife, Helen, built and ran the assisted living facility, Moran

Vista, located on the south hill During his life he was very active

in the Spokane community He was a member of Spokane Medical

Society and in 1983 was selected as Physician/Citizen of the Year

Bob enjoyed skiing, duck hunting, mountain climbing and white

water canoeing He ran in Bloomsday races from 1977 until 2004

He is survived by his wife of 68 years, Helen, daughter

Katherine (William) Hunt, sons Dr Jack (Phillis Levin) Shanewise

and Steven Shanewise, grandchildren Creedence (Rowena) Smith, Sarah and Charlotte Shanewise, nieces Sharon Smith, Christine Shanewise and nephew Craig Shanewise


A Physician Perspective on the Beacon Community ProjectBy Colleen Carey, MD, Endocrinologist

The Beacon Community of the Inland Northwest (BCIN) project is designed to provide support to physicians and other care providers for the management of Type 2 Diabetes Mellitus across a large, 25-county geographic area in eastern Washington and northern Idaho. The project’s overall goal is to achieve better outcomes for this growing population of patients that are typically very difficult to manage.

Type 2 diabetics have multiple medical issues that must be addressed. These include blood glucose control, blood pressure and lipid management, and lifestyle intervention with nutritional and exercise counseling. They are at risk for coronary artery and peripheral vascular disease and diabetic nephropathy which may progress to dialysis or kidney transplant. Diabetic retinopathy can lead to loss of vision without timely intervention by an ophthalmologist.

Managing all of these problems and coordinating subspecialty consultations create an enormous demand on the provider. There is abundant data supporting early aggressive interventions in diabetic risk factors to improve outcomes. However the care of this vulnerable population is burdensome and physicians traditionally have focused on their sicker diabetic patients, those who have progressed to severe hyperglycemia or developed serious complications. Although understandable, this focus results in a lost opportunity to prevent or delay complications by aggressively managing diabetics much earlier in the course of their disease.

The BCIN project uses information technology to facilitate patient care. This includes filling information gaps so that caregivers have more complete medical records. Consultations by ophthalmologists, nephrologists, cardiologists and other medical specialists would be readily available to the provider. It is much more helpful to review what the ophthalmologist’s report found than to have only the patient’s report that he or she saw an eye doctor. Laboratory testing, such as a fasting lipid profile, would be available in the medical record so the information is known at the time of the visit and the possibility of duplicate testing could be avoided. Timely hospital in-patient and emergency department records will improve continuity of care.

Standards of care have been developed through an understanding of the pathogenesis of diabetes mellitus and its complications. Those will evolve over time and health information exchange provides a way to give current guidelines in an interactive format.

Some clinics have full diabetic support with diabetic educators, nutritionists and diabetic nurse practitioners. Others have limited resources. BCIN can connect clinics with those support services depending upon their needs and help coordinate services. Participating providers can more readily track their patients’ outcomes, which will make it easier to focus on those areas where more intensive care is needed. For example, a patient may be checking blood glucose at home but unable to understand guidelines for adjusting insulin. A diabetic educator could help here. Often patients want to follow a healthier diet but lack of knowledge, limited financial resources or irregular work hours present barriers. A skilled nutritionist can help patients tackle those issues.

The BCIN will help us achieve more consistent care for diabetic patients in our region. As primary care physicians participate in the BCIN project, I anticipate they will become more confident in managing their diabetic patients, and by utilizing care coordination services find that they can do so more efficiently.

Dr. Colleen Carey is an Endocrinologist and the CHER Diabetes Education Center's Medical Director. She specializes in Endocrinology and Metabolism and has been in practice in Spokane, Washington since 1980. Dr. Carey obtained her degrees from Pomona College and the Medical College of Pennsylvania. She was a member of the clinical faculty of the University of Washington School of Medicine for a number of years and since January of 2010 has been an assistant clinical professor at the University, working with students and residents at the Internal Medicine Residency Clinic. She is especially interested in Diabetes Education.

