JULY EDITION, VOLUME 2015, NO. 7
DOCTOR/DAUGHTER BANQUET – LOTS OF FUN AND LASTING MEMORIES By Shannon Boyle, CMS Communications and Events Coordinator
Supporting Sponsor, Hancock Bank: (l-r) Emory Mayfield, Diana Cureton, and Abby Smith.
Supporting Sponsor, SunTrust: (l-r) Tom Pennekamp, Brett Allen, and Karen Watts.
More than 140 doctors and their daughters/granddaughters attended this year’s CMS Doctor/Daughter Banquet on May 28th at Golden Eagle Country Club. There were plenty of fun activities for kids and adults – pottery painting, cupcake decorating, face painting, balloon artist (courtesy of Hancock Bank), and wax hand molds. There were lots of souvenirs to take home, but most importantly, lasting memories were made. We extend our appreciation to Dr. Tracey Hellgren for all of her help in planning this very fun event, to Betsy Barfield for continuing the tradition of capturing beautiful portraits of our doctors with their daughters/ granddaughters, and to my Mom, Debbie Dent, for volunteering to help with the cupcake station.
Representatives from the Florida Students Against Destructive Decisions (Florida SADD) program shared some helpful information on how to engage families with teens in a conversation about safe driving.
We thank our sponsors for the event:
SUPPORTING SPONSORS Hancock Bank – Diana Cureton, Ben Graybar, Emory Mayfield, and Abby Smith SunTrust – Brett Allen, Tom Pennekamp, and Karen Watts
EVENT SPONSOR The Krizner Group – Bill Krizner
CMS President, Joshua Somerset, M.D. with his daughters, Naomi and Norah.
CONTINUED ON PAGE 4
CAPITAL MEDICAL SOCIETY 2015 MEETINGS CALENDAR September 15, 2015 CMS Membership & CME Meeting “Rheumatoid Arthritis (RA)” Less Shrestha, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
October 20, 2015 CMS Membership & CME Meeting “Prevention of Medical Errors” – 2 Hour CME Scott Sellinger, M.D. and Jesse Suber, Esq. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
November 10, 2015 December 3, 2015 CMS Membership & CME Meeting CMS Foundation Holiday Auction “Advanced Cardiac Imaging – Cardiac MRI” 6:30 pm Greg Hartlage, M.D. and Ernesto University Center Club at FSU Umaña, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks MEDICAL SOCIETY PUBLICATION CAP SCAN - A CAPITAL 1
MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218 www.capmed.org
BOARD OF GOVERNORS Joshua Somerset, M.D., President J. Daniell Rackley, M.D., President-Elect Tracey Hellgren, M.D., Secretary/Treasurer Alfredo Paredes, M.D., Immediate Past-President Shelby Blank, M.D. Garrett Chumney, M.D. David Dixon, D.O. Shakra Junejo, M.D. Maribel Lockwood, M.D. Amy Pagano, CMS Alliance President Paresh Patel, M.D. Philip Sharp, M.D. Ernesto Umaña, M.D. Kenneth Whithaus, M.D. Pam Wilson, Executive Director Family Medicine Residents William Carlson, M.D./Todd Hewitt, M.D. Internal Medicine Residents Sura Jermanus, M.D./Jose Martinez, M.D.
PUBLICATION EDITOR Charles E. Moore, M.D.,
MANAGING EDITOR Shannon Boyle
GRAPHIC DESIGN Young Design
ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN? Please contact Dr. Charles Moore at cmoore5186@aol.com and Shannon Boyle at sboyle@capmed.org. All articles submitted will be reviewed by your peers prior to publishing. Cap Scan is published during the first week of each month and is the official publication of the Capital Medical Society. Advertising in Cap Scan does not imply approval or endorsement by the Capital Medical Society. The opinions expressed are those of the individual authors and do not necessarily reflect the official policies of the Capital Medical Society. If you are a member of the Capital Medical Society and would like a copy of the Minutes from the Board of Governors meeting, please call the CMS office. Thank you. 2
I N T H I S I SS U E :
CMS FAMILY FUN NIGHT
CMS Doctor/Daughter Banquet …
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CMS New Members …
3
CMS Lunch & Learn …
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Reflections from the Editor …
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TMH Family Medicine Residency Program …
10
Medical/Legal …
12
CMS Membership Meeting Minutes …
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Physician Burnout …
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CMS Foundation …
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CMS Foundation: We Care Network …
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HAPPY BIRTHDAY! {JULY BIRTHDAYS}
Amer Rassam, M.D. – 1st
Amulya Konda, M.D. – 19th
Raymond Shashaty, M.D. – 1st
Thomas Peele, Jr., M.D. – 19th
Larry Deeb, M.D. – 2nd
Andres Rodriguez, M.D. – 19th
Lynn Jones, M.D. – 2nd
Judith Lewis, M.D. – 20th
Rodrigo Agbunag, M.D. – 4th
Robert Thornberry, M.D. – 20th
J. Daniell Rackley, M.D. – 5th
Walter Bunnell, III, M.D. – 22nd
Robert Campbell, M.D. – 12th
William Dixon, M.D. – 22nd
Steve Jordan, M.D. – 12th
Abbas Abbey, M.D. – 23rd
Juan Martinez-Serra, M.D. – 12th
Ricardo Gonzalez-Rothi, M.D. – 23rd
Rodolfo Oviedo, M.D. – 12th
Viralkumar Bhanderi, M.D. – 24th
J. Richard Taylor, M.D. – 12th
David Guttman, M.D. – 24th
Charles Newell, M.D. – 13th
Paresh Patel, M.D. – 24th
Carey Dellock, M.D. – 14th
Omodele Awoniyi, M.D. – 27th
Babatunde Adekola, M.D. – 16th
Tracey Hellgren, M.D. – 30th
Daniel Conrad, M.D. – 17th
John Katopodis, M.D. – 30th
J. Daniel Davis, Jr., M.D. – 17th
Kaushal Patel, M.D. – 30th
David Kahn, M.D. – 17th
Adrian Roberts, M.D. – 30th
Brence Sell, M.D. – 17th
Joseph Soto, M.D. – 31st
HAPPY BIRTHDAY! WE ARE SO GLAD YOU WERE BORN!
