volume 46 no. 2 summer 2015
TODAY’S
CHRISTIAN DOCTOR The Journal of the Christian Medical & Dental Associations
IN THIS ISSUE
Stormy Seas in H ealthcare
Opening a direct primary care practice to restore passion for medicine
How house calls are making a comeback in today’s modern age
Using mobile ministry to meet the needs of the poor and needy in our communities
“As a resident member of CMDA, I know that I contribute to the largest group of Christian healthcare professionals in the country.” —Sherry-Ann Brown, MD, PhD
Why is CMDA so important? Dr. Sherry-Ann Brown has been a member of CMDA since she was a medical student. She understands the value of staying connected to a local group of Christian healthcare professionals who join together in community and fellowship. The ministry of CMDA helps her grow as a leader in her field, as a physician and as a Christian. Plus, she knows that she stands in unity with others who face persecution in healthcare for their faith.
Are you a CMDA member? There’s never been a better time to become a CMDA member. You can join Dr. Brown and more than 15,000 healthcare professionals across the country who are part of this growing movement to change hearts in healthcare.
Join CMDA today. Visit www.joincmda.org or call 888-230-2637 to join us today. P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.joincmda.org memberservices@cmda.org
Stay Connected During Residency and Fellowship $99 annual fee or $150 one-time resident or fellow payment
With our new membership package just for residents and fellows, you can stay connected with CMDA throughout your entire training program for one low fee. In addition to a reduced membership rate, you will also receive a variety of benefits and discounts while avoiding the hassle of annual renewal. Contact Member Services or visit www.cmda.org/premium for details.
Surfing or Drowning? David Stevens, MD, MA (Ethics)
Someone said, “If you are not riding the wave of change, you will find yourself beneath it.” Change in healthcare is not a wave but a tsunami in a stormy sea, and countless healthcare professionals have been swept into retirement, are being pushed into joining larger healthcare systems or are simply changing their practices. Many more are discouraged and burning out.
but for many, the negatives far outweigh these benefits.
editorial
A third huge wave is forming on the horizon—the implementation of ICD-10 with its five times as many codes. It will create the need for more training and cause more costs, greater delays in reimbursement and more errors in coding that will increase the risk of being We recently asked CMDA members this ques- accused of Medicare or Medicaid fraud. tion, “Have you or a colleague made the choice to change the way you practice healthcare because Is it time to panic because the waves are too of provisions in the Affordable Care Act?” More high and the seas too violent? First, remember that than half of the responders said, “Yes.” The most Christ can walk on water and will give you peace common change they listed was starting to use in the midst of the storm, just as He did with the electronic medical records (EMRs). disciples when they were battered by the waves. God does His best work in us and through us in Their comments were more concerning. They our storms. Secondly, realize that you can’t calm said, “It contributed to my decision to retire… the waves around you, but you can learn to surf! Most of the medical staff quit when we got the This issue of Today’s Christian Doctor is focused EMR—leaving the rest of us to bear more call… I on helping you do that. It shares articles from your retired… I had to leave solo pediatric practice… colleagues about alternate practice methods and I’m losing some patients because of changes in models that may help you ride out the stormy seas mandatory insurance… I changed to hospital of healthcare. employment… I’m thinking about retiring sooner than planned… I reduced or elected not to take I encourage you to especially note Dr. Peter Ancertain insurance… I’m learning my fourth EMR derson’s article about training his staff to do more in three years… I retired due to the destruction than just scribe. He taught them to get the patient’s of the doctor-patient relationship that has caused history and give him an oral summary when he got limited to no interaction between patient and doc- in the room and then close the interview after he tor because of time constraints related to EMR… It left. He increased his income, almost doubled the is part of the reason I am leaving full-time practice number of patients he saw in a day, improved the and going into urgent care work. doctor-patient relationship, increased staff satisfaction and decreased his work hours to a manageable According to survey data, Christian healthcare level. His successful methods have been adopted professionals are more satisfied with their prac- by the Cleveland Clinic and the U.S. military. He is tices than those who aren’t Christians, but there now teaching his techniques to healthcare profesis still a great deal of discontent, growing burnout sionals on a full-time basis. Be on the lookout for my and despair. Two huge waves hit healthcare re- Christian Doctor’s Digest interview and a 30-minute cently. First, the Affordable Care Act brought thou- video I did with him about his Team Care Managesands of new regulations, more patients and often ment. It may be the surfboard you or your organizadecreased reimbursement. The second wave of tion need to ride to refine your joy! EMRs turned healthcare professionals into stenographers, damaged the doctor-patient relationship, As physician and holocaust survivor Victor decreased the number of patients that can be seen Frankl said, “When we are no longer able to in a day and required much more “homework” to change a situation, we are challenged to change finish up incomplete records. Healthcare profes- ourselves.” I would add, “Don’t despair, God is sionals are working more, making less and having there and He will guide and sustain you.” Recite less time with their spouses and families. Don’t and claim the promises of Psalm 23 every day get me wrong, there are many benefits to EMRs, and read on!
INTER ACTIVE Scan this code with your mobile device or visit www.cmda.org/issues for the latest information about today’s healthcare topics. Christian Medical & Dental Associations www.cmda.org 3
contents Today’s Christian Doctor
I VOLUME 46, NO. 2 I Summer 2015
The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.
5 Transformations
Medical Healthcare for 26 Mtheobile Underserved: A Unique
STORY 12 COVER Changes: A New Era
by John R. Crouch, Jr., MD Using mobile ministry to meet the needs of the poor
for Healthcare
by Gregg R. Albers, MD, FAAFP Exploring changes in healthcare as a result of the Affordable Care Act
18 Direct Primary Care
by Frederick A. Martin, MD A physician leaves traditional practice to restore his passion for medicine
Your Professional 22 RLife:esurrect Create an Exam Room Team
by Peter Anderson, MD An alternative to primary care that creates meaningful relationships
and Effective Partnership
ack to the Future: 30 BHouse Calls
by David Fisher, MD, MPH Examining how house calls are making a comeback in today’s modern age
34 Classifieds INTER ACTIVE Scan this code with your mobile device to find more online classifieds.
REGIONAL MINISTRIES
Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community
Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-522-1950 west@cmda.org
Northeast Region Scott Boyles, MDiv Midwest Region P.O. Box 7500 Allan J. Harmer, ThM Bristol, TN 37621 9595 Whitley Dr. Suite 200 Office: 423-844-1092 Indianapolis, IN 46240-1308 scott.boyles@cmda.org Office: 317-566-9040 cmdamw@cmda.org Southern Region William D. Gunnels, MDiv 106 Fern Dr. Covington, LA 70433 Office: 985-502-7490 south@cmda.org
Interested in getting involved? Contact your regional director today!
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TODAY’S CHRISTIAN DOCTOR®
EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD John Crouch, MD Autumn Dawn Galbreath, MD Curtis E. Harris, MD, JD Van Haywood, DMD Rebecca Klint-Townsend, MD Robert D. Orr, MD Debby Read, RN VP FOR COMMUNICATIONS Margie Shealy AD SALES Margie Shealy 423-844-1000 DESIGN Ahaa! Design + Production PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA). TODAY’S CHRISTIAN DOCTOR®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Summer 2015, Volume XLVI, No. 2. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2015, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Non-doctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tenn. Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Undesignated Scripture references are taken from the Holy Bible, New International Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Scripture references marked (KJV) are taken from the King James Version. Scripture references marked (MSG) are taken from The Message. Copyright© 1993, 1994, 1995, 1996, 2000, 2001, 2002. Used by permission of NavPress Publishing Group. Scripture references marked (NASB) are taken from the New American Standard Bible®, Copyright© 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977, 1995 by The Lockman Foundation. Used by permission. Scripture references marked (NIV 2011) are taken from the Holy Bible, New International Version®, NIV® Copyright© 1973, 1978, 1984, 2011 by Biblica, Inc.™ Used by permission. All rights reserved worldwide. Scripture references marked (NKJV) are taken from the New King James Version. Copyright© 1982 by Thomas Nelson, Inc. Used by permission. All rights reserved. Other versions are noted in the text. For membership information, contact the Christian Medical & Dental Associations at: P.O. Box 7500, Bristol, TN 37621-7500; Telephone: 423-844-1000, or toll-free, 888-230-2637; Fax: 423-844-1005; Email: memberservices@cmda.org; Website: http://www.joincmda.org. If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.
New CMDA President and President-Elect Every two years, the CMDA membership elects a new President-Elect. Now serving two years as incoming President-Elect, Al Weir, MD, will begin his two-year term as CMDA President in 2017 and will continue his service for an additional year as Past-President. The President-Elect announcement came as the passing of the gavel from President Richard E. Johnson, MD, to incoming President James Hines, MD, took place at the National Convention at Ridgecrest, North Carolina.
Al Weir, MD
Serving as the current President, Dr. Hines is an OB/ Gyn and adjunct associate professor at Central Michigan University College of Medicine in Saginaw, Michigan. President-Elect Dr. Weir serves as an oncologist at The West Clinic in Memphis, Tennessee, as well as a professor at the University of Tennessee Health Science Center. For more information about CMDA’s Board of Trustees, please visit www.cmda.org/trustees.
James Hines, MD
Vice President for Stewardship Development CMDA is excited to welcome Jamey Campbell back as Vice President of Stewardship Development for CMDA. Jamey completed his bachelor’s degree in communications at East Tennessee State University. In his career, he has served in several communications positions including on the staff of Senior Majority Leader Senator Dr. Bill Frist. He began his fundraising career at East Tennessee State University leading the development effort for the Health Sciences Division before joining Precept Ministries International in 2000. He previously served with CMDA from 2007 to 2011. Jamey and his wife Janeen live in Elizabethton, Tennessee. They have two daughters and one grandson. “I’m excited to be back with CMDA and look forward to serving our members and supporters as they seek to honor God in their stewardship,” said Jamey. He can be reached at 888-230-2637 or stewardship@cmda.org.
