The Message, May 2013 by Spokane County Medical Society

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A MON T HLY NE WS M AG A ZINE OF SPOK A N E COUN T Y M EDIC A L SOCIE T Y â&#x20AC;&#x201C; M AY 2013

Medical Education in Spokane and Your Medical Society Anne Oakley, MD SCMS President

Being a Part of Lasting Change Regional Strategic Initiatives Why I Teach

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May SCMS The Message Open2

Table of Contents

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

Medical Education in Spokane and Your Medical Society .

Why I Teach .

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Being a Part of Lasting Change .

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Terri Oskin, MD Immediate Past President

Farewell to Keith .

Shane McNevin, MD Vice President

Volunteering Abroad Panel Presentation .

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On Becoming a Doctor .

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

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Residency: Day Number 1276 .

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Medical Training in Spokane .

Shriners Hospital for Children .

The Need for Preceptors .

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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.

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New Horizons for Medical Education in Spokane .

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Spokane Regional Health District One of First in Nation to Receive National Accreditation . .

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

Washington State University (WSU) College of Nursing – An Update on Nursing . . . . . . . . . . . .

Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society.

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Orthopaedic Residency Training in Spokane . Clinical Guides .

For Your Information .

Regional Strategic Initiatives . in memoriam .

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AMA Plans to Transform Medical Education Again .

AMA’s “Prescription for a Healthier Practice” .

Membership Recognition for May 2013 .

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Cognitive Pain Management: An Alternative .

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Positions available .

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2013 SCMS events calendar .

new physicians .

cme, meetings, conferences & events .

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classified ads .

“We

can ’t solve problems by using the same kind of thinking we used when we created them .”

–A lbert Einstein

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Medical Education in Spokane and Your Medical Society By Anne Oakley, MD SCMS President There are so many things going on today in the arena of medical education that it is hard to prioritize the issues! What are the regional needs for medical students, residents and future doctors? What types of doctors? How should we train them? What are the roles of current clinicians here in town? What is the training capacity? How do we partner our perceived needs with all the federal and state regulations and cut backs? Those issues involve the never ending political and practical battles for time, place and money. The good news is that great things are actually happening right here in Spokane at a steady clip due to a unique partnering of multiple institutions and enormous physician and community support. Most of you are aware that the large construction project on the Riverpoint Campus is Spokane’s new Academic Health Science Center. The project began when the business, education and medical communities came together with the vision, jointly invested in the economic impact studies necessary to prove the value of the project, then collaboratively lobbied for the funds to move to forward. I had the privilege of touring the construction site this week with members of GSI (Greater Spokane Inc.) and Chancellor Lisa Brown. It will be beautiful, functional, progressive, and on schedule! It will house the first and second year WWAMI students, the WSU School of Pharmacy, and research facilities for each of these programs. The recruitment of research talent has been so successful that the lab space is almost full! The medical students on the campus come to Spokane through the WWAMI program of the University of WA. This is a forty year old program which trains doctors in their home states of Washington, Wyoming, Alaska, Montana, and Idaho for their first year, has traditionally brought all these students to Seattle for the second year, and sends students throughout the region for the third and fourth year rotations. Our campus in Spokane will host twenty second year students for the first time beginning this fall, giving students the potential to spend all four years of their education here, a new opportunity which has been embraced by many students. Hopefully the number of students can increase over time, but that goal can only be reached if we can provide enough quality clinical training sites for the increased volume during the third and fourth

years. Developing these sites is complicated. Doctors are facing increasing pressures for “production” which can make teaching a challenge, and the departmental oversight for each rotation of the major rotation is in Seattle making it hard for local doctors to become instructors. Read Dr. Trytko’s article to gain a little perspective on the history of credentialing medical schools. The other large issue in increasing medical student capacity is their post graduate training. It is predicted by the AMA that as soon as 2015 we will have more medical school graduates than residency programs available. The goals and needs of the region for more physicians, particularly primary care physicians, are more likely to be reached if we can train them here, but the cap on training slots established in the late 1990’s remains in place, and the public sentiment towards shifting more of the health care budget into these programs is against this. The medical society, partnering with the AMA, has been lobbying for more support of GME, particularly in under served areas such as ours, but there has not been much support in these days of budget worries. The current administration is in favor of funneling more money toward the training of mid-level providers to fill the projected shortfalls, and this sentiment is supported by many lobbying groups. This is a fine plan in a city with lots of physician back up, but not for our rural sites. We all need to be aware of these issues. Learn a little about the history of medical training in the US. Consider becoming involved if you are not, and be proud and supportive of the work being done to ensure a strong future in this arena.

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Why I Teach By Matt Hollon, MD MPH Faculty – Providence Internal Medicine Residency Spokane Clinical Associate Professor – University of Washington School of Medicine Last year, I was kindly awarded Spokane Track Teacher of the Year by the third- and fourth-year University of Washington medical students. At the award presentation, I had intended to say a bit about the rewards of teaching that might encourage others to embrace or expand teaching roles – we certainly need this in Spokane. Instead, overcome by gratitude and emotion (not unusual for me) I just babbled a bit about how great it is to be in Spokane (which it true). I’m thankful to have the opportunity to put my thoughts down on paper. Teaching is easy – or at least easier than I ever thought it would be. There is no doubt that it takes extra work to make the experience exceptional for students and residents. For example, I spend 10 to 20 minutes at the end of the clinic day giving third-year students feedback. However, almost all of the important teaching can take place in the routine context of our daily work. What makes it easy and what we tend to forget is that for medical students (and residents early in training) almost everything is a learning opportunity. Once in practice, we tend to take for granted so much of the knowledge we’ve acquired. We are prone to thinking that a medical decision such as how to choose an antihypertensive agent is too simplistic and that we should be teaching how to diagnose pheochromocytoma. (I personally would have to look this up.) Students, however, need straightforward, foundational knowledge. So, simply talking out loud for a couple minutes about how you pick initial antihypertensive therapy or a general approach to dizziness is a perfect teaching moment. There are dozens of these teaching moments in any given clinical day so if you take advantage of just a few of them it will be a rewarding day for the student.

that they bring to the practice of medicine always keeps my perspective fresh. Their enthusiasm for the idea that simply listening to a patient is often help enough keeps me oriented to the work of doctoring. Teaching is valuable for patients. I almost always have the student present in the room in front of the patient including presenting his assessment and plan that proves educational for the patient as well. Patients appreciate listening to and learning from the teaching that takes place as we modify or validate the student’s plan. Patients also enjoy the sense that they are contributing to the education of a future physician. The older patients in particular enjoy the additional time the student spends with them. What was going to be a rushed 20 minute check up on blood pressure and diabetes becomes 30 minutes with the student and perhaps a chance to tell the story of the new great-grandchild in the family. While the student is seeing this patient, I’ll see another patient, then spend 20 minutes or so with the student and patient during what would have been the patient’s 20 minute appointment. Teaching is part of our professional responsibility. A good friend and a Seattle colleague of mine, Rick Arnold, teaches about professionalism in medicine. He once made the wonderful point to me that one of the defining characteristics of a profession is that we train our own. Think back to a mentor you had during medical school or residency and how much you appreciated the time she gave you. Now, you can be this mentor for a student or resident. Your contribution to the student’s learning experience is as invaluable and appreciated as when you were a student. If you aren’t taking on this professional responsibility, who will? I get choked up thinking about all the wonderful students and residents I’ve worked with over the past 15 years. At least this time I got the words out! If you are interested in embracing or expanding a teaching role please don’t hesitate to contact one of the Regional Deans for the University of Washington School of Medicine or the Program Directors of area residency programs.

Teaching makes me a better doctor. I value the reciprocal relationship between the learner and educator. We all know that we can’t know everything in medicine. Oftentimes students bring interesting questions or even bits of knowledge that they can share with me. The questions they have often help me spot my own knowledge gaps and organize my continued learning. And, if they have a question for which I don’t know the answer, such as how to diagnose pheochromocytoma, it’s a great opportunity to give the student a learning assignment (I try to give just one assignment from each session I am with a student). This is another way that teaching can be made simple. For those knowledge gaps we encounter in our days, have the student take on the responsibility of self-directed learning, find the answer, then share the knowledge with you. It’s a strategy that ends up rewarding everyone. Teaching keeps me enthusiastic about medicine. The data around declining compassion and increasing burnout among physicians in practice always scares me a bit. I sometimes wonder what will keep me from being a bitter, overworked and frustrated physician. Having students around and tapping into the idealism May SCMS The Message 2

Being a Part of Lasting Change

Farewell to Keith By Anne Oakley, MD

By Derek Khorsand, MS-3 University of Washington School of Medicine In discussing my third-year experience with my fellow classmates, what struck me most was how different of an experience we in Spokane receive, relative to those in Seattle. In Seattle, you commonly find yourself shadowing residents and, in the operating room, perhaps closing on one or two cases throughout your entire six-week rotation. In Spokane, you are the first assist on every surgery during your rotation, and on medicine, you have the opportunity to manage patients at an intern level. This depth of involvement in patient care has given me some tremendous experiences that I will never forget. I met one of my most memorable patients of third year while on my internal medicine rotation. Sue, a 31-year-old mother of two, had just had a stroke. Though we were unable to find any precipitant, she was obese, never exercised and didn’t take any of her prescribed anti-hypertensives. Before she was discharged from the hospital, I took the time to talk with her about how important diet, exercise and preventative care would be to avoid a future stroke. Even in my short period of involvement in medicine, I had already given this talk countless times, only to see patients return in a month, adherent to their old ways. As I left Sue’s room, I felt much as I had after similar discussions, hopeful about the possibility of changing someone’s life for the better via education. However, another competing emotion, that of resignation, eventually took over, knowing the reality that Sue would, upon discharge, take her chlorthalidone for a few weeks, then forget to fill her next prescription, eventually even forgetting that she was supposed to take it. All the while, her diet would remain unhealthy and exercise would continue not being a part of her life. I had all but forgotten Sue’s story, when, seven months later, I received an unexpected email from Jim, Sue’s father. He explained that, after discharge, Sue had started exercising, was taking her blood pressure medicine and was eating healthfully for the first time in her life. In addition, she was spending more time with her husband and kids, and less time at work. Jim admitted that he didn’t know what I said to Sue, but it had certainly made an impression on her. The same was true for me. Sue’s story and success made an impression. In a world where we often accept almost universally that having a patient ‘attempt lifestyle modifications’ is actually code for ‘wait three months before starting medications,’ this was refreshing. More than that, it was inspiring. I emailed Jim back and thanked him for the update about Sue. I explained that what I did was the easy part. Anyone can teach a patient how to live a healthier life; the hard part is turning those words into actions, which was exactly what Sue had done. While the gravity of her medical experience certainly played a large role in helping Sue to address her health, I felt honored to be a part of such a dramatic and lasting change for the better.

On behalf of the entire SCMS I want to thank Keith Baldwin for all he has done for our organization and the medical communities of eastern Washington since becoming the CEO in November 2009. He has been instrumental in reforming the Medical Society into a forward looking organization, focused on community wellness, as well as professional wellness. He led our role in the collaboration with community leaders in planning the Academic Health Science Center at the Riverpoint Campus, and played a key role on countless other committees. Most importantly, he became CEO at a difficult time in our medical community with many hospital and physician alliances in great transition. He made sure the SCMS remained completely neutral in all those arenas and never made judgmental comments about any group at any time. His professionalism is something for which we can all strive. I know I have learned much from working with him. Best of luck in your retirement, Keith. It is well earned!!

