The Message, August 2013 by Spokane County Medical Society

August SCMS The Message Open2

Table of Contents

2013 Officers and Board of Trustees Anne Oakley, MD President David Bare, MD, President-Elect

This is Your Message! .

Terri Oskin, MD Immediate Past President

Internships . . . . . . . . . . . . . . . . . . . . . .

Shane McNevin, MD Vice President

Second-Year Medical Students to Learn In Non-Traditional Ways . . .

Matt Hollon, MD, Secretary-Treasurer

Physicians Lead Medical Home Improvements

Trustees: Robert Benedetti, MD Audrey Brantz, MD Karina Dierks, MD Clinton Hauxwell, MD Charles Benage, MD J. Edward Jones, MD Louis Koncz, PA-C Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – David Bare, MD

at Group Health, Columbia and Providence .

Molecular Infectious Disease Testing on Cervicovaginal Samples . . .

Hot Spotters Group Gets Boost from Providence Community Benefit Fund . . . . . . . . . . . . . In memoriam .

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High School Students Introduced to Health Care Careers Through ‘Work 101’ . . . . . . . . . . . .

Project Access Patient Jack Schierholz and Advanced Dermatology and Skin Surgery .

Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society. Advertising Correspondence Quisenberry Marketing & Design Attn: Lisa Poole 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 Lisa@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.

Darryl Potyk, MD named as Assistant Dean for UWSOM .

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Medical Mission Opportunity .

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Membership Recognition for August 2013 .

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3rd Annual River Cruise .

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continuing medical education . . . . . . . . . . . . . . . 15 meetings/conferences/events .

Classified Ads . . . . . . . . . . . . . . . . . . . . . 16 Medicine 2013 .

Master in public health .

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17 . 18

Events calendar . . . . . . . . . . . . . . . . . . . . 19

“I

will prepare and someday my chance will come .”

– A braham L incoln

August SCMS The Message Open3

This is Your Message!

Internships

This publication has one simple goal--to connect our members! It is open to any of you who have ideas or events to share. There is usually a monthly theme and we attempt to contact our members when we know they are particularly involved or knowledgeable about the topics for our articles, but you are also welcome to reach out to us! I have been reading this publication for more than 20 years without really wondering where the articles come from or thinking about the great staff behind the work! Hats off to Michelle Caird in our office and to all of our contributing members. Now it’s your turn.

Do you remember your first day of internship? If you are like most physicians, that day is indelibly imprinted on your consciousness. So think back, back, back to that first day, the first admission, the first page, and (heaven help us!) the first code. Now you are in the mindset of the 33 interns who just arrived in Spokane and are starting their very first rotation.

By Anne Oakley, MD SCMS President

By Judy Benson, MD, Providence Internal Medicine Residency Spokane Program Director

Next month we would like to feature those of you involved in “Leadership”. This word can encompass many ideas including running an office, working for one of our large provider groups, working in government, community building, etc. We would love to hear facts about your roles, why you chose to become involved and the challenges you face. We can all benefit from hearing both the positive and negative stories. Topics in upcoming issues include Physician Assistants and their training, roles, practice models and evolution of the practice. There will be an issue focusing on the Medical Society itself, detailing its value to the community, membership and where it is heading. And probably most challenging, there will be an issue focusing on our own health, mental and physical. This will include how our jobs and lives can be affected and resources available to help members in need. If you have special insights into any of these topics, we welcome your articles or thoughts. One focus area we would like to add to The Message is human interest stories. We are interested in members involved in exciting, different or unusual activities and hobbies. It can be anything from stamp collecting to skydiving. We just need your help getting the names and ideas to the SCMS staff. Our writers will do the interviews. We believe this is another way to build collegiality. If you are a creative writer that would like to write one or two human interest stories a year for The Message please contact Michelle at the SCMS office at michelle@spcms.org or (509) 3255010. Also needed are photographers willing to add that special touch to the stories. This month we have several articles about medical education in our community from contributors working on programs for high schoolers, medical students and residents. You can read about Group Health’s physician-led development of a new Medical Home model. We also have an article about new developments in laboratory medicine. There is a lot going on here in Spokane! Let us publish what you care about.

They started their year with a week of orientation – you remember, that time when every department of the hospital wanted to come to talk with you while you remembered about 10%. Then with a heavy heart you begin two days of ACLS. You have already reviewed BLS on line with a test to receive an electronic certificate but now you wander into a room full of “Annies” of every shape and size – many of whom are just torsos with an occasional free arm or leg floating around the room. Then you learn to use an AED (how many of you can use an AED – great machine for the office if you don’t want the traditional hefty defibrillator, code cart, etc.). Finally, after lectures on pharmacology, arrhythmias, acute coronary syndrome and stroke, you begin your stations where you are coached to use the classic Bee Gees’ song “Stayin’ Alive” to monitor your chest compressions, learn about door-to-drug time, defibrillate or cardiovert (you remember the drill-the list is endless). Then the BIG test – Megacode with all of its stuttering, stammering and sweaty palms. Ready for a break, the new residents begin a scavenger hunt – first at SHMC to find the “hidden” spots so you make it to the code before it is done and then off to find the “hot” spots of Spokane. Then PPD, urine drug testing, mask fitting, oodles of paperwork, but at the end of that will come that first paycheck. FINALLY! And to top it all off they learn Stentor, two Meditech systems and EPIC. Of course, passwords don’t work, are lost or changed multiple times before this day is done. Don’t forget that you still have to move in, unpack and wait for that new bed to be delivered. But always in the back of your mind is the ever looming first day of real work and your first patient. You come to the wards, someone introduces you as Dr. Somebody and you look around wondering who they are talking about. Your white coat is longer now, clean, crisp (for the first and last time) and loaded with books, phones, pagers (that you don’t know how to use yet even though it has gone off twice), pen lights, hammers and other paraphernalia. You struggle to find the 9th floor resident office where everyone is waiting at 0630 for sign-out. You open the door; take a big breath and walk-in. Your first day of medicine has begun.

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Second-Year Medical Students to Learn In Non-Traditional Ways By Doug Nadvornick, WSU Medical Sciences

“I believe this model is an excellent way to go,” said Dr. Michael Ryan, the UWSOM Associate Dean for Curriculum. “Many students don’t find traditional lectures are useful as they have in the past. Attendance at lectures is lower than it used to be in some courses. There’s so much content out there and students are constantly out there searching for it.”

