The Message, August 2012 by Spokane County Medical Society

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A MON T HLY NE WS M AG A ZINE OF SPOKANE COUNTY MEDICAL SOCIETY –AUGUST 2012

HEALTHCARE LEADERSHIP IN SPOKANE By Terri Oskin, MD SCMS President

PHYSICIAN LEADERS IN A NEW WORLD CROSSING BOUNDARIES

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T a b l e o f C o n te n ts

2012 Officers and Board of Trustees Terri Oskin, MD President Anne Oakley, MD President-Elect Bradley Pope, MD Immediate Past President David Bare, MD Vice President William Keyes, MD Secretary-Treasurer Trustees: Robert Benedetti, MD Audrey Brantz, MD Michael Cunningham, MD Karian Dierks, MD Randi Hart, MD Louis Koncz, PA-C Shane McNevin, MD Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – Anne Oakley, MD

Healthcare Leadership in Spokane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Crossing Boundaries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Changing Role(s) of Physician Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 The Path to Physician Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Physician Leaders in a New World . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 What Does It Take to Become a Certified Physician Executive? . . . . . . . . . . . . . . . . . . . . 5 What Prevents Breakthroughs In Physician Leadership Performance? . . . . . . . . . . . . . . . . . 6 Training Students as Leaders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Is Leadership Overrated? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Physician Leadership – Why Doctors Make Poor Leaders and What YOU Can Do About It . . . . . 10 Physician Leaders in Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 New Spokane County Medical Society Program: Consistent Care Washington . . . . . . . . . . . 15 MEDICOR Receives $15,000 to Develop Disaster Health Portal . . . . . . . . . . . . . . . . . . . 16 Providence Hospitals among Nation’s “Best” . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 MEDICOR to Develop a New Diabetes Care Information Portal . . . . . . . . . . . . . . . . . . . 17 Leadership Spokane 1000 Graduates Strong! . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Spokane County Medical Society Message A 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: Jordan Quisenberry 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 jordan@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.

In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 High Value Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 FYI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Physician Leadership Resource . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Membership Recognition for August 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Meetings, Conferences & Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2nd Annual River Cruise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 New Physicians and Physician Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

"Leadership and learning are indispensable to each other." John F. Kennedy

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Healthcare Leadership in Spokane

Crossing Boundaries By Jeffrey O’Connor, MD

By Terri Oskin, MD SCMS President Each year the Spokane County Medical Society (SCMS) offers the president the opportunity to participate in the Leadership Spokane program. You, the members, through your dues sponsor this opportunity. I know many of you are familiar with the program or are graduates yourselves. For those of you not familiar with Leadership Spokane, it is an intense leadership course sponsored by Greater Spokane, Incorporated (GSI). Its focus is our community - the leaders and the people. I just want to take a moment to say thank you for allowing me to participate in such an incredible opportunity. I met with many of the amazing leaders in our community and saw just how much those leaders give back to Spokane. Through Leadership Spokane I developed a new and deeper understanding and appreciation of Spokane, both its strengths as well as its weaknesses. The program stresses the role of the servant leader and active participation. A speaker on our last day spoke about the role of a board member. He stressed that to be a good board member you must do more than just show up. You need to know your mission statement and believe in it. You should come to meetings prepared, ready to participate and bring your ideas and skills to the table. When asked to serve on the SCMS Board of Trustees five years ago I thought this was a small way to get involved with the organization other than just paying dues. I never thought I would be president five years later. And how things have changed! We have a semi new CEO, Keith Baldwin, who has done just an outstanding job moving us forward in these changing times. More and more physicians from every specialty are becoming employed. And, of course, with the security of employment comes the loss of some autonomy. The future of our present healthcare system, how it will look, how it will function, is also unknown. And affordable healthcare is getting to be unattainable for more and more of our community. It is for those reasons that I want to continue to serve my local community and colleagues. The need for us to have a clear and loud voice is greater than ever. As our new mission statement states, the role of the SCMS is to fairly and objectively serve as a guardian for our community’s health and wellness while also leading and promoting the professional practice of medicine. I was talking to a friend and colleague just the other day regarding the future of healthcare and our role as physicians. Sadly, he said, “I think it’s too late. We’ve lost that battle.” This is why I am involved and hope to continue my participation and leadership role to this community. I don’t think we’ve lost. I’d like to think Spokane can continue to be an outstanding place to receive healthcare and be known for its healthy community.

What does one make of the lifeguard who was fired for saving a life? Unfortunately for the lifeguard, the victim tried to drown outside the lifeguard’s assigned area. After the successful rescue, the hero was let go. As the lifeguard's boss said: "I had to fire him. It's against company policy to leave your assigned boundaries. It is a liability." Choose humanity over policy and liability, and you get fired. Such can be the price of leadership and character. The simplest way to find the principal focus of any enterprise is to remove individual elements of the job until you find the one element without which the enterprise ceases to exist. For a lifeguard, that would be swimmers. The beach or poolside can be littered with people, but none needs a lifeguard if no one goes in the water. What about medicine? The early Sisters of Providence provided care without hospitals. Medical insurance didn’t become a reality until the 1930s. If corporate or non-profit medical groups, Medicare and Medicaid ceased to exist, we would still be doctors. But if there were no patients, there would be no doctors. Patients are our only reason for existence. Even though the American medical system is awash with innovation, initiatives, mergers, expansions, accountability, technology, reforms, best practices and a search for meaning, there is only one reason to go to work each day: our patients. They are the yardstick by which every present and future endeavor is measured. I used to be a true believer. I viewed everything I was taught, the articles I read, the medications that I used, the experts and their opinions and the systems around me as gospel: helpful, altruistic and fact based. My pillars of faith began to fracture when I first learned about evidence-based medicine. This was the mid-1980s and I thought everything I worked so hard to master was “real.” As I sat listening to a lecture about the actual state of medical knowledge, I realized much of what I was taught was tradition, opinion or ego. If my professors ever mentioned that, I missed the memo. I thought I knew where I was but I was misled. Now I am a skeptic. Not a “child of the sixties, don’t trust anyone over 30” skeptic, but more of a “prove it” skeptic. I have grown “statistically significant” antennae. In a world of publish or perish, it seems the experts keep publishing but our patients perish for lack of something meaningful. I want to know if the 50% reduction of an illness due to a procedure or medication is a reduction from 2 to 1 per 10,000 or 50 to 25 per 100. Both might have stellar p-values but only one result has value to patients.

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Continued from page 1 I am however an enthusiastic, hopeful, somewhat trusting skeptic. My hope is based on the progress I see every day in diseases that threatened my patients a generation ago. My enthusiasm is inspired by the true advances coming towards us, advances that will make our successes in the past seem like child’s play. But my trust must be earned. I have respect for the Cochrane Collaboration and my faith in the US Preventive Services Task Force is growing. I would trust my life to some of you here in Spokane. Yet I don’t serve my patients well unless I look at the world of medicine and ask “why” or “what if.” I am not talking about some internet cowboy type of medicine but I’d like to know some things: Why it took so long for Halstead to be really questioned? Who are the Halstead’s in our midst now? Is Da Vinci a real breakthrough or just really cool? What if computers took our medical English diagnoses and converted them into ICD “X” codes? Why do I have to do it? I don’t treat 250.00. I help Fred with his diabetes and hope I give good advice. When will we move from a malpractice system based on fear and theater to a medical court system that has knowledgeable verdicts based on the best science available at the time of the incident? If we focus too much on Best Practices will we miss even better ones? Why do most EHR’s stink? Don’t get me started! Finally, in some respects, aren’t I my patient’s lifeguard? Will I be willing to cross artificial boundaries, if that is what it takes, to help my patients, even if I might get “let go?”

The Changing Role(s) of Physician Leadership By David Bare, MD “What do you do when you don’t have a clue?” That was my suggested title for our scenario planning session I participated in last year as the Chief Medical Officer (CMO) and member of the leadership team at Community Health Association of Spokane (CHAS) a Federally Qualified Health Center (FQHC) that serves as a big portion of the safety net for our community. Anyone that is in the field of healthcare and healthcare delivery has had difficulty with the “what next” question. I wrote this a day before the Supreme Court ruled on the Affordable Care Act (ACA). And now that we know the results, there are still huge questions left to be answered. No matter what direction we eventually find ourselves heading, one trend that I see is the ever increasing role that physician leaders will play in the destination of our industry. For so long insurance companies and the Federal Government have made

mandates on individual providers related to how we will get paid and what services will be covered. Then we, as small groups of providers or solo practitioners, moaned and complained but felt helpless to mount a response to such mandates. With the financial crisis beginning in 2008 we as a nation finally came to the conclusion that ever increasing medical costs with so-so outcomes for population management is not sustainable in our current system of delivery. This resulted in the need for change, big change that results in better outcomes, better access and improved efficiency equating to lower cost per patient (the so called Triple Aim). The change is resulting in more providers being asked to help lead the charge to arrive at those better outcomes. Not only because of the clinical aspect of the answers but because we have influence with our colleagues regarding behavior towards such an end. I also see that solo practices and private group practices have declined dramatically as models of care. More providers and practices are being bought by larger organizations and being placed into vertically integrated delivery systems ready for a new payment model, Accountable Care Organizations (ACO), first with Medicare but eventually with all payors. That has brought more demand on providers to be leaders of ACOs, health plans and ambulatory care organizations, hospital committees, out-patient care teams, community task forces and medical societies, as physician input is needed to guide from the clinical as well as the administrative point of view. In all of those scenarios physician leaders have to learn how to be adaptable in helping their organizations not only survive but thrive. They have to be able to develop new capabilities and strategies to address all of the change. They have to know and give input to their organization regarding 1) what processes and activities need to continue as necessary elements for survival, 2) what elements need to be stopped or modified as no longer useful and finally, 3) know what to start doing innovatively that will promote sustainability. Like so many businesses in the last few years ours has had some funding cuts due to state budget shortfalls. That required presenting some hard choices to our staff who elected to step up to the plate and do what needed to be done to not only survive the cuts but to thrive! It was largely because of a new direction in our leadership framework that allowed for this. Instead of just one CMO adding input and then helping the troops “buy in” to the new strategy we have essentially developed a leadership “Web” that has allowed far broader input from our providers. It includes formal and informal roles, large and small roles, roles that are ongoing and roles that are time and task specific. It has involved developing and mentoring provider leaders from within each of our clinics and further recognizing that all of our providers are viewed by the staff as leaders. This has allowed for change to have ownership from the front lines up.