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
DID WE MISS YOUR BIRTHDAY? IF SO, PLEASE EMAIL ROSALIE CARLIN AT RCARLIN@CAPMED.ORG!
CMS NEW MEMBERS
CAPITAL MEDICAL SOCIETY IS PLEASED TO WELCOME THE FOLLOWING NEW MEMBERS:
Irene Alexandraki, M.D. Medical School: University of Athens Internship/Residency: Allegheny University Hospitals Fellowship: Baylor College of Medicine Specialty: Internal Medicine Practice: Associate Professor, FSU College of Medicine
Angelo Ayar, M.D. Medical School: University of Toronto Internship/Residency: University of Michigan Specialty: Dermatology Practice: Dermatology Specialists of Florida
Saurabh Sheel, M.D. Medical School: Maulana Azad Medical Center Internship: Lok Nayak Hospital Residency: Nassau University Medical Center Specialty: Pulmonary Disease Practice: Capital Regional Pulmonary Associates
Jeffery Snyder, M.D. Medical School: University of South Alabama Internship/Residency: University of Florida Fellowship: University of Florida Specialty: Cardiothoracic Surgery Practice: Capital Regional Heart and Lung Surgical Associates
PROFESSIONAL NOTES CMS Members:
John P. Fogarty, M.D.
Alma Littles, M.D.
Myra Hurt, Ph.D.
John P. Fogarty, M.D., Dean and Professor, Family Medicine at Florida State University College of Medicine is now serving as Chair of the Liaison Committee on Medical Education (LCME). LCME is recognized by the U.S. Department of Education as the reliable authority for the accreditation of medical education programs leading to the MD degree.
Alma Littles, M.D., Senior Associate Dean for Medical Education and Academic Affairs Professor, Family Medicine and Rural Health, Florida State University College of Medicine is now serving as Chair of the AMA’s Academic Physician Section.
Alma Littles, M.D. and Myra Hurt, Ph.D. served as faculty facilitators in the Harvard Macy Program in June. The Harvard Macy Institute was unique in the continuing professional development field when it was created in 1994 as an interprofessional, international incubator for innovators in healthcare education. Over the past twenty years, the Institute has been an engine of change in education, creating innovation-inspiring communities including over 3,500 scholars representing more than 800 institutions across the globe, including over 170 institutions that sent five or more faculty. Today, alumni innovations are enhancing the care of patients worldwide.
If you receive accolades, please let us know so we can include you in this section! Email the details to Shannon Boyle at sboyle@ capmed.org.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3
CMS DOCTOR/DAUGHTER BANQUET
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS DOCTOR/DAUGHTER BANQUET
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS LUNCH & LEARN
CAPITAL MEDICAL SOCIETY LUNCH & LEARN On May 20th, Jarrod Fowler and Gail Stewart gave an excellent program on “Payment Advocacy”. Mr. Fowler is the Director of Payment Advocacy at the Florida Medical Association and Ms. Stewart is the Regional Hospital/EMS Coordinator at the Florida Department of Health. You can reach Mr. Fowler at (850) 224-6496 ext. 231 or jfowler@flmedical.org or Ms. Stewart at (850) 606-8164 or Gail.Stewart@FLHealth.gov.
Hancock Bank sponsored the May 20th Lunch and Learn. Diana Cureton was in attendance as a representative of Hancock Bank (pictured with Troy Johnson, TPCA). You can reach Ms. Cureton at (850) 325-3159 ext. 53159 or diana.cureton@ hancockbank.com. Seminars are held at the Capital Health Plan on Governor’s Square Blvd. – and we thank them for providing this lovely venue.
The CMS Lunch & Learn Seminars will resume in the Fall. Mark your calendars and watch for updates on topics and speakers! September 16 • October 21 • November 18
Announcements
In Memoriam
Dr. Marc Inglese and his wife, Melissa, welcomed their third son on June 9, 2015. John Baldwin weighed 7 pounds 3.3 ounces and measured 20 inches long. John Baldwin joins big brothers, Logan and Graham. Congratulations to the Inglese family!
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Baxter H. Byerly, M.D. 1927 – 2015
REFLECTIONS FROM THE EDITOR
MY TURN
By Charles Moore, M.D.
This little series on why “I yam what I yam” is determined to carry on, at least until the end of the year. As you have doubtless noted, being an avid Cap Scan reader, it began in January with Mahoney’s entertainments…he stumbled into pathology almost by happenchance…and most recently in the June issue Pat Woodward’s idealistically impassioned devotion to pediatrics, which appears to have started when he was about two years old. In between we have had Frank Skilling (ophthalmology), Barbara Williams (Family Practice), Charlie Williams (Radiology), and Joshua Somerset (Gastroenterology). And so…it is “My Turn.” You are going to have to put up with why your Editor went into medicine and then plastic surgery. Well, after three years in the Navy (NROTC), when I got out it soon dawned on me that I probably would have to do something. Classically (how many interviewers of candidates for medical school have had to hear this!) I thought I wanted to “help people,” and maybe even children particularly, almost in some vague way dimly resembling Pat Woodward. So I thought that I would drop in at the UNICEF offices at the United Nations Building in New York. After all, I had a degree, and had written, as duly required by my college of every graduate, a 20,000 word research paper; mine on Andre Malraux, at about that time the French Minister of Culture under the Charles de Gaulle regime. I explored, with vast numbers of footnotes citing original sources, Malraux’s philosophical revelations regarding how all Art, that of Michelangelo, that of the creators of the Benin Bronzes, the drawings of the Australian aborigines, the totems of the Indigenes of north-west America, not to omit the Tusk carvings of the Inuits, and so on, united us all as partakers of a single Destiny in search of God and, to boot, some answer to Gaugin’s great question, “Where do we come from? What are we? Where are we going?” What more do you need if you want “to help children!”