Volunteering Abroad Panel Presentation Thank you to Jonathan Keeve, MD; John Shuster, MD; Eric Johnson, MD; Mark Paxton, DDS and Larry Keyser, PA-C for presenting at the Volunteering Abroad Panel at the Providence Sacred Heart Auditorium. Presentations included Health Care Professionals Volunteering Abroad (Keeve); Building a Heart Surgery Program in Rwanda (Keyser); Combat Care for America’s Injured Troops (Johnson); Reflections on 25 Years of Oversees Medical and Surgical Mission Trips: The Good, the Bad and the Really Awesome Adventures (Paxton) and Volunteering in Haiti (Shuster). For information regarding the programs and opportunities available for volunteering contact Michelle at michelle@spcms.org. Refreshments for the event were generously donated by Numerica Credit Union, a Spokane County Medical Society Community of Professionals partner.

From left to right Larry Keyser, PA-C; Mark Paxton, DDS; John Shuster, MD; Jon Keeve, MD and Eric Johnson, MD

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Medical Humanities can take many different forms, but at its core medical humanities strives to emphasize the human aspects of medicine. Amidst the explosion of diagnostic and therapeutic technologies, the focus often shifts from the patient to the technology itself. Similarly, in a busy practice we can become focused on the “case” rather than the person bearing the burden of disease. The inclusion of Medical Humanities in medical education is an effort to reverse this trend, to remind us of the human side of medicine, what it means to be a patient and similarly, what it means to be a physician. This can be achieved in a variety of ways including; the history of medicine, visual arts, music, literature, movies and reflection. A Medical Humanities course has been offered to the 1st year medical students in Spokane and has been very well received. In addition, the Medical Humanities faculty have begun to encourage medical students and residents to reflect on their experience of becoming a doctor. Each year these essays are reviewed by medical educators, practicing physicians and community members who choose one essay that best exemplifies humanism and professionalism in medicine. The resident winner is honored with a cash prize and an “Osler Award” that is presented at the Spokane Society of Internal Medicine Annual Meeting. This year’s winner is Jack Stringham MD, a Transitional Year resident at Sacred Heart Medical Center. His essay is included below. Darryl Potyk, MD, FACP

On Becoming a Doctor By Jack Stringham, MD I arrived at the hospital in the early hours of the morning. The air was still and cold outside, the sky cloudy and black. I rubbed my hands together to warm them before entering Doug’s room. Doug was a 72-year-old man with multi-system atrophy who was readmitted for aspiration pneumonia, this was his fifth admission this year for treatment of his condition. His body was beginning to fail him as his multi-system atrophy continued to progress, putting him at greater risk of aspiration and decreased reserve to recover from the ensuing pneumonia. In his most recent hospitalization he required intubation to help him overcome the pneumonia. This most recent hospitalization had lasted two weeks and now Doug’s family faced a very difficult decision: should we continue to intubate their dear father, grandfather, husband, uncle? Or was it time to let him go? After much thought and difficult deliberation, the family decided that we would give him as much respiratory support as possible, but that we would no longer intubate him. Despite receiving oxygen through a high flow nasal cannula and antibiotics, he became increasingly weak. On this cold winter’s morning I was certain Doug would not live much longer, his eyes struggled to focus on mine as I wished him a good morning and examined him. He was struggling to breath and had decreased conscientiousness secondary to carbon dioxide retention, so orders were written to make him as comfortable as possible in his remaining hours. We contacted his family and let them know that his time was short. I had gotten to know his family as they had visited Doug frequently over the past two weeks. Today those familiar faces filled his room to say their last goodbyes. Later that afternoon I received a call informing me that Doug had passed away and that the family wanted to speak to me. I entered his room expecting to answer questions the family might have about Doug’s final moments. Instead I found fifteen pairs of teary eyes and a silent room. As a new intern, I wasn’t sure what to say. I was about to ask, “So, do you have any questions?” I was prepared to speak to them scientifically about Doug’s death, and then I remembered my medical school admissions essay.

I had written that I wanted to become a doctor because I wanted to make a difference in the lives of the people I would treat. I talked about an experience I had just prior to medical school when I volunteered in a medical clinic in Cambodia. I met a woman there, Sobin, a single mother suffering from leukemia. Her poor withered body looked like a skeleton resting on a gurney. Watching Sobin’s teeth clench with agonizing pain I had feelings of inadequacy. Trying to find a way to help, I began spending time listening to Sobin’s stories and telling jokes while I occasionally massaged her legs as her sporadic muscle cramps occurred , hoping to relieve some pain. During my time spent with Sobin, I saw firsthand the powerful effects that personal attention can have on health. In medical school I learned about the science of death, the cause of death, and how to prevent death, but not how to comfort those who were dealing with the death of a loved one. But here in this quiet room filled with a mourning family I had a chance to be a true physician, a healer. To realize my pure motivations for becoming a doctor: to make a difference in the lives of those I treat. I began by telling the family that Doug had fought a hard battle and that he’d done it well. I told them how lucky he was to have the support and love of his family throughout his fight, and how he was especially lucky to have them all gathered there that day. After doing my best to provide words of comfort, Doug’s wife and daughters gave me a tearful hug. I finally asked whether they had any questions, but they did not, they had simply asked me to come to the room because they needed to see a familiar face and to find some closure and comfort before leaving the hospital. Medical school does not create doctors; we become doctors throughout our training during moments like these when we are reminded that medicine isn’t always about science. That patients are not just labs and diseases, but humans who need personal attention and compassion.

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Residency: Day Number 1276 By Arthur S. Watanabe, MD It was dark outside. He pulled his car up to the curb outside his apartment building and killed the ignition. His hands rested on the wheel of the four-year-old fading red Toyota that his parents gave him for medical school graduation. The engine was running backwards, dieseling in the auto mechanic’s jargon. It had been over two years since the last tune up. He had no idea when he would have the time to take it to have another badly needed service. Perhaps it was the cheap gas he’d been using. Low probability diagnosis he thought out loud. National Public Radio was still on. All Things Considered told him about a county health department who finally convinced some OB docs to provide care to their pregnant female population by agreeing to indemnify the docs. Essentially it meant that the patients sued the county rather than the physicians for any bad clinical outcome. Hooray for the good guys, he thought. Then some high powered attorney came on talking about how wrong this was since it “insulates incompetence.” His stomach turned and he changed the radio station. An old Rolling Stones tune came on and Mick Jagger was screeching about not being able to get no satisfaction. The engine had stopped dieseling and he got out. The drug company penlight illuminated the apartment lock and he opened the door into his cold, unlit living room carrying his mail under his arm. His mail contained the usual – a few bills, a few journals, AM news and a letter from a pal in California. As always, the AM news went straight into the overflowing trashcan. The journals, still in their plastic and paper wrappers, landed on an ever growing stack of unread medical periodicals in an abandoned corner of the apartment next to a bookcase full of textbooks equally neglected. The bills, some marked second notice, landed upon a pile of fellow unpaid bills on the Formica topped dining table. He heard a beer can call his name from the refrigerator. Instantly the pop top gushed open and the primary and secondary esophageal waves washed the pleasant taste and sensation of the brewer’s finest art into the fundus and body of this stomach. He felt some of the fatigue, stress and frustrations of the day ease as his mind recalled some the day’s events. He thought about his attending that had skillfully shredded his clinical acumen and competence; leaving him with a pronounced feeling of minimal self-worth. Goes with the territory he thought. If you can’t stand the heat, get out of the kitchen his dad used to tell him. His attending once told him the same thing in the context of not being a wimp. He had a transient thought about how battered children grew up to batter their own children. The first beer was followed by a second, equally satisfying. His stream of consciousness wandered further. He remembered the aggressive nurse who questioned his assessment of abdominal pain in a dying cancer patient who had abscess drainage tubes in place. Unkindly he thought, if she wanted to what docs do, why didn’t she go to medical school? At the same instant, he remembered himself changing that patient’s foul smelling drainage bag because it had been unattended for over a day. What would Florence Nightingale think, he wondered? Trying to be optimistic he recalled the day’s positive moments – no one had thrown up on him that day.

His stomach churned another knot. Hunger, he thought, but his mind thinking in differentials couldn’t rule out the effects of the gallons of caffeine he had drank, disguised in a black solution the hospital called coffee. He couldn’t rule out peptic disease, Zollinger-Ellison or linitis plastica either; maybe he should get one of the radiology residents to do an UGI on him. Common things being common, he selected hunger as the most likely diagnosis and decided to treat it. The 1980s high tech answer to TV dinners, Lean Cuisine, was excavated from a freezer badly in need of defrosting. Stripping it of its colorful marketing package, he tossed it into the microwave that he set on high fry. He sat at the table ignoring the accumulating unpaid bills and opened the letter from his friend who had been practicing internal medicine in California for 10 years. As he read through weary and sleep deprived eyes, his jaw went atonic. His pal was leaving the rat race of metropolitan medicine. His friend wrote about cutthroat medical practices, questionably ethical self-referrals, sky-high malpractice insurance premiums and the driving motivation of the almighty dollar for too many physicians who fought each other to maintain their incomes. His friend had decided to go practice in a small town of 20,000 where he thought he might be better appreciated. He wondered if it was true that California might be predicting future events. The third beer followed the microwave heated convenience food leaving him and his stomach with a faintly warm glow and a feeling that nearly approached satiety. His telephone answering machine was message less. He hadn’t heard from his “significant other” for almost a week. But then he hadn’t had time to talk to her answering machine either. He flashed on a thought his resident had told him as an intern. She had said there were the five “Ss” of residency: sleep, sh*t, skiing, shower and sex. The last two were optional. Another thought wandered across his waning consciousness. He recalled an attending who once declared an expectation of all residents to read a thousand pages every six weeks. He glanced casually toward the veneer oak bookshelves holding all his medical textbooks, most unread, some not even out of their clear plastic wrappers. In the next instant there was another thought of impending board exams a year away. There was a twinge of anxiety, but it was only brief. A year was beyond his time frame of comprehension. Midnight. It was becoming difficult to maintain any significant level of consciousness with his reticular activating system. The cumulative effect of every fourth night sleep deprivation and ethanol were impending. He crawled into a perpetually unmade bed still wearing the polyester scrubs he had worn home. Staring up at the white stucco ceiling he thought how different medicine was turning out. The enthusiasm and excitement he had felt in his first year of medical school had given way to realism, practicality and survival. It occurred to him at that moment that medicine was changing and would change even more and not necessarily, he thought cynically, for the better. Before he faded off into the oblivion of the desperate sleep experienced by a multitude of residents, he made a mental note to dig the AM news out of the garbage in the morning.