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Continued from page 2 A colleague of mine, Even Oaks, MD, Associate Medical Director of Health Point, a large Community Health Center (CHC) in the Seattle region, advised; “That in developing new leaders he and nine manager/medical director-type teams recently participated in the “Enhancing Collaborative Management” seminar that was sponsored by the National Association of Community Health Centers (NACHC) and the Northwest Regional Primary Care Association (NWRPCA) last week. The program was an extension of the Managing Ambulatory Healthcare sessions that were put on by Bob Hoch and Paul Campbell from the Harvard School of Public Health. The Managing Ambulatory Care sessions are specifically targeted at our CHC medical directors. The Enhancing Collaborative Management session is starting to extend the training to how we now interact with each other (providers in leadership and non-physician leaders).” This points out the need for increasing collegiality in light of the change in the practice of primary care and hospital-based physicians and collaboration within organizations to get the job done.

The Path to Physician Leadership By Glen Stream, MD Leadership is a key attribute of a physician. There is ongoing debate whether leaders are born or made, but whichever the case, the role and training of physicians nurtures leadership skills. As physicians we become comfortable shouldering tremendous responsibility. Physicians by selection and definition have significantly above average intellect. During training and practice, we develop strong analytic and decision-making skills. Increasingly, the practice of medicine involves teams of health professionals lead by a physician.

There are many opportunities and venues for physicians to utilize their leadership skills, both within and outside of medicine. We are blessed by the opportunity to be physicians. Despite the high cost of medical school, society invests heavily in our training. Because of this investment and our leadership abilities, I believe we have an obligation to serve in leadership roles of our choosing. For many of us, this will be opportunities in organized medicine. For others, it may be more community-based leadership opportunities. I am fortunate to have the opportunity to serve this year as president of the American Academy of Family Physicians (AAFP at www.aafp.org). It is a leadership role I am enjoying very much, but not one that was in my long-term plans as a young physician. When I think back on how I got to this position, I’m reminded of the film “The Matrix.” In the film, the character Neo is uncertain of his role and future. His mentor Morpheus, reassures him “it isn’t necessary to know the path, to walk the path.” My path to my AAFP leadership role began in a local AFP Chapter. It was time for a new chapter president and initially no one volunteered. One of the senior physicians in the community then offered. This physician had contributed in leadership of this same organization for years and was only volunteering because no one else had offered. So I volunteered and was made president. Activity in the local chapter brought me in contact with the Washington AFP chapter. I served as a delegate to the state Academy and was responsible for planning several of the annual meetings. As a result of this involvement I was asked to run for the position of alternate delegate to the AAFP. At the time, I had no idea this was the path to a national AAFP leadership position. I simply accepted the position because I was asked and was fortunate to be elected. Attending AAFP Congress of Delegates (COD) meetings, I was impressed by the fund of knowledge, public speaking ability and leadership skills of the AAFP leaders. It was truly humbling. Continued on page 4

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Continued from page 3 Participating in the AAFP COD over several years resulted in me developing some of those same skills, but I never envisioned I would have the necessary depth of skills necessary for AAFP leadership. They had capabilities far beyond mine and I still had no intention of seeking an elected AAFP position. Then something happened to change my perspective. The AAFP Board took a position and took actions that made me upset… no, actually angry. The result was I could see those individuals having weaknesses along with their strengths. I could now see myself becoming just as qualified as them to serve in AAFP leadership. Now I had to make a choice; step up or shut up. I’m not very good at shutting up. I made the decision I would run for the AAFP Board. I made a concerted effort to build the necessary leadership skills to serve effectively in this role. I was encouraged by friends and colleagues. I was fortunate to be elected to the board and turned my efforts to being the best contributing board member I could be. I continued to work on the leadership skills that would be necessary at the next level. At the end of my three-year board term, I was elected president-elect. I offer these suggestions based on my experience: Although as a physician you already have leadership skills, work to further develop those skills. You can develop the same leadership skills you observe in others. They are not better than you. Specifically to younger physicians, offer to serve in a leadership position and do not let senior physicians serve more than their fair share. Accept the opportunity to serve in a leadership position when asked. Those asking see leadership potential in you that you may not see in yourself. If an organization important to you is making decisions with which you don’t agree, step up to serve as a leader to do better. Not all of us want to be leaders in organized medicine, medical groups or hospitals. But we can offer our leadership skills in other venues such as church, schools, community organizations, scouts and other youth organizations, and for the truly brave, elected public office. Choose to serve where you are called. Choose to make a difference.

Physician Leaders in a New World By Rodney L. Trytko, MD, MBA Never before have we seen such dramatic changes in healthcare like we see today. Some describe the last 150 years as the golden age for physicians. They claim that the central role of physicians in the delivery of healthcare will vanish in the future. I personally believe that nothing could be further from the truth. Here are their concerns. We are experiencing rapid consolidation and vertical integration among providers, resources are becoming scarce, physician shortages are evident and expected to worsen, mid-level provider surpluses are mounting, and reform efforts are everywhere. Also, new technology will reduce the reliance on a physician’s intelligence and knowledge and facilitate the ability to remotely diagnose and treat. I think we can safely conclude that things are going to change. A new world of healthcare delivery is rapidly approaching. Despite those changes, physicians will still command a high level of respect among other physicians, patients, hospital administrators, regulators and politicians. We are unique in our ability to both provide high quality healthcare and coordinate care. We are at the center of healthcare delivery, provide the highest level of expertise and perform the most challenging medical procedures. Because of those reasons, our leadership will be a necessary feature of a successful organization as it seeks to improve quality and performance in order to be competitive and achieve its mission. Physician leaders of the future will be most effective if they have the correct mental model, utilize an effective leadership model and affiliate with a company or organization with a competitive business model. The correct mental model is the first and most important characteristic of an effective physician leader. Most physicians, especially in my day, were trained to be “heroic lone healers.” We relied upon our own individual skill set, knowledge, work ethic and compulsiveness. We used our positional power to dominate disputes. We sought perfection in everything we did and devoutly believed that our individual autonomy solely protected our patients. Those attributes worked well when resources were abundant, competition was non-existent and information systems were primitive. They will not work well in the future. The future physician leader will promote a value system that places the interests of patients first. They will understand that those interests are best served by a team approach rather than the traditional individual approach.

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Continued from page 4 They will be keenly aware that times have changed, systembased care will predominate and communication and consensus development are necessary skills for success. They will think beyond the daily operational decisions in order to consider advancing the mission and vision of the organization that they serve. Clarity of direction and communication of vision are necessary for enrolling physicians to pursue a unified and shared agenda. Communication skills will be vital. The successful physician leader will learn to focus on each individual team member while they listen and seek to understand their views. The leader will also genuinely display empathy, develop trust and masterfully explain issues. Only then can the physician leader influence team members and improve performance. The second factor is an effective leadership model. Up until now, physicians were typically led by other physicians with dominating and influencing personalities. Those leaders typically surrounded themselves with other physicians who were like-minded in order to increase their collective political clout. How else could anyone have kept a group of physician partners together? Since future health care delivery systems are based on a team model, physician leaders will have to be team leaders. High performing teams will be able to increase their collective capabilities and average intelligence. Team leaders will typically possess collaborative and supportive business behavior personalities, the type of personalities that facilitate a cohesive and well-functioning team. The leadership team will be best served by gathering a wide diversity of team members in order to capture all of the necessary perspectives and talents. Open forums for sharing information and developing consensus will be developed and promoted. The best decisions will be by consensus, and this will lead to better decisions and a greater willingness to monitor the decision’s effects in order to consider future revisions. The third and final factor is affiliating with a hospital, practice or company with a competitive business model. In the past, most physician groups had weak business models. They were typically small or medium sized pass-through partnerships. Many were reliant upon consultants and business associates for even the most basic business functions. Specialized skills were performed by those without specialized training. Their ability to accept any reasonable amount of risk was severely limited. There were no competitors and resources were abundant, so there was no reason to change. Future physician leaders will work for organizations with business models that are substantially larger and more sophisticated. They will be surrounded by an assortment of business professionals. Medical billing, malpractice, quality and performance

improvement, managed care contracting, and human resources will all be internal. Access to capital markets will enable the group to respond rapidly to changing market conditions, accept reasonable risk, and seek strategic mergers and acquisitions. These companies will thrive in an era of rapid change and uncertainty. While a business background will always be beneficial to the physician leader, it will not be a necessity. The best companies will separate the medical and operational divisions; however, both will seamlessly work together. The physician leader will not have to deal with operational issues. They will focus on their strengths: medical care and care coordination. The most competitive companies will invest heavily in physician leadership development in order to ensure a continuous and stable supply of physician leadership talent. Leadership development will be identified as a critical success factor, and sufficient resources will be allocated. I believe that many successful companies will be led by enlightened and talented physicians in this new world. Dr. Trytko practiced medicine in Spokane for over 25 years and is now a Regional Medical Officer for TeamHealth Anesthesia.

What Does It Take to Become a Certified Physician Executive? By Gary Knox, MD Nearly a year and a half ago I obtained my “CPE”, or certified physician executive, credential. When I was on the Board of Directors, and later as Associate Medical Director, at Rockwood Clinic I began taking management courses through the American College of Physician Executives (ACPE). Courses are offered in live groups at conferences, and many of the courses can be taken from home online. Once I had 150 credit hours I was eligible to sit for the CPE “tutorial”. I had not studied business in undergraduate training, and certainly didn’t get management and business courses in medical school. So, I really needed to have more instruction in areas of management that related to my job. The ACPE courses cover subjects such as quality improvement, physician performance management, financial management, leadership skills, influence, change management, business development, health law, and many others. They keep adding new courses every year, and I continue to take courses from ACPE, even after obtaining my CPE. I have found that the ACPE stays very up to date in the courses they offer, updating established ones and adding new ones.