Picture these two scenarios involving second-year University of Washington medical students taking classes, beginning in August 2013.

Ryan says he noticed during a recent lecture session one UWSOM student scouring the University of Michigan website for a lecture covering the same material he was listening to in Seattle.

In Seattle more than 200 students will spend a significant amount of time parked in a large lecture hall, listening to UW School of Medicine (UWSOM) faculty members talk about pathology or one of the other subjects in the second-year curriculum.

“Students are also searching social media for answers,” Ryan said. “They’re crowdsourcing to get information from outside sources, information that’s sometimes more succinct than what they’re getting from us.”

In Spokane a group of fewer than 20 students will spend a significant amount of time parked in a small classroom. The difference is, instead of a professor lecturing, he or she will lead a discussion with the students on a case related to that day’s topic.

Several of Spokane’s incoming second-year students say they’re intrigued by the new model. They like the idea of fewer lectures. But at least one, Scott Hippe, admits he’s taking a chance that the education he’ll receive in Spokane will be inferior to what he would get in Seattle.

The Seattle example is the traditional model for medical education, still used by many American medical schools. The Spokane example, a two-year pilot program, is part of a “flipped classroom” used by a growing number of schools, from K-12 to graduate-level programs, said Dr. Bill Sayres, one of four Spokane physicians creating the Spokane hybrid in conjunction with the UWSOM.

“That’s not surprising,” said Bill Sayres. “Medical students don’t succeed by taking chances. The amount of time and energy it takes to get into medical school is enormous. These are very focused students who have their long-term goals in mind,” he said.

“We’ll be using the same curriculum as the students in Seattle. After all, the students have to take the same exam and they’re graded the same way,” Sayres said. The difference is in the delivery. “By not attending lectures, students are demonstrating that the traditional lecture format may not be relevant to how they master a subject,” he said. Sayres says the Spokane model will differ from the traditional format in three ways. One is class size. While much of the curriculum in Seattle is delivered to a large group, Spokane is thinking small. Its 19 second-year students will be split into two groups. Each group will be staffed by two local physicians (“guides”) who will serve as academic mentors for the entire school year. The second difference is that students will be required to do far more prep work before class, to read and study the material that their Seattle peers will hear for the first time in the lecture hall. The third difference is that Spokane classroom sessions will be “lecture-free zones,” devoted instead to discussions about specific medical cases. What Spokane is trying is new to the University of Washington School of Medicine, said Dr. Ken Roberts, director of WSU Medical Sciences and the WWAMI Spokane medical education program. “But other medical schools have been using these methods for many decades, so there is much evidence that these changes improve curriculum delivery,” he said.

Still, Sayres thinks they’ll adjust well and become much more active participants in the small-group sessions. The UWSOM’s Michael Ryan says one impetus for the pilot is a shortage of space in Seattle. He says the UWSOM would have difficulty accommodating an increase in class size in a smallgroup format. If the pilot proves to be as successful as hoped, he says the medical school may adopt some of Spokane’s delivery model and figure out how to make room to accommodate it. In addition to Sayres, a family doctor at Group Health, the new Spokane “guides” are Group Health family doctor Dr. Alisa Hideg, Group Health pediatrician Dr. Cicely White and pediatrician Dr. Bruce Abbotts of the Valley Young Peoples Clinic.

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Physicians Lead Medical Home Improvements at Group Health, Columbia and Providence

Shifting mindset for physicians These changes represent a significant cultural shift for physicians as they move into more of an attending role. They will be encouraged to spend less time on routine parts of patient visits, phone calls, and secure messaging, and focus more on leading the clinical team.

By Paul Fletcher, MD

Group Health Cooperative, Columbia Medical Associates and Providence Medical Group are all adding new medical home features to their care for patients. As changes play out, the role of primary care physician continues to evolve.

Group Health refines its program At Group Health, we have had a long history of comprehensive primary care supported by electronic medical records (EMRs), quality data, and case managers to coordinate care for patients. Formally launching the medical home a few years ago, we improved the way clinicians manage and respond to phone calls and implemented secure e-mail to boost patient satisfaction and access. Patients were given easy access to their doctors, test results, and medical advice via a Web portal. Nurses and pharmacists became more active in tracking and motivating patients with chronic disease. We also added tools to be prepared for every visit so doctors could provide opportunistic care during patient visits, such as overdue tests and preventive screenings. By combining our focus on medical home elements and new lean-management skills we implemented a reliable and consistent product across all of our medical centers. Our patients now have higher expectations. We are answering the phones and patient questions much more quickly. We improved patient access and our quality scores, and are able to provide more comprehensive care during every visit. We have also increased visits to specialty as we uncovered more health problems and reduced costs for emergency-room (ER) care and hospital admissions.

Lessons learned Some aspects of Group Health’s medical home weren’t as successful as we’d hoped. We relied too heavily on the pairing of a doctor and nurse to care for a panel of patients, and realized that we need to broaden the team. We also expected secure e-mail to reduce the number of in-person visits and work load much more than it did. Primary care doctors are still overburdened, so we are making adjustments. We are trying to reduce the time physicians spend on indirect patient care, forms, faxes, refills, and gathering data. Our staffing model is also changing. Team size will remain the same, but include more mid-level and support staff, caring for more patients. Advance Practice Practitioners (nurse practitioners and physician assistants) and clinical pharmacists will handle more patient teaching and secure e-mail.

Some physicians may find it difficult to step away from patient counseling and teaching because they enjoy the relationship building with their patients. We share that value and are having lots of discussion about continuing the relationship, though in a different way. Because Group Health will rely on teams to care for patients like never before, physicians will need team-leadership skills. We are now investing in training so physicians will feel comfortable leading and trusting their colleagues, giving feedback, and sharing their expertise.

Columbia defines its population This year the physicians of Columbia Medical Associates decided they too would implement a patient-centered medical home. Although practitioners already used many of the principles, creating a formal system in Columbia’s fee-for-service environment is a first. “One challenge in a fee-for-service setting is that we only see patients who show up in the office for appointments. But it’s not good enough just to evaluate patients as they come through the door. This doesn’t capture the necessary comprehensive health monitoring for our patients who don’t come in at all,” says Roger Woodruff, MD, a family physician for Columbia Medical Associates. Columbia’s first step has been to define panels and teams at its 13 offices. It used its billing system to pull patients seen over the last three years and study how patients interacted with providers. Leaders assigned patients to providers based on who saw a patient most frequently for annual care and chronic conditions. They also designated each clinic as a care team, although some larger offices will break into smaller groups over time.