I accordingly arrived to the U.N clothed in my best “preppie” look, with a slightly rolling swagger suggesting that I had been an officer in the United States Navy. Someone came in, sat down, and looked at me as John Mahoney might look at a biopsy of a liver with advanced cirrhosis, or Somerset at a particularly virulent hemorrhoid. “What,” said the interviewer, “have you to offer us? What is it that you can do?” I was flabbergasted. I roamed lamely about within such vocabulary as I had, digging my own grave with my own tongue. I was ushered out completely bedrazzled. I went and sat on a bench in a nearby park, and marveled. I bought, and pensively licked at an ice cream cone. The sun slipped lower into the west. The shadows lengthened. And then, very gradually, I started to think: a.) That the next time anyone asked me what I could do I would have a dynamite answer, and then b.) What is the best answer I could give? And that is why I decided to go to medical school, to the utter astonishment of my parents, whose only knowledge of me and medical practice had been my youthful screams when taken to the Doctor. But now, blessed to be armed in those good old days of President Eisenhower with a stipend as a result of my military service, I found myself taking all the necessary pre-med courses, and then got into the University of Missouri Medical School by replying, when asked by the admissions committee, “that I wanted to help people.” I can cut to the chase from here. In my second or beginning third year of med school, fooling around in the library, I came across the two volume work by Ralph Millard, M.D., plastic surgeon of such note that he actually found himself on the cover of “Time.” Aside from inventing the cleverest way to repair a cleft lip, Dr. Millard had written a two volume surgical biography of Sir Harold Gillies, F.R.C.S., etc., under whom he had trained in the late 1940s. Sir Harold, a gentleman of numerous astonishing accomplishments and eccentricities, was an ENT surgeon who essentially created plastic/reconstructive surgery at “Queen Mary’s Hospital,” built in 1916 on the grounds of Frognal House, an old estate just south of London. It was intended to be a merely temporary facility, essentially a series of prefab huts seemingly constructed of flimsy CONTINUED ON PAGE 9
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7
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REFLECTIONS FROM THE EDITOR
stick and cardboard, very hastily built. The haste was in order to meet what had become the urgent need to provide some form of surgical cure and care for what had become the thousands of young men who had had, as they left the trenches to march across “No-Man’s Land,” their faces blown off. The face, of course, is necessarily the first anatomical item to go “over the top.” Then, if the face made it, there was further anatomy that followed into the Hell of high explosives and machine gun bullets. At the Battle of the Somme in 1916 the British Army had expected to have perhaps two or three hundred young men with various facial injuries; in the event there were overwhelming thousands, with injuries vastly more than merely “various.” Fascinated by this work, in my third year of Med School I took an elective six weeks with Dr. Hal Bingham, Professor of Plastic Surgery at the University of Missouri, and thus my specialty became settled; but this, of course, only after a rotating internship, four years of general surgery, and finally two of plastic. Toss in four years shared between Newfoundland and East Africa and it is no wonder I did not open my practice until I was 40. But time is quick; and that is suddenly over forty years ago. Now, of course, every time one hears “plastic surgery,” the world thinks “big boobs, a tummy tuck, and why not a face-lift for sport.” So be it. But let me add, if you can so consider it, that time and perceived inadequacies also diminish lives, if not so dramatically as bullets and high explosives. People can be made better, and so feel better, and so do better, for longer. How lucky I feel that “my turn,” came to “help people.” How proud we can all be that we chose medicine to live our own lives by, no matter how we came to that choice. Certainly it was a great one for me! Just as for you.
FOOTNOTE
As a footnote to “My Turn” the following was culled from the archival Website of Queen Mary’s Hospital, for which my thanks to the Archivist, Dr. Andrew Bamji, F.R.C.P.
Gillies on the far right, the O.R., despite all, wonderfully well lit.
As Dr. Sam Alberti, director of museums and archives at the RCS of England, says, Gillies’s “innovation was as much about gathering together teams of experts” as it was about pioneering techniques. He married up the skingrafting methods he had learned from Hippolyte Morestin in France, the maverick dental work pioneered by Charles Valadier and the newish antiseptic techniques (antibiotics were not yet invented). He used photographs, X-rays and Tonks’s talented paintings to detail his patients’ injuries and their progress: some were not fully discharged until 1924. He printed up luggage labels that nurses in the field could attach to soldiers who could no longer speak, specifying that they should be shipped back to him — often, appallingly, weeks or months after they had been injured. He was not above circumventing the military and medical hierarchy, or gambling on the support of his patron Queen Mary, to get his way. CMS
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 9
TMH FAMILY MEDICINE RESIDENCY PROGRAM
TMH Graduating Residents Choose Tallahassee
David Castillo, M.D.
Amanda Pearcy Davis, MD
Klive Forde, M.D.
Michelle Miller, M.D.
Practice: Hospitalist
Practice: Urgent Care
Practice: Obstetrics Fellowship
Practice: Primary Care
TMH
Capital Health Plan
TMH FMRP
Capital Health Plan
A May 2012 graduate of Florida State University College of Medicine, David is excited to continue medical training in Tallahassee. Completing a BS in Human Sciences at FSU in 2004, he continued his education while completing his athletic eligibility as a member of the FSU football team.
Graduating from Florida State University College of Medicine in May 2012, Amanda is excited to be continuing medical training at Tallahassee Memorial. Family Medicine has always appealed to her due to the variety of patients and pathologies, as well as diverse career paths. Since her time as a mathematics major at the University of Florida to her completion of her medical degree at FSU, she has continued to immerse herself in various aspects of medicine including rural practice, emergency medicine, women’s health, and procedural and diagnostic skills. In addition to her avid interest in medicine, Amanda enjoys spending time with her husband, Lance, reading about a wide variety of topics, cooking, and visiting family in Central Florida.
Born and raised on the island of Barbados, Klive is a 2008 medical graduate of the University of the West Indies in Kingston, Jamaica. His academic career has been characterized by excellence with one of his most cherished awards being a medal he received for attaining the top rank in his class over the first three years of medical school.
Michelle was raised in Wauchula, Florida, but has been a Florida State Seminole since 2003. Following a BS in Psychology, she earned her medical degree from Florida State University College of Medicine in May, 2012. At FSU COM, Michelle volunteered with FSUCares, where she experienced her first international medical trip to Panama. As a national student leader in such organizations such as American Medical Women's Association and American Medical Students Association she was able to see the impact of the Family Medicine specialty. She enjoys reading, crocheting, and walking her dog, Jojo, in her spare time.