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Continued from page 5 In order to sit for the CPE designation, one must complete 150 hours of tested management education or have a management degree, be board certified in a specialty, have at least three years of clinical experience after residency and fellowship, and have appropriate references. The certification program then is 4 ½ days, and consists of communication strategies and styles, techniques of effective presentations, mentoring, organizational politics, and instruction on influencing physician behavior and dealing with disruptive physicians. It is also designed to aid physician executives in their search for executive leadership positions, and they will even help you develop your resume`, learn job search tactics, and salary negotiation if you desire. The end of the week culminates in a short presentation before a panel after the candidate has had some coaching in speaking and presentation skills. It was not too nerve-wracking or high pressure, and they tried hard to make it truly a learning environment. The CPE certification is administered by the Certifying Commission in Medical Management (CCMM). “The Certifying Commission is a not-for-profit corporation chartered by the American College of Physician Executives—the association for physicians in health care leadership—to establish and maintain the highest standards for certification of physician executives. “ The goal of the American College of Physician Executives (ACPE) is to educate and prepare physicians to be leaders in health care at the highest levels. More and more provider organizations, payers and hospitals, and now accountable care organizations, are all looking for physicians to be at the top of the organizational structure. It is no secret that many physicians feel more comfortable working with leaders of their organizations who are also physicians because of the perceived ability to understand the physician culture better than a non-clinician with a business degree. My feeling about the ACPE and CPE certification is that the courses offered can be helpful to physicians in any level of management, whether the desire is to do a better job of managing a clinic, have a better understanding of the financial data, or advance to higher levels of leadership in a large organization. The CPE is not as rigorous as an MBA, and some organizations may prefer to hire a physician executive that has an MBA. But, much of the content leading to the CPE is similar to that of an MBA, and many of the courses offered by the ACPE will serve as prerequisite to a Masters in Medical Management or an MBA through one of the partner universities that participate with the ACPE.

What Prevents Breakthroughs In Physician Leadership Performance? The Tissue Paper Barrier By Gordon Barnhart Senior Partner, Physician Leadership A very smart and experienced physician leader recently asked me the following question:

“Why are we so stuck in physician leadership development and performance?” His healthcare system has invested a lot of time, money and effort in developing physician leaders. They have not been avoiding the challenge. They have had both administrators and physicians involved in trying to achieve the desired physician leadership performance. His is one of the most admired organizations in healthcare and yet, with almost a sense of despair, he asked that question. The answer that popped into my head surprised both of us.

“The barrier to effective physician leadership development and performance has the consistency of tissue paper – but it is opaque, so healthcare systems don’t punch through it.” The barrier is an outdated mindset about how to design physician leadership roles and relationships and how to develop the leadership competencies that are required in today’s healthcare environment. There is plenty of capability on both the physician and administrative sides to dramatically increase physician leadership performance if they punch through the tissue paper barrier together.

It’s Not an Indictment That sounds like an indictment, but it isn’t. In dealing with the dynamic balance between the care of patients on one hand and the business of healthcare on the other, we have seen three periods of leadership challenge and response. Prior to the early 1980s there was sufficient money to fund both sides of the balance, so there was relatively little pressure to develop a large number of highly qualified physician leaders. Between the early 1980s and 2010 the game changed primarily because of changes in healthcare finance. Significantly more focus was placed on physician leadership development, but the game didn’t change dramatically. Now it has.

Why the Barrier is a Problem Now Post 2010 the game has changed in fundamental ways – from financial and quality requirements to the integration of care across many corporate boundaries, professions and functions. Continued on page 7

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Ten Characteristics of the Required Leadership Web

And the game will keep changing. That means that healthcare organizations must become “agile organizations,” organizations that can design and implement strategies quickly and keep doing so as environmental realities keep evolving.

There is no chance of being an “agile organization” without an extended web of physician leaders that is closely aligned with administrative leaders. That is why the tissue paper barrier is now a problem. The old ways of thinking about physician leadership worked in the past. They won’t now, so we need a new mindset about physician leadership.

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Punching Through the Tissue Paper Barrier - The Vision There are two major differences between the old physician leadership approach and the new approach required to build agile organizations:

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Physician “Development” vs. “Physician Leadership “Performance” 9. Previous conversations were mostly about “physician leadership development.” The new conversations need to be about “physician leadership performance.” That is a profound shift and one that will lead to very different outcomes.

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The requirements of leadership are spread across an aligned and extended web of physician leaders The leadership web includes formal and informal roles, large and small roles, roles that are ongoing and roles that are time and task specific Large formal ongoing roles are limited The variety of leadership roles closely matches the key work of the organization The competencies of the physicians in each specific role match the work of that role Physician leadership development is customized to the role and physician and it is delivered through multiple methods. It is most often “on-the-job” and “just-intime” development. Physician leaders are partnered with their appropriate administrative counterparts Compensation is flexible - a combination of salaries for the large formal roles and flexible reimbursement for most roles Compensation closely matches the work load required and is related to outcomes There is a major focus on the development of a culture of effective followers to complement leadership

Punching Through the Tissue Paper Barrier - Four Core

Leadership Pipeline and Leadership Web

Strategies

Previous efforts focused on a pipeline for leadership development that primarily fed a few corporate leadership positions and a committee structure that could manage incremental change. The new focus needs to be on the rapid creation of a flexible web of leaders who can design and implement strategy in a rapidly changing environment – repeatedly. This is not an either/or issue, but the pipeline (in most instances) should not receive more than 20% of the time, attention and resources. The goal is an immediate impact on performance as well as long-term sustainability.

Building a web of physician leaders is very straightforward. It involves four core strategies: design the web, build the competencies, align compensation and do all of that in a way that is worthy of the physicians who make the commitment to lead.

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etc. Reinforce both the importance of self-directed learning as well as frequent and informal accountability checks to ensure the desired experience and outcomes

Strategy #1: Design the Web of Physician Leaders • Map the work to be done and design the roles to match that work. The design can include large and small roles, formal and informal roles, roles that are ongoing and roles that are time and task specific. The reason to maintain as much flexibility as possible is to ensure that roles can be matched to work as priority work changes. Leadership roles can take many forms. Some will be traditional such as CMO and VPMA. Some will become new traditions such as Chief Quality Officer or Chief Clinical Information Officer. Many will be project or initiative specific, such as leading PCMH implementation, the effective use of EMRs or the development of integrated delivery systems. Much of the opportunity and the flexibility will come from developing a variety of roles of smaller scale and scope – or teaming on an initiative - to bring newer leaders into the game and keep those in larger roles from being overwhelmed. • Design leadership roles to match the available talent and map that talent based on interest and current capabilities. Leadership roles should not be seen as “representative” roles. Talent is the key factor in selecting physician leaders, not the desire to have departments or organizations represented. • Expand roles as capability increases. There may be significant numbers of physicians new to leadership roles who will rapidly increase their capabilities and their roles can expand to take advantage of the capability. It is better to start with smaller roles that can be rapidly expanded to match developing capabilities than to overwhelm new leaders. • Expect that there may be significant, or even dramatic, changes in leadership structure to match the requirements for leadership in the emerging healthcare environment. • The final step is to carefully recruit physicians into the appropriate roles, orient them and provide as much early support as possible to ensure successful initial experiences Strategy #2: Customize Physician Leadership Development • Map the competencies to be developed for the physicians in their specific roles and determine the patterns. There will be a few core competencies that need to be developed for all physician leaders – but only a few. • Customize a development plan for each physician that matches their role and specific development needs, uses multiple methods and reinforces self-management of the process. In other words development is physician and role specific. It is primarily “on-thejob” training and development and it is “just-in-time.” Customization is key to both conserving resources (from time to money) as well as generating desired results quickly. • Ensure that the appropriate relationships are in place – with administrative partners, other physician leaders, coaches or mentors,

Note: It is important to have a pipeline for physician leaders in place that takes a longer view, but for most healthcare organizations the strategy recommended here will bring the fastest and most focused benefits as well as significantly influence the leadership culture. Strategy #3: Tie Compensation to Activities and Outcomes, Not Roles • This is particularly important in situations where the physicians in leadership roles are also practicing medicine. • Rather than salaries that are attached to roles and loosely tied to outcomes, tying compensation to specific activities and clear quantitative and qualitative metrics provides both flexibility and clarity about what is being rewarded. Some roles, like full-time physicianexecutive positions, will have traditional salaries tied to them. • The leadership flexibility comes in keeping as much compensation as possible tied to the critical work of the organization at any time. When that work is finished, the compensation can be redeployed to new work that becomes the priority. Strategy #4: Be Worthy of the Physicians Who Answer the Call to Lead (A Challenge for the C-Suite) • Asking physicians to take on meaningful leadership roles and prepare themselves to do so carries a moral/ethical challenge for healthcare leaders. That challenge is to be worthy of those who say “yes” to the call to lead and put themselves on the line. • We must acknowledge that we are asking physicians to move away, to varying degrees, from their areas of passion and preparation and enter a world that is profoundly different. They are leaving a history of success for the unknown. • This is a C-Suite challenge for two reasons. First, physicians will look to the C- Suite to judge whether the organization is really serious about physician leadership performance or whether it will be business as usual. Second, because the approach required now is so different from previous efforts it is the C-Suite that must provide the vision and resources and then “hold the course.” The C-Suite cannot expect others to go against the entrenched approach to physician leadership development if they don’t lead the way. Rapidly developing a high level of sustained physician leadership performance is a critical success factor for healthcare organizations in today’s environment. That is a radical change in the game, and it requires a fundamental shift in how healthcare leaders build that performance. Healthcare leaders need to punch through the ‘tissue paper’ barrier and adapt the 4 core strategies. If done with real commitment and follow-through, most systems will be very pleasantly surprised at the level of leadership performance their physicians will achieve – and how quickly they achieve it.