Improving chronic disease care Columbia is now focused on managing chronic disease, targeting diabetes because the group had the most data on this condition and diabetes reflects a high “misery index” for patients and high care costs. Insurers are very interested in quality measurement and most share data on how their patients are performing, but Columbia’s reported volumes for each insurance company were typically small and not very useful. Instead, Columbia is building a recordkeeping platform to include all of its patients no matter the insurer, and the physicians are deciding what to monitor largely based on HEDIS measures.

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“It’s exciting. We’ll come up with our own standards and recordkeeping so that the data will be meaningful to us so we can improve,” adds Woodruff. At one clinic, employees are now screening patients scheduled for appointments and making sure that those with diabetes codes have had a current eye exam, lab tests, and other measures critical in comprehensive diabetic care. They are also giving the doctors gap-analysis reports so the doctor can address needed care during the visit. In addition, employees are screening panel lists at the office level to verify when diabetes patients were last seen and encouraging overdue clients to come in for care. By year-end 2013, Columbia plans to expand these tools across all of its clinics and to fully monitor basic preventive screenings including mammograms and colorectal screening.

Providence expands team approach Providence is expanding its team-based approach so that physicians, advance practice practitioners, nurses, and medical assistants work more collaboratively to coordinate care. One of Providence’s main goals is to improve care transitions by contacting patients who have been hospitalized or visited the ER and making sure they are seen by their primary care provider for follow-up care. Providence is also using care teams to manage patients between visits in order to reduce hospitalizations and improve care of complex patients. “Over the past four years, Providence Medical Group has grown from 45 to over 400 physicians. Many primary care groups have joined, and in the next six to 12 months, we expect to take care of many new patients,” says Brian Seppi, MD, Providence medical director for primary care redesign.

Wherever one practices, physicians are in the same boat. We all need more cost-effective care models because patients expect great service at an affordable price. When Washington’s health care exchange goes live this fall, more patients will gain coverage and seek primary care beginning in 2014. At the same time, the industry is experiencing a shortage of primary care providers, so we must try new approaches. As we delve deeper into primary care redesign, Group Health, Columbia and Providence are meeting regularly to share best practices and learn from each other. We are committed to finding new ways to provide quality care and meet patient and clinical staff needs, all in a cost-effective way. By Paul Fletcher, MD, assistant medical director for primary care at Group Health Cooperative with input from Roger Woodruff, MD, of Columbia Medical Associates and Brian Seppi, MD, of Providence Medical Group.

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“Because our current primary care providers don’t have capacity, we are looking at different ways to care for patients and using physicians’ time to the best of their ability. They should not be spending two hours a day doing paperwork, but instead caring for their patients,” says Seppi.

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In February Providence implemented a new EMR. This has improved patients’ access to their medical information and allowed better communication between providers, which are essential to placing the patient at the center of the medical home.

Who pays? Why now? “One large barrier we’ve faced is how to pay for this work before we get the resources from payers. In the short term, it makes your bottom line worse,” says Dr. Woodruff. All three organizations grapple with the issue and the solutions haven’t matured yet. Group Health is paying Columbia a fee to coordinate its care, but payments from health plans aren’t yet the industry norm.

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Molecular Infectious Disease Testing on Cervicovaginal Samples

Studies have shown that Amsel criteria and wet mount microscopy have their own set of problems, and misdiagnosis can still occur using these time-tested approaches. In a study of the use of Amsel criteria and microscopy, it was found that the use of these measures and tools did not reduce the number of misinterpretations, and some studies reveal that the misdiagnosis of patients with vaginal complaints can be rather high.2

By Felix Martinez, Jr., MD

In our world of rapidly evolving technology, does molecular testing for infectious disease offer value? If there is a current practice or test that detects disease and helps administer good care to patients, is there reason to readily adopt a new approach? Specifically, will molecular testing for specific organisms aid in the work up of vaginal discharge? Is this new testing a better mousetrap? We ask these questions in the difficult clinical realm of vulvovaginitis/vaginosis and the new tests now available to identify organisms associated with these conditions. It is important to understand exactly what the testing offers, as well as what if any changes that we might initiate would mean to our patients. Vulvovaginitis/vaginosis affects many women and can be associated with several serious health conditions. Identifying a specific cause of some types of vulvovaginitis/vaginosis has remained enigmatic, and there is controversy and variation in overall approach to this sometimes difficult-to-treat problem. Many women who experience a vaginal infection have discharge, itching and odor, which often continues after alternative therapies, including over-the-counter medications. In a small sample of self-diagnosed women who were studied, 34% had vulvovaginal candidiasis, 19% bacterial vaginosis, 21% mixed vaginitis, and 2% Trichomonas vaginitis. In the remainder, no disease was detected or involved a non-infectious condition (for example, lichen sclerosis)1. This variety of causes and imputed causes of vulvovaginitis/ vaginosis illustrates part of the problem that medical professionals face in trying to help patients with vaginal discharge and the difficulties encountered in selecting correct treatment choices.

Polymerase Chain Reaction (PCR) analysis of vaginal swabs has proven to be a useful adjunct test for vulvovaginitis/vaginosis. Several improvements have been offered by this testing. First, the collection process has improved. A flocked swab is now available that collects a sample from many areas on the vaginal wall, where flora is most abundant. Another improvement has been the improved sensitivity and specificity of molecular testing. This allows for identification of specific organisms that respond to specific antibiotic therapy. Molecular testing for gonorrhea and chlamydia offer testing convenience when performed on a Pap collection, but samples obtained from the cervical area using traditional Pap collection devices may not offer the most sensitive means of collecting causative organisms of vulvovaginitis/vaginosis. Accurate speciation of identified organisms in this testing allows for appropriate treatment options and lower recurrence rates. In summary, molecular testing has shown value in the evaluation of patients with signs and/or symptoms of vulvovagintis/vaginosis. The testing is both highly sensitive and specific. Speciation of organisms allows for selective employment of antibiotics, and a separate swab collection provides the best means to detect, identify and speciate organisms. So, if a better mousetrap does come along... References: 1 Ferris DG et al. Over-the-Counter Antifungal Drug Misuse Associated With PatientDiagnosed Vulvovaginal Candidiasis Obstet Gynecol 2002;99:419 â&#x20AC;&#x201C;25. 2 Andreas Schwiertz*, David Taras, Kerstin Rusch and Volker Rusch. Throwing the dice for the diagnosis of vaginal complaints? Annals of Clinical Microbiology and Antimicrobials Annals of Clinical Microbiology and Antimicrobials 2006, 5:4 doi:10.1186/1476-0711-5-4