During his time as a student athlete he was named to the ACC All Conference team and was captain of the 2005 ACC championship team. He also received recognition for his work in the classroom including being named an ESPN Magazine Academic All-American, James Tatum award winner for top scholar athlete in the ACC, and being honored as the Arthur Ashe Jr. Male Scholar-Athlete of the year. In addition, he received the National Football Foundation, Weaver-James-Corrigan, NCAA Enhancement and Time Warner postgraduate scholarships. His research “Knowledge and Attitudes concerning Sickle Cell Trait among Minority Student Athletes” was published and presented at several conferences. David’s love of sports and patient interaction has fueled his desire to pursue a career in Family Medicine with a sports medicine emphasis. David and his wife Nicole love being a part of the Tallahassee community and spending time with their lovely daughter, Anna Grace.
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Following graduation Klive worked in multiple settings in his native Barbados, and chose a career in Family Medicine because of the diversity of experiences the specialty offers, and the breadth of medical knowledge required. He believes that the opportunity to get to know his patients and their families over time helps him to be able to treat them holistically. He is excited to have the opportunity for residency training in Tallahassee. Outside of medicine, he is active in his church as a youth leader and member of the praise team. He also enjoys camping, hiking, reading and public speaking.
TMH FAMILY MEDICINE RESIDENCY PROGRAM
Two FSU College of Medicine Tallahassee Regional Campus medical students who were awarded $1,000 scholarships from Capital Medical Society in 2014 have started their residencies in north Florida in Family Medicine.
Agustin Vilardo, M.D.
Thomas Austin Zorn, M.D.
Nizar El Kinge, M.D.
Practice: Primary Care
Practice: Urgent Care
Practice: Primary Care
TMH Physician Partners
TMH
TMH Physician Partners
Born in Montevideo, Uruguay, a country that seems to live and breathe soccer, Agustin got caught up as a youngster training to be a goal keeper. Discovering the value of practice and perseverance, his efforts were rewarded with his selection as Uruguay’s national team goal keeper for indoor soccer. After receiving an MD degree from Universidad de la Republica, Uruguay, he decided to take a chance on another of his dreams, studying medicine in the US.
Austin is a Tallahassee native, born at TMH. He graduated from Leon High School where he was the centerfielder on the baseball team and active in the music program. Receiving a BS in Neuroscience from Furman University in South Carolina in 2008, he worked as a youth director for a local church and spent time volunteering at a retirement community, and singing with an a cappella group, “The Bell Tower Boys.” In 2012, he received his medical degree from Emory University in Atlanta, Ga. Having grown up in a family with several physicians, Austin was drawn to Family Medicine because of the diversity of the field and the type of people who choose the discipline. In his spare time, he enjoys being with family, the outdoors, sports, fishing, the beach, and singing.
After being a research volunteer at Jackson Memorial Hospital in Miami and working in clinics for underprivileged residents, he saw the importance of preventive medicine and the urgency for people of his community to reach optimal health. This goal is now being fulfilled and he is very happy to be pursuing a career in Family Medicine. He shares, “I am very fortunate to bring my wife, Carmen, our three year old daughter, Andreina and newborn son, Benjamin to a community like Tallahassee. I hope to be able to practice in this community long after graduation.”
Perry, FL
Shermeeka Hogans-Mathews matched at St. Vincent’s Medical Center, Jacksonville, Florida, in Family Medicine.
John Turner matched at Tallahassee Memorial Hospital, in Family Medicine. CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 11
MEDICAL/LEGAL
IS THE “MANAGED CARE CARTEL” SQUEEZING YOUR BOTTOM LINE? By Valerie Shahriari, Esq., The Florida Healthcare Law Firm
According to an article in the Wall Street Journal on May 27, 2015, antitrust lawsuits in federal court allege that 37 independently owned companies are functioning as a cartel in the healthcare space. Who are the 37 independently owned companies? All Blue Cross and Blue Shield companies as well as the Blue Cross Blue Shield Association. These claims have now been consolidated into two lawsuits, one of which represents health care providers who allege that decreased competition is resulting in lower payments for providers. It’s obvious that providers and healthcare businesses are feeling the squeeze of decreased payments but a costly and lengthy antitrust lawsuit is far from the best way to fight back. Providers need to know that managed care contracts usually suffer from two common problems: 1) very important terms are unclear and 2) the cost control provisions are unfair. In addition to the need for clarity, most managed care agreements lack what many consider to be basic procedural fairness. For instance, most agreements contain provisions that permit the plan to implement any rules, regulations, policies and procedures the plan desires at any time and often without notice or public dissemination. The physician does not necessarily know about these things, and such things can undermine the very language of the contract. To meet these concerns, the following should be helpful: “[Participating Provider’s] agreement to be bound by such [policies, procedures, rules or regulations] shall be contingent upon [Participating Provider] being provided advanced written notice or any proposed adverse decision or event and a reasonable opportunity to respond to such proposal. Moreover, the parties agree that to the extent the foregoing conflict with the terms of this Agreement, the terms of this Agreement shall govern.” Sometimes, however, the payer is not actually responsible for payment, but rather acts as a middleman between the provider and the payer. In those instances, it is essential to create clear lines of accountability. For instance: “In the event a Payor fails to make payment pursuant to the terms of this Agreement, [Plan] shall (a) make such payment on behalf of the Payor, (b) initiate legal action to recover such payment on behalf of [Participating Provider], or (c) assign to the [Participating Provider] the right to initiate such action. In the event of (b) or (c), Payor shall provide [Participating Provider] a copy of the agreement