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About O’Brien Group The O’Brien Group® is an executive leadership consulting firm that works with healthcare CEOs, Physician Executives and their teams to strengthen team dynamics, better manage conflict and improve their readiness for reform. The results: The health systems they work with now tackle big problems with a renewed sense of alacrity, lead their peers on numerous operational measures and have won Top 10 Best U.S. Health System Awards (Thompson-Reuters). O’Brien Group’s team of former CEOs, psychologists and physicians will help you add new executive work practices, senior leadership approaches and new ways of thinking directly into your system's business issues. They coach your team one-on-one AND as a group to help them think clearer, lead better change and achieve faster results in an environment moving at a speed the human brain has never encountered. Using your "live" business issues as the agenda, O’Brien Group works alongside your senior administrative and physician executive teams to help you: • Align system, region, hospital & physician group leadership relationships to accelerate the impact of major change initiatives. • Improve executive team decision-making and take full advantage of the collective intelligence of the entire team. • Develop more effective and efficient executive work processes. • Lead more innovation without hurting operations. • Train your mind to lead through the brain's nor mal, automatic

care needs of our region especially by recognizing the importance of primary care and providing service to underserved populations; advancing knowledge and assuming leadership in the biomedical sciences and in academic medicine.” Those are noble goals, but how does this really play out? How do we in Spokane inculcate into our students and residents the idea that they are going to be leaders in their communities, organizations and health systems? It starts before students are admitted to medical schools. The UWSOM selects students who are well-rounded and have leadership qualities knowing that these students will invariably be asked to assume leadership roles. Those students have a predisposition to be leaders and benefit from opportunities to enhance their skills once in medical school. At the same time, it is intriguing in that there is not a “curriculum” in how one can become an effective leader. Medical students spend the same four years in school I did 25 years ago but the amount of information they are expected to master has grown significantly. The idea of adding more “non-health related curricula” to their plate is difficult to conceive. This begs the question; “What is done to foster leadership in today’s medical education?” There is no specific training but fortunately students remain invested in their communities and have this propensity to lead. They are driven to decipher this and my experience as a student is not unlike what I believe their experience to be. My interest in leadership positions came from my interactions with mentors who modeled the kinds of physician behaviors I wanted to emulate. The concept of mentoring, official or unofficial, is integral in how we train physicians to assume roles which are integral to our community’s health. Students and residents are “primed” to take their skills, education, and innate abilities and use them to advance a greater good. We need to supply them with a framework and a structure wherein they can take on these roles.

and dysfunctional responses to change. • Create a cohesive and unstoppable senior executive team that exudes the personal courage and integrity that people will want to emulate and follow. For more information on this topic, contact Gordon Barnhart at gordon@obriengroup.us or Dr. Michael O’Brien, (513) 821-9580, michael@obriengroup.us, www.obriengroup.us. Reprinted by permission

Training Students as Leaders By John McCarthy, MD Assistant Dean for Regional Affairs UWSOM The University of Washington School of Medicine’s (UWSOM) mission statement reads in part: “…we place special emphasis on educating and training physicians, scientists, and allied health professionals dedicated to two distinct missions: Meeting the health

In Spokane, our learners jump at the opportunities to assume those roles. At the beginning of the academic year, the student leaders at the House of Charity free clinic assume leadership of the studentrun clinic. Over the last four years, they have developed the clinic to a year-round clinic which has served hundreds of patients and have invited Physician Assistant students to accompany them. Students have done similar things for education in the community, mentoring elementary students in health sciences. They take on roles of helping educate us by their work with faculty development and make us better teachers. Students do have some formal opportunities and these positions have historically had no trouble being filled. They become engaged with professional organizations and are encouraged to assume those roles with the American Medical Association, Washington State Medical Association, Spokane County Medical Society, American Academy of Family Physicians and Washington Academy of Family Physicians.

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Continued from page 9 They are encouraged early on in their careers to become politically active and engaged with their communities. In Spokane, students have helped to put together an elective class in community organization. They serve on the school’s “honor council”, admissions committee, curricula development committees, etc. Their input is critical to the success of the learning process and they want to engage. In the residencies, there are similar opportunities. The residents are invited to engage with hospital committees, professional organizations, CME programs, Graduate Medical Education committees, volunteer overseas work and much more. We work in professions where we are chosen because of our leadership potential, we are expected to be leaders and we have abundant opportunities to assume those roles. Fortunately, we all had wonderful mentors who showed us successful paths, we work in environments to further our skills in those areas if we are so inclined and we have the opportunity to mentor the leaders of tomorrow.

Is Leadership Overrated? By Deb Harper, MD I have been reflecting on leadership recently. I’ve done various “leadership” kinds of things during my life. This spring I took the WSMA/UW Leadership course (BTW, great fun, terrific information, I recommend it – email to Jennifer Hanscom to attend the Seattle based one this fall or the Spokane course in the spring jgl@wsma.org). But, upon reflection, I don’t believe leadership is important. Imagination is. Without imagination there is no vision. Without a vision there is no plan. Without a plan there is no need for leadership. You imagine an improved healthcare system or one with better equity, access or quality. Or you can imagine a better community, neighborhood, garden, society or country. Then you look around for a group that is working in the same direction as your imagination is taking you. If you find a group you can work with other imaginative people. If you don’t, well, now you need to be a leader and form a group of your own. Or, sometimes you need to work on your own; all by your lonesome self to get to the place your imagination leads you. Leadership is just a tool, a set of skills, to help you bring your imagination and vision to actualization. It is about inspiring others to work together toward a common vision. Those skills can be learned through experience and coursework. I have developed some skills from observing mentors (most of who didn’t know I was surreptitiously apprenticing myself to them).

of great things, but doesn’t have the time or freedom to bring them to reality. For me, when my children were small, I did not take on any leadership roles outside of our family. For others it is when they are learning a new musical instrument, starting a new practice, helping out in their faith community or training a rescue dog. We can’t do everything and be everything all of the time. During those times I like to plant the seeds of my imagination with others who may be able to carry on without me or to store the seeds for later planting. In the end it is about imagination. It is about leaving the world a better place.

Physician Leadership – Why Doctors Make Poor Leaders and What YOU Can Do About It By Dike Drummond, MD www.TheHappyMD.com One of the big practice challenges most of us face is a frustrating gap in our physician leadership skills. We step out of residency and are instantly installed as the leader of a multidisciplinary team charged with delivering the highest quality care to our patients. This new physician leadership role can be daunting. We are prepared to diagnose and treat … but what about all the other questions that come our way? At times It can feel like you don’t “have what it takes” when, in fact, this physician leadership vacuum is a natural consequence of our medical training and medicine’s unique business model. Here are three challenges to acquiring physician leadership skills that are hard wired into our training process – with suggestions on how to bypass them for a better day at the office for you, your staff and your patients.

1) A Dysfunctional Default Physician Leadership Style Our medical training is almost exclusively focused on our clinical skill set. We take a minimum of seven years in medical school and residency to learn and practice the ability to diagnose and treat. That knowledge base is nearly overwhelming all by itself and it is unfortunately not sufficient once we are out in practice. Once we graduate we quickly recognize that the act of seeing patients and delivering our treatment plan is dependent on a whole team of people. We are meant to be an effective team leader right out of the gate, but were never taught the basic physician leadership skills to play this role. We automatically adopt a dysfunctional physician leadership style based on “giving orders”

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2) No Physician Leadership Training & a Nonsensical

The clinical actions of diagnosis and treatment are simply adopted as our default physician leadership style. When faced with any practice challenge, we assume we must be the one who comes up with the answers (diagnose) and then tell everyone on the team what to do (treat).

We learn a “top-down” physician leadership style naturally and automatically This default “command and control” physician leadership style – the same one used in the military – has its consequences. It turns your team into sheep. Here’s what I mean …It will seem to you like they have lost the ability to make independent decisions. Everything they perceive as a problem — from the front desk to the billing office — is brought to you for a solution. Have you ever felt overwhelmed by people asking you nonclinical questions about scheduling, billing and such? The top-down physician leadership paradigm produces that naturally. They all look to you for answers because you are the apex of the top-down pyramid. It does not have to be that way. A simple change to a more collaborative and team centered physician leadership style can make a huge and immediate difference. What you can do differently Understand there are multiple areas of your practice where YOU ARE NOT THE EXPERT and start to use the whole team’s expertise to address the problems you are facing. After all, you are in the room with the patient, doing your best to solve the clinical issues while the rest of your staff spends their day actually working in your scheduling and billing systems. They are the experts in what is going on in those areas … not you. The key to leveraged physician leadership is not you figuring out the answers … it is easier than that.

The key is to ask more questions … and give fewer orders Try becoming more of a facilitator … not “the boss” and source of all the answers. A more effective physician leadership style is to ask your people what THEY suggest as the solutions to the problems they discover. You might even tell them to only bring you a problem if they bring their thoughts on a solution at the same time. Have regular meetings where you work “on” the practice and deal with these issues as a collaborative team … rather than spending all your time working “in” your practice. This is the key to a much more effective physician leadership style. You begin leveraging the skills and experience of your entire team. When you work together to systemize and delegate you won’t feel like you are doing all the work and your team will feel honored and more involved. A better practice experience for you, your staff and your patients will result.

Business Model When did you ever receive training on physician leadership skills? Didn’t happen in my residency. It is foreign territory for most of us. Physicians as a group tend to see physician leadership, facilitation and the meetings required to coordinate the actions of a team as necessary evils we would like someone else to address. I have heard this over and over. “I just want to be left alone and see patients.” That is because you were only trained to perform that activity. The subjects of physician leadership and organizational development are absent in our medical training and yet become crucial to our success out in practice. Then there is our business model … which often makes no sense at all. Imagine the CEO of an automobile manufacturer who is simultaneously the only person who can put the doors on the cars in the assembly line. The boss is the biggest bottleneck in the system. Who would design a business like that? Welcome to the world of medicine. You are the leader and the piece worker on the line at the same time. You have the complete skill set to do your work on the line … seeing patients behind a closed door in the office. Unfortunately your physician leadership skill set is ignored at the same time that it is required to fill the other major role you play in the practice. The key is to respect, understand and begin acquiring physician leadership skills. Understand how to lead effectively will make your life easier and your team and patients happier and healthier. A great place to start is to beef up your physician leadership skills with some of the best books on the general subject of business leadership. Books like these classics. “First Break All the Rules” “The E-Myth” “The Five Dysfunctions of a Team” “7 Habits of Highly Effective People” “The Leadership Challenge” “What Got You Here, Won’t Get You There” Any of these books will give you multiple instantly effective tools you can use with your teams.