The three diseases most frequently associated with vaginal discharge are bacterial vaginosis (caused by the replacement of the vaginal flora by an overgrowth of bacteria, including Gardnerella vaginalis, Mobiluncus, Ureaplasma, Mycoplasma, and numerous fastidious or poorly characterized anaerobes), trichomoniasis (caused by the protozoan Trichomonas vaginalis), and candidiasis (genital fungal infection, usually caused by Candida albicans). In addition, cervicitis, both infectious and non-infectious, can also sometimes cause a vaginal discharge. Vulvovaginal candidiasis is usually not transmitted sexually, but it can be a frequent persisting condition in women who have vaginal complaints. An important tool in evaluation of vaginal discharge has been wet mount microscopy. Wet mounts, however, require experience to interpret and are sometimes difficult to evaluate. Also, microscopes have become an expensive piece of office equipment that many practitioners now choose to forego.

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Hot Spotters Group Gets Boost from Providence Community Benefit Fund

benefits across the board—for patients, doctors, health systems and communities. We know anecdotally, intuitively and from the data coming out of similar programs around the country that this works, but we must build our own body of research in order to efficiently tailor the program to our community.

By Lee Taylor, Director Strategic Initiatives

3. Legal support staff from the Center for Justice

The work of the Hot Spotters Group is modeled after the Camden, New Jersey Coalition of Healthcare Providers, which originally coined the name “Hot Spotters”. The Spokane Hot Spotters Group focuses on high risk patients with a history of high utilization of health care and emergency services. The group collaborates with providers of medical, behavioral health, substance abuse and housing services to develop a community care plan that will provide the best care available while working to reduce community costs. This group is embarking on a very important focus on community-wide collaboration to solve some of the most challenging medical and behavioral health cases in the community.

The Hot Spotters Group was given a big boost recently with generous funding from the Providence Community Benefit Fund. This is essential start-up funding that will help pave the way for additional revenue from foundations and other sources. Ultimately, the work of the Hot Spotters Group will improve the overall health of very complex patients while dramatically reducing the cost of care across the system. Those valuable services will be sustained by funding from health care insurance providers and other health care stakeholders. The recent Providence contribution will help us grow the Hot Spotters Group program in three key areas:

1.Staffing for a Community Health Work (CHW) and administrative personnel.

The Community Health Work component is the foundation of this work. CHWs are trained to view the client with the broadest lens possible and then connect the dots between primary care providers, specialists, behavioral health professionals and others in an effort to maximize the health benefit to the client while improving the overall functionality of the system for the benefit of everyone. Additional staffing in this area will greatly expand the potential of the Hot Spotters initiative.

2. Health care economist staffing from WSU to work on outcome measurement strategies

Tracking the outcomes of this work is crucial, particularly in the early stages. First and foremost, the data will enable us to continually improve our efforts to coordinate care for those vulnerable individuals. It will also demonstrate to community leaders and funding sources that this work has quantifiable

The legal support provided for the Hot Spotters Group by the Center for Justice is an element of the emerging Health and Justice Initiative which strives to increases the collaboration of the legal system with healthcare providers. Efforts by hospitals and health care systems to address the problems of hospital recidivism through social interventions point out that reducing costs in the health care system will not happen if we merely reduce resources available for the providers who are treating the symptoms of poverty, mental illness, substance abuse, and homelessness. High health care costs are not solely the result of an individual’s failure to take personal responsibility for one’s health nor are they solely the result of waste in the system or poor quality care. They are the result of complex and pervasive problems with no easy solution. The legal community across the country has recognized this over the past ten years and is addressing it by embracing a holistic approach through the use of medical-legal partnerships. In these partnerships, a lawyer is placed at a hospital or community health center that treats low-income people, and is trained to work with patients on the problems of poverty that cause poor health outcomes. With help from the Center for Justice’s Health and Justice Initiative, the Spokane Hot Spotters Group will be tracking the results of those efforts, both for health care outcomes and for costs. The Providence Community Benefit Fund contribution is an important milestone in the growth of the Spokane County Medical Society Foundation’s ambitious, multi-faceted effort to tackle the most confounding health care problems in the region through forward-thinking community partnerships. If you would like to discuss how we can partner with you or your organization on these or other community health initiatives, please call me at (509) 220-2651 or email at lee@spcms.org.

In Memoriam

Leif J. Larson, MD On July 12, 2013Leif Larson passed away unexpectedly. He was born on February 3, 1953. Leif received his medical degree from the University of Hawaii, John A. Burns School of Medicine in 1984. He worked as a respected urgent care physician for 28 years, most recently for Rockwood Clinic. He is survived by his children Katherine and Kristine and by his sisters Anita and Ingrid.

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High School Students Introduced to Health Care Careers Through ‘Work 101’

By Kevin Dudley, Marketing and Communications Coordinator, Greater Spokane Incorporated Who are the health care professionals of tomorrow? How will they be trained? Those are some of the questions the community is asking, and it’ll take a community effort to ensure there are enough skilled workers to serve the needs of area residents for years to come. A number of area organizations teamed up to create ‘Work 101,’ a program that connects high school students with professionals in STEM (Science, Technology, Engineering and Math) workplaces. Its goal is to link the business and education sectors and create experiential job experiences for high school students.