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upon which [Participating Provider] may rely in prosecuting such action and shall release [Participating Provider] from any further obligation to provide services to [Members].” It is also fairly common for physicians to be denied payment even for patients who were authorized and treated. In addition to requiring the plan to identify members, the following should be helpful in dealing with those instances: “Verification of coverage at the time of service will be final. Moreover, notwithstanding any provision of this Agreement to the contrary, any preauthorized admission or covered service shall be paid, regardless of any subsequent benefits determination.” Even after a contract is signed by a provider, the managed care company does not always fulfill its contractual obligations to pay according to the contract which results in many practices leaving money on the table and ultimately, remaining in the bottom line (i.e., profit) for the managed care company. The MGMA states that only 35% of providers and healthcare businesses appeal denied claims! The key to mitigating this financial impact is to know the problem before it becomes a trend. For instance, one of the ways to get ahead of a developing trend is to monitor a payer’s denial rate. A denial rate is by definition a percentage of claims denied by the payer. A low denial rate indicates cash flow is healthy. A good benchmark for payer compliance would be a denial rate of 5-10%. Often times, practices and healthcare businesses operate with a much higher rate, and even in the 20- 30% range without even knowing it. The AMA states that a 5% denial rate for an average family practice equates to about $30,000 walking out the door! It makes sense that this perfect storm of poorly negotiated and constructed contracts, increasing denial rates by payers, and unfilled contractual obligations leaves many providers and healthcare businesses feeling like a cartel now runs their practice and their bottom line. However, there are many opportunities throughout the progression of the managed care process for providers and healthcare businesses to take back control. Contributed by The Florida Healthcare Law Firm. For more information, visit http://www.floridahealthcarelawfirm.com/index.html. CMS
MEDICAL/LEGAL
MONEY, MONEY, MONEY, MONEY…. MONEY!! How Doctors Can Plan to Win Against Their Student Loans Student loans. I’ve heard many of my doctor clients use terms and phrases such as, “crippling,” “underwater,” and “no end in sight” when conversing about them. While it is a large debt, it doesn’t have to define the next 10+ years of your life. The next bullet points are some efficient strategies, resources and thought processes for paying off your student loans. These ideas will be generalized, however, as there are many different situations for each doctor and his/her family. 1. Strategies a. Utilize a 70/20/10 mindset as a resident/fellow As a resident, most physicians will make somewhere in the $40-50k range in Florida (not including moonlighting in their later years). This typically isn’t enough money to make a significant dent in your student loans, but it is enough to create the habit to do so. •
Use 70% of your Net Income (This is take home pay after taxes, insurances, etc.) on living expenses. This includes not just housing, but car payments, food, going out, cell phones, pets, etc.
•
Use 20% of your Net Income on debt reduction. Student loans, credit cards, and any other debt (not mortgage or cars).
•
Use 10% of your Net Income for cash savings to build a cushion. This isn’t investment money. Everyone needs a cash cushion. Period. This strategy helps to reasonably budget and builds the habit to create a line item for your loan repayment. The other benefit is you’re not singularly focused on debt reduction. You’re also building a cash cushion for the emergencies in life that will happen.
b. Once an attending physician, use a One-Third mindset with your additional income Once you become an attending physician, your income will typically increase substantially. Assume you go from $50k to $200k. Here’s how you can utilize that $150k increase. • Use One-Third of the increase on taxes. You don’t control this aspect, but understand about $50k is going to taxes. • Use One-Third of the increase on living expenses. Assuming you had $2,000 a month to live on before, you’re now living on roughly $5,500. Not a bad increase! • Use One-Third of the increase on debt reduction. Now you’re able to pay roughly $4,000/month toward your loans. Again, since they’re general guidelines, use these strategies as they fit your particular situation.
2. Resources Another frequently asked question is, “which option should I take regarding paying my loans back?” This website has a plethora of insight regarding the option that would work best for your situation: https://studentaid.ed.gov/sa/repay-loans/understand/plans/ income-driven In my experience, most students chose the IBR, or Income-Based Repayment option. If you’re unmarried and filing as a single person with resident’s pay of $40-$50k, you’re monthly payment comes out to $400-$500/month. This option usually fits well into the 70/20/10 system. 3. Thought Process on Student Loans Probably the biggest area I coach doctors on regarding their student loans is how to think about them. Coming out of school, making $40-$50k a year and seeing $100k+ of debt can create a feeling of paralysis. Add the 6.8% interest rate to that and it’s no wonder these loans feel crippling. Here are some helpful ways to think about student loans: a. Paying down debt is the inverse of investing. Consider paying your student at 6.8% is investing into a guaranteed fund providing a 6.8% return. b. Your loans were an investment into human capital: you becoming a doctor. Very few, if any, investments will give you this kind of return. c. In the long scheme of life, $100k, $200k or even $300k is not a ton of money for a physician. It’s likely as an attending, you will achieve these numbers in gross annual wages. In conclusion, these are general guidelines. Every doctor’s situation is different for a variety of reasons. Work with a professional advisor in these matters. There are caveats and other tax strategies you may consider utilizing as a resident or early on in your career (Ahem…ROTH IRA). Contributed by Tyler Huston CFP®, AEP®, CLU®, ChFC®, CASL®, Pyxis Advisors, 850-629-7220 or THuston@financialguide.com.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 13
MEDICAL/LEGAL
ELECTRONIC MEDICAL RECORDS MAY CAST PHYSICIANS IN UNFAVORABLE LIGHT DURING LAWSUITS By Keith L. Klein, M.D., FACP, FASN
EMRs can increase malpractice risk in documentation of clinical findings—copying and pasting previously entered information can perpetuate any mistakes that may have been made earlier.1 Incorrect information is the most common userrelated contributing factor in malpractice cases involving EMRs, according to a study by The Doctors Company of EMR-related closed claims from 2007 to 2013. In the study, 15 percent of cases involved pre-populating/ copy-and-paste as a contributing factor. Copy-and-paste is a necessary evil to save time during documentation of daily notes,
While the electronic medical record (EMR) has advantages, it also
but whatever is pasted must also be edited to reflect the current
has introduced liability risks. EMRs can lead to lawsuits or result
situation. Too often the note makes reference to something
in a weak defense by casting the physician in an unfavorable light.
that happened “yesterday.” For example, the sentence “Patient
For example, examine these exchanges in a recent malpractice trial: •
presented to ED with chest pain yesterday…” is pasted over the next two weeks in the daily progress note. An even more telling example is a sentence like “Patient’s admitting lab is normal…”
Plaintiff Attorney: Doctor, if the emergency renal consult was called in at 11:30, why did you wait until 6 PM to see the patient, during which time his kidneys became severely damaged?
being perpetuated while the actual creatinine levels rise every day. In one case, the judge commented about copy-and-paste issues: “I cannot trust any of the physician notes in which this occurred and the only conclusion I can reach is that there was no examination of the patient…it means to me that no true thought was given to
•
Doctor: I did see the patient within 30 minutes.