3) We Demonize Managers and Become Part of the Problem If I say – “Medical Director” to you … what are the first words that come into your head? I will wager they were not positive ones.

This common knee jerk reaction has important negative consequences for everyone.

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COLUMBIA MEDICAL ASSOCIATES is currently seeking a BC/BE Internist to join our Northside Internal Medicine Group in Spokane, Washington to meet our increased service utilization. We are a group of over 40 physicians providing comprehensive medical care to families and

InCyte Pathology Delivers Answers

individuals of all ages within the Spokane

InCyte Pathology

region. The position offers the following:

Welcomes Alden Webb, D.O.

• Flexible schedules and outstanding teams make this opportunity worth exploring. • Competitive Salary and Generous Benefit Packages • Conveniently located only two blocks from Holy Family Hospital • Established relationship with local hospitalist group for admitting, rounding, and discharge Our physicians are committed to maintaining the health and well being of all their patients through preventive

InCyte Pathology welcomes Alden R. Webb, D.O., to its growing Dermatopathology Services Department. InCyte Pathology’s dermatopathologists work closely with area dermatologists to provide the best treatment for patients with skin conditions and diseases. Dr. Webb recently completed his fellowship at Indiana University School of Medicine in Indianapolis and will join InCyte Pathology in early August. Dr. Webb is board certified in anatomic pathology and clinical pathology and is board eligible in dermatopathology.

care measures and working closely with community specialists. Our new partnership with Group Health and collaborative care models ensure patients have access to the

You deliver quality healthcare.

InCyte Pathology delivers quality diagnostics.

best care in Spokane. To apply or inquire for further information

Learn more by calling us at 509.892.2700 or visit www.incytepathology.com.

please contact: Nancy Longcoy, Physician Recruiter Longcoy.n@ghc.org; Ph: 206-448-6132

Proudly serving SCMS physicians and their patients since 1957

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Physician Leaders in Training

Physicians as a group tend to see anyone in a management role as “the enemy”. If these people would just do their jobs, we could finally be left alone to “just see patients”. These are the “bean counters” and “pencil pushers”.

By Jennifer Hanscom Associate Executive Director/Chief Operating Officer Washington State Medical Association

It gets even worse if that same manager, medical director or administrator is also a physician. For those of our brothers and sisters who have stepped into administrative roles … we tend to see them as failures, traitors … “they’ve gone over to the dark side” or worse.

We demonize managers/administrators at our own risk These organizational leaders are charged with managing and improving the function of the larger systems that play such a big role in your practice. We can fight them and become part of the problem. We have all seen and done this … bringing them only problems and complaints. Our interactions can become hostile venting sessions and nothing gets accomplished.

Or we can take responsibility to become part of the solution As a team leader in the front lines of patient care, you can make a difference by working to influence and support these managers and administrators. You and your team have valuable experience to share with those who are charged with running and improving these larger systems. This physician leadership role at this larger system level is even more important now as hospital based physician networks are rapidly forming across the nation from what used to be independent practices. - What are your suggestions for improvement in these larger systems? - Who needs to know and how can you help them implement the changes you recommend?

We can each play a role in helping these larger systems

Of the countless terms that enter the medical field’s lexicon each year, the phrase “physician leader” has garnered significant attention in the recent past. According to Hospitals & Health Networks magazine, medical school deans, health system administrators and physicians themselves, sizing up the clinical and economical shifts in the healthcare industry, are calling for a growth in the comprehensive leadership skill development afforded to physicians. In Washington State, the Washington State Medical Association (WSMA) is providing just such an opp ortunity with our biannual Physicians Leadership Course. In 2010 we conducted a survey and series of focus groups to assess our members’ needs regarding the expertise outside the patient care realm. The results revealed that approximately 40% of our members practice in a group of 100 or more physicians, and that the incident of leadership responsibilities was frequently disproportionate to a member’s level of leadership training. Through our focus group discussions we found that physicians in those larger practices, particularly younger physicians, were being asked to serve on committees or head sections and didn’t feel prepared to do so. In addition, our members wanted to seek out the necessary training, but between their practice and personal life they didn’t have the time to commit to getting a MHA or MBA. What our members needed was a convenient introduction to leadership, so with the help of a grant from The Physicians’ Foundation and guidance from our physician advisory board, the WSMA partnered with someone well-versed in helping physicians craft the type of training most applicable to their career paths.

become more functional, but not if we retreat to our

Tailor Made

exam rooms and simply complain. In my experience, any

“At the University of Washington, we have a master’s degree leadership track for those intent on becoming a chief medical officer, but very few physicians are attracted to that level of commitment. About 15 years ago, we began to offer a pared down version in a certificate course for those more interested in a clinical director position,” says Edward Walker, M.D., M.H.A., Director of the University of Washington (UW) Healthcare Leadership Development Alliance. “Based on the growing interest in the certificate course, a 101 style course that included all the constructs of the in depth curriculums seem like it would be appealing.”

efforts doctors put into their own physician leadership development pays immediate dividends. Putting some effort into • Studying Physician Leadership • Leveraging your team with your new physician leadership skills • Playing a role in improving the larger systems is a way to quickly improve the practice experience for you and your staff and the quality of care you and your team provide to your patients. Dike Drummond is a family physician, entrepreneur and business coach. He provides burnout prevention and treatment services to physicians and healthcare organizations through his site, The Happy MD.

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HEIRLOOMS TO LIVE IN THOUGHTFUL SITE INSPIRED ARCHITECTURAL DESIGN

What I remember the most about the design experience was how our vague ideas would be rendered into several potential and elegant solutions by Sam. When I look at my home I can’t tell what came from me or my wife or from Sam. It doesn’t matter of course, we just love the results. Sam was honest and ethical in every aspect of our work together. He worked diligently to understand what we really wanted. Such questions as “what does quality mean to you” were taken up with all seriousness to find the subtle differences that make a custom home custom. We recommend Sam to anyone who wants a thoughtful, intelligent, honest partner in the design of a unique and personalized dwelling. - Don George

SAM RODELL

W W W. R O D E L L . C O

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ARCHITECT AIA 509.939.7007

Continued from page 13 The WSMA Physician Leadership Course is a partnership with the University of Washington Graduate Programs in Health Administration and UW Professional and Continuing Education. The course represents the intersection between physicians’ needs and interests and their time constrains. Our 10-week course consists of eight weeks of online assignments and group work bookended by two in-person weekend meetings. The first inperson session spans two days and involves forming six groups of five physicians who collaborate throughout the rest of the course and learn about each participant’s personal and leadership styles, in addition to how differing styles can interact productively. While the in-person sessions are held in either Seattle or Spokane, because the majority of the course is taught online a physician from any state can participate in the course. In fact physicians from the Cleveland Clinic and Montana have participated in previous courses. The online portion is formatted in a Moodle (Modular ObjectOriented Dynamic Learning Environment) — an open source course management system — through which groups spend roughly two hours a week completing assignments and working toward a final capstone case. The WSMA/UW Physician Leadership Course is rooted in the constructivist theory that advocates learning by actively building and doing rather than passive reading. Divided into four units, the eight weeks cover leadership and management, quality and patient safety, planning and budgeting, and the synthesis and application of those principles. The final in-person meeting provides a forum for physicians to discuss the next steps in their leadership futures and participate in a closing ceremony. For Dr. Walker, the direct relationship between what participants learn in the course and what they take back to their respective organizations is crucial. Just as important is the familiarity physicians gain through exposure to financial, planning and interpersonal management concepts and how that exposure may spark an interest in individuals, leading to further leadership development. “I think that trained physicians make very good leaders because they understand how to balance what the organization needs and what the individual patient needs,” says Dr. Walker. “Administrators of small and large healthcare organizations need strong, well-trained physician partners to help them partner with the medical and nursing staff, and these are the doctors who are most likely going to be able to do that.”

New Spokane County Medical Society Program: Consistent Care Washington Awarded Grant to Create Health Housing Homeless Integration Pilot Program By Lee Taylor, CCW Business Director Consistent Care Washington (CCW) is the newest program of the Spokane County Medical Society. CCW will support two of the strategic initiatives that are part of the new Spokane County Medical Society Strategic Plan - Community-Wide Care Coordination and Community-Wide Emergency Department (ED) Use Optimization. The Health Housing Homeless Integration Pilot (H3) will be implemented in collaboration with Volunteers of America, Providence Sacred Heart Medical Center, Spokane Falls Community Clinic, Frontier Behavioral Health and other community service providers. H3 will create a multidisciplinary team of providers that will work with homeless people visiting the emergency department who are in need of integrated services to address medical, behavioral health and housing needs. CCW was created to collaborate with the existing Providence Sacred Heart Medical Center Consistent Care program and enable the expansion of the Consistent Care emergency department (ED) care coordination program to all fours hospitals in Spokane. CCW will also create broad and deep capabilities for patient care coordination targeting patient populations that are frequent users of emergency department and other medical services. CCW care coordination services will be focused strategically to be nonduplicative and add value across the regional medical community, rather than competing with other existing care coordination services from hospital or clinic systems or medical services payers. The overarching goal of CCW is to work collaboratively with the Spokane community to accomplish the triple aim of reducing the cost of care, improving the patient experience and boosting the overall health of the population served. Darin Neven, MD is the Medical Director of Consistent Care Washington and Lee Taylor is the Business Director. Please contact Lee Taylor for additional information at lee@spcms.org or (509) 220-2651.

For more information or to register for the upcoming WSMA/ UW Physician Leadership Course, visit www.wsma.org or send an email to jen@wsma.org.