A Riverpoint Academy junior gets an up close, hands-on lesson at the health clinic at Fairchild Air Force Base

There was a focus put on health care

professions when placing students. “We have a medical school coming….this is a perfect opportunity for businesses in the health sciences to be active in helping to shape our future workforce and helping to create those learning experiences,” said Alisha Benson, the Director of Education and Workforce at Greater Spokane Incorporated. This being the first year Work 101 was implemented, only students from Mead’s Riverpoint Academy completed internships. Next year, students from Spokane Valley Tech will also complete internships. In the health care realm, four students interned at Fairchild Air Force Base’s health clinic. For Lt. Col. Matthew Albright, hosting a high school student was the base’s way of helping students figure out whether they like a career or not, and before it’s too late. “Once you’re into a career field, it’s really hard to change that career to a different career that maybe you enjoy more,” he said. “That was the push behind allowing students to come out here and job shadow.” Students at Fairchild learned how to apply an IV, how the military tests pilots for various ailments that might occur while flying, the proper technique to use when x-raying a patient and much more. Learning the day-to-day tactics medical professionals use, though, was just a sliver of what the students learned. When going to the doctor or being treated in a hospital or clinic, patients aren’t aware of what goes on when the doctor leaves the

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Continued on next page room: who he or she talks to, what decisions they make and why, and how many people are actually working on one patient. “What’s nice for these students is they get the behind the scenes exposure of how the medical technicians, the doctors, the medical administrators all work together for that patient to problem solve,” Albright said. Problem solving is a key component to the curriculum at the Riverpoint Academy. “I’ve learned you need a lot of teamwork,” said Sonia Khokhar, a student at the Riverpoint Academy and an intern at Fairchild’s health clinic. “Communications-wise, you need to talk to everyone about what’s going on with each patient.” The early returns for Work 101 are positive, both from an employer and student perspective. “The businesses have been impressed with how prepared the students are,” Benson said. “They’ve also been impressed with realizing they can be a link and be an influence. They have a real opportunity to help take what the students have been learning in the classroom and put it into action in a workplace.” At a recent Riverpoint Academy Advisory Committee meeting, three students who completed internships presented what they learned, and all of them talked about teamwork, workflow and collaboration – things that you really only learn by doing. Next year, there will be a higher demand for internships offered in the health care sector when Spokane Valley Tech also allows students to complete internships. “We’ll go from having fifteen bioscience internships to seventyfive,” Benson said. Work 101 was created through a partnership between the Riverpoint Academy, Spokane Valley Tech and the Spokane Area Workforce Development Council. Businesses have to be at the table during the process as well for the program to be successful. “We know that we have a workforce shortage, especially in the STEM careers,” Benson said. “One of the things we’ve learned is that exposure of students to these workplaces helps to shape their future career choices and now is a critical time for businesses to be active in helping to recruit our future workforce.” Now that the first round of internships are complete, Work 101 organizers are gearing up for the fall, when more students will need to find places to gain job experience. So far so good, according to Benson. “The takeaway from the businesses and the students is that we’re headed in the right direction,” she said.

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Project Access Patient Jack Schierholz and Advanced Dermatology and Skin Surgery By Jim Ryan, Project Access Program Coordinator

In this space each month, Project Access will feature one of our generous providers, in appreciation of all the medical professionals in the region who donate their time and talents to the care of our clients. In order to give you a complete picture of the good work being performed by those physicians, physician assistants and health care providers, we will also share the story of a Project Access client served by our featured provider. If you have a great Project Access story to share, please let us know! Send it to Jim@spcms.org.

We asked Jack about his experience with Advanced Dermatology. “Dude, those guys are awesome,” he said. “I’ve spent my life helping people and I never expected anyone to step up and help me like that.” In the year since Jack’s surgery, he has been unflinching in his desire and willingness to give back in any way he can, saying “we’ve gotta take care of each other, man.” Jack is currently working on starting up a non-profit hot dog cart to benefit wounded warriors. He’s going to call it “Veteran Dogs.”

In 2012, the ten-person team at Advanced Dermatology and Skin Surgery saw 22 patients under Project Access. That would be a remarkable donation in itself, but it represents only what we’ve asked of them, not a limit on their willingness to give. Advanced Dermatology has never turned a Project Access client down. This is a testament both to Project Access’s dedication to referring only those patients who qualify and to Advanced Dermatology’s commitment to providing care for those in need. It must be mentioned here that this is also due to the generosity of our other dermatology partners, including Dermatology Specialists of Spokane, Dermatology Associates of Spokane, Northwest Dermatology and Spokane Dermatology Clinic, all of whom pledge to Project Access. The generosity of those providers means that Project Access can grow in leaps and bounds without capacity concerns in this specialty area.

BEFORE

A Client’s Story In March of 2012, Jack Scheirholz went for a routine checkup at Spokane Falls Family Clinic that resulted in the diagnosis of a lesion on his nose as a probable basal cell carcinoma. Jack was uninsured and collecting unemployment at the time, with a weekly benefit amount of $195—$10,140 per year—leaving him with few options for treatment. Spokane Falls Family Clinic referred Jack to Project Access and we received his application in early April. He was immediately approved for a specialist referral. Spokane Falls Family Clinic conducted a biopsy of the lesion on April 19 and confirmed a diagnosis of cancer. Jack was referred to Advanced Dermatology through Project Access and had his first appointment on May 8. Dr. Cvancara and his team removed the cancer shortly thereafter. When we contacted Jack a year later, he said that everything had “healed up beautifully.” “You can hardly even tell that anything happened there.”

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AFTER

Darryl Potyk, MD named as Assistant Dean for UWSOM By John McCarthy, MD, Assistant Dean for Regional Affairs UWSOM

During the past several years, medical education in Spokane and eastern Washington has evolved and grown in a number of significant ways. Much of that growth and development has occurred during the tenure of Deb Harper, MD, who served as University of Washington School of Medicine’s (UWSOM’s) Assistant Dean for Clinical Medical Education for the last eight years in Spokane. She fostered the growth of Spokane’s clerks from approximately 75 to 250 per year. It was during her time in this role that five years ago WSU Spokane and UWSOM developed 20 new medical education seats for first-year students. And this year, for the first time in the UWSOM’s history, training for second-year medical students will be possible outside of Seattle and occur in Spokane. Dr. Harper has decided to now return to more of a clinical focus, which opened recruitment for a new Assistant Dean for UWSOM. We were fortunate in that a number of excellent candidates expressed interest in this role. Darryl Potyk, MD has been named as the new Assistant Dean. He will join me in leading clinical education initiatives for eastern and central Washington. Dr. Potyk has been working primarily in Graduate Medical Education, having served as the Transitional Residency Director and more recently as the Assistant Director with Providence

Internal Medicine Residency Spokane (he will continue in that role part-time). He brings an appreciation of the complexity of GME development and sustenance as well as a significant connectedness with the Spokane community. His organizational skills will be significantly appreciated as will his leadership and relationships within the community. UWSOM and WSU Medical Sciences leadership and staff look forward to having Dr. Potyk join medical education efforts in Spokane and eastern Washington. Dr. Potyk will be taking over the responsibilities for the third- and fourth-year clinical students within the Spokane area. He will be working closely with the TRACK students (those spending most of their year in Spokane) as well as with the rotating students who select clerkships in Spokane. I will continue to focus on rural clerkship education activities in eastern Washington with emphasis in the rural longitudinal programs. Both of us will continue working to develop more GME opportunities within our community. We will continue to work closely and synergistically with Dr. Ken Roberts in his role to lead education for medical students in their first and second years. As this leadership collectively pursues avenues to meet the critical physician workforce needs, we speak clearly with one voice – we need to develop medical education opportunities for the students and patients who live east of the Cascades. We ask that you welcome Dr. Potyk as he assumes his new position and that you continue to be aware of the need for growing medical education for the future of our patients. It is an exciting time and we remain in a growth phase.