Project Access UpdateBy Lee Taylor

The New Project Access Director

I’m still the “new guy” for a little while So far, so good! I am learning and gathering lots of information that will help us increase the value of Project Access in the community

A physician I know reached out to me after seeing the announcement of my position with Project Access He said, “Welcome to our world – glad to have you on board!” And my thought was yes it is a different world and yes I feel welcome! I have already learned a great deal from many doctors and administrators who are very willing to share ideas and give me candid feedback about the value of Project Access to them and to their organizations This is very good! It will keep us healthy, help us grow and provide the path to creating more value in the community

The baseline for this new chapter for Project Access is our performance in 2010 Last year we coordinated donated




specialty medical services to 571 Project Access patients with acute conditions The patients had no other way to access proper health care They had no medical insurance and they were not eligible for any other public assistance programs to help pay for their healthcare, even though many are working Without Project Access, they would have gone without treatment, or showed up in the emergency room when their condition went from acute to emergent That is really good but our goal in 2011 is to serve many more patients

Last year approximately 600 specialty physicians and providers volunteered their services to help Project Access patients It is more than the previous three years, but our goal in 2011 is to build more partnerships and engage additional physicians who are willing to help more people in need

There is no question that the need for Project Access services is great, and growing The Community Indicators Initiative of Spokane, under the leadership of Eastern Washington University, reported that 31 1% of Spokane County residents with incomes at or below the Federal poverty level are uninsured And 20 8 % of the county’s residents with incomes between 100% and 199% of the Federal poverty level are uninsured This research shows that the number of uninsured people in Spokane County has increased by 4 7% in the past two years We know that negative health outcomes often correlate with low income, less educated, uninsured populations This is a huge problem with no solution until health reform provides insurance for many more individuals if it ever does Even with successful health reform in 2014 and beyond, it is clear that ALL people will not have health insurance coverage Project Access, and many physicians with a big heart, will continue to have an important role in helping people who have “fallen through the cracks”

No matter how obvious the need for those services may be, I believe we need to know the quantitative value of Project Access’ services to our community at-large, and to the medical community Reducing the use of the emergency room for non-emergency health care is one of the areas where Project Access can work to reduce the cost of medical care We are working with area hospitals to refer patients with acute medical problems that are not a medical emergency to Project Access Those patients can be seen by a primary care physician who has agreed to donate services The referral provides the patient a medical home and helps make sure that they receive the proper diagnosis and a referral to a specialty physician if needed If surgery or other hospital services are prescribed by the specialty physician or the primary physician, the patient can then access the needed care through regular hospital services, rather than being treated in the ER

And then there is opportunity to eliminate services that are not needed That adds value to our community too We provide case management and patient coordination services for Project Access patients Case management services include medical screening by the Project Access nursing staff and with volunteer physicians through our Therapeutics Committee One area where we know Project Access adds value is the screening of prescribed imaging services to insure that they are necessary and appropriate for each patient The imaging screening alone saved over $55,000 in resources during 2010 that would have been expended unnecessarily without Project Access case management

I know there are many more ways that Project Access can collaborate with our partners to make smart and valuable decisions that will make a difference in the medical community and for Project Access patients

I am looking forward to learning more! If you have ideas that you would like to share please call me at (509) 220-2651 or email me at lee@spcms org

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The Physician Pipeline Really Works!By Deb Harper, MD

UW School of Medicine

Assistant Dean for Regional Affairs & WWAMI Clinical Coordinator

for Eastern & Central Washington

Five years ago I began working for the UW School of Medicine’s WWAMI Program as an Assistant Dean for Eastern Washington That year we had two 3rd year Spokane Track students (students who spend at least five of their six required clerkships here) One of them stayed on to do his residency at Family Medicine Spokane and, in July 2010, Dr Eric Tubbs joined me as a colleague in practice at Group Health How cool is that?

This year we have thirteen 3rd year Spokane Track students and we have added a 4th year Track as well The growth of our Tracks can be attributed to two factors First, our clerkships are getting terrific reviews from the students who appreciate the great teaching, access to patients and attendings, and the support of the Spokane medical community and community at

large Second, our inaugural class of first-year students is now in their third year and they wanted to return to this community which gave them such support and a warm welcome

But wait, there’s more! Next year we will have thirteen 4th year Track students And not all of them are from our 3rd year Track cohort Several students who did only one or two 3rd year clerkships here had such a good learning and living experience they have asked to spend their final medical school year here as well

This year we have 67 individual students coming to Spokane for their 3rd year clerkships We also have 59 students who are coming to eastern and central Washington for clerkships in Omak, Yakima, Walla Walla, the Tri-Cities, Othello and Wenatchee