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MEDICOR Receives $15,000 to Develop Disaster Health Portal

National Networks of Libraries of Medicine and others, the portal will also house a permanent repository for library disaster-related information. The portal will be publicized widely within the region and be freely accessible to anyone through guest access.

By George McAlister SCMS Director of Health Information Resources The Spokane Medical Library, a private foundation of the Spokane County Medical Society, has received a $15,000 Outreach Award to add a new Disaster Health Information portal to its Web-based MEDICOR electronic library system. The new portal will organize, store and deliver disaster medicine and public health information to health professionals, first responders and others who play a role in health-related disaster preparedness, response and recovery. Funds for the nine month project were generously provided by the National Networks of Libraries of Medicine (Pacific Northwest Region), along with the National Library of Medicine (NLM), who as organizations work to establish relationships that encourage and foster communication and information access. Ready access to disaster health information, augmented by Web-based education and training in disaster medicine, can increase a healthcare professional’s ability to effectively prepare and respond to emergency situations, and ultimately improve patient outcomes and overall community health. And once the immediate needs of the emergency are addressed, information and resources can also become a vital part of the important recovery phase of the disaster cycle. Developing the new portal will involve working extensively with the Spokane County’s Department of Emergency Management, the Emergency Preparedness Response Team at the Spokane Regional Health District and others to identify key disaster information to support first responders and healthcare workers. Working with the

Launched in 2008, MEDICOR (http://spcmsmedicor.org) is a Webbased content management and evidence-based information delivery system for healthcare professionals available at the point of care. MEDICOR operates through the generous support of Providence Health Care and Rockwood Health System.

Providence Hospitals among Nation’s “Best” U.S. News & World Report has released its annual Best Hospitals rankings. The medical centers in the Best Hospitals Honor Roll make up less than 0.4 percent of the nearly 5,000 hospitals nationwide that U.S. News evaluated for the 2012-13 rankings. Providence Sacred Heart Medical Center and Children's Hospital ranked #4 in Washington and is recognized among the Best Hospitals in Northeastern Washington. U.S. News also named Sacred Heart as high-performing in the following specialties: Cancer, Cardiology & Heart Surgery, Diabetes & Endocrinology, Gastroenterology, Gynecology, Nephrology, Orthopedics, Pulmonology and Urology. Providence Holy Family Hospital ranked #6 in Washington and is recognized among the Best Hospitals in Northeastern Washington. It was deemed high-performing in these specialties: Gastroenterology, Orthopedics and Pulmonology. For more details, visit http://health.usnews.com/best-hospitals.

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MEDICOR to Develop a New Diabetes Care Information Portal Leadership Spokane 1000 Graduates Strong!

By George McAlister SCMS Director of Health Information Resources The Spokane County Medical Society, through its Spokane Medical Library Foundation, has joined with the Beacon Community of the Inland Northwest (BCIN) to develop a Diabetes Care Information portal within its state-of-the-art MEDICOR electronic library system. The new BCIN diabetes portal will be populated with a wealth of clinical treatment information, guidelines and protocols, and serve as a support platform to store and easily access point-of-care information and regionallyrelevant content on diabetes and other related chronic diseases and conditions. Funded by the American Recovery and Reinvestment Act, the BCIN is one of 17 communities across the country selected by the U.S. Department of Health and Human Services to serve as pilot communities for wide-scale use of health information technology. Led by Inland Northwest Health Services (INHS), the BCIN is dedicated to improve the quality of care of diabetes patients in rural and urban communities across 14 counties in eastern Washington and northern Idaho.

On Thursday, June 7 more than 300 people joined together in celebrating the Graduation of the Classes of 2012. Dr. Terri Oskin (Columbia Medical Associates/President, Spokane County Medical Society) was the 1000th Leadership Spokane graduate to walk across the stage. Marlene Feist, City of Spokane Director of Communication, Class of 2006, (and graduate #717) presented a greeting from Mayor Condon. With the graduation of the Class of 2012, Leadership Spokane is 1000 strong. This is a real milestone for us. After nearly three decades of leadership training in Spokane, over 1000 Leadership Spokane alumni are actively leading in business, finance, government, education, medicine, the arts, and in non-profits, in our state, around the nation and internationally. In addition to celebrating our graduates, Leadership Spokane presented the Trustee Leadership Awards, Distinguished Leadership Award, Board of Directors Spirit of Leadership and the Silver Spirit of Leadership Award.

Financial support received from the Beacon project will fund the setup of a new portal within MEDICOR that will give healthcare providers, clinical coordinators and other Beacon partners and organizations access to authoritative databases, electronic journals, e-books and other Web-based resources on diabetes and its related diseases and conditions. Additionally, we will also work with BCIN to produce a customized content management system to store and retrieved developed guidelines, protocols and other diabetes-related clinical and outcomes data.

Several members of the Class of 2013 received the Northern Quest Resort & Casino/ Kalispel Tribe of Indians Scholarship and one, the DaZelda Scholarship.

MEDICOR is currently available to the medical staff and employees of Rockwood Health System and Providence Health Care and is generously supported by those organizations.

Mark your calendars now for Leadership Lights the Way, our annual Gala, on March 8.

Thank you for celebrating with us! As a non-profit organization, Leadership Spokane relies on the investment of the community that it serves. We look forward to seeing you at Graduation next year and throughout this year as we celebrate our 30th Anniversary.

August SCMS The Message 17

In the News

FYI

Matthew Layton, MD Recognized as a Distinguished Fellow of the American Psychiatric Association

Adolescents and Young Adults with Mental Health

Matt Layton, MD, a clinical associate professor in the WWAMI Medical Education Program, has been recognized as a Distinguished Fellow of the American Psychiatric Association (APA). The highest honor bestowed upon members by the APA, Distinguished Fellowship is awarded to psychiatrists who have made significant contributions to the profession. Layton was also appointed as one of two district branch representatives for the Washington State Psychiatric Association, the APA's district branch for Washington.

Patients ages 13 to 24 who are given opioids for pain are more than twice as likely to become addicted if they have mental health disorder, according to a study by Dr. Laura Richardson, MD, MPH, University of Washington associate professor of pediatrics in the Division of General Pediatrics, and a team of investigators at the Seattle Children’s Research Institute and the UW. Richardson’s team examined the association between mental health disorders and subsequent risk for long-term opioid use among adolescents and young adults. They found that those with mental health disorders were not only more likely to be prescribed opioids for chronic pain but also 2.4 times more likely to become long-term opioid users than those without a mental health disorder. For more information please go to the Pain Management Resources page on our Website at http://tinyurl.com/7rvqh8a

InCyte Pathology Teaches Second Year WWAMI Students Commencing in the fall of 2013, InCyte Pathology pathologists will teach second-year medical students in Spokane under the WWAMI training consortium. The pathology curriculum will begin with an introductory course on the fundamentals of pathology. A pathology component will then be integrated into nine systems courses using a case-based, active-learning methodology in a small-group setting. The program will start with 20 students in 2013 and another 20 in 2014.

High Value Healthcare (Developed by a group of health leaders in 2012) This list describes a comprehensive approach to promoting high-value healthcare and can serve as a blueprint for executives when considering their own efforts to improve the value of care delivered. Checklist items include: • Senior leadership that is committed, visible and determined, • Institutional culture of continuous improvement and real-time learning, • Comprehensive IT systems for integrated, streamlined and safe care, • Evidence-based care to ensure the best care is delivered every time,

Disorders at Risk of Long-Term Opioid Use

New White Paper Examines Physician Competencies for Value-Driven Health Care Delivery The AHA’s Physician Leadership Forum recently released “Lifelong Learning – Physician Competency Development,” a white paper that examines the skills needed to practice in the next generation of health care delivery. The paper discusses how hospitals and physician-associated organizations can help mold the next generation of physicians to function in a reformed health care delivery system that emphasizes team-based, valuedriven care. The paper is the culmination of about six months of work with the AHA's regional policy boards, governing councils and committees, the PLF Advisory committee and a clinical task force. “Lifelong Learning” includes case examples of activities underway at various hospitals and health systems throughout the US to embrace a set of core competencies. The PLF is working with AHA members and a variety of physician groups to stimulate thinking about how hospitals can begin to ingrain the competencies into their organizations and help support efforts to move towards greater adoption of the competencies. The paper is available at www.ahaphysicianforum.org/competency.

• Optimized resource utilization to reduce waste, • Integrated care delivered in the setting most appropriate for the patient’s needs, • Patient-clinician collaboration on care plans, • Targeted resources for the sickest patients, • Safeguards to reduce injury and infection, and • Internal transparency on performance, outcomes and cost.

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August SCMS The Message 19

Physician Leadership Resource

UPCOMING SCMS EVENTS

A link for any of the resources listed can be found at the SCMS website (www.spcms.org) Leadership Resources tab.

SEPTEMBER

Book

Board of Trustees’ Meeting and Caucus – 12

The Influence Game

House of Delegates (Tacoma) – 15 & 16

50 Insider Tactics from the Washington D.C. Lobbying World that Will Get You to Yes June 2012 Imagine a world where you are offered every job you seek; every business venture you undertake is successful; and every potential customer you approach buys your product. Now imagine that all of this can be achieved--ethically and honestly. All you need is the help of one battle-tested guide, The Influence Game. Former Washington, D.C. lobbyist Stephanie Vance dispenses everything she's learned about effective (and, believe it or not, honest) persuasion. Learn how to apply this power to any situation by using D.C. insider influence strategies and applying a step-bystep, easy-to-understand process for success.

Moderate Conscious Sedation CME Program – 27 SCMS Presents Medicine 2012 – 28

OCTOBER Senior Physicians’ Dinner – 18

DECEMBER Board of Trustees’ Meeting – 12

* Learn how to develop and articulate effective goals

In Memoriam

* Structure both long and short-term persuasion efforts * Identify and research primary and secondary audiences

Joseph A. Tedesco, MD

* Crafting those all-important personal stories Stephanie Vance has seen the influence game from every angle. Follow her lead to get past being heard to the real goal of being agreed with.