INTER ACTIVE Scan this code with your mobile device or visit www.cmda.org/stewardship for more information about how you can get involved with CMDA’s Stewardship Department. Christian Medical & Dental Associations www.cmda.org 5
transformations
CMDA 2015 Member Awards 2015 Educator of the Year Award
2015 Missionary of the Year Award
Dr. Bruce and Micky Steffes are natives of Lapeer, Michigan and attended the same church as children. He graduated from the University of Michigan College of Medicine in 1976 and then trained for six years in general surgery at the University of Florida. Micky attended Grand Rapids Baptist Bible College and finished her degree in accounting at the University of Michigan, Flint College.
Dr. Kenneth C. Hinton was born and grew up in Tuscaloosa, Alabama where he was baptized at an early age. He received his bachelor’s of science in chemistry from the University of Alabama in 1970 and then continued his studies at the University of Alabama School of Medicine. After graduating from medical school in 1974, he completed a residency in pediatrics at the Lloyd Nolan Foundation Hospital in Fairfield, Alabama.
He entered medical school with the intent of becoming a surgical professor and staying in academic medicine for a lifetime. However, he was lured into private practice in 1982. Feeling it to be God’s will, he resigned from his position of president and senior partner of his practice in 1997. He married Micky in April 1998. Since that time, they have used their surgical, business and administrative skills in hospitals and other missionary efforts in the developing world. He has spent the majority of each year since early 1998 as a volunteer physician and general surgeon in countries around the world. In addition to being speakers for for churches, service groups and missionary conferences in the U.S., they are also the authors of two books: Medical Missions: Get Ready, Get Set, Go! and Your Mission: Get Ready, Get Set, GO!
In 1977, Dr. Hinton began his journey to serving on the mission field. While he was in language school in Indonesia, he realized that his most satisfying ministry was teaching Scriptures to young people. In 1979, “Dr. Ken” began putting this teaching ministry into practice while serving for 18 years as the staff pediatrician at Kediri Baptist Hospital in East Java. He was also an instructor in pediatrics and English at the Baptist School of Health Nursing in Kediri. After leaving Kediri, he spent 15 years teaching pediatrics, medical English, English speaking and reading and cross-cultural understanding at Universitas Wijaya Kusuma, a large university in Surabaya, a sprawling metropolis of four million people in East Java. During those 34 years on the mission field, he helped form new Bible groups for young seekers and believers.
In 2003, Bruce was named to the commission of the PanAfrican Academy of Christian Surgeons (PAACS) and became the volunteer Chief Executive Officer in 2006. Bruce recently stepped down as Executive Director, but continues to serve as the Chief Medical Officer for PAACS, allowing him more time to teach and provide support for surgical educators.
In 2012, Dr. Hinton returned to West Alabama for retirement. He continues to teach English, American (Southern) culture and the Good News to international students from Mexico, Guatemala, Brazil, China, Vietnam, Korea and the Middle East through the ministries of two local churches and in three home groups.
Dr. Bruce Steffes and his wife Micky accepted the Educator of the Year Award from CMDA Past President Dr. Richard Johnson (right).
Dr. Richard Johnson (right) presented the Missionary of the Year Award to Dr. Kenneth Hinton.
Dr. Bruce and Mrs. Michelle Steffes
Kenneth C. Hinton, MD, FAAP
INTER ACTIVE Scan this code with your mobile device or visit www.youtube.com/CMDAvideos to watch the award presentation videos.
6 Today’s Christian Doctor Summer 15
transformations Editor’s Note: The following awards were presented at this year’s National Convention. These articles are excerpted from the actual award citations which can be viewed at www.cmda.org/awards.
2015 Servant of Christ Award
2015 President’s Heritage Award
Dr. William “Bill” Ardill was born and raised in Nigeria where his parents served as missionaries. He went to Ursinus College in Pennsylvania for his undergraduate degree and then to George Washington University School of Medicine in Washington, D.C. During his senior year of medical school in 1980, Bill went on a two-month missions trip to ELWA Hospital in Monrovia, Liberia. He completed his residency in surgery at Baylor University in 1985 and returned to Liberia in 1986 to serve as the surgeon at ELWA.
Dr. Jeff Keenan received his undergraduate degree in biology from Bucknell University in Lewisburg, Pennsylvania. He graduated from Jefferson Medical College in 1983, followed by a residency in obstetrics and gynecology at Vanderbilt University Medical Center in Nashville, Tennessee from 1984 to 1988. Dr. Keenan also completed a fellowship in reproductive endocrinology and infertility at Hutzel Hospital of Wayne State University School of Medicine in Detroit, Michigan from 1988 to 1990.
Dr. William and Mrs. Dorothy Ardill
Dorothy was raised in a Christian home and accepted Christ as a child. After completing her education as a medical technologist, she went to Hong Kong and Macau where she worked in the laboratory of a small mission hospital. In 1987, Dorothy met Bill when she spent the summer working at ELWA. They were married nine months later. They served in Liberia until 1990 when they were forced to leave because of the civil war. Bill and Dorothy were reassigned to Jos, Nigeria in 1992. Bill was in charge of the surgical program at Evangel Hospital, and he had the opportunity to perform surgery, teach residents and medical students and start a number of ministries. Dorothy initially worked in the Evangel Hospital laboratory, and then started a street children outreach and an AIDS widow outreach before getting a master’s degree in elementary education.
Dr. Jeffrey and Mrs. Sandy Keenan
Jeff and Sandy met while he was in medical school and they married in 1986. In 1990, Jeff and Sandy returned to Tennessee, where Jeff began serving as an assistant professor in reproductive endocrinology and infertility at the University of Tennessee Medical Center in Knoxville. In the late 1990s, CMDA approached Dr. Keenan with the idea of creating a medically-based non-profit embryo donation center as a response to the growing number of frozen human embryos in U.S. fertility clinics. That idea grew into the National Embryo Donation Center (NEDC) in Knoxville. Today, the NEDC is the premier center for embryo donation and adoption in the world, serving families throughout the United States and Canada.
Bill and Dorothy left Nigeria in May 2012, and they are now in San Diego, California where Bill works as a general surgeon at the VA Hospital in San Diego and teaches in the UCSD School of Medicine.
Sandy spent many years doing abstinence education programs in schools and now works with Jeff during embryo transfer cycles. Throughout his career, Dr. Keenan has continued to serve on faculty at the University of Tennessee. In addition to their work with the NEDC, they have also been actively involved in their local churches and international missions. Through Jeff’s church, they helped to establish an outreach program in Haiti that has built schools and a medical clinic that has grown into a hospital.
Dr. William Ardill and his wife Dorothy received the Servant of Christ Award from CMDA President Dr. James Hines (left).
The President’s Heritage Award was presented to Dr. Jeffrey and Mrs. Sandy Keenan by Dr. James Hines (left).
Christian Medical & Dental Associations www.cmda.org 7
transformations
Helping Our Colleagues in the “Other” Georgia It has been the tradition of CMDA for many years to collect an offering at the National Convention that is used to support our Christian colleagues and sister organizations around the world. CMDA-US is one of more than 75 national organizations that make up the International Christian Medical and Dental Association (ICMDA). The offering from our 2014 National Convention was used to provide financial support to doctors from developing countries to attend the ICMDA World Congress in Rotterdam last summer. With our support, more than 200 colleagues from around the world were able to attend who could not otherwise.
Included among these 200 colleagues was a group from Georgia, the nation located in the Caucasus region of Eurasia. Motivated and equipped by the conference, this group returned home to start a new “CMDA” organization for Georgia. When a recent ICMDA newsletter reported the birth of this new ministry, it was reported as being part of North America by someone thinking it was our state of Georgia. The ICMDA director in Eurasia contacted
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8 Today’s Christian Doctor Summer 15
cmda.org/icmda.
c Memoriam and Honorarium Gifts d Gifts received January through March 2015 Michelle Charlesworth in honor of Dr. Paul Halverson The Daniel Family in honor of Holly and Andy Austin Mr. Rodney and Mrs. Pauletta Lovett in memory of Dr. Mark Lovett Mark and Bonnie Renner in memory of Dr. Donald Humphreys Glenda Kirkpatrick in memory of Dr. Robert D. Kirkpatrick Elizabeth Van Ness in memory of Dr. Noel Van Ness For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.
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Of interest, the new Students at the 2014 ICMDA World organization was Congress display their nations’ flags started near the birth- during the Parade of Nations. place of Joseph Stalin, the ruthless Russian czar who tried to wipe out Christianity. We can reflect on the words of Jesus, “ . . .on this rock I will build my church, and the gates of Hades will not overcome it” (Matthew 16:18, NIV 2011). God continues to use your support of the ministries of CMDA in marvelous ways! To contribute to the 2015 ICMDA offering, please visit www.
MEDICINES FOR MISSIONS
Proverbs 27:23
us to explain the mistake, but added that the new ministry in the nation of Georgia should be credited to North America since it was our funding that made it possible.
transformations
Event Calendar
For more information, visit www.cmda.org/events.