This is our opportunity to shine and be able to attract our future colleagues, and the high quality people who will be our personal physicians in the future

If you would like to begin teaching students or if you are already teaching students but want to improve your teaching skills, you are invited to the conference “Having Fun Teaching: The Joys of Teaching Medical Students, Residents and Physician Assistant Students” on the morning of May 21 Admission is free, there will be food, lectures and time to interact with students and residents as well We have applied for Category 1 CME (3 5 hours) For additional information, please contact John McCarthy at mccajf@uw edu or me at djharper@uw edu

FYI

PAML Support Medical Education

By Judy Benson, MD

Family Medicine Spokane,

Internal Medicine Residency Spokane

Transitional Year Residency

The PAML Foundation has donated four laptop computers for resident use As electronic documentation has become increasingly common, computers are in huge demand Resident staff have been experiencing frustration when computers on the floors of the hospital are unavailable for their patient care needs The PAML Foundation graciously came forward to donate computers to graduate medical education which is very much appreciated by the Family Medicine Spokane, Internal Medicine Residency Spokane and Transitional residents and faculty They are truly remarkable partners in furthering medical education in our region

Valley Hospital and Medical Center - Pediatric Hospitalists: In mid-March a Pediatric Hospitalist Program was added to the clinical services at the Valley Hospital and Medical Center The hospitalists will work with the pediatric nursing staff and provide care for non-critical children on the 12-bed Family Care Services Unit The service will also be at Deaconess Medical Center Pediatric hospitalists will be available to care for patients 24 hours a day, 7 days a week By calling (509) 473-PEDS, community physicians can directly admit patients to the Valley or Deaconess Pediatric Units or request a hospitalist consult

In Memoriam

George Yip Min Wang, DO

George Yip Min Wang passed away February 11 George was born in Hong Kong, China the second sibling in a family of seven, to Shung Heung Li and Din Ying Wong He attended Diocesan Boys School in Hong Kong and graduated in 1959 At age 17 he left home and came to the United States to follow his dream of becoming a physician He attended the Iowa College of Osteopathic Medicine and Surgery in Des Moines, Iowa and graduated with his medical degree in 1966 He completed his internship at Cafaro Memorial Hospital, Youngstown, OH in 1966-1967 From 1971-1974 he completed his residency in Psychiatry at Western Missouri Mental Health Center, University of Missouri School of Medicine, Kansas City, MO He became certified with the American Board of psychiatry and neurology in 1977 George was an instructor at the University of Missouri School of Medicine, Kansas City from 1972-1974, and was the Adjunct Clinical Assistant Professor of Psychiatry at the University of Kansas School of Medicine He worked at the VA Hospital in Kansas City, MO as staff psychiatrist in charge of psychiatric consultation and liaison from 1974-1976 In 1967 George joined the Navy as Lieutenant Commander-General medical officer and served until 1971 He then served in the Active Reserve Navy from 1971 to 1976 when he joined the Air Force until his retirement in 1992 He worked at Eastern State Hospital as a staff psychiatrist until his retirement George loved long walks, Mahjong Games, dinner parties, fishing and travel He leaves behind his wife Cean, of 40 years, one son Jason of Hilo, HI, sister Alice of Vancouver, BC, brother Joseph and wife Eliza of Hong Kong, brother Edward of Hong Kong, sister Grace and husband Anthony of Hong Kong, sister Emily and husband James of Vancouver, BC, brother Robert and wife Angela of Vancouver, BC and many nephews and nieces and great nephews and nieces


SPOKANE COUNTY MEDICAL SOCIETYCONTINUING MEDICAL EDUCATION

2011 Program Schedule

APRILUpdate in Pain Management

Thursday, April 28, 5:30 - 9:15 pmEvening Seminar for the Primary Care Update Conference

Red Lion Inn at the Park(Two one and one-half hour topics will be presented)

JUNEEndocrinology Update 2011

Wednesday, June 8, 5:30 - 9:15 pmDeaconess Health and Education Center(Three one-hour topics will be presented)

OCTOBERModerate (Conscious) Sedation and Analgesia

Wednesday, October 5, 5:30 - 9:15 pmDeaconess health and Education Center

(SCMS' annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical

community in order to increase patient safety)

NOVEMBERTopic TBD

Tuesday, November 8, 5:30 - 9:15 pmDeaconess Health and Education Center(Three one-hour topics will be presented)