Joseph Alexander Tedesco, MD was born in San Mateo, CA March, 10, 1931 and passed away on July 7, 2012. He was predeceased by his parents, Leona Valencia Tedesco, Joseph Alexander Tedesco and sister Fran Thomson.

“Very easy read and helpful.” – Jeffrey O’Connor, MD

Membership Recognition for August 2012 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today. 20 Years

Joseph graduated from San Mateo High School, Tulane University and moved to Cordova, AK to begin practicing medicine as a general practitioner in the late 1950s. By the early 1960s he returned to Tulane University to specialize in ophthalmology and later settled in Spokane opening the Valley Mission Eye Clinic. Joseph is survived by his three children: Christine Tedesco, Mia Tedesco and Todd Tedesco; as well as twin granddaughters; one grandson and three great-grandsons.

Susan L. Ashley, MD

8/18/1992

Daniel P. Brutocao, MD

8/18/1992

Larry K. Lamb, MD

8/18/1992

Tim P. Lovell, MD

8/18/1992

Gregory K. Luna, MD, MPH

8/18/1992

Anne D. Oakley, MD

8/18/1992

Joseph had a passion for fishing, hunting, cooking, opera, the arts and having new experiences with friends and family all over the world. He continued to read and keep up on all the newest medical breakthroughs in research and always had an open mind to learning. He built two large aluminum jets boats and was a craftsman in designing his own home.

John M. Wurst, MD

8/18/1992

He will be missed by his family and friends.

10 Years John F. Long, DO

8/1/2002

M. Shane McNevin, MD

8/1/2002 August SCMS The Message 20

Continuing Medical Education

2nd Annual River Cruise

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 CreditTM. For more i nformation www.ama-assn.org.

A perfect summer evening was the setting for the 2nd annual river cruise on Thursday, July 12. SCMS members and their spouses cruised to Lake Coeur d’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, Fruci & Associates, Sterling Bank, Witherspoon·Kelley, US Bank and Numerica Credit Union. To view photos of the evening, visit the SCMS website at www.spcms.org.

Moderate (Conscious) Sedation and Analgesia: 3.0 Hour(s) of Category I CME credit, sponsored by the Spokane County Medical Society. Conference held on Thursday, September 27, 2012 at the Providence Sacred Heart Medical Center Auditorium. 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. See the Spokane County Medical Society’s website for more information and to view the program brochure at www.spcms.org or contact Jennifer Anderson at (509) 325-5010 or email jennifer@spcms.org. Spokane County Medical Society presents MEDICINE 2012: 8.0 Hour(s) of Category I CME credit, sponsored by the Spokane County Medical Society. We will be honored to hear from Dr. Glen Stream, president of AAFP, on Health Reform, Dr. Jeffrey Fox from Kaiser Permanente in California regarding Updates on Gastrointestinal issues and Dr. David Spach from the University of Washington regarding immunization updates to name a few. Conference will be held on Friday, September 28, 2012 at the CenterPlace Regional Event Center in Spokane Valley, WA. Visit the Spokane County Medical Society website for more information and to view the program brochure at www.spcms.org or contact Jennifer Anderson at (509) 325-5010 or email jennifer@spcms.org.

Meetings, Conferences & 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. WSU College of Nursing is pleased to present the 14th Annual Cleveland Visiting Scholar Event “Infusing True Patient-Centered Care into Improving the Quality of Transitional Care” A conversation with Eric Coleman, MD, MPH Join WSU College of Nursing and Dr. Eric Coleman as he discusses improving healthcare systems by building in transitional care as a standard component of healthcare delivery. Dr. Coleman’s presentation will examine the confluence of national policy efforts that address transitional care; provide a seven-prong approach for improving quality and safety during transitions; and describe the “Coleman Model,” which is the foundation for his national Care Transitions Program. Wednesday, September 5, 2012 Red Lion Hotel Inn at the Park, Skyline Ballroom 5:00 Networking and No-host bar 6:00 Dinner 6:30-7:30 Presentation Cost: $55 per person; $400 per table of 8 Seating is limited! RSVP at http://wsunursing.eventbrite.com/ Dr. Coleman is the director of the Care Transitions Program, aimed at improving quality and safety during times of patient “hand-offs.” As a board-certified geriatrician, Dr. Coleman maintains direct patient care responsibility for older adults in ambulatory, acute, and sub-acute care settings. August SCMS The Message 21

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 applicantâ&#x20AC;&#x2122;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

Tailor, Shamit D., MD Internal Medicine Med School: Saba U (2008) Internship/Residency: Metro Health Medical Center (2011) Practicing with Apogee Physicians 9/2012

Baker, Ryan J., MD Pediatrics Med School: U of Cincinnati (2007) Internship/Residency: Cincinnati Childrenâ&#x20AC;&#x2122;s (2010) Fellowship: U of California (2012) Practicing with Providence Medical Group - Pediatric Hospitalists 8/2012

PHYSICIANS PRESENTED A SECOND TIME

Behne, Christopher M., DO Internal Medicine Med School: Western U of Health Sciences (2009) Internship/Residency: Internal Medicine Residency Spokane (2012) Practicing with Providence Medical Group - IM Hospitalists 7/2012 Cady, Francois M., MD Anatomic & Clinical Pathology Med School: Louisiana State U (2001) Internship/Residency/Fellowship: Medical U of South Carolina (2006) Fellowship: Mayo Clinic (2007) Practicing with Pathology Services (Deaconess) 8/2012 Clauser, Janelle M., MD Internal Medicine/Pediatrics Med School: Loma Linda U (2006) Internship/Residency: Georgetown U (2010) Practicing with Providence Medical Group - IM Hospitalists 7/2012 Doggett, Casey R., DO Family Medicine Med School: Kansas City U (2009) Internship: U of Medicine & Dentistry of New Jersey (2010) Residency: Bluefield Regional Medical Center (2012) Sports Medicine Fellowship with Family Medicine Spokane 7/2012 Kelly, Alan J., MD Internal Medicine Med School: U of Nevada, Reno (1994) Internship/Residency: U of Nevada, Reno (1998) Practicing with Rockwood Main Clinic 8/2012 Mantei, Kristin M., MD Anatomic & Clinical Pathology/Hematology Med School: U of Washington (2001) Internship/Residency: U of Washington (2006) Fellowship: U of Washington (2007) Practicing with Pathology Services (Deaconess) 8/2012 Murphy, Cynthia R., MD Neurology/Vascular Neurology Med School: Louisiana State U (2002) Internship/Residency: Boston U Medical Center (2006) Fellowship: Boston U Medical Center (2007) Practicing with Providence Nuero Science Center 8/2012

Ondersma, Ross M., MD Diagnostic Radiology/Nuclear Medicine Med School: Wayne State U (2006) Internship: Grand Rapids Medical Education Partners (2007) Residency: Indiana U (2011) Fellowship: Indiana U (2012) Practicing with Radia, Inc. 9/2012

Aharon, Alan S., MD Cardiothoracic Surgery/General Surgery Med School: Tulane U (1990) Practicing with Rockwood Heart & Vascular 6/2012 Archibald, David J., MD Otolaryngology Med School: Mayo Clinic (2006) Practicing with Rockwood Main Clinic 8/2012 Biswas, Shaluk, MD Internal Medicine Med School: Mymensingh Medical College (2002) Practicing with Apogee Physicians 9/2012 Coan, Michael C., DO Rheumatology Med School: Des Moines U Practicing with Rockwood Main Clinic 9/2012 Cook, Jill A., MD Pediatrics Med School: St. Louis U (2006) Practicing with Washington-Spokane Primary Care, LLC 9/2012 Gerhardt, Christina M., MD Pediatric Endocrinology Med School: U of Birmingham (2003) Practicing with Providence Pediatric Endocrinology 6/2012 Harwood, Mark D., MD Cardiology Med School: Keck School of Medicine (2004) Practicing with Providence Spokane Cardiology 8/2012 Hubbell, Michael P., MD Otolaryngology Med School: Rush U (2007) Practicing with Rockwood Main Clinic 8/2012 Le, Uyen (Michelle) T., MD Family Medicine Med School: Ross University, West Indies (2009) Practicing with Spokane Falls Family Clinic 8/2012 Liu, Eashen M., MD Gastroenterology Med School: George Washington U (2006) Practicing with Providence Adult Gastroenterology 8/2012

August SCMS The Message 22

PHYSICIANS PRESENTED A SECOND TIME CONT. In Memoriam

Macutay, Gerry B., MD Internal Medicine Med School: U of the Philippines (1998) Practicing with Apogee Physicians 8/2012

Marshall, Suzan E., DO General Surgery Med School: Philadelphia College of Osteopathic Medicine (2000) Solo Practice Hakone Surgery & Wellness 11/2012 Rhee, Paul H., MD. Plastic & Reconstructive Surgery Med School: U of Colorado (1995) Practicing with Rockwood Main Clinic 8/2012 Sanborn, Adam M., MD Family Medicine Med School: Creighton U (2006) Practicing with Spokane Falls Family Clinic 10/2012 Sanborn, Melanie J., MD Pediatrics Med School: Creighton U (2006) Practicing with Washington-Spokane Primary Care, LLC 7/2012 Sebley, Caroline M., DO Internal Medicine Med School: Kansas City U of Medicine and Biosciences (2009) Practicing with Rockwood Main Clinic 8/2012 Spinning, Kristopher A., MD Diagnostic Radiology Med School: Oregon Health Science U (2006) Practicing with Radia Inc., PS 7/2012 Watterson, Kara A., MD Family Medicine Med School: Creighton U (2009) Practicing with Group Health Permanente (Riverfront) 7/2012 Wilson, Jeffrey D., DO Internal Medicine Med School: A. T. Still U (2008) Practicing with IPC Hospitalist Co. 7/2011 Zhuo, Ying, MD Hematology/Medical Oncology Med School: Hunan Medical U, China (1994) Practicing with Medical Oncology Associates, PS 7/2012 Diagnostic Radiology Med School: U of Colorado (2006) Practicing with Radia, Inc., PS 7/2012