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Medical Training in Spokane By Richard L. Martin, MS4 University of Washington School of Medicine WWAMI Upon graduating from Ferris in 2003, I was all too happy to leave Spokane for a more thrilling college life at the University of Washington in Seattle. Spokane seemed regressive, sleepy and significantly lacking in entrepreneurial and educational investments. But to my surprise, seven years later, I returned to find a vibrant and developing city with a newly established UWSOM WWAMI site. Overtaken with pride and wishing to contribute to my hometown resurgence, I jumped at the opportunity to receive my medical training in Spokane. It has been one of the best decisions of my life. Spokane is proving to be an exciting and attractive place to train and practice medicine, due in large part to the incredible students, faculty and administration who genuinely care about the community and each other. Rachel Safran, a Utah native, was at first extremely disappointed to have been “WWAMI-ed” to Spokane, but after spending her first year training under mentors such as Drs. George Novan, Matt Hollon and Mary Noble, Rachel quickly realized that Spokane was special. In fact, after graduating from the UWSOM, Rachel chose to continue her training in Spokane in internal medicine. She now calls Spokane home, having just purchased a house on the South Hill. She plans to continue practicing medicine in Spokane after residency; carrying on the work of Dr. Mary Noble at the Internal Medicine outpatient clinic. Tim Hatlen is one of Spokane’s first TRUST (Targeted Rural and Underserved Track) students. Tim is graduating AOA, top of his class, and recently received the Washington State ACP medical student service award for his outstanding record of leadership in the community. Similar to Rachel, Tim will be continuing his training at Spokane Internal Medicine. His fiancée, Sara, is a first-year medical student and she hopes to be one of the first students to stay in Spokane for all four years. Ben Arthurs was concerned by the lack of research and fellowship opportunities in Spokane. Ben begrudgingly chose to complete his residency training at Stanford University. Soon after his decision, however, Ben realized that Spokane was the place he wanted to train. This July, Ben will be transferring back to Spokane to complete his Internal Medicine Residency. Ben’s decision is truly a testament to the strength of training and sense of community here in Spokane. Though exceptional, Ben, Tim and Rachel are hardly exceptions to the rule. Since its creation, Spokane WWAMI has consistently graduated a higher percentage of AOA students and service award students than the UWSOM class average. Our students certainly deserve credit for this success, however, credit also belongs to our amazing faculty who go to great lengths to improve medical teaching and support student-generated service ideas.

Dr. Chris Coppin teaches – or rather “guides” - our cellular physiology course. The course is taught through a series of interactive discussions rather than passive lectures. Although our class initially struggled with this approach, the struggle ultimately proved worthwhile. Not only did our class dominate the final exam, scoring well above the total UWSOM average, we were the only training site to gain an appreciation for an entirely new way of learning. Through our discussions, we learned how to communicate our thoughts, recognize our own limitations and appreciate our classmates as both a resource and as an opportunity for teaching. Those skills cannot be taught through standard lectures, yet they are invaluable to the success of a physician. By the end of the course, our class essentially became self-sufficient, creating our own review objectives and using each other as experts on various topics. Naturally, we overwhelmingly voted for Dr. Coppin as teacher of the year. I have the highest confidence that applying Dr. Coppin’s teaching model to other courses - including second-year courses - will build upon this success. During my first year of medical school, two of my classmates, Colette Inaba and Denny Goulet, developed an idea to turn our local House of Charity volunteer clinic into a teaching clinic. Thanks to the overwhelming support of Dr. John McCarthy and others, their idea was realized within a matter of months. Three years later, the clinic is stronger than ever before. And over the past three years, a growing number of community physicians have joined the clinic, rekindling - or perhaps discovering for the first time - their passion for teaching and volunteerism in Spokane. Many of those physicians are now requesting greater opportunities to teach medical students and residents. Thanks to the tremendous efforts of our administration, faculty and students, the demand for Spokane medical training is stronger than ever before. In fact, demand is increasing so rapidly, that where it was once difficult to fill Spokane training slots, students are now being turned away. Students such as Tim, Ben and Rachel want to train, volunteer and practice medicine in Spokane and eastern Washington. At a time when eastern Washington is struggling to maintain an adequate physician workforce, turning those students away could have a profoundly negative impact on the long term viability of eastern Washington medicine. Fortunately, Spokane appears ready to expand its medical training capacity. Next year will mark the first class of students staying in Spokane for their second year of training. Residency programs are pushing for more training slots. There is even talk about bringing fellowship programs to Spokane. None of those achievements would be possible without our community of passionate physicians and students, and the support of our local businesses and politicians. To keep the passion and support alive and strong, keep in mind the stories of Ben, Rachel, Tim, Dr. Coppin, Dr. McCarthy and so many others. Their tireless efforts are guided by a belief that this city has the potential to become a premier location for medical training capable of competing with any program in the country. Their belief can become a reality if we continue to support the future of Spokane medical education.

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Shriners Hospital for ChildrenSpokane’s Forgotten Hospital Part 2 of 3 By Paul Caskey, MD Orthopaedic Surgery The Shriners Hospital’s mission is threefold, providing excellent pediatric orthopaedic services, teaching of physicians and other health care providers and performing research to ensure quality care, develop new knowledge and improve the quality of life for our patients. Our second mission is teaching of physicians and other health professionals. At any time we have two orthopaedic surgery residents are learning the art of pediatric orthopaedics from our staff. We have a four-month didactic curriculum as well as the operative and clinical experience. A number of our residents have chosen pediatric orthopaedics as a career. Medical students from the University of Washington School of Medicine and Pacific Northwest University of Health Sciences College of Osteopathic Medicine can rotate at our hospital during their third and fourth year. The fourth-year rotation is ideal for the medical student that plans to pursue pediatrics, family practice or emergency medicine so they can be prepared to deal with musculoskeletal complaints and learn a good orthopaedic history and physical examination. As teaching and research are part of our mission, many of our medical staff has academic appointments and several are on national committees.

Orthopaedic Residency Training in Spokane By Emily Nuse, MD Madigan Army Medical Center and Savan Patel, MD McLaren Flint Hospital The orthopaedic residents learning pediatric orthopaedics at the Shriners Hospital for Children in Spokane (SHC) are typically thirdyear residents, meaning they graduated medical school three years ago. At any one time two of us rotate at the Shrine Hospital to increase our exposure to pediatric orthopaedics. We are from two orthopaedic residency programs, one from the McLaren Flint Hospital, Michigan State University Program based out of Flint, Mich. I am given one week for cross country travel and to get settled into the two-bedroom furnished apartment. The second resident is from Madigan Army Medical Center, a medical training facility for the Army located at Fort Lewis, Wash. While orthopedic practice and training at Madigan or Flint involve

pediatric patients, the volume of patients and diversity of the patient experience is not sufficient for training and education, therefore, all residents are sent to Shriners Hospitals for Children for four months in order to widen their breadth of practice and enhance their educational experience. All rotations are four months and focus solely on pediatric orthopaedics. The patient population at SHC is unlike any other institution. Pediatric patients with a variety of diseases ranging from congenital abnormalities to fractures to sports related injuries are seen and treated at SHC. This includes both common conditions that are seen in everyday practice and rare conditions that may be seen once in a provider’s lifetime. Many patients with congenital conditions are followed from early childhood to early adulthood, forming long-term relationships with their providers. Residents are exposed to these patients in a variety of situations from the clinic, the inpatient or outpatient setting, to the operating room. Our operative experience at Shriners Hospital is among the best in terms of getting in the operating room and assisting in a variety of cases from the common to the very complex. The residents participate in surgical cases almost every day of the week rotating between all of the attending surgeons. This provides the residents with operative knowledge and experience that is applicable to pediatric orthopedics as well as most other subspecialties of orthopedic surgery. Patients are evaluated in clinic by residents, physician assistants and orthopaedic staff; the attending surgeons are always present for supervision, guidance and teaching. This provides an opportunity for us to see how patient care is performed for pediatric orthopedic conditions at many different time points in care, and also to learn about outcomes for surgical procedures are as well as the natural history of conditions managed by orthopedists on an outpatient basis. Clinic also provides an opportunity for continuity of care, as a patient that is seen by a resident may go on to require an operation and be seen in clinic for follow-up after surgery during a resident’s tenure at SHC. In addition to our operative and clinical experience the orthopaedic staff provides a four month educational curriculum, educational conferences, pre-operative indications and post-operative evaluation conferences covering material that an orthopaedic surgeon should be knowledgeable about when residency training is completed. During our rotation we are expected to participate in a research project or give a lecture on evidence based treatment of a pediatric orthopaedic condition. Overall, we find the rotation an excellent part of our five year residency program. Every year the residents from our programs look forward to coming to Spokane, Wash. to be a part of the Shriners experience.

May SCMS The Message 7

Clinical Guides By William G. Sayres, Jr., MD UWSOM 2nd Year Guide Twenty University of Washington School of Medicine (UWSOM) medical students will begin their second year in Spokane this fall. This will be the first time medical students will be able to complete the entire four years of medical school in Spokane. Enormous work and commitment by community and medical leaders in Spokane, as well as on-going intense work by academic leaders at Washington State University (WSU) Spokane and at the UWSOM in Seattle, have made this possible. Although this endeavor is considered a two-year pilot project by the UWSOM, we are confident that not only will the Spokane second year become a permanent option, as the first year is, but also that aspects of the Spokane curriculum will be adopted by the University in Seattle as well. UWSOM is midway through a major curriculum revision as I write and many of the courses are expected to be completely revised in two years. The Spokane second-year curriculum will be taught in two small groups led by what we are calling Clinical Guides. Guides are primary care doctors (two pediatricians and two family doctors) with extensive clinical teaching experience. The guides will facilitate the groups as they master the enormous content of the second year. Following national pedagogical trends, the curriculum will be ‘flipped’ which means that students are expected to use resources such as on-line lectures, textbooks and syllabi prior to class to learn the content discussed in class. Teaching will start with a case from which the content will be developed and explored. Spokane students will take the same exams as their colleagues on the west side of the state. Reflecting the importance of this Socratic as opposed to didactic approach to teaching, all four of the guides were required to audition by teaching a group of our current first-year students. The student evaluations figured heavily in evaluating whom to hire. Reflecting the teaching in Seattle, the Spokane school year will be divided into 11 ‘systems’ courses (e.g. cardiovascular) and five subject-based topics such as epidemiology and ethics. Again, breaking with the traditional second year teaching approach, the systems courses will integrate pathology and pharmacology rather than having the three courses run in parallel. By reducing the inevitable subject redundancy that is part of parallel courses, more time is freed up for discussing and fleshing out the content. Primary care physicians are not experts in physiology and pharmacology. Although much of the content is available to the students on-line, we will still need physiologists, pathologists and pharmacologists to help with the curriculum. Seattle will be sending some teachers to Spokane, but we will also be recruiting local physicians and a pharmacologist among others to participate in the classes.

Finally and no less important, the first year students who have chosen to participate in the pilot are aware that it is just that, a pilot. For the most part, success in medical school depends more on a conservative approach to learning rather than innovation. Our students therefore are taking on more than just a flipped curriculum. They will be active partners in making the courses better as we go. And perhaps, development of the team work skills necessary for our success may be one of the greatest lessons of the year.