To sign up for a Continuing Medical Education class, please contact Jennifer Anderson, CME Coordinator

(509) 325-5010 ext. 28 or [email protected]

Continuing Medical Education An Overview of Care Coordination Essentials – Noon – 1:00

p.m., April 28, 2011 This one-hour webinar will present an in-depth overview of the essentials for effective care coordination, giving participants a practical, four-part framework for improving how care is coordinated among clinical partners Focused on the patient-centered medical home model of care delivery, the framework begins with taking responsibility for the care your patients receive regardless of setting and includes identifying the best practice service partners, building relationships with these partners, providing patient logistical support, and developing formal agreements and connections to improve care coordination The webinar will be presented by Ed Wagner, MD, MPH, FACP, a general internist/ epidemiologist and Director of the MacColl Institute for Healthcare Innovation at the Group Health Cooperative Center for Health Studies This webinar is free of charge for medical groups, physicians or other health care providers A fee of $75 will be charged for all others

Register online at www wsma org/CPIN This activity has been approved for AMA PRA Category 1 Credit AAFP Preferred CME credit has been applied for and determination is pending If you have questions about registration call Jenelle Dalit at 1-800-552-0612 or jcd@wsma org If you have questions about webinar content or CPIN in general: call Lance Heineccius at (206) 956-3657 or Lance@wsma org

Other Meetings, Conferences and Events

Institutional Review Board (IRB) – Meets the second Thursday

of every month at noon at the Heart Institute, classroom B

Should you have any questions regarding this process, please

contact the IRB office at (509) 358-7631

Caduceus Recovery Group Meeting for Healthcare

Professionals – Meets every Thursday evening, 6:15 p m – 7:15

p m , at 626 N Mullan Rd, Spokane Contact (509) 928-4102

for more information Non-smoking meeting for Healthcare

Providers in recovery

Physician Family Fitness Meeting – Physician Family Fitness

is a recently created meeting for physicians, physician spouses,

and their adult family members to share their common problems

and solutions experienced in the course of a physician’s practice

and family life The meetings are on Tuesdays from 6:30 p m – 8

p m at the Sacred Heart Providence Center for Faith and Healing

Building, due east of the traffic circle near the main entrance of

SHMC Enter, turn right, go down the stairs, Room 14 is on your

right Format: 12-Step principles, confidential and anonymous

personal sharing; No dues or fees Guided by Drs Bob and Carol

Sexton The contact phone number is (509) 624-7320

Health Care Team Challenge – Monday, April 11 from 4:30 to

6:30 p m in the South Campus Facility Court located on the

Riverpoint Campus organized by the Riverpoint Interprofessional

Education and Research student group For more information

contact Barbara Richardson, RN, PhD at barichardson@wsu edu

or (509) 358-7582

Save the Date: Saturday morning, May 21, 8:15 - 12:15 “How

to have fun teaching, learning to enjoy working with medical

students, residents and PA students!" The morning will include a

chance to interact with medical students, information on teaching

without impacting productivity and an introduction to the UW

online library services CME Category 1 has been applied for

More information to come


The following physicians/physician assistants have applied for membership, and notice of application is presented Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St , Orange Flag Bldg #114, Spokane, Washington, 99202

PHYSICIANS

Barber, Anna A., MDPediatricsMed School: U of Washington (2004)Internship/Residency: U of California, Davis (2007)Practicing with Providence Family Medicine North beginning 8/2011

Barber, Douglas R., MDObstetrics & GynecologyMed School: U of Washington (2004)Internship/Residency: U of California, Davis (2008)Fellowship: U of California, Davis (2011)Practicing with Sacred Heart Center for Maternal Fetal Medicine beginning 8/2011

Brown, Anthony N., MDOrthopaedic SurgeryMed School: U of Minnesota (1992)Internship: Hennepin County Medical Center (1993)Residency: U of California, Davis (2000)Fellowship: St John’s Health Center (2007)Practicing with Providence Orthopedic Specialties beginning 8/2011

Feliciano, Beejay A., MDSurgery/Vascular SurgeryMed School: U of California, Davis (2004)Internship/Residency: Virginia Mason Medical Center (2009)Fellowship: Indiana U (2011)Practicing with Rockwood Heart & Vascular Center beginning 8/2011