Paid Advertisement
New Medical Missionary Training July 16-19, 2015 Abingdon, Virginia www.cmda.org/orientation
Grace Prescriptions Live Seminars September 25-26, 2015 – Los Angeles, California October 23-24, 2015 – Triangle Area, North Carolina November 13-14, 2015 – Indianapolis, Indiana www.cmda.org/graceprescriptions
Marriage Enrichment Weekends July 17-19, 2015 – Seattle, Washington September 25-27, 2015 – Minneapolis, Minnesota October 30 – November 1, 2015 – San Antonio, Texas www.cmda.org/marriage
Global Missions Health Conference November 5-7, 2015 Louisville, Kentucky www.cmda.org/events
Women Physicians in Christ Annual Conference September 17-20, 2015 Colorado Springs, Colorado www.cmda.org/wpc
2016 CMDA National Convention April 21-24, 2016 Ridgecrest, North Carolina www.cmda.org/nationalconvention
The UNIVERSITY OF TENNESSEE COLLEGE OF MEDICINE Department of Family Medicine (Chattanooga Campus) invites applications from highly qualified and experienced Family Physicians to fill a full-time faculty position at our UTErlanger Medical Center Residency Program. Qualified applicants should hold an MD/DO degree, be board certified or eligible, and have proven experience as a clinician, clinical educator and leader. Responsibilities include training our six residents per class in both inpatient and outpatient care. OB and research skills negotiable. Academic rank and salary are commensurate with qualifications and experience. Send curriculum vitae and three references to: J. Mack Worthington, MD Professor and Chair Department of Family Medicine 1100 East Third Street Chattanooga, TN 37403 Phone (423) 778-2957 Please visit the following links for information about the University, Erlanger Health System and Chattanooga: www.utcomchatt.org, www.erlanger.org, www.chattanooga.gov and www.chattanoogafun.com.
Christian Medical & Dental Associations www.cmda.org 9
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SEEN & HEARD THE CMDA VOICE
The CMDA Voice in Ministry “I began coming to Side By Side just a year and a half ago, but it has completely transformed my life and my heart. I have become closer to my Savior, my husband and have met amazing women. I cannot tell you just how much that group of women lifted me up during the struggle of intern year!”
— A Side By Side participant
“I was burning out as a physician and contemplating ways to quit medicine. Coaching completely turned this around. I went from being certain that I was done with medicine to becoming excited again about the ministry that God called me to. I am truly amazed at how quickly this transformation occurred. With a few direct questions and active listening, my coach helped me to clarify my jumbled thoughts. She pushed me to dream and imagine what my practice could possibly look like. Things that I didn’t think would ever happen are now taking place after just a few weeks.”
— Participant in CMDA’s Life & Executive Coaching program
“Some time ago, at the convention in North Carolina, you gave me a copy of the book Leadership Proverbs. I have referred to it many times since then and have suggested others buy it as well, but there is one short story in particular I wanted to pass on. We employ a number of people in India and recently the head of our India operations was over for a visit. He needed a place to sit for a day and I happened to be visiting another office for the day, so I told him to feel free to use my office. Later that night we were out to dinner with my boss and another peer and during the dinner, he proceeded to ask me about ‘that book’ I had sitting on my desk. Said he had started to read through it and really liked it. ‘That book’ was Leadership Proverbs. He proceeded to tell me he had been raised Catholic in India and really enjoyed it. He went on to say he had decided to order it for all of his managers in India. In a world where we can’t put a Bible verse on the wall in our offices anymore, I was grateful that God had found a way to pass on His Word in the corporate world despite the challenges, even more so that it was headed to India.”
— An attendee at a prior CMDA National Convention
Website Directory Members
Resources
Automatic Dues – cmda.org/autodues Join CMDA – joincmda.org Membership Renewal – cmda.org/membershiprenewal
Chapel & Prayer Ministries – cmda.org/chapel CMDA Bookstore – shopcmda.org Commission on Human Trafficking – cmda.org/humantrafficking Continuing Education – cmda.org/ce Ethics Hotline – cmda.org/hotline Events – cmda.org/events Life & Executive Coaching – cmda.org/coaching Marriage Enrichment – cmda.org/marriage Medical Malpractice – cmda.org/mmm Placement Services – cmda.org/placement Publications – cmda.org/publications Scholarships – cmda.org/scholarships Speaker’s Bureau – cmda.org/speakers Stewardship and Development – cmda.org/giving
Ministries Outreaches Campus & Community Ministries – cmda.org/ccm Dental Ministries – cmda.org/dentist Side By Side – cmda.org/sidebyside Specialty Sections – cmda.org/specialtysections Women Physicians in Christ – cmda.org/wpc
Missions Center for Medical Missions – cmda.org/cmm Commission for Advancing Medical Missions – cmda.org/camm Continuing Education for Missionaries – cmda.org/cmde Global Health Outreach – cmda.org/gho Global Health Relief – cmda.org/ghr Healthcare for the Poor – cmda.org/domestic Medical Education International – cmda.org/mei Pan-African Academy of Christian Surgeons – cmda.org/paacs 10 Today’s Christian Doctor Summer 15
Issues American Academy of Medical Ethics – ethicalhealthcare.org Ethics Statements – cmda.org/ethics Freedom2Care – freedom2care.org Washington Office – cmda.org/washington
“CMDA has been a great source of Christian community. Christian community is especially hard to find in medical school because everyone has this inherent sense that they’ve worked hard and earned their way in. It’s refreshing to know people that see their admission as a gift from God and they keep me grounded in my faith in times of trial.”
— A CMDA student member
The CMDA Voice in Missions “After the meeting we were informed of how encouraged they were to see ‘older’ medical professionals as Godly examples, living out their faith. How important it is for the younger generation to have role models and mentors to emulate. That was certainly very humbling. This experience and feedback underscores my conviction that providing encouragement and moral support to local believers whether in student ministry gatherings, the Mongolian CMDA Good Acts Society, area churches or our breakfast meetings with missionary and ministry leaders is a vital part of the spiritual work and service of MEI.
— A team participant on a MEI trip to Mongolia
“This has been an absolutely amazing experience. I had been on several short-term missions trips prior to this but this was my first primarily medically-focused excursion. Not only was I able to tangibly see and take part in what I hope to do as an integral part of my future career in medicine, but I was able to see the central role that faith plays in administering physical and medical care to the patients we served. I was stretched in a spiritually invigorating way to pray for every patient and I am appreciative that we had the opportunity and prompting to do that. Another unique aspect of the clinic that I loved was the fact that there were so many different disciplines that we were able to rotate through—PT, dental/dental hygiene, medicine, pharmacy, peds, OB/Gyn—and seeing all of us working together and using the specific gifts we’ve been given to bless others individually and corporately demonstrated tangibly before my eyes what it looks like for the body of Christ to be actively at work. Thank you again so much for your support. Know that it is not just an investment into this short week-long trip, but rather the impact of this trip will stretch into our future careers and continue to fuel our hearts for serving those in spiritual and physical need.”
— A CMDA student member on a GHO trip
“The simple ability of bringing hope to those less fortunate than we are was, in my opinion, a powerful spiritual message. This trip raised my awareness of other places in which I can serve, and feel more like I am following God’s plan for me.”
— A nurse anesthetist on a GHO trip to Honduras
“I was able to share my testimony in church, which was definitely a stretching experience for me. I experienced God’s grace made perfect in my weakness. God is more concerned with what He is doing in your heart than what He is able to accomplish through you!”
— A nurse on a GHO trip to Nicaragua
“One particular day a few of us put on a clinic of sorts for homeless people in the city, in conjunction with a pastor there who runs a church that ministers to the homeless. This pretty quickly evolved into a feet washing (literally) and prayer clinic, but the upshot of it was that we (hopefully) conveyed to those poorest of the poor that they had dignity, at least in our eyes and in those of God. I made a commitment to pray for one of these men I met for 40 days.”
— A physician on a MEI trip to Mongolia
??? HAVE YOU BEEN
TRANSFORMED? ARE YOU
TRANSFORMING OTHERS?
We want to hear from you Send your transformation story, letter or photos to communications@cmda.org or to P.O. Box 7500, Bristol, TN 37621. Please include an email address for us to contact you.
We want to hear your story It can be a simple comment about a CMDA ministry; it can be an account of your experiences on a missions trip; it can be a profile of a member who has had a huge impact upon you; it can be photos from a campus meeting; it can be statistics showing how your trip served the needy; it can truly be anything— we want to see how your work is making a difference.
We want to hear your ideas Do you have a great idea for Today’s Christian Doctor? Send your ideas to communications@cmda.org.
TRANSFORMATIONS SHOWCASING THE IMPACT OF CMDA ONE STORY AT A TIME
Christian Medical & Dental Associations www.cmda.org 11
cover story
Changes: A New Era for
Healthcare by Gregg R. Albers, MD, FAAFP
INTER ACTIVE Scan this code with your mobile device or visit www.cmda.org/reform for the latest information from CMDA about healthcare reform.
12 Today’s Christian Doctor Summer 15
Editor’s Note: It’s been more than five years since the Patient Protection and Affordable Care Act was officially signed into law, and just over two years since most of the law’s major provisions took effect. Healthcare reform has been a polarizing topic for far longer than that, and it still continues to be a point of contention in our country today, with some calling for its total repeal, others praising its effectiveness and even others fighting against it in the court system. While its future remains unclear, we are seeing significant and long-term changes in healthcare. And that change will continue to affect us as healthcare professionals. In response to the importance of healthcare reform to us as Christian healthcare professionals, Today’s Christian Doctor asked Dr. Albers to take an in-depth look at ACA’s status from a variety of perspectives. The views expressed in this article are the author’s, as CMDA does not have an official position on ACA. CMDA has addressed how some parts of the law clash with principles supported in CMDA’s biblically-based ethics statements, including right of conscience and abortion. Whether you support ACA or disagree with it, we hope this article will serve as a resource for you as you face how the law is affecting you, your practice and healthcare as a whole. ********************************
T
he word “change” provokes different reactions in each of us—positively or negatively, with excitement, trepidation, disdain or even concern. No matter how you feel about change, there’s no question that the healthcare industry in the United States has changed drastically in the last five years since the Patient Protection and Affordable Care Act (ACA) was signed into law. As healthcare professionals, we’ve been calling for change for far longer. In fact, healthcare professionals have discussed reimbursement for more preventative healthcare as a way to help reduce the overall costs of healthcare for decades. However, until the last few years, the idea fell on the deaf ears of insurance providers as progress remained stagnant.