•
Plaintiff Attorney: Where does it show that in the chart?
•
Doctor: Uh…it doesn’t, I guess. I saw the patient but wrote
nemesis. It’s easy to click on checkboxes, and often they are pre-
the note later.
checked in templates. EMRs have been presented in court that show,
the content that was going into ‘the note.’” Checkboxes, particularly those that pre-populate, can be a physician’s
•
Plaintiff Attorney: So you claim you saw this critically ill patient in 30 minutes, spent one hour evaluating him, but did not document your findings for another six hours?
And later in the trial: •
through checkboxes, daily breast exams on comatose patients in the ICU, detailed daily neurological exams done by cardiologists, and a complete review of systems done by multiple treating physicians on comatose patients. Questioning in court as to how long it takes to do a review of systems and a physical examination, the patient load of the physician for that day, and how many hours the physician was
Defense Attorney: But the lab record shows that the kidney
at work cast doubt on the truthfulness of the testifying physician. A
function was declining…
time analysis showed that there was no way the physician could have accomplished all that was charted that day.
•
Judge: [interrupting] The physician notes state each day that kidney function was normal. How do you explain that
In one case that typifies how to impeach a doctor, it was clear that
in the face of deteriorating kidney function? Why would
the doctor spent eight hours at work and, accounting for lunch,
a physician write that, unless he hadn’t looked at the lab
spent a little over seven hours seeing patients. But the total time
testing or the patient?
it was documented that he spent on each patient would have required his time at work to be 15 hours. As one judge stated in court: “This medical record is simply not believable. I don’t know whether to fault the hospital, the company that wrote the software, or the physician, but the only one on trial here is the physician. In medical malpractice, the record must speak for itself, but this record is worse than silent. It is egregious.”
14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
MEDICAL/LEGAL
Notes can also be problematic. One issue that frequently comes up
The fundamental mantra when writing a note in an EMR is to show
is the actual time the patient was seen. It is the accepted practice,
that you put thought into the record. Discrete data, though strongly
especially on teaching rounds, to see all patients and then write
favored by IT professionals and insurance companies, does not
notes at the end of the day. The EMR will automatically date
accomplish this. Free-text entry of three or four sentences can convey
and time-stamp the physician’s note as the time the note was
far more information than several pages of template-driven notes and
created. This gives a misleading impression of when the patient
will reflect that you saw the patient and put thought into the note.
was actually seen, and in a rapidly changing clinical situation, the note may not accurately reflect the patient’s clinical condition at the time the physician actually saw him. Therefore, it’s important to state in the note the specific date and time that the patient was seen and examined.
All these common EMR issues—incorrect information, copy-andpaste, and poor note-taking—cast doubt on the integrity of the doctor and the medical record. While the doctor may not have committed a clear-cut act of malpractice, these types of issues in the medical record cast the doctor in an unfavorable light in front of a judge or jury.
CMS
Reading an EMR is like taking a drink out of a fire hydrant—it is bloated with repetitive data, and critical findings can easily be missed. Copying information such as entire x-ray reports and lab data into notes only adds to this problem. Because the details of the chest x-ray can easily be looked up, the x-ray should only be summarized in the note, such as, “chest x-ray normal except for right upper lobe infiltrate consistent with a viral pneumonia.”
Reference Mangalmurti S, Murtagh L, Mello M. Medical malpractice
1
liability in the age of electronic health records. N Engl J Med. 2010: 363:2060-2067. http://www.nejm.org/doi/full/10.1056/ NEJMhle1005210?viewType=Print&. Accessed December 8, 2014. Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.
Welcome
J. RobeRto mendoza, md
Medical Services: » Disease Prevention » Pulmonary Diseases (COPD, Asthma) » Endocrine Conditions (Diabetes, Hypothyroidism)
J. Roberto Mendoza, MD Board Certified in Internal Medicine
» General Healthcare to Adults 18+ » Cardiovascular Conditions • Hypertension • Coronary Artery Disease • Peripheral Vascular Disease
Now Accepting New Patients. We Accept CHP and Most Insurances. Same Day Appointments Accepted
2770 Capital Medical Blvd., Suite 200 • Tallahassee, FL 32308 Hours: Mon. – Fri. 8 a.m. to 5 p.m. 850.878.8235 • CapitalRegionalMedicalGroup.com CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 15
CMS MEMBERSHIP MEETING MINUTES
Minutes CMS Membership Meeting May 19, 2015 The mission of the Capital Medical Society is to promote the practice of medicine for the ultimate benefit of the patient.
I. Business Meeting – Capital Medical Society A. Welcome – Dr. Joshua Somerset, President, called the meeting to order at 6:35 pm. He welcomed the members and sponsors in attendance. Dr. Somerset thanked Westminster Oaks for use of their beautiful facility. Ms. Sheri Whigham, Sales and Marketing Director at Westminster Oaks, welcomed everyone to their facility. B. Dr. Somerset thanked our sponsors for the evening: Meeting Sponsors Digestive Disease Clinic and Tallahassee Endoscopy Center – Dr. Joshua Somerset and Dr. Amulya Konda Gilead – Shannan Coleman
II. Upcoming Events/Meetings Dr. Somerset announced upcoming events and meetings: May 28, 2015 – Doctor/Daughter Banquet, 6:00 pm, Golden Eagle Country Club September 15, 2015 – CME/Membership Meeting, “Rheumatoid Arthritis (RA)”, Dr. Less Shrestha, 6:00 pm, Maguire Center for Lifelong Learning at Westminster Oaks III. Tonight’s CME Program – this is a 1 Hour Category One Program Topic: “HCV – Back to the Future” Speaker: Amulya Konda, M.D. Dr. Konda gave a detailed and informative program on Hepatitis C.
MagMutual – Staige Hoffman C. New Members Dr. Somerset asked new members in attendance to stand and be recognized. No new members were in attendance.