The Need for Preceptors By Judy Benson, MD Providence Director of Medical Education Medical education gives thanks for many blessings! All of the residency programs have been very successful with recruiting efforts and have amazing incoming intern classes who will start at the end of June. You may recognize names of several University of Washington and Pacific Northwest University “soon-to- be” graduates who have completed anywhere from one rotation to many years (including their first) here in Spokane. The “grand” plan to have first-year medical education in Spokane has been so positive for recruiting. Imagine how great the second-year will be! The Providence Department of Medical Education (DME) is actively working with Drs. Matthew Layton and Tanya Keeble to “re-start” a psychiatry residency program. (The current program will end June 2014 with an anticipated new program start date of July 2015). One of the best side-effects of this planning process has been the active involvement of the Veterans Administration and their commitment to teaching – not just psychiatry, but for all residencies. A special thank you to U.S. Senator Patty Murray for her strong advocacy and help with this endeavor. As undergraduate medical education expands to include the second year, there is an increasing need for preceptors both for medical students and residents. I am aware that many of you would like to teach but worry that it will consume more time than you have or perhaps interfere with productivity. Medical education has developed several faculty development seminars to help clinicians learn to teach effectively and efficiently and would be happy to bring this teaching to you and your clinic. Teaching is truly a delight – it keeps you up-todate, enthusiastic about medicine and younger. Okay you may not look younger, but you will feel younger! Please give a call to the DME office at (509) 242-2867 and let us know how we can help you.

May SCMS The Message 8

New Horizons for Medical Education in Spokane By Kevin Dudley Marketing and Communications Coordinator Greater Spokane Incorporated A bundle of new horizons are in view regarding medical education in Spokane. The most visible is the Biomedical and Health Sciences Building that is nearing completion on the south side of the WSU Spokane’s Riverpoint Campus. The building will open this fall. The school also has a new Chancellor in Lisa Brown, the former State Senate Majority Leader. While Brown used to be the one WSU Spokane went to when it needed help growing medical education, now her role has flipped. Brown sees that as a big advantage. “I’m kind of the number one advocate for everything we do here,” she said. “What I think I bring to that is an understanding of where the policy makers are coming from.” Another momentous occasion will happen in August when the second year of medical education studies is offered in Spokane. As is already known, years one, three and four of medical education through the WWAMI program have been in Spokane since 2008. Students would go to Seattle for year two, and possibly return to Spokane for the rest of their studies. The community raised enough funds to develop the curriculum for the second year, and WSU Spokane has asked the state legislature for operating funds to continue second year studies. As of this writing, the Senate’s proposed budget has funds allocated to WSU for second year studies. Staying in Spokane for four years straight would have been beneficial for some students, including Mallory Beale, a fourthyear medical student from Pomeroy. “I really like the quality of the educators (in Spokane) and their willingness to give us hands-on experience,” Beale said, adding that if the option to study in Spokane for four years was available, she’d take it. With around 33,000 people working in the health care sector in our region, a full, four-year medical school is something this region deserved. Establishing the second year of studies was a huge step in growing medical education in our region. The next step is to grow residency slots in Spokane – also known as Graduate Medical Education. Greater Spokane Incorporated has led the efforts to expand medical education at the Riverpoint Campus and will continue to do so.

According to the WWAMI Clinical Medical Education program, there are 100 residency slots in central and eastern Washington compared to 1,517 in western Washington. Population differences are obvious and the main driver of the discrepancy, but consider this: in central and eastern Washington, there are 6.8 medical residents per 100,000 people. The national average is 35.7 medical residents per 100,000 people (in fairness, western Washington has 29.8 residents per 100,000 people – also below the national average but not nearly as far below as our region). Brown is quick to point out that our community doesn’t want to grow residency slots just to grow residency slots – it needs to be strategic and expand where there needs to be expansion, like in rural areas. “Someone is three times more likely to practice in a rural area if they have a residency in a rural area,” Brown said. “Our mission is not just to expand (residency) slots, but to expand them in a way that’s targeted toward underserved populations, like rural areas.” Residencies are federally funded and expensive, but that doesn’t mean we can’t see more residencies in Spokane and rural areas. “Whenever you’re talking about something that is national in scope and involves big dollars, it’s never going to happen overnight,” Brown said. Finally, WSU’s College of Pharmacy will move the rest of its students and faculty to Spokane by the end of 2013. Currently, first- and second-year pharmacy students study in Pullman, while third-year students study in Spokane and fourth-year students complete internships at locations throughout the region. Linda MacLean, the Associate Dean of the College of Pharmacy, said consolidating the college into one location puts the university on the right track to attract students and researchers. In all, 270 additional students will be in Spokane to go along with at least 18 faculty members. The college hopes to attract 30-35 more faculty members in the next five years. Attracting faculty and researchers is a top priority for WSU Spokane. Last year the school attracted two distinguished researchers in Michael Gibson, PhD. and Phil Lazarus, PhD. Four years of medical education and the College of Pharmacy consolidation will aid in the school’s goal. WSU Spokane’s designation as the Health Sciences Campus for WSU is attractive to researchers the school recruits, Brown said. Having more research programs and research faculty members helps the school and the community. “We already see a lot of companies that are out there that have a connection to the campus and the research we’re doing,” Brown said. “As we bring more research programs here, I think that creates more potential for spin-off opportunities.”

Beale was selected to receive one of the residency slots in Spokane. The number of slots available in Spokane and surrounding rural areas, though, is small. May SCMS The Message 9

Washington State University (WSU) College of Nursing – An Update on Nursing By Alli Benjamin Communications and Marketing Manager Washington State University College of Nursing WSU College of Nursing provides the first step in developing new nurse leaders through its undergraduate, graduate and doctorate nursing programs. This education prepares our region’s future nurses, with approximately 80% of our BSN and 90% of our RN-BSN graduates staying in Washington State to work postgraduation. The college’s growing research repertoire – much of it done in interprofessional, collaborative teams, informs health care practice and policy, reflecting relevant health issues affecting our region and specific populations. The College of Nursing is located at campuses and sites across Washington, in Spokane, Vancouver, the Tri-Cities, Yakima and Walla Walla. The college relocated to WSU Spokane’s Riverpoint Campus in 2009 from its former location. At its current site, faculty and students are engaged in teaching and learning along with research, interprofessional education, simulation and clinical practice on campus. The college partners with WSU College of Pharmacy, an innovative medical program that unites WSU and the University of Washington (WWAMI) and Eastern Washington University allied health students to begin modeling interprofessional, patient-focused care teams. Students learn from shared experiences and gain understanding around the roles of fellow providers.

Registered Nurse to Bachelor of Science in Nursing In addition to approximately 240 Bachelor of Science in Nursing students who graduate every year, the college offers a highly flexible, distance-friendly RN-BSN program. The degree is typically completed in one to two years and students can complete coursework online or in-class. The program provides an excellent opportunity for nurses living far away from a college site to complete their BSN.

Master in Nursing in Advanced Population Health For more than twenty years, the college has prepared nurse practitioners and advanced practice nurses through its Master in Nursing program. In 2010-2011, WSU prepared 54% of the state’s licensed Advanced Registered Nurse Practitioners. The MN Advanced Population Health program and post-master’s certificates in Nurse Leadership and Nurse Education continue to prepare nurses for careers emphasizing leadership or teaching roles in public health and community care settings.

Doctor of Nursing Practice (DNP)

for advanced practice nurses. DNP programs prepare nurse practitioners in primary care (DNP-FNP) and psychiatric mental health (DNP-PMHNP) as well as in advanced population health (DNP-APH). Coursework and clinical experiences focus on advanced, evidence-based practice, translational research and organizational leadership. Faculty emphasize the imperative to provide patient-centered care, practicing care coordination, maintaining good communication with colleagues and remaining sensitive to social, environmental and cultural factors. The program uses a hybrid model, with students attending class on-site once every two to three weeks. Interactions with fellow students and the completion of additional coursework are coordinated online using videoconferencing and videostreaming.

PhD in Nursing The college’s PhD in Nursing welcomes its eighth cohort of students in summer 2013. A new BSN-to-PhD program is launching at the same time, with the goal of preparing nurse scientists earlier in their careers. PhD-prepared graduates generate new knowledge – from basic to translational research – to inform health care policy, practice and science. Research conducted by faculty and student scholars at WSU College of Nursing typically falls into one of four research foci: • Behavioral Health: The study of human and population behavior focused on chronic conditions, substance abuse, preventative care, and mental illness. Research occurs across settings, including rural, communitybased, outpatient and acute care. • Community and Public Health: Exploring the health and environments of specific populations and focusing on health promotion and disease prevention. One area of emphasis is environmental health and environmental sustainability in health care practice. • Educational Innovations and Outcomes Testing: Evaluates various teaching modalities and their effectiveness in preparing competent and compassionate nurses. Simulation used in nursing education is one area of expertise. The college in Spokane maintains a large clinical simulation program, and currently is involved in a national study, which evaluates how much simulation can substitute for clinical practice in BSN education. • Patient Care Safety and Quality: Working in interprofessional, collaborative teams, WSU College of Nursing research faculty explore ways to optimize patient care safety. Areas of emphasis include transitional care, medication management, addictions, implementation of new technology and processes, and evaluating standards of care provided in acute and outpatient settings.

In 2012, the WSU College of Nursing launched its Doctor of Nursing Practice (DNP) program, a new educational pathway May SCMS The Message 10

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To respond to the complex health care needs of patients, families and communities, nurses need higher levels of education to fill expanding roles, master new technologies, incorporate evidencebased practices and collaborate with health care professionals from multiple disciplines. WSU College of Nursing is evolving and expanding to meet nurses’ needs to maintain competence, add knowledge and learn new skills. Students within the college will become part of the solution to the health care challenges faced by our nation and all health care providers. Learn more at nursing.wsu.edu.

Spokane Regional Health District One of First in Nation to Receive National Accreditation

Public Health Accreditation Board designation recognizes high-performing health departments By Kim Papich, SRHD Public Information Officer

Spokane Regional Health District (SRHD) announced that it has achieved national accreditation through the Public Health Accreditation Board (PHAB). The national accreditation program works to improve and protect the health of the public by advancing the quality and performance of the nation’s tribal, state, local and territorial public health departments. “More than anything this accreditation is a testament to health district employees and the work they do each day to improve and protect the health of our community,” said Dr. Joel McCullough, SRHD health officer. “The accreditation process validates the responsiveness of our staff and programs in meeting the needs of residents. With accreditation, we’re demonstrating increased accountability and credibility to the public, funders, elected officials and partner organizations with which we work.”

Out of 130 health departments across the country seeking accreditation, SRHD is one of only eleven that earned first-ever accreditation through PHAB, the independent organization that administers the national public health accreditation program. The program is jointly supported by the U.S. Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation. These organizations worked to set standards against which the nation’s more than 3,000 governmental public health departments can continuously improve the quality of their services and performance. To receive accreditation, a health department must undergo a rigorous, multi-faceted, peerreviewed assessment process to ensure it meets or exceeds a set of quality standards and measures. Public health is an essential set of services guaranteed to all citizens. It is a network of local, state and national professionals working together for a safer and healthier community. From restaurant inspections and drinking water safety, to health education, immunizations and disease control and prevention, Spokane Regional Health District provides over 20 different programs and services to individuals, families and organizations across Spokane County. Despite an unstable funding environment year after year at the local, state and federal levels, the health district still employs over 200 employees dedicated to bettering the lives of Spokane’s residents. “Spokane Regional Health District is one of the first of many health departments that we look forward to being able to recognize as a high-performing public health department,” said PHAB President and CEO Kaye Bender, PhD, RN, FAAN. ”The peer-review process provides valuable feedback to inform health departments of their strengths and areas for improvement, so that they can better protect and promote the health of the people they serve in their communities.” More information can be found at www.srhd.org. SRHD’s Web site offers comprehensive, updated information about Spokane Regional Health District and its triumphs in making Spokane a safer and healthier community. Become a fan of SRHD on Facebook to receive local safety and wellness tips. You can also follow us on Twitter @spokanehealth.