The lack of progress remained until healthcare reform took center stage in the public eye and the political arena in recent years. And suddenly, it wasn’t just healthcare professionals calling for change—it was our patients, our families and our friends. As the clamor grew louder from all sides, our government believed it was given a mandate for change and signed the ACA into law, thereby irrevocably changing the healthcare industry in the U.S. Championed by government regulations, this change in philosophy has the potential to improve the quality of life and the cost of healthcare. Other philosophical changes aim at improving patient access to care, record compatibility and transferability, enhancing communication and improving patient safety. Increasing the quality of care morphed into the concept of paying for quality, instead of fee-for-service, without taking into consideration the issue of compliance and the difficulties with transportation for the poor. With the mandate to change, many other arms of government began flexing their administrative muscle, increasing the complexity, workload and time spent on documentation instead of time spent with the patient. With good intent, the patient-centered medical home requirements, new Drug Enforcement Administration regulations and changes in Medicare reimbursement attempt to improve care. But they also require more and more documentation, resulting in significant injury to the relationship between patients and primary care physicians. Many physicians are working two to three hours more per day just to complete this documentation, with no increase in reimbursement. Surveys of patients show that a majority of Americans were against the law before it was approved by Congress. Many of its benefits are overshadowed by its financial and procedural shortcomings. As is typical for any program designed and run by the government, the ACA is far more complex, is wrought with unintended results and bears much higher costs than originally anticipated. As we move forward, will this expensive program be overhauled, adorned with some modest
Christian Medical & Dental Associations www.cmda.org 13
improvements or transformed into a government-run single-payer system? And how will this affect the relationships we have with our patients and the work we do for them?
BENEFITS OF THE AFFORDABLE CARE ACT The Affordable Care Act pushes private insurance companies to add to their preventative care menu and meet benchmarks and requirements for exchange and private insurance programs. The improvements with private insurance increase preventative exams and immunizations, while also expanding gynecological options and services. ACA also extends to provide Medicare patients with preventative exams, immunizations and improved pharmaceutical coverage. Most importantly, a person who has a chronic medical problem or condition can now buy insurance without rejection. Politically-oriented options have become part of the preventative health menu for women’s issues, including some birth control products that are actually abortifacients. Abortion is now a part of every healthcare policy purchased, male or female, private or exchange.1 The prime financial objective of ACA is to spend money on prevention to reduce hospital costs and medical complications in the future, a worthwhile goal. Though this will help to reduce long-term care and hospital costs in the future, it will never “reduce the bloated healthcare budget” without “mandated” reductions in service, testing, pharmaceutical, procedural and malpractice costs.
PROBLEMS EXPECTED AND UNEXPECTED
When signing up, those who cannot afford insurance are referred for Medicaid or given subsidies through tax breaks. Signups to date are 13.9 million new Medicaid patients and 10 million for exchange insurance (11.8 mil14 Today’s Christian Doctor Summer 15
The law requires private insurance exchange policies hold administrative costs to 20 percent (current average is 17 percent).12,13 However, it doesn’t restrict the profits taken by the private insurers and counts on freemarket forces to keep the exchange policies affordable. Countries with universal healthcare allow only 8 to 10 percent for administrative costs and profits, plus they have government-controlled insurance prices, regulated pharmaceutical prices and much less expensive malpractice insurance and judgments. In fact, their universal healthcare costs per capita are 35 to 50 percent of what we pay for our ACA policies.14 Most patients expected the ACA changes would lower their premium costs, but now they are angry and confused as premium costs continue to rise. In the U.S., we are currently paying $10,300 per capita for healthcare. This is compared to New Zealand (socialized medicine) at $3,500 per capita and Germany (universal healthcare) at $4,900 per capita.12 Not only are U.S. health premiums twice the cost of what other countries pay for healthcare, but patients also see the physician less often.15 When you look at a taxpaying couple in the U.S., depending on deductible, the premium plus employee contribution per individual adult is $9,000 (18 percent of GDP) with $3,500 of their taxes going toward Medicare and healthcare taxes (based on a median income of $51,000 per individual).3,16,17,18,19
President Barack Obama at a healthcare rally at the University of Maryland. The rally took place on September 17, 2009 as Obama tried to get the youth involved in the fight for healthcare reform.
Photo by Daniel Borman, Creative Commons License
ACA has increased the cost for private insurance premiums that now cover preventative healthcare, along with absorbing the cost of patients with chronic health problems that will require expensive medications, services and surgery. Insurance providers have increased their premium charges an average of 7 to 9 percent. For larger, self-insured companies with healthier patients, this may be 0 to 5 percent, but for small businesses and individual policies the increases are between 20 and 50 percent, if not greater.2,3,4,5 In California, some policies have exceeded 100 percent increases.6 These increases in premiums keep people with part-time jobs or lower paying employment unable to afford private healthcare coverage, and they will be fined as a result.
lion total, but only 80 percent have paid).7,8,9,10,11 We do not know the total dollar value of subsidies and reductions offered to exchange patients. The number of healthy young people buying policies is also lower than expected, thus increasing the government’s cost estimates to higher levels than predicted. Somewhere between 60 to 70 percent of the new insurance costs will be paid for by the government through our individual and business taxes, as well as new additions to the deficit.8
In a recent public survey policy of our members,
52%
said they or a colleague have made the choice to change the way they practice healthcare because of provisions in the Affordable Care Act. Here are some of their comments: “ACA contributed to my decision to retire.” “I have been able to care for more underserved children now on Medicaid.” “I had to leave solo pediatric practice.” “Cost of practice’s health insurance has skyrocketed since ACA.” “I retired due to destruction of the doctor/patient relationship.” “Everything has changed—makes one consider getting out of medicine if it weren’t for Christ.” Many primary care and specialist physicians are unwilling to accept the lower levels of reimbursement for seeing Medicaid and exchange patients, resulting in fewer provider options for these patients. Older primary care providers are retiring early, resulting in even less available appointment slots. Recent surveys of physicians suggested six out of 10 physicians would like to retire early instead of continuing to practice.20,21,22,23 Since some of these loses were anticipated, the administration pushed for the training of new nurse practitioners to fill this gap, along with adding money for community health clinics, though many are already overwhelmed. Healthcare professionals are working more, making less and spending too much time dealing with bureaucracy. It is not surprising that many are dissatisfied and retiring early, but sadly it is leaving many patients without a medical home.
COMBINING HEALTHCARE ECONOMIC MODELS How do we change a for-profit healthcare model into a healthcare-for-all model? The authors of ACA had a huge challenge of fitting together two economically opposite portions of healthcare, dealing with both government price-control and free-market forces within the current healthcare industry. Like universal healthcare and socialized medicine, all U.S. physicians, medical offices, clinics, hospitals and rehabilitation centers are “price controlled” through Medicare allowable-pricing, a pricing that all private insurers comply with to be a co-Medicare insurance provider. The free-market portion of U.S. healthcare offers no controls on pharmaceutical pricing, insurance rules, pricing, profits, malpractice premiums or malpractice awards. Universal healthcare regulates all providers, hospitals, insurers, pharmaceuticals, malpractice and medical suppli-
ers with price controls, but all the parts are privately owned. Socialized medicine is completely owned and price controlled by the government. Before debating, reconciling and voting on this expensive two-system model, did our government look at these or other programs to weigh their benefits, costs, supply issues and the quality of care being offered? In 1996, Switzerland chose to accept universal healthcare by a slim margin of only 48 to 52. Now 19 years later, more than 90 percent of the participants rate their system good, very good or excellent.24,25
OPPORTUNITIES FOR REAL CHANGE By understanding the differences in these systems, we have a huge opportunity to change the ACA to improve and lower our healthcare costs. But the first decision is the hardest—will we put aside the free market and freedom to choose healthcare or not—because we believe all Americans deserve healthcare, no matter their ability to pay? What will happen with equal cost controls across the entire healthcare economy? Physicians will have lower salaries; hospitals will have to reduce the pay of nurses and other staff; rehabilitation facilities will offer less care; pharmaceutical companies will have less profits and initiate far fewer new medication research projects; insurance companies will have less profits and less budget for administrative costs, along with more payments for more care; and the lawyer’s medical awards “well” will be much dryer. Most healthcare professionals fear this sort of radical change, but there are no other choices to significantly reduce costs while also providing care to those who cannot afford the premium. Many needy people shun the prospect of going to a “free clinic” or applying for Medicaid to pay for health problems. Finding an answer that will be acceptable for all will require significant changes and sacrifice from everyone. The two most efficient ideas that offer the least change and help reduce the cost of healthcare are the “Medicare for all” proposal and the acceptance of universal healthcare with private ownership and controls for all healthcare costs. Under “Medicare for all,” Medicare would continue as is for our senior citizens, and the cost of a “Medicare” policy for a non-senior would be based on current average of expenditure of about $12,000 per senior member. Administrative costs for Medicare average 3 percent, Christian Medical & Dental Associations www.cmda.org 15
MINISTRY OPPORTUNITIES “When God closes a door, He always opens a window.” Popularized in The Sound of Music, most of us have seen this truth reflected in our personal lives over and over again. Even with all of the changes in patient-centered medical homes, Meaningful Use documentation, DEA regulations, Medicare changes in reimbursement and Accountable Care Organizations, there are windows of opportunity to improve the way we care for patients and minister to their spiritual needs. Though significant healthcare change is frightening for most of us, standing up for care-for-all without hesitation gives us the opportunity to share scriptural principles of individual worth, dignity and God’s desire to minister through healthcare. What about those “windows?” When most large organizations are moving toward seeing patients at five-minute intervals, Medicare and private insurers are increasing reimbursements for upper level codes, where spending time for medical evaluation, counseling and personal time are required. Investing free time in church-based free clinics and in hospital and church outreach opportunities to provide preventative healthcare to neighborhoods allows us to share our faith, both directly and through our actions. Joining and contributing to an Accountable Care Organization locally to guide their decisions on quality-of-care topics will allow you to share your witness and your motivation to help others with colleagues. Increasing the number of Medicaid and exchange patients who are invited into your practice may offer an excellent platform to witness for Christ—low income patients will realize you are sacrificing your time and money to meet their medical and spiritual needs.