Francis “Van” Leonard van Veen passed away on June 28, 2012 at the age of 94 following a brief illness. Born December 15, 1917 to Theodore and Doris (Habersetzer) van Veen in Portland, Oregon, Van graduated from Franklin High School in Portland, received a BS and Masters in chemistry from the Oregon State University (1941 and 1942 respectively) and a medical degree from Oregon Health Sciences University (1946). Van met Patricia Konrad at a school dance in 1939, and in 1945, they married in Portland. In October, 2010, they celebrated 65 years of marriage; soon after Patricia became ill and died in February, 2011. Van was drafted into the Army as a medical student as was common practice at the time. Soon after a civilian internship he was called back into the Army where he was assigned to research the effects of radiation at Los Alamos as an extension of the Manhattan Project. He was discharged as a Major following four years of service. Van and Patricia lived in different cities across the U.S. while working in medical research, and eventually settled in St. Ignatius, Montana where he developed his medical practice and the family grew to 15 children. In 1964, they moved to Spokane where Van had a long and distinguished career practicing internal medicine and geriatrics. He worked for a time as the Deputy County Corner. Together, Van and Patricia raised 16 children. He will be tremendously missed by all including many sons- and daughters-in-law and their families. He is survived by his sons John, Richard, Michael, Robert, Steven and David; daughters Mary Strzelec, Christina Ager, Kerry, Suzie Scofield, Barbara, Julia Shaughnessy, Annette Moore, Margaret van Veen-Smith and Sara Desmond; twenty grandchildren, and three great-grandchildren; brothers Allen and Tom; sisters Dorothy Iverson and Mary Lisignoli; and numerous nieces and nephews. Van is preceded in death by his wife, Patricia, and their son Paul, and two brothers and a sister.

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME Stimpson, Debra A., PA-C Physician Assistant School: U of Washington, Medex Northwest (2005) Practicing with Providence Internal Medicine Residency 9/2008

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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 Toni Weatherwax at (509) 444-8888 or hr@chas.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, oncall shifts, overhead and case file administration. Please contact Gia Melkus at 1-800-260-1515 x5366 or email gmelkus@qtcm.com or visit our website www.qtcm.com to learn more about our company. PRIMARY CARE INTERNIST WANTED (Pullman) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential. Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments. We can’t wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or email tkwate@ palousemedical.com. Contact us today and discuss your future at Palouse Medical! FAMILY MEDICINE SPOKANE Immediate opening with Family Medicine Spokane (FMS) for a full time BC/BE FP physician who has a passion for teaching. FMS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships. This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Diane Borgwardt, Administrative Director at (509) 459-0688 or e-mail at BorgwaD@ fammedspokane.org. SPRINGDALE COMMUNITY HEALTH CENTER ARNP or PA-C N.E. Washington Health Programs (NEWHP) has an immediate opportunity for an excellent Physician Assistant (certified) or Nurse Practitioner with Family Practice experience to join our Springdale Community Health Center located in rural Springdale, WA. This position is for Family Practice outpatient care; urgent care experience is a plus but not required. NEWHP offers competitive compensation, comprehensive benefits. . NHSC eligible site. EOE and provider. Application Deadline: Until filled. Send resume to: N.E. Washington Health Programs Attn: Human Resources PO Box 808 Chewelah, WA. 99109 or electronically to desirees@newhp.org. PROVIDENCE HEALTH & SERVICES is building its Urgent Care presence in Spokane. We are recruiting for BE/BC Urgent/ Immediate Care physicians and advanced practice providers (nurse practitioners and physician assistants welcome to apply). This is a great opportunity to join a growing employed medical group in

beautiful eastern Washington. The exceptional Providence care team is implementing a system-wide standardized EHR and providers benefit from shared best practices and robust clinical and business support. Providence already operates hospitals, residency programs and numerous primary care and specialty clinics in Spokane. Competitive compensation and excellent benefits package, including relocation. Learn more: Mark Rearrick, Providence physician recruiter, (509) 474-6605, mark.rearrick@providence.org, www.providence.org/ physicianopportunitiesexperience is a plus but not required. NEWHP offers competitive com COLUMBIA MEDICAL ASSOCIATES is currently seeking a BC/BE Internist to join our Northside Internal Medicine Group in Spokane, Washington to meet our increased service utilization. We are a group of over 40 physicians providing comprehensive medical care to families and individuals of all ages within the Spokane region. The position offers the following: • Flexible schedules and outstanding teams make this opportunity worth exploring. • Competitive Salary and Generous Benefit Packages • Conveniently located only two blocks from Holy Family Hospital • Established relationship with local hospitalist group for admitting, rounding, and discharge Our physicians are committed to maintaining the health and well being of all their patients through preventive care measures and working closely with community specialists. Our new partnership with Group Health and collaborative care models ensure patients have access to the best care in Spokane. To apply or inquire for further information please contact: Nancy Longcoy, Physician Recruiter Longcoy.n@ghc.org; Ph: 206-448-6132 PREMIER CLINICAL RESEARCH, an independent dedicated research facility here in Spokane with 20 years of research experience is looking for a Pediatrician to be a part of our physician network for future studies. For more information please contact: April Gleason, Director of Business Development, (509) 390-6768, premierclincalresearch@gmail.com. PHYSICIANS NEEDED FOR WORKERS COMPENSATION EXAMS Let us help you get started in earning additional professional income! We are an established I.M.E. practice currently looking for Active Practice and Board Certified Orthopedic and Neurological Doctors, to perform Workers Compensation Exams. Located just minutes away from Rockwood Clinic in North Spokane, we offer a flexible schedule in a helpful, working environment. Previous experience performing Workers Compensation Exams is not required. Please contact Lorraine Stephens for further information at (509) 484-0380. PARTNERING FOR PROGRESS is a humanitarian Spokane-based nonprofit that is committed to ensuring that residents of the Kopanga, Kenya community have improved access to healthcare, clean water, sanitation and education. Through generous donors, P4P built a clinic for the Comprehensive Rural Health Project that is run by Alice Wasilwa RN with two other Kenyan nurses and provides primary care. Some of the common diseases include malaria, water borne illness as well as the diagnosis and treatment of HIV. There are approximately 12 deliveries per month and the clinic staff treats 900-1000 patients monthly. We are in need of medical providers, optometrists and dentists to travel to Kopanga to provide primary care on Oct. 18 – 28, 2012. If you would like to volunteer please contact Stacey Mainer at info@partneringforprogress.org. Continued on page 25

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Continued from page 24

MEDICAL OFFICES/BUILDINGS

CONTRACT BACK-UP PHYSICIAN 4 + HOURS/MONTH Octapharma Plasma is hiring a Contract Back-Up Physician in our Spokane, WA Donor Center! This position requires just 4 hours per month. GENERAL DESCRIPTION Provide independent medical judgment for issues relating to donor safety, health and suitability for plasmapheresis and immunization. Provide federal and international mandated training and supervision of donor center medical staff to assure compliance with applicable laws. We provide on-the-job training. WHO IS OCTAPHARMA PLASMA? Octapharma Plasma, Inc. is dedicated to improving the health and lives of people worldwide.

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.

OPI owns and operates plasma collection centers critical to the development of life-saving patient therapies utilized by thousands of patients globally. Learn more at www.OctapharmaPlasma.com! APPLY TODAY! Apply today by sending your resume/CV to Careers@OctapharmaPlasma.com! MEDICAL DOCTOR (MD/DO) (PRN openings in Spokane, WA) Physicians needed to perform physicals and health screenings at a non-commercial medical facility. MD/DO must have a current active, license from any state, available 1 to 3 mornings a week. Send CV to or call: Gil: 210-424-4008 meps@thi-terra.com EOE REAL ESTATE Medical Offic Space in the heart of Spokane Valley. Formerly occupied by Group Health and C.H.A.S. Highly competitive rent starting at $8/SF NNN for the first year. The building can be leased in its entirety of 12,459 SF or portions thereof. 57 car parks, X-ray room, pharmacy if needed, etc. It is ideal for a family practice or a combination of medical practitioners. Approx. 20 exam rooms, 8 offices. For information and a flyer contact: Pete Thompson, Stonemark Real Estate Company. Cell is 509-995-2919 and e-mail is: pete@stonemark.org. 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 fullsized 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. 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.

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. Clinical Space for Lease - Built in January 2011. 1128 sq ft, four exams rooms, two administrative offices, one office with a counter (electronic bar for laptops, etc.), restroom, reception area and waiting room. Rates are negotiable. Interested parties contact Sharon Stephens at Bates Drug Stores, Inc. 3704 N. Nevada, (509) 489-4500 Ext. 213 or Sam@batesrx.com. Office space located at 1315 North Division. This location is two miles north of downtown Spokane and just west of Gonzaga and the university district. It consists of 902 sq. ft. and rents for $1015 per month plus 20% of the building Avista and City of Spokane bills. The rest of the building is occupied by a physiatry and pain management medical practice. The space would be ideal for an ancillary medical, chiropractic or therapeutic clinic. Parking is ample and convenient. The space has a nice waiting area and receptionist-enclosed area, with several office, storage or exam rooms. Call (509) 321-2276 for more information or for a showing of your ideal location. 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 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.

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August SCMS The Message 26

PRSRT STD

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

U.S. Postage

PAID

Spokane, WA Permit No. 512

ADDRESS SERVICE REQUESTED

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

COBRA POLO CLASSIC 9th SEPT 2012 Date: Sunday, September 9th, 2012 Time: Noon - 4:00 pm Location: Spokane Polo Club Experience the event that combines the strength, elegance, speed, pride and love of fair play with tents, hats and champagne.

Limited seating. Make reservations now!

The price per ticket is: $2,500 for a sponsored table of 10 $175 per person / $350 per couple prior to August 12th. After August 12th the price per ticket is: $200 per person / $400 per couple Along with live polo action you’ll enjoy: Live Music, Champagne Divot Stomp, Hat Competition, Silent Auction, Gourmet Food & Wine and Whiskey Cigar Tent.

For more information: Dee Knight DuBey deek@rmhspokane.org Or Ami Kunz-Pfeiffer amik@rmhspokane.org rmhspokane.org / 509-624-0500

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