Our business is turning them into realities. We do this by helping our clients plan and manage their financial resources. Fee-only.

For a complimentary consultation or brochure, call: Greer Gibson Bacon, CFP® (509) 838-4175 or (888) 864-8827 assetplanning.com

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Medical Mission Opportunity

The following information was sent to SCMS President Anne Oakley, MD from a fellow Leadership Spokane program graduate. If you are in the health profession, willing and able to go to the Honduras (Guanaja and the Bay Islands) for a week, two or a month, please send me your information along with possible dates. I am looking to bring a group of professionals and mission groups to Guanaja mid to end October, December before the holidays and the first week in February. You will need to have the resources to travel to Guanaja and cover your expenses while there. For a minimal cost you will receive accommodations on the islands with three meals a day and beverages, boat transfers to the areas in need and a local guide. You will have time to enjoy the water and local adventures as well. You are welcome to bring your families along to learn about the area. Possible volunteer opportunities are listed below: 1. Women’s Health Doctors to come for two week or more to train local interns on procedures of yearly exams, breast self-exams and sexually transmitted disease prevention. 2. Dentist or Hygienists to provide cleaning, treatment and education for youths and adults. 3. Mission groups to assist with obtaining and delivery of medical and dental supplies and equipment. Approximate costs per person: • Transportation Airfare from Spokane $680 to Roatan and $162 to Guanaja. Boat transfer to the Cay is included in weekly rates. • Weekly Accommodations rate on Clark’s Cay or similar $ 1350 per person per week based on double occupancy includes seven nights (two single or one double bed room with private bath), breakfast, lunch and dinner with daily beverages. Dinner out on your arrival Saturday with welcome drinks. Boat transfers to and from airport and weekly transportation as needed to and from The Cays, Savannah Bight and Banacca. • Other miscellaneous expenses you may incur include purchasing your favorite snacks (bring them with you), alcoholic beverages (can be purchased locally or bought at US Duty Free shops prior to departing the US), souvenirs (sold locally) and tip money as you see fit. • If you are unable to travel, donations can be made to assist in this project. If this adventure and mission fits your expertise or calling, please contact Connie Stark, CEO StarkTours at Connie@starktours.org or (509) 315-6717.

New Physicians and Physician Assistant for August The following physicians and 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 to the Spokane County Medical Society, 104 South Freya Street, Orange Flag Building, Suite 114, Spokane, Washington, 99202.

PHYSICIANS Alhafez, Fadi, MD Internal Medicine Med School: Tishreen U, Lattakia, Syria (2001) Internship: Damascus University (2002) Residency: Rosalind Franklin U, Cook County Hospital (2006) Fellowship: U of WA (2013) Practicing with IPC – Holy Family Hospitalists 08/2013 Carter, Gregory, MD Internal Medicine Med School: Loyola U of Chicago (1986) Internship: U of CA Davis Medical Center (1987) Residency: U of CA Davis Medical Center (1990) Practicing with St Luke’s Physiatry Practice 08/2013 Cope, Jeremy M., MD Internal Medicine Med School: Flinders, U, Australia (2005) Internship: Gold Coast Hospital (2006) Residency: Providence Spokane Internal Medicine Residency (2013) Practicing with IPC – Holy Family Hospitalists 08/2013 Hwang, Becky J., MD Radiology Med School: UMDNJ-SOM New Jersey (2007) Internship: UMDNJ-SOM New Jersey (2008) Residency: NY Medical College - St Vincent’s Hospital (2010) Practicing with Inland Imaging Associates 08/2013 Jones, Geoffry, MD Family Medicine Med School: U of Washington (1996) Internship: Family Medicine Spokane (1997) Residency: Family Medicine Spokane (1999) Currently practicing with Family Medicine Newport Li, Frank D., MD Pain Management Med School: U of North Carolina (1997) Internship: Pittsburgh County Memorial Hospital (1998) Residency: U of CA Irvine (2001) Fellowship: U of CA Los Angeles (2002) Practicing with Spokane Pain Center 07/2013

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Continued on next page

Santarpio, Camille, DO Obstetrics and Gynecology Med School: U of New England (2002) Internship: Maine Medical Center (2003) Residency: Maine Medical Center (2006) Practicing with Obstetrix Medical Group of WA 10/2013 Snyder, Jennifer C., MD Family Medicine Med School: U Autonoma de Guadalajara, Mexico (2008) Internship: Central Washington Family Medicine Residency (2011) Residency: Central Washington Family Medicine Residency (2013) Practicing with Providence Family Medicine Residency Spokane 08/2013 Tryon, Brian, MD Diagnostic Radiology Med School: Drexel U (2000) Internship: Drexel U Hospitals (2001) Residency: Drexel U (2005) Practicing with Radia, Inc., PS 09/2013

Kaur, Jasdeep, MD Internal Medicine Practicing with Holy Family Hospital 08/2013 Lawson, Andrew J., MD Family Medicine/Sports Medicine Practicing with Providence Family Medicine Residency 08/2013 Marchion, Christina S., MD Family Medicine Practicing with Providence Family Medicine Residency 08/2013 Mezei, Gabor C., MD Obstetrics Practicing with PMG - Maternal Fetal Medicine 07/2013 Mejia, Juan C., MD Surgery Practicing with PMG - Kidney Transplant Surgery 08/2013 Plymale, Jennifer M., MD Pediatrics Practicing with PMG - Center for Congenital Heart Disease 08/2013

Vanderhoeven, Jeroen, MD Maternal-Fetal Medicine Med School: Flinders, Drexel U (2006) Internship: Oregon Health Sciences U (2007) Residency: Oregon Health Sciences U (2010) Practicing with Deaconess Perinatal Services 07/2013