CONCLUSION As the ACA continues to create waves throughout healthcare, there is no question that more changes are coming. Many physicians are looking at methods to increase their reimbursement, trading fee-for-service income into other forms of income. Patient-centered medical homes will get increased reimbursement for offering improvements in accessibility and quality of care. Concierge care, pay16 Today’s Christian Doctor Summer 15
Ahead of the anniversary of the Affordable Care Act on March 23, 2012, House Democratic Leaders held a press conference to highlight the benefits of the Affordable Care Act for America’s families and small businesses.
ing for care through a monthly retainer, will be sought by some, but it requires a high deductible insurance to cover emergencies and hospital coverage. Direct healthcare offers multiple options under the same roof. How about computer-based healthcare, telemedicine, email-based refills and distant care via internet and surgical robotics? A few primary care practices will also combine urgent care with continuous chronic disease care as visits are paid at a higher rate for urgent visits. And this is just a small segment of alternatives to traditional healthcare that we are now seeing in the U.S. No matter if we like the changes or not, the healthcare industry and our current practices have been permanently changed by the ACA. The tests and trials have arrived and, with God’s wisdom and understanding, we will find opportunities within the storm to honor Him through our care and compassion for our patients. Be open to praying for how God can open new opportunities for ministry in your practice and the area where you are working. Now is a great time with new opportunities to take our light out and let it shine for Christ. Want to join the conversation? Share your comments with us at www.cmda.org/healthcare. Bibliography 1 Plaster, Genevieve C. “Total Confusion on Elective-Abortion Coverage.” National Review Online. 5 Aug. 2014. Web. 7 Apr. 2015. http://www. nationalreview.com/article/384618/total-confusion-elective-abortioncoverage-genevieve-c-plaster. 2 The author conducted an independent survey of individuals from large companies and small companies in the Lynchburg, Virginia area, as well as a review of a broad range of statistics from government and private sources. There was an extremely broad range of percentage increases from state to state, company to company. 3 Isidore, Chris. “Health Insurance Premiums See Smallest Increase in 15 Years.” CNNMoney. 14 Nov. 2012. Web. 15 Apr. 2015. http://money. cnn.com/2012/11/14/pf/health-insurance-premiums.
Photo by Nancy Pelosi, Creative Commons License
compared to the average for private insurance of 17 percent.12,13 The non-senior pricing would be less for those who are younger and utilize less care, surgery and pharmaceuticals. The overall prices would come down due to cost adjustments in all sectors. The other option, universal healthcare, would place price controls on all sectors and slowly move prices down equally across all sectors, while maintaining ownership in private hands. Most of our current debates include these two realistic ideas.
4 “The Burden of Health Insurance Premiums Increases on American Families.” Executive Office of the President, 22 Sept. 2009. Web. 15 Apr. 2015. https://www.whitehouse.gov/assets/documents/Health_Insurance_ Premium_Report.pdf. 5 Young, Jeffrey. “Health Insurance Premium Increases Vowed By Companies For 2014.” The Huffington Post. 22 Mar. 2013. Web. 15 Apr. 2015. http://www.huffingtonpost.com/2013/03/22/health-insurancepremium-increases_n_2932704.html. 6 Jugan, Bruce. “UHC Estimates Premium Increases as High as 116% in 2014 from Health Care Reform (ACA).” California Health Insurance Information and News. 12 Dec. 2012. Web. 15 Apr. 2015. http://www. benefitscafe.com/blog/2012/12/06/uhc-estimates-premium-increases-ashigh-as-116-in-2014-from-health-care-reform-aca. 7 From the Medicaid and exchange numbers including the first quarter of 2015, a survey of multiple sources show that estimates of non-payment on the exchanges was higher than the 88% predicted. 8 Gaba, Charles. “ACA Medicaid/CHIP Spreadsheet.” ACASignups.net. 20 Jan. 2014. Web. 15 Apr. 2015. http://acasignups.net/spreadsheet-med. Estimates from ACA Medicaid/CHIP numbers, modified by reduced numbers or young/healthy insured individuals, 20 percent non-payment rate and rapid attrition rate for original exchange sign-ups. 9 Gaba, Charles. “ACA Private QHP (Qualified Health Plan) Spreadsheet.” ACASignups.net. 28 Dec. 2013. Web. 15 Apr. 2015. http://acasignups. net/spreadsheet. 10 “ACASignups.net.” Web. 15 Apr. 2015. http://acasignups.net. Confirmed Exchange QHPs: 11,780,577 as of 4/10/15. 11 Haberkorn, Jennifer. “Medicaid Enrollment Surges Ahead of ACA Sign-ups.” POLITICO. 29 Oct. 2013. Web. 15 Apr. 2015. http://www. politico.com/story/2013/10/medicaid-enrollment-surges-ahead-of-acasign-ups-98977.html. 12 “Myth vs. Fact: Administrative Costs in Medicare & Private Health Plans.” AHIP Coverage. 3 Jan. 2014. Web. 15 Apr. 2015. http://www. ahipcoverage.com/2014/01/03/myth-vs-fact-administrative-costs-inmedicare-private-health-plans. 13 Hall, Katy. “Why U.S. Health Care Is Obscenely Expensive, In 12 Charts.” The Huffington Post. TheHuffingtonPost.com, 3 Oct. 2013. Web. 15 Apr. 2015. http://www.huffingtonpost.com/2013/10/03/healthcare-costs-_n_3998425.html. 14 “Organisation for Economic Co-operation and Development.” Wikipedia. Wikimedia Foundation. Web. 15 Apr. 2015. http:// en.wikipedia.org/wiki/Organisation_for_Economic_Co-operation_and_ Development. Figures published in 2011 and extrapolated to 2014 based on 6 percent increase per year. 15 PBS Universal Healthcare Program, stated initial referendum numbers. 16 Bihari, Michael. “What Affects Cost of Health Insurance in the U.S.” About Health. 29 Dec. 2014. Web. 15 Apr. 2015. http:// healthinsurance.about.com/od/healthinsurancebasics/a/cost_of_health_ insurance.htm. 17 Robertson, Lori. “FactChecking Health Insurance Premiums.” FactCheckorg. 24 Oct. 2011. Web. 15 Apr. 2015. http://www.factcheck. org/2011/10/factchecking-health-insurance-premiums.
About The Author
Photo by Will O’Neill, Creative Commons License
Voters show their support of Obamacare on the steps of the U.S. Supreme Court on June 28, 2012.
18 “Fact Check on Administrative Costs.” AHIP Coverage. 11 Apr. 2013. Web. 15 Apr. 2015. http://www.ahipcoverage.com/2013/04/11/factcheck-on-administrative-costs. 19 “What’s the True Cost of Health Insurance Under Obamacare: EHealth Launches First National Health Insurance Price Index.” Reuters. 26 Feb. 2014. Web. 15 Apr. 2015. http://www.reuters.com/ article/2014/02/26/idUSnMKW4mVRFa 1ce MKW20140226. 20 “US Physician Survey: Health Information Technology | Deloitte US | Center for Health Solutions.” Deloitte United States. Web. 15 Apr. 2015. http://www2.deloitte.com/us/en/pages/life-sciences-andhealth-care/articles/center-for-health-solutions-us-physicians-surveyhealth-information-technology.html. 21 Christensen, Jen. “Obamacare, Doctor Shortage Could Crash Health Care System.” CNN. 2 Oct. 2013. Web. 15 Apr. 2015. http://www. cnn.com/2013/10/02/health/obamacare-doctor-shortage. 22 Gaiser, T. Elliot. “Obamacare Causes Doctor to Retire.” Daily Signal. 2 Apr. 2013. Web. 15 Apr. 2015. http://dailysignal. com/2013/04/02/obamacare-causes-doctor-to-retire. 23 Unruh, Bob. “Obamacare Has Doctors Planning Exit.” WND. 19 July 2013. Web. 15 Apr. 2015. http://www.wnd.com/2013/07/ obamacare-has-doctors-planning-exit. 24 Bachmann, Helena. “Health Insurance: Switzerland Has Its Own Kind of Obamacare -- and Loves It.” Time. 16 Aug. 2012. Web. 15 Apr. 2015. http://nation.time.com/2012/08/16/health-insuranceswitzerland-has-its-own-kind-of-obamacare-and-loves-it. 25 Roy, Avik. “Why Switzerland Has the World’s Best Health Care System.” Forbes Magazine. 29 Apr. 2011. Web. 15 Apr. 2015. http://www.forbes.com/sites/theapothecary/2011/04/29/whyswitzerland-has-the-worlds-best-health-care-system.