Grosse, Scott E., MDPhysical Medicine & RehabilitationMed School: U of Washington (1992)Internship/Residency: U of Washington (1996)Practicing with Spine Team Spokane since 3/2011

Henkel, Amy E., MDDiagnostic RadiologyMed School: Creighton U (2005)Internship/Residency: Loyola U Medical Center (2010)Fellowship: The Methodist Hospital (2011)Practicing with Inland Imaging Associates, PS beginning 7/2011

Poulton, Thomas L., MDUrologyMed School: Uniformed Services U of Health Sciences (1996)Internship/Residency: Madigan Army Medical Center (2003)Practicing with Rockwood Kidney and Hypertension Center beginning 5/2011

Sandhu, Neelwant, MDPhysical Medicine & RehabilitationMed School: Oregon Health & Science U (2005)

Internship: Rochester General Hospital (2006)Residency New York U Medical Center (2009)Fellowship: New England Baptist Hospital (2010)Practicing with Inland Neurosurgery and Spine Associates since 3/2011

PHYSICIANS PRESENTED A SECOND TIME

Chappell, John S., MDPediatric SurgeryMed School: U of Witwatersrand, South Africa (1960)Practicing with Pediatric Surgery Center since 2/2011

Goswami, Sushanta K., MDInternal MedicineMed School: Sri Ramachandra U, India (1986)Practicing with Sound Physicians since 3/2011

Maixner, Andrew H., MDAnesthesiologyMed School: U of Washington (2005)Practicing with Anesthesiology Associates, PS beginning 4/2011

Messick-Laeven, Petra M., MDPediatricsMed School: U of Amsterdam, Netherlands (1995)Practicing with Pediatric Surgery Center since 1/2011

Nievera, Jr., Conrad C., MDNeurologyMed School: U of the Philippines (1991)Practicing with Rockwood Clinic, PS beginning 8/2011

Pidgeon, John S., MDNeurologyMed School: Upstate Medical U (2003)Practicing with Rockwood Clinic, PS since 3/2011

Saw, Eng C., MDSurgery/ Thoracic and Vascular SurgeryMed School: Loma Linda U (1969)Practicing with Department of Veterans Affairs Medical Center since 7/2010

Webb, Joel D., MDObstetrics & Gynecology/ Gynecologic OncologyMed School: U of New Mexico (1992)Practicing with Rockwood Clinic, PS beginning 6/2011

Wyrick, Jared J., MDInternal MedicineMed School: Medical College of Wisconsin (2005)Practicing with Rockwood Clinic, PS beginning 8/11

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME

Quinlan, Linda A., PA-CPhysician AssistantMed School: U of Washington, Medex Northwest (1999)Practicing with Inland Neurosurgery and Spine Associates, PS since 6/2000


REAL ESTATE

Luxury Condos for Rent/Purchase near Hospitals. 2 Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess) Security gate, covered carports, very secure and quiet Newly Remodeled Full appliances, including full-sized washer and dryer Wired for cable and phone For Rent $ 850/month For Sale: Seller Financing Available Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price Please Contact Dr Taff (888) 930-3686 or dmist@inreach com

All Costs Included--Upscale View Condo One of a kind, separate entrance condo built into an upscale home on the north side (Owners rarely in residence) This home is located in a quiet, upscale-gated community, with panoramic views overlooking a small lake and golf course It is totally turnkey furnished, dishes, linens, cleaning supplies etc All new appliances, modern decor One bedroom (king size bed/rollway for guests) one bath, complete laundry room w/full size wash/dryer and one car garage with extra storage ALL COSTS ARE INCLUDED! Heat/AC, Utilities/Water, Cable TV, Internet/Wi-Fi, Long Distance phone Golf and walking trails right out the door Close to Holy Family Hospital and Whitworth College Please call 954-8339 for details Also willing to rent "unfurnished ”

For Sale: 17718 E Linke Rd, Greenacres WA $649,900 Elegance redefined featuring a custom-built rancher and horse property situated on 5 breathtaking acres For you over 3,800 sq feet, opulent master bedroom, formal dining, open floor plan & a gourmet kitchen For your horses a 56’ x 48’ metal show barn, heated tack room, 12x12 wash area, 11 matted stalls, mechanical horse walker Everything to accommodate you & your equestrian needs Offered by John L Scott Real Estate – John Creighton at (509) 979-2535 For a virtual tour www tourfactory com/709316