May SCMS The Message 11

For Your Information CMS Now Accepting 2014 Eprescribing Hardship Requests to Avoid Penalties Physicians will receive a two percent penalty in 2014 if they do not meet the requirements of the Medicare ePrescribing (eRx) program this year, meet one of the limited exemption categories or obtain approval for a hardship exemption. From March 1 through June 30, 2013, CMS has re-opened the Quality Reporting Communication Support Page to allow physicians to request a hardship exemption for 2014. Physicians who do not meet one of the exemption or hardship categories must: (1) report the eRx measure via claims (10 eRx events for individual physicians and larger numbers for groups using GPRO); (2) register for the meaningful use (MU) of electronic health records (EHR) incentive program by June 30, 2013 or (3) achieve MU under the EHR Incentive Program during one of the reporting periods needed to avoid an eRx penalty in 2014. For additional information on the 2014 eRx penalties and how to avoid them, review CMS’ 2014 eRx Payment Adjustment Fact Sheet at the AMA website (www.ama-assn.org).

Prescription Monitoring Program Videos The Washington State Department of Health’s Prescription Monitoring Program (PMP) has created new educational videos for healthcare providers and law enforcement. The videos are designed to help the two groups: • Understand the prescription drug abuse problem

The videos are online at: http://www.doh. wa.gov/PublicHealthandHealthcareProviders/ HealthcareProfessionsandFacilities/ PrescriptionMonitoringProgramPMP/EducationVideos.aspx or at the SCMS website at www.spcms.org under the Pain Management Tab. If you have any questions, please contact Program Director Chris Baumgartner at (360) 236-4806 or chris.baumgartner@doh.wa.gov.

More Annual Match Day Students Choose Primary Care Residencies More medical school seniors are choosing residencies in primary care, according to new results released from the National Resident Matching Program (NRMP). The number of U.S. students choosing primary care – internal medicine, family medicine, and pediatrics – rose by almost 400 during this year’s annual Match Day. A total of 17,487 graduating seniors participated in the event, the largest to date with more than 40,000 registrants, including 1,000 more seniors from the U.S. “We attribute the rising number of U.S. students to three new medical schools graduating their first classes as well as enrollment expansions in existing medical schools,” said NRMP Executive Director Mona Signer. The total number of positions offered in the Match was 29,171, an increase of 2,399 over last year and an all-time high. “The significant increase in positions was due to a change in NRMP policy that requires Match-participating programs to register and attempt to fill all positions in The Match,” Signer said.

• Learn about the program’s history, purpose, goals, and basic operations • Know how to successfully register for and use the system Videos available for each group are:

I make house calls.

• A PowerPoint presentation with voice-over giving a general overview of the program • Tutorials on how to use the system (step-by-step video directions with voice-over) • A compilation video with the overview and all the tutorials

Jurene Phaneuf SPECIALIZING IN P H Y S I C I A N R E L O C AT I O N S

The goal is to make the information available wherever a user has Internet access. That provides more opportunities for PMP education and training. Users can learn about the program and get help with using the system when it best fits their schedule.

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C E L L : 5 0 9 -2 9 4 -119 2 O F F I C E : 5 0 9 - 5 3 5 -74 0 0 J U RE N E P H A N EU F @ G M A IL .C O M

CellNetix is pleased to announce our merger with

PATHOLOGY SERVICES, (P.S.)

at Deaconess Hospital

As well as having 4 great pathologists in Spokane, we offer over 25 subspecialty areas of expertise to Spokane patients through effective use of telepathology and slide imaging. This allows remote internal consults at no additional cost to patients. Pathology Services, P.S. has been providing pathology services in Eastern Washington since 1979, and serves Deaconess Hospital, Shriners Hospital, Okanogan Douglas Hospital, Lincoln County Hospital, Veterans Administration Medical Center-Spokane and many clinics in Eastern Washington.

Vann E. Schaffner, M.D.

t: 866-236-8296

w: cellnetix.com

Jeffrey T. Bunning, M.D.

Irby V. Cossette, M.D.

Dennis J. Small, M.D.

a: 1124 Columbia Street, Suite 200, Seattle, WA 98032

Dr. Bishop has joined Providence Physicians Clinic of Spokane at the Medical Center Building, 820 South McClellan, Suite 500. The clinic is conveniently located in two suites in the Medical Center Building and at a second location on 5th Avenue.

Providence proudly welcomes Leigh Bishop, MD to our team.

Physicians specializing in internal medicine provide comprehensive care for patients 18 and older, and offer routine exams and primary care, as well as help managing chronic illness. Medical Center Building 820 South McClellan, Suite 500 Spokane, WA 99204

For appointments call 509.353.3950

PROVIDENCE PHYSICIANS CLINIC OF SPOKANE

phc.org

May SCMS The Message 13

910 West Fifth Avenue, Suite 701 Spokane, WA 99204

For appointments call 509.624.0111

Endocrinology – Physician

Spokane, Washington Columbia Medical Associates, a subsidiary of Group Health Physicians, is currently seeking a BC/ BE Endocrinologist to join our Medical Group in Spokane, Washington. The position offers the following: • Competitive Salary and Generous Benefit Package. • Full-time opportunity joining two established providers. • Opportunity to become a shareholder. Our physicians are committed to maintaining the health and well -being of their patients through preventative -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. For additional information or to submit your CV, please contact: Cayley Crotty, Crotty.c@ghc.org GHP Recruiting Dept. | 1-800-543-9323 | Or visit Grouphealthphysicians.org

May SCMS The Message 14

EASTERN WASHINGTON PHYSICIAN HEALTH COMMITTEE (EWPHC) EWPHC is a “quick call” to find assistance

Assistance is available to you in the following areas: 

Marital and Family Issues



Death of a Spouse or Family Member



Drug/Alcohol Misuse

This commi�ee, a fusion of the former SCMS commi�ee and one including members of medical staﬀs of Community Health Services and Providence Health Care Hospitals, meets quarterly to educate ourselves about physician health issues, review u�liza�on and sa�sfac�on with the Wellspring Employee Assistance Program (EAP) and plan ac�vi�es, programs and resources to address needs in those areas.



Lawsuit Educa�on and Support

Some of the guiding principles of the commiƩee are:



MQAC/OSTEO Board Issues





Boundary Issues

The medical profession and healthcare community should foster physician well‐being





Disrup�ve Behavior

A sense of community with one’s peers is vital to personal well‐being



Elder Care



Assess the changes in the healthcare environment



Prac�ce Management

Physician Commi�ee Members (Name and Contact Informa�on) Jim Shaw, Chair 710‐3151 Barry Barnes

255‐6557

Michael Metcalf

927‐4102

Paul Russell

954‐4989

Steve Brisbois

953‐3798

Michael Moore

747‐5141

Robert Sexton

624‐7320

Andi Chatburn

624‐2313

Mira Narkiewicz

889‐5599

Tasca Snow

565‐4000

Deb Harper

443‐9420

Sam Palpant

467‐4258

Alexandra Wardzala

990‐1938

Michael Henneberry

448‐2558

Tad Pa�erson

939‐7563

Hershel Zellman

993‐4274

Greg Loewen

844‐8476

Rod Peterson

944‐5781

Caduceus Al Anon Family Group ‐ Meets every Thursday evening from 6:15 pm un�l 7:15 pm at 626 N. Mullan Rd., Spokane, WA. Non‐smoking mee�ng for spouses and signicant others of Healthcare Providers who are in recovery or who may need help seeking recovery. Facilitated 12 Step Al Anon Format. No dues or fees. Contact (509) 928‐4102 for more informa�on. Physician Family Alanon Group ‐ Physicians, physician spouses or signicant others and their adult family members share their experience, strength and hope concerning diﬃcult physician family issues. This may include medical illness, mental ill‐ ness, addic�ons, work‐related stress, life transi�ons and rela�onship diﬃcul�es. We meet Tuesday evenings a�er 6pm. The format is structured by the 12‐Step Alanon principles. All is conden�al and anonymous. There are no dues or fees. To discuss whether this group could be helpful for you, contact Bob at 998‐5324. May SCMS The Message 15

Regional Strategic Initiatives

Major Components of the New Mission of the Spokane County Medical Society By Lee Taylor Director Strategic Initiatives The community health and wellness regional strategic initiatives are programs of the Spokane County Medical Society (SCMS). They are primarily carried out in two programs, Project Access and Consistent Care Washington (CCW), and will be guided by the advice and counsel of the SCMS Community Advisory Board.

SCMS Community Advisory Board The Advisory Board will advise the SCMS Board regarding strategic activities and regional initiatives that support the SCMS Mission of serving as a guardian of community health and wellness. Members will be appointed for their community based leadership, expertise, wisdom and contacts, to support the advancement and effectiveness of the SCMS.

Regional Health Improvement Collaborative Steering Committee SCMS serves on the steering committee of the Eastern Washington Regional Health Improvement Collaborative (EWRHIC). The vision of the EWRHIC is to promote the health of our region’s residents, making the eastern Washington region the healthiest in the state. The Collaborative aim is to achieve improved personal and community health and reduced costs through coordination of providers and public resources in the most effective and efficient way. SCMS works closely with the EWRHIC to coordinate and gain support for the SCMS strategic initiatives.

Partnership for Patients - Care Transitions Pilot SCMS is sharing the project management of the Care Transitions Pilot Project in Spokane with the Washington State Hospital Association (WSHA). This work is part of the Centers for Medicare and Medicaid Services’ (CMS) Partnership for Patients National campaign to reduce harm by 40% and readmissions by 20% by the end of 2013. The Partnership for Patients project intends to leverage local and national resources with the goal of identifying solutions that are already working and bringing lessons learned to other hospitals in the region. The Pilot Project offers customized technical assistance to the Spokane region to build upon and further develop a tool kit that will be offered region wide. This tool kit will be a regional resource containing best practices as well as tested tools and information. These tools will help communities maximize quality, safety and financial outcomes and facilitate coordinated and standardized transition processes across settings.

Project Access is a network of over 600 physicians, pharmacists, allied healthcare providers and hospitals serving people with no other access to health care. $56 million of free care has helped 6,500 residents of Spokane County since 2003. Project Access served 1013 clients in 2012, up from 651 in 2011, providing medical services valued at over $12 million. Over $23 in medical services value was delivered for each dollar invested in operating funds. 2011 and 2012 have seen significant operating deficits that have depleted the reserve account to the lowest acceptable level. Support from community stakeholders has already increased in response to the Call-to-Action in the fall of 2012. In addition to the activity focused on sustainable funding, Project Access reduced operating expenses by 11% in 2012 and the 2013 budget has been reduced by 20%. The needs of uninsured individuals will continue and Project Access intends to increase the community impact.