GREGG R. ALBERS, MD, FAAFP, has practiced in Lynchburg, Virginia for the last 31 years. He was trained at the Medical College of Ohio and completed his residency in family medicine at Mercy Hospital, Toledo. He is board certified in family practice and addiction medicine. Dr. Albers maintains privileges at both area hospitals in Lynchburg, is the medical director at Pathways Treatment Center and is a medical consultant for the department of psychiatry at Liberty University. He previously had a nationally broadcasted radio program called “Health Journal,” and he also works with publishers for articles and editing. He is the author of four books, including the American Academy of Family Practice Family Health Guide and three books on AIDS. Dr. Albers speaks nationally on issues related to healthcare reform, addiction medicine and professional practice issues. Along with Dr. Timothy Clinton, he is a co-founder of Light Family Health Center, a multi-specialty Christian clinic staffed with counselors, dentists, chiropractors, physicians and others. Christian Medical & Dental Associations www.cmda.org 17
Direct
Primary Care by Frederick A. Martin, MD
I
n late 2011, I was becoming more and more dissatisfied with practicing medicine. I was being driven by what insurance companies dictated instead of the needs of the patients I was treating, in addition to having to see more patients in a shorter amount of time to maintain the income to which I was accustomed. I began seeing and reading articles about “direct primary care” models and how the doctor-patient relationship could be restored. So, in the spring of 2012, I decided to leave the practice I was part-owner of to start my own direct primary care practice.
What is direct primary care? Direct primary care (DPC) is an innovative alternative payment model for primary care that has been spreading across the country for the last 15 years. The primary element of DPC is getting back to the basis of the doctor-patient relationship without insurance or other entities being involved because that relationship is the key to improved health outcomes, improved patient and physician experiences, lower healthcare costs and improved access to care. For a modest monthly fee—about the cost of a gym membership—patients receive personalized medical care including basic lab tests, x-rays and minor procedures. Plus, there are no co-pays or deductibles to keep track of and no permis18 Today’s Christian Doctor Summer 15
sion requirements for ordinary procedures. In addition, patients have fewer trips to the emergency room and specialists when the primary care physician can handle the matter in the office. DPC achieves this relationship with the patient by focusing on five key tenets: 1. Service: The hallmark of DPC is adequate time spent between the patient and physician. The physician is able to spend more time with each patient without hurrying to see the next patient, which allows more frequent and detailed discussions regarding lifestyle choices and treatment decisions aimed at long-term health and wellbeing. 2. Patient Choice: Patients can choose their own personal physician and are fully involved in making their own medical and financial choices. Additionally, DPC patients have the right to transparent pricing, access and availability of all services provided. 3. Elimination of Fee-For-Service: DPC eliminates the undesired fee-for-service incentives in primary care which distort healthcare decision-making by rewarding volume over value. DPC helps avoid inappropriate testing, referrals and treatment based on brief patient encounters. 4. Advocacy: DPC healthcare professionals are com-
mitted advocates for patients and assist them in their healthcare decisions. 5. Stewardship: DPC healthcare professionals believe healthcare must provide more value to the patient with higher performance, so the ultimate goal is health and wellbeing, not simply treating the disease.1
How does it function? In its truest form, a retainer-based alternative payment practice seems to be the most common form of practice. Other forms include numerous variations on the retainer-based model to an “a la carte menu” type practice. While they do have some similarities, most do not consider concierge practices to be DPC practices because of their differences. Both seek to improve the quality of care for the patient along with improvement of physician job satisfaction and pay, but concierge practices tend to have significantly smaller panel sizes than DPC practices. Access to care through the concierge practice is limited due to affordability of the membership fee, whereas DPC practices tend to improve access for low income and uninsured patients by being more affordable to the average person. DPC practices can survive in all types of communities with lower out-of-pocket and downstream costs. In the retainer-based model, the patient and physician are mutually benefited. The retainer is charged monthly and a small visit cost is collected at the time of the visit. From the patient standpoint, their monthly fee is low enough not to cause difficulty with their family’s livelihood and the office visit cost is minimal. The monthly retainer and small visit cost usually covers in-office care including minor procedures, IV fluids and basic labs. These fees ranged from $45 to $100 per month per adult and $25 to $50 per month per child, with the office visit fee from $20 to $40 per visit.
retainer-based practice model. The monthly fee allows physicians to have a guaranteed monthly income without having to worry about how many patients they see each day. This type of model also allows for much lower overhead cost. In most cases, the minimal visit cost basically covers the overhead cost for that visit. Therefore, the physician is able see fewer patients per day with more time to see each patient. Allowing more time to develop the doctor-patient relationship without interruption will lead to better quality of care and improved outcomes. Having adequate time to listen to and care for the patient is the one of the main reasons we went into healthcare in the first place. More time with patients is the biggest contributing factor to why DPC physicians report significantly improved job satisfaction. However, DPC practices do face some uncertainty due to legal concerns with regard to lack of policy consensus regarding DPC providers. Specifically, the concerns focus on how the state and federal laws and regulations should treat such practices. The first concern is whether DPC providers are acting as “risk bearing entities” when providing care in exchange for a monthly fee, as well as whether or not they should be licensed and regulated as insurers. Currently, the policies and regulations vary from state to state. For example, Utah enacted laws to clarify that DPC practices are explicitly exempt from insurance regulation. In the Affordable Care Act, the U.S. Department of Health and Human Services (HHS) recognizes that direct primary care medical homes are providers, not insurance companies. However, to qualify under this, the DPC medical home enrollment
When I began researching different models of DPC clinics, I didn’t think my local Tri-Cities area in East Tennessee was ready to buy into this current retainerbased model. Instead, I decided to start this new venture with a “pay as you go” model. With this model, the patient pays for the visits at the time of service without a monthly or quarterly membership fee. Our office visit fees are significantly lower than traditional practices and urgent care visits. Our goal at the beginning was to run the practice as lean as possible with very low overhead, so we started with two volunteer staff members: one nurse (my wife) and one receptionist (my mother).
Is it working? Based on a review of data regarding DPC practices, the model that seems to be the most successful is the Christian Medical & Dental Associations www.cmda.org 19
Based on NHANES 2007-2010 data, only 50 percent of patients nationally with high blood pressure who are seeing a doctor and are being treated for high blood pressure have their blood pressure under control. On the other hand, patient data from Dr. Forrest’s DPC clinic in North Carolina from 2011-2013 showed 80 percent of patients at goal at a lower cost of care. During my time practicing my DPC model, I believe my stress level has significantly decreased and my enjoyment of caring for patients has increased. Being able to return to the doctor-patient relationship renewed my reason for becoming a physician. I am able to invest in both patients’ and their families’ lives. Together, we are able to provide care by treating their physical, emotional and spiritual illnesses. In this model of practice, I have the ability to spend time talking with patients without feeling rushed by the need to see more and more patients per day. must be coupled with a wraparound insurance plan (catastrophic insurance) that meets all applicable requirements. Unfortunately, at this point the Secretary of HHS is responsible for setting these requirements, and the secretary has been slow in establishing these criteria. Additionally, under IRS code, health savings accounts (HSAs) cannot be used to cover the monthly fees if the patient is covered under a high deductible health plan that covers primary care benefits. Several members of Congress are currently trying to address this issue by changing the code to allow HSAs to cover DPC fees for patients. And finally, in order for DPC providers to see Medicare patients, the providers have to opt out of Medicare, otherwise they may violate Medicare’s current balance billing prohibition which forbids physicians from charging in excess of allowable rates. If physicians who are participating in Medicare try to collect a monthly fee for direct primary care for services covered under Medicare, then they are in violation of this law. Therefore, physicians who provide direct primary care to Medicare patients should opt out of Medicare for now. Until Congress eliminates current barriers and restrictions, it will be difficult if not impossible for Medicareparticipating physicians to see Medicare patients through the DPC model.
Pros vs. Cons From the patient side of the DPC model, patients are able to benefit from lower out-of-pocket healthcare costs with better quality of care––which leads to better outcomes. In studies conducted by Brian Forrest, MD, he found these premises to be true and reproducible. 20 Today’s Christian Doctor Summer 15
In our DPC model, the practice overhead is lower, but it does vary based on services provided by the practice. In my current practice, I provide a full range of services from suturing, casting, lump and bump surgery, vasectomies, colposcopy, cryosurgery, biopsies, etc. As such, my overhead runs approximately 45 percent, which is about 15 percent lower than traditional family practice. Another advantage to DPC practice is less bureaucracy and paperwork. However, there are some disadvantages too. My income has not been consistent due to fluctuating numbers of visits per day. People will not see us unless they have the cash on hand, so our schedule can be extremely light some days and heavy other days (averaging nine to 15 patients per day). This makes my income significantly less than what I was making in traditional fee-forservice practice. Based on our experience, the model of a monthly retainer or membership fee with a small visit fee provides a higher, more consistent monthly income. Patient recruitment is also more difficult because of the “co-pay” mindset—they expect to either not pay or pay very little for their healthcare. DPC is a foreign concept for most patients who don’t like to pay for something they don’t receive or use, so the retainer or membership models require some education to the advantages of this style of practice.2
The Christian Perspective From a Christian perspective, DPC opens a great avenue for sharing your faith with your patients and their families as it allows you to spend more time getting to know and interacting with them during the visits. In traditional practices, time constraints can limit your ability to allow deeper discussions about underlying
issues influencing the patient’s condition. Recently, a young lady presented to my office with complaints of having frequent palpitations and associated symptoms including anxiousness. She was seen by several other physicians throughout the course of her care with only partial evaluation of the problems due to cost of care. In the DPC setting, she was able to complete her work-up including a holter monitor for less than $200. During the prolonged office visit, we were also able to explore the underlying cause of her anxiety which was the source of her cardiac symptoms. She had been the victim of abuse by a family member when she was a teenager. Only because I was able to spend time with her, listening to her describe her symptoms and developing the doctor-patient relationship, were we able to get to the base of the problem. Now that trust has been established, we can work together toward both emotional and spiritual healing for her. In the DPC setting, underinsured and uninsured people are able to have access to quality physician-driven healthcare that doesn’t break the bank. By eliminating the middle man in healthcare, physicians are able to care for those with limited resources and inadequate access to good healthcare. And as Christian physicians, we are afforded the opportunity to provide care to the poor with minimal to no cost, depending on their needs. Plus, our charges are frequently adjusted because of our patients’ various financial situations.