Preugschat, Dexter A., MD Internal Medicine Practicing with PMG - Internal Medicine Hospitalists 07/2013

PHYSICIANS PRESENTED A SECOND TIME Barry, Robert T., MD Diagnostic Radiology Practicing with Inland Imaging 01/2014

Roberts, Meghan E., MD Internal Medicine Practicing with PMG - Internal Medicine Hospitalists 08/2013

PHYSICIAN ASSISTANT

Bettesworth, Jacob G., DO Anesthesiology Practicing with Providence Anesthesia Services 06/2013

Carlson, Casey, PA-C Physician Assistant School: Oregon Health Sciences U (2009) Practicing with PMG â&#x20AC;&#x201C; Orthopedic Specialties 08/2013

Cannon, Todd A., MD Anesthesiology Practicing with Anesthesia Associates (Deaconess &Valley) 09/2013 Condon, Erik J., MD Anesthesiology Practicing with Providence Anesthesia Services (Sacred Heart) 08/2013 Do, Johnny N., MD Internal Medicine Practicing with Holy Family Hospital 08/2013

Membership Recognition for August 2013

Guzman Aguayo, Nelio, MD Pediatric and Adult Nephrology Practicing with PMG - Kidney Care of Spokane 07/2013

Thank you to the member listed below. His contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.

Hill, Chandler H., MD Emergency Medicine Practicing with Valley Hospital /Sacred Heart Emergency Departments 08/2013

10 Years S. Alan Rietze, MD

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8/1/2003

3rd Annual River Cruise A perfect summer evening was the setting for the 3nd annual river cruise on Thursday, July 11. SCMS members and their significant others cruised to Lake Coeur dâ&#x20AC;&#x2122;Alene on The Serendipity listening to guitar player, Steven King, and visiting with colleagues. The cruise was sponsored by the Community of Professionals partners: UBS - The Prewitt Group, US Bank and Numerica Credit Union.

Anne Oakley, MD and Mihai Alexianu, MD

Ellie McIntyre from Numerica Credit Union; Anne Oakley, MD and Jennifer Mayfield, MD

Kingsley Ugorji, David Bare, MD, and Bill Bender, MD

Jim Nania, MD and Karina Dierks, MD

Providence Family Medicine Residency Spokane physicians with spouses and significant others

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Continuing Medical Education

Meetings/Conferences/Events

Moderate (Conscious) Sedation and Analgesia: 3.0 Hour(s) of Category 1 CME credit, sponsored by the Spokane County Medical Society. Tuesday, September 17 5:30 – 9:15 p.m. at the Providence Sacred Heart Medical Center Mother Joseph Room. This is SCMS’ annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety. For more information contact Karen Hagensen at (509) 325-5010 or karen@spcms.org. Spokane County Medical Society presents MEDICINE 2013: 7.0 Hours of Category 1 CME credit, sponsored by the Spokane County Medical Society. The program will focus on the more challenging management issues that clinicians encounter. Speakers from the University of Washington, Virginia Mason Medical Center as well as several local experts will present. The conference will be held on Friday, September 27, 2013 at the Davenport Hotel. Visit the Spokane County Medical Society website for more information and to view the program brochure at www.spcms.org or contact Karen Hagensen (509) 325-5010 or karen@spcms.org. Rockwood Health System Breast and General Tumor Boards: The tumor boards are jointly sponsored by Rockwood Health System and the Spokane County Medical Society. Tumor Boards will be held weekly June – December 2013. Each Tumor Board is worth 1.0 Category 1 CME credits. For more information please contact Sharlynn M. Rima CME Coordinator at SRima@rockwoodclinic.com. Promoting Healthy Families (Practice Management Alerts from the American Medical Association) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain— positive changes for the whole family. The continuing medical education activity includes a video module, a detailed monograph and patient handout. These activities have been certified for AMA PRA Category 1 Credit™. For more information www.ama-assn.org.

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. Spokane Guild of the Catholic Medical Association- is pleased to present a lecture by Father Robert Spitzer, SJ, PhD, on “The Scientific Evidence for the Existence of God”. Father Spitzer is the past president of Gonzaga University. He is an author, educator, philosopher, and founder of the Magis Center of Reason and Faith. Please join us on 3 October, Thursday evening at 6 p.m. at Providence Auditorium, Sacred Heart Medical Center. All health care professionals are welcome. Atheists and agnostics are especially welcome. For more information contact Al Oliva, MD at (509) 220-3586. National Environmental Health Association Courses sponsored by the CDC and EPA available. Courses include National Environmental Public Health Performance Standards Workshop: Building Local and National Excellence, Biology and Control of Insects and Rodents Workshop, Environmental Health Training in Emergency Response and Environmental Public Health Tracking 101. For more information go to the website at www.nehacert.org. Physician Family Alanon Group: Physicians, physician spouses or significant others and their adult family members share their experience, strength and hope concerning difficult physician family issues. This may include medical illness, mental illness, addictions, work-related stress, life transitions and relationship difficulties. We meet Tuesday evenings after 6 p.m. The format is structured by the 12-Step Alanon principles. All is confidential and anonymous. There are no dues or fees. To discuss whether this group could be helpful for you, please contact Bob at (509) 998-5324.

Expedited Partner Therapy in the Management of STDs: 1.5 Hour(s) of Category 1 CME credit, sponsored by the Spokane Regional Health District’s STD Medical Coalition, the Seattle STD/ HIV Prevention Training Center and Sacred Heart Medical Center. Presented by Matthew Golden, MD, MPH at the Providence Sacred Heart Medical Center Auditorium (20 W 9th Ave) on August 20 from noon to 1:30 pm. Expedited Partner Therapy (EPT) is the strategy by which the identified sex partners of a patient diagnosed with a treatable STD, usually chlamydia or gonorrhea, are provided directly with therapy without an intervening medical evaluation. Join us to learn about the practice of EPT and how to access free medications for your patients’ partners. Lunch will be provided. Register at srhd. org/stdcme or contact Anna Halloran at ahalloran@srhd.org for more information.