Consistent Care Washington The overarching goal of CCW is to work collaboratively with the Spokane community and other communities in the Northwest to accomplish the triple aim of reducing the cost of care, improving the patient experience and boosting the overall health of the population served. CCW will collaborate with the existing Providence Sacred Heart Medical Center (PSHMC) Consistent Care program to expand the Consistent Care emergency department (ED) care coordination program in Spokane and the Northwest region of the United States. CCW will also create broad and deep capabilities for patient care coordination targeting patient populations that are frequent users of the ED and other medical services. CCW care coordination services will be focused strategically to be non-duplicative and add value across the regional medical community, rather than competitive with other existing care coordination services from hospital or clinic systems or medical services payers. CCW is managing the following initiatives that leverage the collaborative community efforts to better serve complex patient groups that are high utilizers of our hospital EDs and other community healthcare services.

1. ED Medical Directors Work Group Established in July of 2011, this group continues to be the catalyst for many of the community care coordination initiatives. The medical directors from all four Spokane EDs agreed to work together on providing the best and most efficient patient care for the population presenting at the Spokane EDs. The key goals of the group include:

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1. Ensure Continued Sharing of Patient Information in all Spokane EDs 2. Creating City Wide Standards for Clinical Evaluation in the Spokane EDs 3. Developing an Integrated Delivery System for Medical Services to Medicaid Insured Visitors to the ED The group members actively participate in many of the community initiatives that evolved from their collaboration.

2. Behavioral Health Work Group This workgroup brings together the ED providers, case management staff, hospital Psychiatric staff and providers of behavioral health services to establish community-wide protocols and pathways for discharging acute mentally ill patients from the local hospital emergency departments in Spokane. This work group meets approximately once per quarter to follow up on the projects that were defined in an all-day planning meeting facilitated by a Lean Practices Black Belt facilitator on staff at Providence Health and Services. The meeting was attended by ED medical directors, providers, case managers, social workers, Psychiatric staff from all four Spokane hospitals as well as community behavioral health providers.

3. Prescription for Housing CCW received a grant from the City of Spokane called the Health Housing Homeless Systems Integration Pilot Project. The community name for this project is Prescription for Housing because the clients who will benefit from the services provided need health care services to “turn the ship” in the right direction for successful transition away from homelessness. The pilot project will serve approximately 40 homeless persons with complex medical conditions. Legal support services and outcome measurement services provided by a health care economist are components of this program. The expected outcomes of the pilot project are to create a collaborative system of care by engaging community partners in development and implementation of an effective system of providing medical care and social services for homeless clients with high risk medical conditions that will continue after the grant ends.

4. Inland Northwest Transitional Respite Program CCW was the catalyst to significantly expand the small onebed homeless respite program developed by WSU PhD nursing student Becky Doughty, in collaboration with the House of Charity. Sparked by the need for more respite housing for the homeless clients in the Prescription for Housing program, CCW brought together the leadership of Catholic Charities, operators of House of Charity for men, and Volunteers of America, operators of Hope House for women, to discuss rapid expansion of the program. Thanks to CCW and funding from the Providence

Health Services Foundation, within two months the respite program grew to six beds for men and three beds for women and plans are being made for further expansion. CCW continues to play a key role in this new expanded program and the ongoing care for these homeless clients.

5. Hot Spotters Group This group evolved from years of important work by the ED doctors and case managers, the city police and fire departments and other providers of health services. The Prescription for Housing project was the catalyst that recently launched this group. The work of the group is modeled after the Camden, New Jersey Coalition of Healthcare Providers, which originally coined the name “Hot Spotters”. The Hot Spotters group focuses on high risk patients with a history of high utilization of health care services and develops a community care plan that will provide the best care available while working to reduce community costs. The group includes the fire and police departments, behavioral health, substance abuse and housing services providers and Consistent Care Washington staff. This group is embarking on a very important focus on community-wide collaboration to solve some of the most challenging medical and behavioral health cases in the community.

6. ED to Primary Care Program The ED to Primary Care Program will provide access to primary care medical services from providers willing to donate their services for low-income uninsured people residing in Spokane County. Participating providers are Group Health and Providence Internal Medicine Residency. They will provide no cost care for up to six months for approximately 50 patients per year referred by all four Spokane EDs. The role of CCW will be to provide support for establishing ED protocols, enrollment screening, care coordination, health coaching and outcome measurement.

7. Community Care Coordination A common thread in the initiatives outlined above is robust and intelligent care coordination. CCW is developing community care coordination capabilities based on the Pathways Community HUB model that is being used successfully by many communities across the United States. The Community HUB model is designed to improve the system by which at-risk individuals within a community are identified and connected to appropriate health care and social services. The Community HUB and accompanying pathways represent effective vehicles for achieving the goals of health care reform legislation creating financial accountability for the delivery of high-value health and social services, and improving health outcomes.

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CCW care coordination services are also informed by:

IN MEMORIAM

• Care Coordination Model: Better Care at Lower Cost - Published in 2010 by Institute for Healthcare Improvement (IHI)

Stanley Burton “Burt” Covert, MD

• Camden Coalition of Healthcare Providers (Hot Spotters) • Dr. Rick Shepard, Group Health, Care Management Medical Director • Care Coordination Organization Essential Requirements, Washington State Health Home CCW is well positioned to participate as a care coordination organization in the Washington State Health Home services program currently being implemented across the state.

8. Statewide Expansion of Emergency Department Consistent Care Services Emergency Department (ED) Consistent Care Services, ED diversion programs focused on reducing unnecessary visits to the ED, have been proven effective in reducing ED visits by 50%. Programs similar to the Consistent Care program at Sacred Heart Hospital in Spokane are in place in Olympia and the Tri- Cities. CCW is working collaboratively with health plans and other community organizations on incremental expansion of ED Consistent Care services in other communities across the state of Washington. CCW will be the business headquarters for the expansion and will develop outcome-focused teams to implement ED Consistent Care programs in major population centers across Washington.

9. Framework for Cost Effectiveness Analysis Evaluating the cost-effectiveness of a community based health care performance-improvement program is critical in order to assess whether the resources allocated to it are being put to their best use. The Framework for Cost Effectiveness Analysis will perform a financial analysis of the Prescription for Housing Program and other community based health coordination programs. CCW is currently working with Providence Health Care and Washington State University Department of Health Policy and Administration to gather de-identified data on the costs of health care provided to clients in the Prescription for Housing Program, the Transitional Respite Program and the Hot Spotter Program. This framework will pave the way to gathering data from other medical and behavioral health services organizations to build a more comprehensive base of data and better outcome measurements for health improvement programs.

Stanley Burton “Burt” Covert passed away on April 10, 2013. “Burt” or “Doc”, as he was known by his friends and patients, was born February 22, 1926 in New Rochelle, NY to Stanley and Dorothy Burton, and lived in that area until 1949. He graduated from Mamaroneck High School and completed his premedical education at Cornell and Columbia Universities, graduating from New York Medical College in 1949. He married Carolyn Lambright shortly afterwards. During his internship two children, John Burton and Peter Lambright, were born. After a year of internship, he enlisted in the Army and was sent to Korea where he ran a battalion aid station at the front lines of the war. He was awarded two Bronze Stars for valor. Following his two years of service, he retired and opened a family practice in Kingfield, Maine where he was the sole provider to a number of towns in the area. Soon after, Linda Carol and Daniel Dunning were born. An adopted son, Donald Kenneth, joined the group in the seventies. Burt then moved to Shelton, Wash. and opened a pleasant, but hectic family practice. He saw fifty-five patients opening day. During the entire course of his practice he delivered more than a thousand babies. Burt served as Director of Student Health Services at Eastern Oregon State College and taught holistic health courses for ten years before moving to Elk, Wash. where he met and married Sally Louise Christian who preceded him in death in 2010. He will be missed by his family, friends and patients.

If you would like to discuss how we can partner with you or your organization on these or other community health initiatives, please call me at (509) 220-2651 or email me at lee@spcms.org.

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AMA Plans to Transform Medical Education Again By Rodney L. Trytko, MD, MBA AMA Delegate, Chair Washington Delegation Health care is rapidly changing. A gap is now evident between how physicians are being trained and the future needs of our health care system. In the past, physicians worked independently or in a small group and provided services on an individual fee-for-service basis. In the future, most physicians will be employed by large corporations that will contract for populations of patients. Care will be delivered by teams of providers. Physicians will work not only in an individual practice setting but also as leaders and members of teams that stretch across different professions, locations and practice settings. The skill of finding and applying information will be as important as memorizing it. The internet and mobile technology will allow physicians to quickly and easily review treatment guidelines and look up information on diseases, pharmaceuticals and procedures. Telemedicine will make the physical location of physicians and patients far less important. Better health, better care and lower costs will be the overreaching goals. In order to address those changes, the AMA has created a $10 million initiative called “Accelerating Change in Medical Education.” An RFP was sent out to all of the US medical schools and there was an overwhelming response. Proposals were submitted by 119 US medical schools and of those 31 are being furthered considered. The criteria for determining the winners are:

But this is not the first time the AMA has effected fundamental change in the medical education system. In 1904, the AMA Council on Medical Education (CME) adopted two controversial policies. The first was minimum prior education required for admission to a medical school and the second defined a medical education as consisting of two years training in human anatomy and physiology followed by two years of clinical work in a teaching hospital. At that time, the 155 medical schools in North America differed greatly in their curricula, methods of assessment and requirements for admission and graduation. Many of the medical schools were small and proprietary. In 1907, an AMA CME carried out inspections of US medical schools and created a ranking system. The results were never published. Because of the associated resentment toward this activity, the AMA solicited the Carnegie Foundation for the Advancement of Teaching to repeat the survey as a neutral party and in 1910 Abraham Flexner published his shocking results. Of the 155 medical schools, only 31 were recommended to remain open. The Flexner Report was not without its controversy at the time; however, dramatic changes subsequently occurred. Over the next 25 years, half of all US medical schools either closed or merged. Medical education standards were greatly improved as was average physician quality. Medical education was transformed into its current modern age. Unlike 100 years ago, the problem now is very different. Quality is high and cooperation with the medical education system is very good. It is the health delivery system that is rapidly changing. It is time for the medical education system to change as well and like before, the AMA will lead that change.

• Developing new methods for teaching and assessing key competencies • Foster methods to create more flexible and individualized learning plans • Promoting exemplary methods to achieve patient safety, performance improvement and patient-centered teambased care • Improving medical students’ understanding of the health care system and health care financing • Optimizing the learning environment Eight to ten schools will be announced at the AMA Annual Meeting in June as sharing in the $10 million initiative to help implement their ideas. But this is just the beginning. A critical component of the AMA’s initiative will be to establish a learning consortium with the selected schools to rapidly disseminate best practices to other medical and health profession schools. The goal is to fundamentally transform the way that we train physicians in order to better serve the needs of the future health care system. May SCMS The Message 19

AMA’s “Prescription for a Healthier Practice”

days) vs. no status communication from the payer with paper processing *Note: Sample results from several practices that have been engaged in eBilling from one to over five years, with varying numbers of payers they are submitting to.