Conclusion Before transitioning to this DPC model, I communicated with my patients and explained my future plans both during visits and by letter. In total, approximately 300 patients started the new practice with me. Since that time, the practice has grown slowly but steadily, gaining several new patients per week on average. So far, our best means of publicity has been word of mouth. As our patient base grows, so does our publicity through word of mouth. Since making the change nearly three years ago, we have been able to keep the bills paid at home and at the office by God’s provision on more than one occasion. He has been faithful in meeting our needs when we least expect it. We have sacrificed and not done some of the things we did previously with the higher income, but we have been less stressed and more relaxed than when I was in the traditional group practice. You can take advantage of this practice model too. More and more healthcare professionals are turning to DPC practices to be able to spend time with patients, developing relationships and sharing both emotionally and spiritually. Plus, you can improve the doctor-pa-
tient relationship without outside interferences from insurance companies while providing care that is lower cost with improved satisfaction of care and better outcomes. I personally am glad that I have transitioned to the DPC model and will not go back. If you are missing patient-centered care, I encourage you to seriously consider joining me in the direct primary care model. Additional Information cCorry, Daniel. “Direct Primary Care: An Innovative Alternative M to Conventional Health Insurance Backgrounder.” The Heritage Foundation. 6 Aug. 2011. Web. 27 Apr. 2015. http://www.heritage. org/research/reports/2014/08/direct-primary-care-an-innovativealternative-to-conventional-health-insurance. ii “DPC: An Alternative to Fee-for-Service.” American Academy of Family Physicians. Web. 27 Apr. 2015. http://www.aafp.org/ practice-management/payment/dpc.html. iii “AAFP Direct Primary Care Toolkit.” American Academy of Family Physicians. Web. 27 Apr. 2015. https://nf.aafp.org/Shop/practice-management-tools/dpc-toolkit. iv Ferris, Jennifer. “The Happy PCP: $400K/Yr and Home in Time for Dinner.” MedPage Today/North Carolina Health News. 7 Nov. 2014. Web. 27 Apr. 2015. http://www.medpagetoday.com/Blogs/ ProfilesinPractice/48459. v Chase, Dave. “On Retainer: Direct Primary Care Practices Bypass Insurance.” California Healthcare Foundation. Apr. 2013 Web. 27 Apr. 2015. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20 Files/PDF/O/PDF%20OnRetainerDirectPrimaryCare.pdf. i
Bibliography 1 “Our Principles.” Direct Primary Care Coalition. Web. 27 Apr. 2015. http://www.dpcare.org. 2 Forrest, B.R. “New Primary-care Models Can Change the Way You Practice Medicine.” Physician’s Practice Pearls. 11 Dec. 2011. Web. 27 Apr. 2015. http://www.physicianspractice.com/ pearls/new-primary-care-models-can-change-way-you-practicemedicine.
About The Author
FREDERICK A. MARTIN, MD, received his medical degree from University of Tennessee - Memphis then completed his residency in family medicine at Spartanburg Regional Medical Center. He went on to start a solo practice in Banner Elk, North Carolina, practicing the full scope of family medicine including surgical obstetrics for more than 10 years before moving back to the Tri-Cities in Tennessee where he grew up. In 2012, he left traditional practice to start a direct primary care practice. Dr. Martin enjoys his time with family which includes his wife of over 31 years, Carol, and three children, Rachel, Benjamin and Joshua. His passion includes devoting time to mission work in both Haiti and Mexico. Christian Medical & Dental Associations www.cmda.org 21
INTER ACTIVE Scan this code with your mobile device or visit www.shopcmda.org to order your copy of A Model for Joyful and Efficient Patient Care with Peter Anderson, MD. In this new resource, Dr. Anderson will share more about how this new model of patient care will help you revitalize your passion for healthcare. —Photos courtesy of Peter Anderson, MD
Resurrect Your Professional Life Create an Exam Room Team by Peter Anderson, MD
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idway through 2003 I was $80,000 in the red, working 60 to 65 hours per week, hating healthcare and trying to figure out why I ever became a family physician. My patients were frustrated by the poor access and rushed visits, plus my staff morale was low. Worst of all, I had become a ghost to my wife. Ever since I began using my hospital system’s electronic medical record (EMR) in 1998, all of my time at home was controlled by the need to get back to the computer to finish office work. Evenings, early mornings and weekends were no longer family time but time with my computer instead. I reached the end of my rope in late 2003, but God’s grace began inspiring new ideas and enabling me to risk some changes. The previous 20 years had shown me the exam room was the critical place in need of innovation. I realized I needed a new approach and this was the time.
The world in which we practice primary care today is drastically different than it was in the past. Significant changes have occurred in the last 30 years as a result of an aging population with numerous chronic diseases, an explosion of pharmaceuticals, a rise in malpractice concerns, an expanded regulatory environment, a growing pool of recently covered patients, high expectations all around and the mixed blessing of electronic medical records. In the midst of these changes, almost all clinicians are still working within an exam room process that has not been altered much since modern medicine moved away from house calls in the 1940s. More equipment may be attached to the exam room wall these days, but the process itself has changed little, except for the fact that, in many cases, the physician has also added computer-based data input to his or her responsibilities. One of the greatest casualties in medical practice over the last three decades from the aforementioned changes is the loss of the doctor-patient relationship. Due to poor access and exhausted physicians, patients no longer expect to see a physician they know. Yet the relationship of trust between physician and patient has long been recognized as critical to quality care. One of the foundational principles of medical education is the clinician’s responsibility to build and sustain trustworthy relationships in order to understand patient concerns, elicit requests, negotiate diagnostic and treatment strategies, educate patients about their health or illnesses, review adherence to treatment plans and assess intervention outcomes. Throughout the history of healthcare, this “familiar physician”—the most important entity in medicine—has been the key to qual-
ity-producing, cost effective and patient-satisfying care. Any meaningful, truly corrective innovation for the needs of today has to restore access to this trusted relationship. The patient-centered medical home, the new standard for primary care in the 21st century, has become the ideal and rightly so. The foundational elements— a personal physician, team dynamics, whole person orientation, access, communication, quality, health information technology, coordination and cost savings—are good, but not easy to accomplish when healthcare professionals are already overwhelmed. Essentially, healthcare delivery is relying on an obsolete “inside-the-exam-room” process that includes the healthcare professional doing too many tasks that other staff members with different (and less) training can do well. The result is a growing number of unsatisfied physicians, a host of patients left feeling rushed, staff members not working at the full capacity of their training and the looming threat of professional burnout, a possibility raising considerable concern in the healthcare community. For these reasons, I knew any possibility of saving my practice had to begin in the exam room through the transformation of clinical delivery. Initially birthed from desperation, The Exam Room Team model later became a rewarding process I have now used effectively for years. The process looks like this: A medical assistant, licensed practical nurse or registered nurse (for brevity’s sake, we’ll use MA going forward to describe all three positions) welcomes the patient and begins asking symptom or disease-associated questions based on physiciandeveloped protocols related to the reason for the visit. This preliminary information is recorded in the patient record. The MA then performs medication reconciliation by reviewing the current list in Christian Medical & Dental Associations www.cmda.org 23
the EMR and documenting any inaccuracies. The MA also reviews and makes necessary updates to the patient’s allergy, surgical, social and family histories. In addition, the MA reviews approaching or overdue health maintenance topics and pending orders for recommended tests or procedures, as well as the responsibilities given to the patient in previous visits. Next, the MA updates medical events occurring outside the office since the patient was last seen and performs a specific review of systems appropriate for the patient’s current needs. When the physician begins the patient visit, the MA verbally communicates the preliminary information to the physician in the patient’s presence and then serves as a scribe during the examination. At this point, the physician confirms the preliminary information and further interviews the patient, completing the information-gathering process. The physician also questions the patient on the status of any chronic conditions and other issues in need of attention while the MA enters additions or corrections into the EMR as directed by the physician.
The physician then performs the exam, verbalizing any abnormalities, which the MA documents in the EMR. The physician spends the rest of the visit developing the diagnoses and treatment plan while maintaining a direct and uninterrupted conversation with the patient and any accompanying family members while the MA carries out all the EMR-related tasks. After the physician finishes discussing the plan with the patient, the physician leaves the room to see the next patient (where another MA has done the same preliminary work for this patient’s visit). In the previous room, the MA once again reviews the treatment plan with the patient and closes out the visit. Quality, productivity and satisfaction for the patient, staff and physician all increased dramatically with this Exam Room Team model.1 Plus, the efficiencies in patient flow leading to more productivity have proven to more than offset the cost of hiring additional staff for this process. I was able to practice the “art of medicine” again because I was available to see my patients when they needed to be seen and could focus on the patients instead of so many ancillary responsibilities. I could provide convenient access in the context of a trusted relationship, the primary thing a patient needs and deserves. This process reestablished the doctorpatient relationship for me as I was freed up from non-physician work. I was able to offer renewed focus on the patients and had time to speak to their physical, emotional or spiritual needs—the real reason I went into primary care. With the restoration of this relationship and the capacity to practice the best care of my 30-year career, I fell in love with family medicine again. With specific help from my nurses inside the exam room, I finished my work at the office and could be present with my wife when I was home. Evenings, mornings and weekends were freed up for my personal life again. The Exam Room Team gave me these results: • All HEDIS measures recorded for my practice were in the national 90th percentile. • Patient satisfaction was at the 95th percentile due to the availability of daily access to their physician.