Physician CME Proof of Attendance Forms will be sent to participants who attend the entire CME program.
IV. Adjourn – Dr. Somerset adjourned the meeting at 7:35 pm.
16
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS MEMBERSHIP MEETING MINUTES
Please Thank Our Sponsors for the May 19th CMS Membership Meeting
Meeting Sponsor, Digestive Disease Clinic and Tallahassee Endoscopy Center: Dr. Joshua Somerset and Dr. Amulya Konda, speaker for the evening.
MEETING SPONSORS
Digestive Disease Clinic and Tallahassee Endoscopy Center
Meeting Sponsor, Gilead: Shannan Coleman.
Gilead
MagMutual
Meeting Sponsor, MagMutual: Staige Hoffman.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
17
PHYSICIAN BURNOUT
HOW TO BEAT BURNOUT: 7 SIGNS PHYSICIANS SHOULD KNOW
If physicians want to keep burnout at bay, Dr. Linzer said there are some serious signs they should never ignore. Here are seven ways to know if your practice is getting the best of you—and when to finally do something about it: 1. You have a high tolerance to stress.
If constant stress has you feeling exhausted, detached from patients, or cynical, take notice. You may be in danger of burnout, which studies show is more prevalent among physicians than other professionals. But how can you avoid it? Learn the signs of physician burnout and what you can do to stay motivated on the job. Mark Linzer, MD, Director of the Division of General Internal Medicine at Hennepin County Medical Center in Minneapolis, has studied physician burnout since 1996. He said he understands why many physicians eventually feel exhausted practicing medicine, but this problem is avoidable. “Burnout doesn’t have to be highly expensive to fix,” Dr. Linzer said. “The problem is that no one is listening. People always want to say that physician wellness and performance measures will cost a lot of money, but preventing burnout can actually save money in the long run on recruiting and training new practice staff.”
Stress consistently ranks as the number one predictor for burnout among physicians, Dr. Linzer said. “Please don’t ignore the stress, even if you can take it,” he said. Physicians who consistently operate under high stress are at least 15 times more likely to burn out, according to his research. 2. Your practice is exceptionally chaotic. A quick glance around your practice will let you know if you or your colleagues may cave to stress. “People tend to think it’s the patients that always stress doctors out, but actually, it’s the opposite,” Dr. Linzer said. “Caring for patients keeps doctors motivated. What burns them out is caring for patients in a high-stress environment. Change the environment and you’ll change the overall quality of care.” 3. You don’t agree with your boss’ values or leadership. This one is particularly tricky to identify but “necessary to prevent burnout,” Dr. Linzer said. Whether at a large hospital or private practice, physicians need to feel as if the people leading them also share their values for medicine and patient care. Otherwise, their motivation can slowly wane. 4. You’re the emotional buffer. Working with patients requires more than medical expertise. “Often, the doctor acts as an emotional buffer,” Dr. Linzer said. “We will buffer the patient from our own stressful environment until we can’t take it anymore.”
18
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
PHYSICIAN BURNOUT
5. Your job constantly interferes with family events.
7. You don’t take care of yourself.
Spending quality time with loved ones helps physicians perform better. “When they can’t do those things, it’s all they think about during the day and the patient suffers,” Dr. Linzer said, citing work-life interference as one of the most common predictors for burnout among physicians in his studies.
When was the last time you enjoyed a nice bubble bath or morning run? If you continually neglect yourself, you may neglect your patients, too. “As physicians, we want to be altruistic but one of the keys to altruism is self-care,” Dr. Linzer said.
6. You lack control over your work schedule and free time. When work demands increase, but control over your schedule doesn’t, stress can kick in and spark burnout. That’s why Dr. Linzer often tells practices, “If you standardize, customize”— a medical mantra to suggest that if physicians must work a long standardized set of hours each week, practices should at least customize their schedules to flexibly fit changes or needs in their daily lives.
Did you fit most of these signs? If you think you or your fellow physicians are suffering from excessive stress, check out these tips from residents who have conquered burnout - http://www.ama-assn.org/ama/ama-wire/post/waysresidents-found-conquer-burnout.
Contributed by AMA Wire. For more information and tips, visit www.ama-assn.org/ama/ama-wire.page. CMS
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 19
The credit you deserve.
The new Business Access Line of credit from Synovus gives your business fast, easy access to cash when you need it most. Even when you’re low on funds, you can get started on spending without ever calling the bank. We understand that your time is valuable, so Synovus keeps things simple. To find out how your business can set up its own line of credit, visit your local Tallahassee State Bank branch or synovus.com/BAL.
Banking products are provided by Synovus Bank, Member FDIC. Divisions of Synovus Bank operate under multiple trade names across the Southeast.
20 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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Special guest speaker: DR. GREGORY FRICCHIONE Director of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital (MGH), Associate Chief of Psychiatry and Director of the Division of Psychiatry and Medicine at MGH, Professor of Psychiatry at Harvard Medical School
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Contact R. Jai Gillum | Director of Health Strategies | O: 850.487.8091 | R.Jai@uwbb.org | 307 East 7th Avenue | Tallahassee, FL 32303 healthstressconf3.indd 4
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6/15/15 3:57 PM21 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS FOUNDATION
Reasons to Give: Funds raised by generous donors benefit the We
Care Network. The We Care Network is a past Blue Foundation Sapphire Award winner and its impact on the community was featured in the Sept/Oct 2014 issue of the Tallahassee Magazine. The We Care Network provides over $6 million in donated specialty medical and dental care to the community’s low-income uninsured annually. In addition, donations support medical school scholarships for medical students at FSU College of Medicine committed to returning to NW Florida
DONATE TO THE CMS FOUNDATION
WE THANK OUR DONORS We thank the following people who made a donation to the CMS Foundation:
after completion of their residencies. In 2014, $40,000 in scholarships were awarded to nine FSU College of Medicine students.
Gifts to Honor and in Memoriam: You can make a donation to the CMS Foundation
For We Care Network Charles Williams, M.D. – for More Simpler Times
in memory of someone who has passed away or in honor of someone, such as a fellow physician you hold in high esteem or has taken care of you
In Memory Ray Bellamy, M.D. – In Memory of Donald Alford, M.D.
or your family. CMS will send an acknowledgement letter to those you memorialize and honor.