MEDICAL OFFICES/BUILDINGS

Good location and spacious suite available next to Valley Hospital on Vercler 2,429 sq ft in building and less than 10 years old Includes parking and maintenance of building Please call Carolyn at Spokane Cardiology (509) 455-8820

Northpointe Medical Center Located on the North side of Spokane, the Northpointe Medical Center offers modern, accessible space in the heart of a complete medical community If you are interested in locating your business here, please contact Tim Craig at (509) 688-6708 Basic info: $23 sq/ft annually Full service lease Starting lease length 5 years which includes an $8 sq/ft tenant improvement allowance Available space: *Suite 210 - 2286 sq/ft *Suite 209 - 1650 sq/ft *Suite 205 - 1560 sq/ft *Suite 302 - 2190 sq/ft

For Lease 3700 sq ft of second floor space in a new 18,900 sq ft building available It is located just a few blocks from the Valley Hospital at 1424 N McDonald (just South of Mission) First floor tenant is Spokane Valley Ear Nose Throat & Facial Plastics $24 NNN Please call Geoff Julian for details (509) 939-1486 or email gjulian@spokanevalleyent com

Sublease: Furnished Medical Office Space ~ Need immediate space for one or more north Spokane care providers? This shared suite is ready for occupancy; all furniture and exam room equipment included Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area 963 sq ft total, original lease $23/sq ft; will negotiate lower rate Excellent location in a full-service medical building with lab and full radiology services For more information, call (509) 981-9298

South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting Building designed by nationally recognized architects Both offices are corner suites with windows down six feet from the ceiling Generous parking Ten minutes from Sacred Heart or Deaconess Hospitals Phone (509) 535-1455 or (509) 768-5860

North Spokane Professional Building has several medical office suites for lease This 60,000 sf professional medical office building is located at N 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue The building has various spaces available for lease from 635 to 6,306 usable square feet available The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors, and stairways Other tenants in the building include, pediatricians, dermatology, dentistry, pathology, and pharmacy Floor plans and marketing materials can be emailed upon request A Tenant Improvement Allowance is Available, subject to terms of lease Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc at (509) 624-6522 or cell (509) 999-2720 Email: psrourke@comcast net

SPOKANE COUNTY MEDICAL SOCIETYCONTINUING MEDICAL EDUCATION

2010 Program Schedule

DECEMBERMental Health Update 2010

Thursday, December 95:30-9:15 pm

(Three one-hour topicss will be presented)


POSITIONS AVAILABLE

PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more To learn more about physician employment opportunities, contact Kelly McDonald at (509)444-8888 or kmcdonald@chas org

OUTREACH CLINIC AT HOUSE OF CHARITY – This is an opportunity to volunteer and bring to the underserved in our community first line medical care We need one or two more doctors to help us We see the homeless, predominantly, two afternoons each week Join four Board MDs and twelve RNs to rotate once or twice monthly in an excellent, well-equipped clinic with pharmacy If you are completely retired, the state will pay for your medical license and malpractice For more information and to sign up, call Dr Arch Logan, Medical Director, at (509)325-0255 or Ed McCarron, Director of the House of Charity, at (509)624-7821

PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Pediatrician and BE/BC Family Practice Physicians Excellent opportunity to join a collegial, physician-led medical group affiliated with the region’s most comprehensive and caring hospitals Providence offers generous hiring incentives, competitive compensation, comprehensive benefits and flexible work arrangements Providence Physician Services (PPS) is our physician-led network of more than 100 primary and specialty care physicians in multiple clinic locations Learn more at www providence org/physicianopportunities or contact Mark Rearrick mark rearrick@providence org or April Mayer april mayer@providence org

PEDIATRIC HOSPITALISTS OPPORTUNITIES: If you would like the opportunity to participate in the growth of our pediatric services at Deaconess and Valley Medical Centers, please consider joining our multi-disciplinary team We need four to five Pediatric Hospitalists at either facility You will be working with nurses with many years of pediatric expertise You will be part of a team of hospitalists providing 24-hour coverage/365 days per year Please contact Evelyn Torkelson Director, Physician Recruitment, at torkele@empirehealth org for more details

EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist Joint Commission accredited, CMS certified, state psychiatric hospital 287 beds Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants Contact Shirley Maike, 509 565 4352, email maikeshi@dshs wa gov PO Box 800, Medical Lake, WA 99022-0800