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REAL ESTATE

MEDICAL OFFICES/BUILDINGS

Comfortable Three-Bedroom Home in quiet neighborhood for rent. Good storage in kitchen, gas stove, dishwasher, refrigerator, washer/dryer and fireplace. Comes furnished or can negotiate. Close to Hamblen Grade School, Sac Middle School and Ferris High School. Three bedrooms, three baths, large living room, family/TV room, master bedroom has private bathroom, two-car garage. Large windows in living room look out into large fenced yard with automatic sprinkler system (front and back). Snow blower and lawnmower provided. Call (408) 594-1234 or (509) 993-7962. Large Second Owner Custom Built Executive Home with unparalleled views of Liberty Lake and Spokane Valley on five acres available for sale or lease. Custom hardwood floors and woodwork throughout, cherry office shelves, cathedral ceilings, central air, three car garage, brick porch, tile roof, large deck, three fireplaces, four bedrooms, four bathrooms, formal dining room, large kitchen, large eating room and den. Walk out basement, wood stove, kitchen and bathroom. Large 30’ x 100’ pole barn with separate utilities, two phase power, three twelve-foot overhead doors. 30 x 60 sports court. Large animals allowed. Water rights included. 4Kw grid interactive, portable battery backup solar system available. Offered for $600k or for lease $3250, no pets/smokers. Seller is a real estate broker at (509) 220-7512.

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 medical office spaces available for lease from 635 to 10,800 contiguous usable square feet. and has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include urgent care, family practice, pediatrics, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials emailed upon request. A Tenant Improvement Allowance is available, subject to terms of lease. Contact Patrick O’Rourke, CCIM, CPM®with O’Rourke Realty, Inc. at (509) 624-6522, mobile (509) 999-2720 or psrourke@comcast.net.

Beautiful Priest Lake Cabins for Rent Our newly restored cabins are located on the historic site of Forest Lodge in the entrance to the scenic Thorofare. Two cabins are available. Each sleeps 8. They are located at the water’s edge, have gorgeous views, bordered by the National Forest and 18 acres of private land. The beds and furnishings are all new and cabins have all the amenities - decks, docks, beaches with fire pits, walking trails and forest to explore. Boating, hiking, swimming, sailing, snowmobiling in winter or just relaxing in the sunshine. You will enjoy a peaceful, fun-filled vacation at this amazing site. For available dates, pricing, photos and details call Jeannie or John at (509) 448-0444. One of Copeland’s best north side homes on over fifty acres with meadows, trees, complete privacy and gorgeous views. This home offers contemporary living at its best featuring four bedrooms, four bathrooms, three-car garage, hard rock maple floors, cabinets and built-ins, three balcony decks plus a patio with water feature. The second level has a distinctive master suite with custom built-ins, large walk-in closet, lovely master bath with lowboy toilet and bidet, a large sitting room with built-in shelving, raised gas fireplace and extraordinary views! The main floor great room boasts granite, stainless appliances, oversized pantry and very functional laundry suite with chute. Super-efficient geothermal heating and cooling affords economical year ‘round comfort. Twenty minutes from Holy Family Hospital. Mead schools! $750,000 Call Marilyn Amato at (509) 979-6027.

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MARK YOUR CALENDARS Watch for more details!

2013 SCMS EVENTS Triple Play/Raptor Reef Family Event September 07 Saturday

Hayden Lake, ID

Moderate (Conscious) Sedation Program September 17 Tuesday SHMCâ&#x20AC;&#x201D;Mother Joseph Room

SCMS Presents Medicine 2013 September 27 Friday The Davenport Hotel

Senior Physicians Dinner October 17 Thursday Manito County Club

Orange Flag Building

Phone: (509) 325-5010

104 South Freya Street, Suite 114

Fax: (509) 325-5409

Spokane, WA 99202-4686

Website : www.spcms.org

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t s e w h t Nor

IF YOU COULD FIT THE

ON A PLATE

Join us at our all new restaurant Chinook Steak, Pasta and Spirits. Acclaimed Executive Chef Adam Hegsted highlights the best of the Northwest, including King Salmon from the Puget Sound, beef sourced exclusively in Washington, Columbia River Steelhead and wild local huckleberries. The menu caters to a variety of tastes, wood-fired pizzas, old-world rustic style pastas, all with thought given to affordability and five-star quality. Join us for dinner or for a drink at our non-smoking bar Wednesday through Sunday. C DAC A SI N O.CO M |

/C D A C A S I N O R E S O R T

Wed - Thur: 5 - 9 pm, Fri - Sat: 4 - 10 pm, Sun: 4 - 9 pm Lounge open daily: 3 pm - close

“WHAT MAKES OUR RESTAURANT UNIQUE IS ITS ‘RUSTIC SIMPLICITY’ AND THE BEST THE NORTHWEST HAS TO OFFER.” – EXECUTIVE CHEF ADAM HEGSTED

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SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

PRSRT STD U.S. Postage

PAID

Spokane, WA Permit No. 307

ADDRESS SERVICE REQUESTED

Printed on GP Spectrum® Paper: Certified by the Sustainable Forestry Initiative. Please recycle.

ROCK CREEK RIDGE at SUNUP BAY Lake Coeur d’Alene - Idaho

Welcome to Rock Creek Ridge at Sunup Bay Rock Creek Ridge at Sunup Bay stands apart on the shores of world famous Coeur d’Alene Lake in North Idaho. Located a short distance south of the City, this spectacular property is limited to 33 estate-size parcels, and the gated community offers a secluded and spacious living opportunity covering an impressive 250 acres. Waterfront lots feature 3-6 acres with 300’ to 350’ of lake frontage and a boat dock with covered slip. Ridge lots have generous 4-20 acres parcels including spectacular views of the lake. Features include a community beach with 800’ lake frontage and a boat slip for each lot. Welcome to Coeur d’Alene Lake.

Ridge Lots Priced from $149,900 Waterfront Lots Priced from $499,500 Amenties Include: • Private Estate Lots in a gated community • Community Water • Private Covered Docks for Waterfront Lots • Community boat slips available for ridge lots • Community Beach with 800’ water frontage

• Rock Creek Golf Club Idaho, an exclusive, invitationonly, private golf club, opened its world class course on July 1, 2012. The club developed a wonderful start with a high energy, fun filled group of Founding Members poised to build the membership one good family at a time. For more visit: rockcreekgolfclubidaho.com

RockCreekRidgeAtSunUpBay.com

Beutler - Waterfront

BILL FANNING

BROKER fanning@21waterfront.com cell (509) 999-5444 direct (509) 321-1132 fax (509) 321-1131