Workers’ Compensation and Auto eBilling Information GENERAL MESSAGE Eliminate expensive and time-consuming manual workers’ compensation and auto claims processing For this month’s practice check-up, switch from a manual claims process to electronic billing or “eBilling” for workers’ compensation and auto claims, which will help your practice reduce administrative costs, receive timely acknowledgement of your claims’ status and reduce the time it takes to submit bills. Physician practices across the nation are slashing expenses by utilizing eBilling for these claims. By doing so, they are getting paid faster and eliminating most of the hassles involved with paper billing. The AMA has developed tools to help your practice automate medical billing for workers’ compensation and auto injury. Start with the AMA’s Property and Casualty (workers’ compensation and auto injury) Toolkit and sign up for AMA Practice Management Alerts for additional helpful resources.

KEY PRACTICE EFFICIENCIES Switch to eBilling and improve key practice metrics Physicians who treat property and casualty (workers’ compensation and auto injury) patients know all too well the administrative hassles that come from filing paper bills. Are you still submitting paper bills for these claims? Did you know you can easily automate this process? Compared with physician practices that have switched to eBilling, the manual, paper-centric approach fails to deliver. Physician practices that have switched to eBilling have realized these critical improvements:

If you could achieve these results, how would it impact your practice? To get started in automating your workers’ compensation and auto claims, view the archived webinars, “Workers’ compensation eBilling - A rapidly evolving solution to a historic revenue cycle headache!” and “How to Automate your Workers’ Compensation Claims” that walk you through the process of adopting eBilling for workers’ compensation and auto claims and provide tips to simplify the process. Many payers are already accepting eBills and attachments nationally today. You can utilize your existing practice management system, billing services or clearinghouses to electronically submit workers’ compensation claim data and attachments.

MARKETPLACE READINESS Learn about vendors offering eBilling solutions The old thinking that electronic billing (eBilling) processing doesn’t work for workers’ compensation and auto claims submission is just that—an old way of thinking. Today, thousands of medical bills for workers’ compensation and auto injury patients are being submitted electronically every day. The AMA has worked at the national and state levels to ensure that the same nationally developed, Health Insurance Portability and Accountability Act (HIPAA)-compliant standard electronic transactions that you use today to submit government and commercial claims can be used for workers’ compensation and auto claims as well. This has enabled practice management vendors and clearinghouses to provide electronic solutions to physicians and payers for workers’ compensation and auto claims. As a result, physician practices can often use existing practice management solutions to submit claims for all lines of business.

California-based small practice* • First time acceptance: 40% (paper) vs. 84% (eBill) • Resubmission rate: 50% (paper) vs. 15% (eBill) • Revenue cycle improvement: oo Accounts receivable (A/R) days were reduced from 75 days (paper) to 39 days (eBill) oo % of Accounts Receivable over 120 days were reduced from 62% (paper) to 24% (eBill) • Payment cycle: 67 days (paper) vs. 20 days (eBill)

Access the AMA’s “Workers’ compensation eBilling vendor” listing to learn about some of the many practice management system and clearinghouse vendors offering workers’ compensation eBilling solutions. This resource can help your practice adopt workers’ compensation eBilling, by introducing vendors that may assist physician practices in automating workers’ compensation claims. Visit the AMA’s workers’ compensation toolkit at www.ama-assn.org/go/ ebilling for additional resources, including an interactive map which provides state-specific resources on workers’ compensation medical reporting and billing requirements, state rules and regulations, how to file an appeal, and more.

• Payer status calls: eBilling reduced status calls by over 50% due to the use of electronic acknowledgements (2 May SCMS The Message 20

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STATE REGULATORY EFFORTS AND AMA INVOLVEMENT Get ready for eBill regulations, coming soon to your state States across the nation are establishing regulations to promote workers’ compensation eBilling. Several states have already adopted regulations and many more are in the process of doing so. The AMA has worked closely with state policymakers and other industry stakeholders to promote a regulatory approach that addresses problems that contribute to the inefficiencies in the current system and promote electronic solutions that work for all lines of insurance. State regulations can help pave the way for eBilling by adopting policies that eliminate administrative hassles and streamline processes. One great example is California’s regulatory requirement that payers pay all uncontested complete eBills within fifteen days. But you don’t have to wait for regulations in your state—you can get started now! Many payers are already accepting eBills and attachments nationally today. You can utilize your existing practice management system, billing services or clearinghouses to electronically submit workers’ compensation claim data and attachments. Get ready! Find out where your state is in the process of adopting eBilling regulatory requirements. Learn how to automate workers’ compensation claims submission and attachment processes in the AMA’s Property and Casualty (workers’ compensation and auto injury) Toolkit. Here you can also retrieve state-specific resources, by accessing an interactive map providing information on state-specific resources on workers’ compensation and medical reporting and billing requirements, state rules and regulations, how to file an appeal, and more. Visit www.ama-assn.org/go/ebilling to access these resources.

ADDRESSING ERAs Fight for accurate payment by decoding payer ERAs It can be a major hassle for your practice to decode electronic remittance advices (ERAs) to determine if a billed claim was properly paid. More and more workers’ compensation payers are accepting electronic claims and sending electronic remittance advices (ERAs) to the practice that include the reason and remark codes required to be sent on commercial and governmental claims to explain payment adjustments. The AMA is working to address the lack of specificity and predictability in how payers use reason and remark codes within ERAs in the context of electronic transactions. Moving forward, this will further enhance the benefits that electronic billing (eBilling) will add to your practice workflow.

The AMA also has developed an innovative practical tool to help address such hassles. If your practice performs property and casualty (workers’ compensation and auto injury) eBilling and receives electronic remittance advices (ERAs), the AMA’s Claims Workflow Assistant tool can help you understand and address payment adjustments from payers. Using this tool, you can look up the reason or remark codes (i.e., CARC/RARC combination code sets) that payers place on the ERA to find out associated workflows that would assist you in addressing claim denials or non-payments. Learn how to use the Claims Workflow Assistant so you can look up the reason and remark codes payers place on the remittance advice to explain how the claim was processed and determine what those codes mean. Then, you can follow the steps provided to ensure accurate payment. The Claims Workflow Assistant even provides numerous helpful template appeal letters that AMA members can easily modify to use in their practices. Visit www. ama-assn.org/go/claimsassistant to start using this tool today.

Keep Informed—Join the AMA’s New Linkedin Group Today! Managing a practice can be complex—and you need a place to turn to when you have questions or want advice. The American Medical Association (AMA) Practice Efficiency and Management LinkedIn Group is designed to encourage dialogue on a wide variety of issues— from contracting strategies, to billing and payment, to making the most of administrative automation—to help your practice run efficiently. Physicians, practice staff, consultants and other health care partners are invited to join this group. If you don’t have a LinkedIn account, we invite you to open one. Comment on our posts or create your own! Ask questions, share your best practices and join the conversations. The above tips are a part of the AMA Practice Management Center’s “Prescription for a healthier practice” series to help physicians and their staff examine how their practices are performing in key administrative processes.

Membership Recognition for May 2013 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. 30 Years Robin L. Mitchell, MD Wayne G. Riches, MD 20 Years Jeffrey D. Burgan, MD Russell S. VanderWilde, MD

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5/24/1983 5/24/1983

5/13/1993 5/26/1993

Cognitive Pain Management: An Alternative By Randall Riggs, MD Managing chronic pain with narcotics presents quality of care, legal, moral, and ethical issues. Patients in pain want something from their doctor to help. NSAIDS and other palliatives have their own challenging side-effects. And, when they don’t work well, narcotics generally will. Continued narcotic use leads to tolerance, increased doses, and chemical dependence or addiction. As the CDC recently reminded us, narcotic overdose can lead to death, and the rate of narcotic overdose deaths has increased. We became acutely aware of our local difficulties with opiate overdose deaths in Spokane County. Our county medical society’s task force’s attention to this issue has already led to a reduction in opiate overdose deaths locally. But what about your patient who is expecting you to do something to help relieve his or her chronic pain? Is narcotic pain medication the only option? Many treatments for traumatic and degenerative tissue injury exist to achieve the best patient outcome including surgery, physical therapy, and orthopedics, but pain may persist. Your patient may have continuing pain from the original trauma and even from the treatment. For some conditions, like fibromyalgia, irritable bowel syndrome, and phantom limb pain, no definitive treatments exist and complaints of chronic and chronic-acute pain prevail. Even with the most effective treatments available, some patients have enough chronic pain to lower their quality of life, interfere with daily living, and degrade familial and interpersonal relationships. When these patients come to you seeking relief from their pain, is prescribing narcotics your only option? Complimentary alternative medicine (CAM) options, such as acupuncture, meditation, exercise, and even music therapy have value in helping mediate pain. Dr. Mel Pohl’s now-classic book, A Day Without Pain, informs us of many CAMs. Cognitivebehavioral treatment and training is another CAM that is valuable in treating chronic pain.

The experience of pain is mediated by the old brain and given meaning by the new brain. Often, if patients change the way they think about pain, they can change the way they perceive it and change the way they manage it. Than can achieve less pain, more pain-free or pain-reduced moments, and improve the quality of their lives and their relationships. For the past year, I have worked interactively with the cognitivebehavioral pain management program at Gateway Counseling for several of my patients. They meet patients for a weekly psychoeducation and process group and provide individual counseling to lead patients into understanding pain and pain management. Patients learn the circular causality of pain, stress, and sleep disturbance and learn and practice thought and behavior changes to manage their pain more effectively. They improve their quality of life and reduce or eliminate their need for narcotic pain management. They also learn strategies and techniques to reduce stress by learning effective ways of dealing with stressors like anger, grief, guilt and shame, and depression. The program also works on building more effective coping skills by improving problem-solving skills, communication skills, and relaxation skills and by generally increasing patients’ emotional intelligence. Occasionally guest practitioners of various CAMs such as yoga and nutrition, meet to inform patients about their CAM. One benefit of this program to doctors is to give their chronic pain patients the possibility of reducing chronic pain without having to prescribe more narcotics by referring them to people who have time and skill to help them learn better pain selfmanagement skills. A benefit of this program to patients is gaining improved pain- and life-management skills both to reduce their experience of chronic pain and to improve their quality of life. George Morrison, who is dually licensed in chemical dependency and mental health counseling, runs the cognitive-behavioral treatment program at Gateway Counseling and you can contact him at (509) 532-8855 for more information.

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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 CHAS Human Resources at (509) 444-8888 or hr@chas. org. Visit our website to learn more and to apply www.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, on-call shifts, overhead and case file administration. Please contact Gia Melkus at (800) 260-1515 x5366 or 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 tkwate@palousemedical.com. Contact us today and discuss your future at Palouse Medical! EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty. Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, (509) 565-4352 or maikeshi@dshs.wa.gov. PO Box 800, Medical Lake, WA 99022-0800.