URGENT CARE POSITION – First Care Med Centers has four Urgent Care locations in Spokane, WA We are seeking a Board Certified physician with comparable Urgent Care experience for a full-time position Excellent salary and benefits package with flexible work schedule - 12-hour shifts and no call Please contact Evelyn Torkelson at torkele@empirehealth org or (509)473-7374

SPOKANE REGIONAL OCCUPATIONAL MEDICINE (SROM) has an opportunity for a physician Our treatment approach takes a comprehensive view that encompasses the medical, psychosocial and functional outcomes of the injured worker and follows best practices as defined by Washington State L&I’s Center of Occupational Health and Education (COHE) SROM

is affiliated with Valley Hospital and Medical Center, Deaconess Medical Center and Rockwood Clinic This affiliation provides exceptional administrative support, offers state of the art diagnostic services’ improving our ability to diagnose and treat, and a referral system that is unmatched For more information contact Evelyn Torkleson, physician recruiter at (509)473-7374 or email at torkele@empirehealth org

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs We are currently expanding our network of Family practice, Internal medicine and General medicine providers for our Washington Clinics We offer excellent hours and we work with your availability We pay on a per exam basis and you can be covered on our malpractice insurance policy The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Katrina Nudo at 1-800-260-1515 x2226 or email knudo@qtcm com or visit our website www qtcm com to learn more about our company

EMERGENCY ROOM PHYSICIAN POSITION OPENING NorthEast Washington Medical Group is currently recruiting for a full-time ER physician to join us in beautiful Colville, a rural northeast Washington community located 75 miles north of Spokane NorthEast Washington Medical Group consists of 27 providers that serve a surrounding area of approximately 30,000 in the very rural tri-county area We offer flexible hours for an ER physician or FP physician with Emergency Room experience Our ER physicians enjoy working in the new emergency department at Mount Carmel Hospital, a 25-bed, full service critical access facility with 24/7 ER and ancillary service coverage This is an outstanding practice community located in the middle of a wonderful recreation area with limitless opportunities for outdoor activities Qualified individuals should contact Ed Johnson, MD, ER Medical Director, via phone at 509-685-7831 or e-mail at edjohnsonmd@hotmail com or Ron Rehn, DHA, Chief Executive Officer, via phone at 509-684-7723 or e-mail at rrehn@newmg org Mailing address is NorthEast Washington Medical Group, 1200 E Columbia, Colville, WA 99114 Visit our website at www newmg org for more information

INTERNAL MEDICINE POSITION OPENING NorthEast Washington Medical Group is currently recruiting for a full-time (Monday through Thursday) Internal Medicine physician to join us in beautiful Colville, a rural northeast Washington community located 75 miles north of Spokane NorthEast Washington Medical Group serves a surrounding area of approximately 30,000 in the very rural tri-county area This is an outpatient based Internal Medicine position with call There is supporting physician call in Family Practice, OB, surgery, and orthopedics Our clinic physicians have privileges at Providence Mount Carmel Hospital, a 25-bed, full service critical access facility with 24/7 ER and ancillary service coverage This is an outstanding practice community located in the middle of a wonderful recreation area with limitless opportunities for outdoor activities Qualified individuals should contact Ramon Canto, MD, Internal Medicine Medical Director, by phone at 509-684-7706 or Ron Rehn, D H A , Chief Executive Officer at 509-684-7723 or e-mail at rrehn@newmg org The mailing address is NorthEast Washington Medical Group, 1200 E Columbia, Colville WA 99114 Visit our website at www newmg org for more information about Colville Medical Center P S


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See what’s changing. See what isn’t.


SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING104 S FREYA ST STE 114SPOKANE, WA 99202

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PAIDSpokane, WA

Permit No. 512

MBA & MACC PROGRAMS

gonzaga mbain Healthcare Management

We invite you to come learn more about Gonzaga’s new hybrid-model MBA in Healthcare Management program, with online and weekend classes for working professionals:

Wednesday, June 1st, 5:30 - 7 PM at Gonzaga’s Jepson Center

RSVP AT: www.gonzaga.edu/MBAinfomtg

Questions? contact Colleen Mallon at [email protected]

www.gonzaga.edu/MBAhcm

ATTEND AN INFORMATION MEETING

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Documents

The Message April 2011