Dr. and Mrs. Charles Williams – In Memory of Donald Alford, M.D.
How to Give:
Dr. and Mrs. Charles Williams – In Memory of Baxter Byerly, M.D.
been created in order to establish financial stability
Dr. and Mrs. Charles Williams – In Memory of Stewart Emhof, Father of Leslie Emhof, M.D.
one of CMS Foundation’s funds.
Through the generosity of donors, three funds have to meet our mission. You can donate any time to 1) The CMSF Endowment 2) The We Care Network Endowment 3) The Scholarship Fund
The mission of the Capital Medical Society Foundation is to support the charitable efforts of physicians and others, increase
Checks should be made payable to the CMS Foundation and indicate on the memo line of your
access to healthcare, promote education and
check to which fund you would like to donate.
serve the community’s health needs through
Capital Medical Society ~ 1204 Miccosukee Road ~
innovative projects that are exemplary, affordable and dignified.
22 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Bring your check to the CMS Office or mail it: Tallahassee, FL 32308.
CMS FOUNDATION: WE CARE NETWORK
The We Care Network strongly encourages our volunteer
THANK YOU! To our CMS members and We Care partners who saw new patients for the We Care Network in May 2015. Your generosity and support of the We Care Network makes a difference. PHYSICIANS Marie Becker, M.D. Viralkumar Bhanderi, M.D. Camille Blake, D.O. Robert Bradford, M.D. Tim Broeseker, M.D. Carlos Campo, M.D. Joseph Camps, M.D. Elizabeth Dickens, M.D. David Durden, M.D. Akash Ghai, M.D. Spencer Gilleon, M.D. Celeste Hart, M.D. Muhanad Hasan, M.D. Okanta Jackson, M.D. Simha Jagadeesh, M.D. Amit Jain, M.D. Arjun Kaji, M.D. Amulya Konda, M.D. Carey Linker, M.D. Maribel Lockwood, M.D. Steven Ostrov, M.D. Rodolfo Oviedo, M.D. Praful Patel, M.D. Timothy Paulk, M.D. J. Daniell Rackley, M.D. Stephen Richardson, M.D. Adrian Roberts, M.D. Laurence Rosenberg, M.D. Eliot Sieloff, M.D. Hardeep Singh, M.D.
Joshua Somerset, M.D. Bob Soni, M.D. Joseph Soto, M.D. Timothy Sweeney, M.D. Jean Paul Tran, M.D. Tony Weaver, M.D. William Yaakob, M.D. DENTISTS Eric Amundson, D.D.S. JP Bastien, D.M.D. Brian Beck, D.M.D. Susan Byrne, D.M.D. David Cardman, D.M.D. Walter Colón, D.M.D. Brittney Craig, D.M.D. John S. Dozier, D.M.D. William McFatter, D.D.S. E. Lynn McLarty, D.D.S. Jim McSoley, D.M.D. Frank Swerdzewski, D.D.S. James Sykes, D.M.D. Jay Walton, D.D.S. Lawrence Weaver, D.D.S. Ed Zapert, D.M.D.
FACILITIES Affordable Dentures Anesthesiology Associates Beachton Denture Clinic Capital Regional Medical Center Dermatology Associates Desloge Home Oxygen Leon County Dental Clinic Pathology Associates Radiology Associates Seven Hills Surgery Center Southeastern Surgery Center Tallahassee Diagnostic Imaging Tallahassee Endoscopy Center Tallahassee Health Imaging Tallahassee Memorial HealthCare Tallahassee Orthopedic and Sports Physical Therapy Tallahassee Outpatient Surgery Center TMH Family Medicine Residency Program Women’s Imaging Center
physicians and dentists to send their value of donated services to us. The value of donated services is important for us to share with our funders and the community. You can send your value of donated services via fax to Sue Michaels, R.N. at (850) 201-0085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you! Please contact Sue Michaels, R.N. at smichaels@capmed.org or 201-0130 if you are a We Care volunteer and you provided volunteer specialty care in the month of May 2015 and your name is omitted.
We thank our referring providers from May 2015: Eboni Allen, ARNP Anne Ananga, ARNP Aaron Appiah, M.D. JP Bastien, D.M.D. Dhananjay Bendre, M.D. Jonna Bradley, ARNP Sherry Bramblett, ARNP Daniel Breivogel, ARNP Earl Britt, M.D. Tim Broeseker, M.D. Kendall Campbell, M.D. Carlos Campo, M.D. David Cardman, D.M.D. Brittney Craig, D.M.D. J. Daniel Davis, Jr., M.D. Elizabeth Dickens, M.D. Lysmar Dinguis, M.D. Mignon Emenike, M.D. Shirley English, ARNP Cynthia Evans, ARNP Dale French, D.O. Terreze Gamble, M.D. Akash Ghai, M.D. Judy Griffin, ARNP Muhanad Hasan, M.D. Hantz Hercule, M.D. Sarah Hinson, ARNP Susan Horton, ARNP Simha Jagadeesh, M.D. David Kahn, M.D.
Howard Kessler, M.D. Farhat Khairallah, M.D. Hari Kolli, M.D. Elaine Larkins, ARNP Linda Maynard, M.D. Damon McMillan, M.D. Kelley Miller, ARNP John Ness, M.D. Teresa Oldham, M.D. Rose Origa, ARNP Winston Ortiz, M.D. Lisa Perkins, ARNP Marlaine Registe, ARNP Stephen Richardson, M.D. Jose Rodriguez, M.D. Mark Saunders, M.D. Roy Schwartz, M.D. Tamara Sealy, M.D. Gadi Silberman, M.D. Robert Snider, M.D. Joshua Somerset, M.D. Alanna Steaple, ARNP Mary Swain, M.D. Tallahassee VA Clinic Faye Tinson, ARNP Marianne Towler, ARNP Richard Zorn, M.D.
DURING THE MONTH OF MAY, THE WE CARE NETWORK: RECEIVED 139 REFERRALS, WITH 79 PATIENTS NEW TO THE PROGRAM
SCHEDULED 88 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS
$94,189 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 23 23
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