PROVIDENCE FAMILY MEDICINE RESIDENCY SPOKANE Immediate opening with Providence Family Medicine Residency Spokane (PFMRS) for a full- time BC/BE FP physician who has a passion for teaching. PFMRS 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 Linda Barkley, Program Assistant at (509) 459-0688 or Linda.Barkley2@providence.org. PROVIDENCE HEALTH & SERVICES has immediate opportunities for BE/BC Family Physicians to join our expanding primary care team in Spokane, eastern Washington’s largest city. Newborns to geriatrics, no OB. Regular 8-5 hours, fiveday week. New physicians will join Providence Medical Group, our physician-led multispecialty medical group with clinics throughout the metropolitan area. Excellent compensation and benefits. Providence Medical Group (PMG) – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence.org or (509) 474-6605 for more information. PROVIDENCE MEDICAL GROUP (PMG) - Eastern Washington is recruiting for an excellent Family Medicine physician to join our care team in this scenic suburb of Spokane. Full-time opportunity with our growing medical group in what will be a large, state-of-the-art medical ambulatory center (construction completion target is spring 2014). No OB. Outpatient only. Competitive compensation and comprehensive benefits. Providence Medical Group – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence.org or (509) 474-6605 for more information.

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

For a complimentary consultation or brochure, call: Spencer T. Shelman, CFA (509) 838-4175 or (888) 864-8827 assetplanning.com May SCMS The Message 23

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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 to the Spokane County Medical Society, 104 South Freya Street, Orange Flag Building, Suite 114, Spokane, Washington, 99202.

PHYSICIANS Akselrod, Dmitriy, MD Diagnostic Radiology Med School: State U of New York Upstate Medical U (2007) Internship: Wilson Regional Medical Center (2008) Residency: U of Vermont (2012) Fellowship: U of Wisconsin (2013) Practicing with Radia Inc. 08/2013 Bani Hani, Samer H., MD Nephrology/Transplant Nephrology Med School: Jordan U of Science & Technology (2003) Internship & Residency: U of Tennessee Health Science Center (2010) Fellowship: U Tennessee Health Science Center (2012) Fellowship: U of South Florida (2013) Practicing with Providence Medical Group - WA Transplant Surgery 8/2013 Barnes, Ryan D., MD Physical Medicine & Rehabilitation Med School: U of Washington (2009) Internship: Creighton U (2010) Residency: U of Utah (2013) Practicing with Rockwood Neurosurgery & Spine 08/2013 Deters, Levi A., MD Urology Med School: U of Washington (2007) Internship & Residencies: Dartmouth Hitchcock Medical Center (2013) Practicing with Spokane Urology, PS 07/2013 Ferrin, Lance J., MD Gastroenterology Med School: Johns Hopkins U (1987) Internship & Residency: U of Washington School of Medicine (1990) Fellowship: Georgetown U School of Medicine (1996) Practicing with Rockwood Digestive Health 7/2013

Forrester, Matthew D., MD Cardiothoracic Surgery Med School: Emory U (2007) Internship & Residency: Stanford Hospital & Clinics (2013) Practicing with Providence Health Services dba Northwest Heart & Lung Surgical Associates 08/2013 Highfill, Thomas M., MD Emergency Medicine Med School: Creighton U (2010) Internship & Residency: Mayo Clinic - Rochester (2013) Practicing with Valley Hospital Emergency Department 08/2013 Mueller, Enkhtuyaa L., MD Interventional Cardiology Med School: Health Sciences U of Mongolia/Sain-Shand Medical College (2001) Internship & Residency: U of Vermont (2009) Fellowship: U of Vermont (2013) Practicing with Rockwood Heart & Vascular 09/2013 Schwintek, Jason R., MD Internal Medicine Med School: Loma Linda School of Medicine (1999) Internship & Residency: Internal Medicine Residency Spokane (2002) Practicing with Apogee Physicians 07/2013 Spangler, Sean A., MD Cardiology Med School: Medical College of Wisconsin (2002) Internship & Residency: Brooke Army Medical Center (2005) Fellowship: Brooke Army Medical Center (2010) Practicing with Providence Spokane Heart Institute 07/2013

PHYSICIANS PRESENTED A SECOND TIME Badgley, Margaret K., MD Internal Medicine Practicing with Rockwood Clinic 07/2013 Phillips, William H., MD Family Practice Practicing with Community Health Association of Spokane 01/2013 Greenawalt III, James W., MD Anesthesiology Practicing with Anesthesia Associates 08/2013

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Continuing Medical Education

Meetings/Conferences/Events

Rockwood Health Systems Breast and General Tumor Boards: These tumor boards are jointly sponsored by Rockwood Health Systems and the Spokane County Medical Society. Tumor Boards will be held weekly January – June 2013. Each Tumor Board is worth 1.0 Category I CME credits. For more information please contact Sharlynn M. Rima CME Coordinator at SRima@rockwoodclinic.com. Promoting Healthy Families (Practice Management Alerts from the American Medical Association) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain—positive changes for the whole family. The continuing medical education activity includes a video module, a detailed monograph and patient handout. These activities have been certified for AMA PRA Category 1 CreditTM. For more information www.ama-assn.org. Physician Contract Review and Wealth-Building Tips for Young Physicians Sunday, May 19, 2013 6:00 – 8:00 pm (Dinner Provided) Luigi’s Italian Restaurant 245 W Main Avenue CoSponsored by the American College of Physicians – Washington Chapter (CME Credits) and the Spokane County Medical Society. Physician Contract Review by Denny Maher MD, JD (WSMA) This presentation will include general information on what to look for before signing an employment contract: Basic information about contracts; Compensation, bonus, malpractice and tail coverage; Physician & employer rights and responsibilities and Contract elements such as non-compete and non-solicitation provisions, indemnification/hold harmless, work hours, on-call obligations and office and staff support. Wealth-Building Tips for Young Physicians by Viral Shah MD, CFP®, EA This talk will include general information on: What is wealth and how does one amass wealth, Investment strategies that work (or don’t work) and How to find a financial planner / advisor. Physicians attending this CME activity may claim two credits of Category 1 to meet the CME requirements of the Washington State Medical Quality Assurance Commission for renewal of licensure. RSVP: We only can accommodate up to 30 people. For questions or to RSVP contact Amanda Watne at (206) 956-3650 or ajw@wsma.org.

Institutional Review Board (IRB) - Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at (509) 358.7631. Spokane Guild of the Catholic Medical Association- Meets second Wednesday of each month at 6 p.m. at Providence Sacred Heart Medical Center Administrative Board Room in Administration on the Main Floor. All are welcome. For inquiries contact Phil Delich, MD at (509) 465-1554 or e-mail at delichphil@gmail.com. Medical Reserve Corps of Eastern Washington General Membership Meeting – Spokane Regional Health District Auditorium, 1101 West College Avenue, 6:00 – 8:00 p.m. Wednesday, 8 May 2013. Meeting topics include Team practice on a trauma manikin; treating patients with gunshot wounds from an active shooter incident and head, abdominal, chest and multiple wounds. Teams will be made up of physicians, PAs, ARNPs, RNs, LPNs, paramedics, EMTs and other health care professionals. Everyone is welcome to attend. Disaster response and preparedness involves all of us at home or at work. For more information contact David Byrnes at DByrnes@srhd.org. Free National Environmental Health Association Courses sponsored by the CDC and EPA available. Courses include National Environmental Public Health Performance Standards Workshop: Building Local and National Excellence, Biology and Control of Insects and Rodents Workshop, Environmental Health Training in Emergency Response and Environmental Public Health Tracking 101. For more information go to the website at www.nehacert.org. Physician Family Alanon Group: Physicians, physician spouses or significant others and their adult family members share their experience, strength and hope concerning difficult physician family issues. This may include medical illness, mental illness, addictions, work-related stress, life transitions and relationship difficulties. We meet Tuesday evenings after 6pm. The format is structured by the 12-Step Alanon principles. All is confidential and anonymous. There are no dues or fees. To discuss whether this group could be helpful for you, please contact Bob at (509) 998-5324. Preparing Your Practice for ICD-10-CM: Transition & Implementation Thursday, May 30 Valley Hospital, Spokane Valley 12:30 to 4:30 p.m. The Department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM code sets with ICD-10 code sets, effective October 1, 2014. This seminar will provide a limited introduction to ICD-10 code sets as well as a detailed review of the operational and financial impacts that physician organizations should consider in preparation for the transition to ICD-10-CM. For more information visit the WSMA website at www.wsma.org.

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Cl assified Ads REAL ESTATE Comfortable Three-Bedroom Home in quiet neighborhood for rent. Good storage in kitchen, gas stove, dishwasher, refrigerator, washer/dryer and fireplace. Comes furnished or can negotiate. Close to Hamblen Grade School, Sac Middle School and Ferris High School. Three bedrooms, three baths, large living room, family/TV room, master bedroom has private bathroom, two-car garage. Large windows in living room look out into large fenced yard with automatic sprinkler system (front and back). Snow blower and lawnmower provided. Call (408) 594-1234 or (509) 993-7962. Large Second Owner Custom Built Executive Home with unparalleled views of Liberty Lake and Spokane Valley on five acres available for sale or lease. Custom hardwood floors and woodwork throughout, cherry office shelves, cathedral ceilings, central air, three car garage, brick porch, tile roof, large deck, three fireplaces, four bedrooms, four bathrooms, formal dining room, large kitchen, large eating room and den. Walk out basement, wood stove, kitchen and bathroom. Large 30’ x 100’ pole barn with separate utilities, two phase power, three twelve-foot overhead doors. 30 x 60 sports court. Large animals allowed. Water rights included. 4Kw grid interactive, portable battery backup solar system available. Offered for $600k or for lease $3250, no pets/smokers. Seller is a real estate broker at (509) 220-7512. Beautiful Priest Lake Cabins for Rent Our newly restored cabins are located on the historic site of Forest Lodge in the entrance to the scenic Thorofare. Two cabins are available. Each sleeps 8. They are located at the water’s edge, have gorgeous views, bordered by the National Forest and 18 acres of private land. The beds and furnishings are all new and cabins have all the amenities - decks, docks, beaches with fire pits, walking trails and forest to explore. Boating, hiking, swimming, sailing, snowmobiling in winter or just relaxing in the sunshine. You will enjoy a peaceful, fun-filled vacation at this amazing site. For available dates, pricing, photos and details call Jeannie or John at (509) 448-0444.

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf. professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue. The building has various medical office spaces available for lease from 635 to 10,800 contiguous usable square feet. and has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include urgent care, family practice, pediatrics, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials emailed upon request. A Tenant Improvement Allowance is available, subject to terms of lease. Contact Patrick O’Rourke, CCIM, CPM®with O’Rourke Realty, Inc. at (509) 624-6522, mobile (509) 999-2720 or psrourke@comcast.net.

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MEDICAL OFFICES/BUILDINGS 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.

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Our team of expert pathologists believes in a collaborative approach to patient care centered on outstanding quality diagnostics and service.

InCyte Pathology, an established and trusted laboratory for over 50 years is adopting a new look and name: Incyte Diagnostics. The progressive logo reflects our history of diagnostic excellence, while capturing the essence of our future as an innovative laboratory poised to meet the needs of clinicians, clinics and hospitals. Learn more by visiting www.incytediagnostics.com or calling 509.892.2700. Proudly serving the greater Spokane healthcare community since 1957. May SCMS The Message 28

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

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