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• Staff satisfaction was at the top of the system because of personal engagement in meaningful work. • Collections were up by almost $200,000 per year within three years after beginning the changes in the exam room process. • Access was restored to an average of 150 patients per week with 15 urgent slots available daily. • Work/life balance was restored and I was working 40 to 45 hours per week (which included all professional activity). With this Exam Room Team, I became the first medical home to be recognized by the National Committee for Quality Assurance in my home state of Virginia in 2009. It took me several years to hone the process, but with proper training, a physician or other clinician-led team can apply what I learned and see demonstrable improvement within six months. Besides specifically equipping the staff with the necessary skills, the biggest obstacle to this process is internal—it requires the willingness of physicians or other healthcare professionals to let go of an obsolete process. I am here to tell you the transformation is worth it. Of course, variations of the approach are available, but anything that enables healthcare professionals to spend more quality time with patients, which statistically results in better outcomes, is a step in the right direction. It only takes seeing about two extra “urgent” patients each day to pay for the specific help of an MA for the entire day. The increased productivity (which can be much more than seeing an additional two patients) of this model easily pays for the extra responsibilities necessary for the PCMH as well as giving a significant boost to the physician’s profit margin. This process actually makes primary care a profitable business again. (A more in-depth look at the history and value of the PCMH and our development of it after mastering the Exam Room Team can be found in my book The Familiar Physician, available through Amazon and Barnes & Noble.)2 Anyone who has gone to medical school can easily understand patients’ needs are met in a well-functioning medical home, but I was drowning in 2003. If I had remained in that condition, it would have been absolutely impossible to meet today’s higher standard of medical care—even adequate care was extremely difficult for me to deliver back then. Simply working harder could not fix the brokenness of my practice—I needed a completely new process. After coming to my office in 2010 and observing our team for two days, Dr. Kevin Hopkins from the Cleveland Clinic validated this process. In his article recently published by Family Practice Management, he confirmed
the same results I experienced. Since his 2010 visit, the Cleveland Clinic has rolled this process out to several primary care practices and plans to move this team model into all their primary care practices and specialty areas as well.3 When I resigned from active practice at the end of 2011 to transition to training other physicians in this process, I realized again that this change was bigger than just staff increases, skill sets or finances. Patients were crying as I said goodbye, and I was crying too. And then it hit me—I had experienced the best of healthcare: meaningful relationships. This process had not only resurrected my professional life; it had restored my friendships. And through friendships, Jesus had used me.
Bibliography 1 Anderson P, Halley M. A new approach to making your doctornurse team more productive. Fam Pract Manag. 2008;15(7):35–40. 2 Anderson P. The Familiar Physician: Saving Your Doctor in the Era of Obamacare. Morgan James Publisher. 2014. 3 Hopkins K, Sinsky C. Team-Based Care: Saving Time and Improving Efficiency. Fam Pract Manag. 2014 Nov-Dec;21(6):23-29.
About The Author PETER ANDERSON, MD, completed his medical degree at the University of Virginia School of Medicine in 1978 and his residency training in family medicine at Riverside Regional Medical Center in Newport News, Virginia. He was a solo practitioner for a dozen years before joining the Riverside Medical Group, a network of more than 475 primary care, specialty and subspecialty providers in Southeast Virginia. In 2003, Dr. Anderson introduced Family Team Care®, a practice model that epitomizes the highest and best use of clinical personnel. In 2005, he authored his first publication, Liberating the Family Physician. In 2009, Dr. Anderson was granted the first NCQA recognition as a patient-centered medical home (PCMH) family practice in Virginia. In 2013, he released his second book, The Familiar Physician: Saving Your Doctor in the Era of Obamacare. Through television, radio, print magazines, and local appearances since 2007, Dr. Anderson has spoken to thousands about the need for physicians to re-invent the exam room care delivery process. To learn more about the impact Team Care Medicine is making in primary care offices, visit http://bit.ly/TCMCaseStudy to download this case study. Christian Medical & Dental Associations www.cmda.org 25
Mobile Medical Healthcare for the Underserved A Unique and Effective Partnership by John R. Crouch, Jr., MD —Photos courtesy of John R. Crouch, Jr., MD
INTER ACTIVE Scan this code with your mobile device or visit www.cmda.org/domestic to get involved with CMDA’s domestic mission outreaches.
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walked into the exam room in our mobile medical van and greeted W.J., a patient whose name looked familiar but I only vaguely recognized him. Then I saw my note from two months ago. He presented then as an early 30s African American male who recently moved to Tulsa, very disheveled, and his train of thought was hard to follow. We gradually ascertained a diagnosis of schizophrenia, diabetes and hypertension. Since his initial visit, he had run out of all his medicines and all his problems were uncontrolled, so we started him back on his meds. Since then, our driver Tommy, along with volunteers from the church partner, have met with him several times and have been counseling and praying with him. He is now going to church regularly, and, with his medical problems better controlled, he shared with me his testimony of how his life has changed as a result of our mobile medical ministry. W.J. is just one patient served by one of our 13 clinic sites where we partner with churches to take whole person care to the underserved right into our communities of need. It’s a ministry we started because caring for the poor is a biblical mandate (Deuteronomy 15:7-11, Luke 3:11-14, 2 Corinthians 9:6-13, Matthew 19:16-24, Matthew 25:31-46), and that includes healthcare.
The Growth of a Mobile Ministry
Caring for the healthcare needs of the poor involves a variety of different methods. Some give financially to support healthcare missions in developing countries. Others give their time and skills to a mission clinic or a church-based clinic for the poor in the U.S. And some have designated appointment times in their practices when they give services without remuneration. Still others run clinics for the poor as a full-time ministry in underserved neighborhoods. Another method is what we do through Good Samaritan Health Services (GSHS) in Tulsa, Oklahoma, as we use mobile medical vans to serve the poor in partnership with multiple churches.
In partnership with Cornerstone Assistance Network of Tulsa, Oklahoma, an organization dedicated to equipping churches for their outreach to the underserved, we started a monthly clinic in 1997 in a low income housing area. We offered a compassionate ministry in a quality and caring way, and the community response was great. It quickly grew into a weekly clinic, and it wasn’t long before we started getting requests from all over Tulsa asking for similar free clinics in areas of need. We reasoned that we must somehow become mobile in order to accommodate the other areas, so we considered a van or minivan to transport our supplies. Then we heard from a CMDA member in Chicago who was doing a church-based clinic for the underserved, and he said that a benefactor was willing to give a mobile medical van to someone who was doing healthcare for the poor in the U.S. as a Christian ministry. Well, that was certainly us, so we immediately applied for a van and a representative of what is now the Foster Friess Family Foundation drove our first vehicle to Tulsa and handed us the keys and title in November 1999. It was a 35-foot truck/van with two exam and treatment rooms, a mini-pharmacy and a nurses’ station, plus it was heated and air conditioned. By early 2000, we were in three different clinic sites partnering with a number of churches. Throughout the years, the ministry continued to grow. By 2007, we were seeing thousands of patients each year at seven different sites, but the van was starting to show some wear and tear. So we went to visit our benefactor, Foster Friess,
GSHS grew out of the In His Image Family Medicine Residency. When the Oral Roberts University School of Medicine and the City of Faith Hospital closed in 1989, we formed In His Image to continue a Christian family medicine residency, support worldwide healthcare missions and do something about healthcare for the underserved in our own community. Christian Medical & Dental Associations www.cmda.org 27
and asked if he would consider giving us another van. He quickly agreed to give us a matching grant for half of the purchase price and suggested we raise the other half in Tulsa. We did so and purchased and refurbished a 63-foot semi-trailer truck with heating and air conditioning, three spacious exam and treatment rooms, mini pharmacy, nurses’ station and a mini lab. Since then, we have grown to 13 clinic sites, partnering with more than 30 churches. More than 200 volunteers provide over 13,000 volunteer hours, we hold more than 50 clinics per month and we provide over $1 million worth of medications and supplies donated by other partners. We estimate that we easily saved more than 486 ER acute care visits in 2014. And it continues to grow, as we just received our third mobile unit. But it doesn’t stop there. A “Well Woman” clinic is also held each month in multiple sites, and we have now started men’s health clinics, where we are discovering untreated hypertension, diabetes and other problems in men who ordinarily won’t go to the physician. In addition, we are in Phase 1 of a project in which we are screening the underserved, particularly diabetics, for retinopathy, one of the great causes of blindness in the middle aged and just beyond. The underserved population simply doesn’t have access to this type of screening, so we are excited to see this project come to fruition.
The Benefits of a Mobile Ministry
So what are the advantages of this particular method of taking God’s healing love to the poor? Most importantly, using mobile medical vans allows us to take whole person quality care right into the community of need! Whether that need is due to geographical isolation with no transportation or social isolation because of a fear of government clinics or feeling dehumanized in other clinics, our church partners respond to those patients by reaching out with Christian love, care and prayer. Additionally, our church partners provide many compassion ministries to bless our patients and form a groundwork of trust for prayer and sharing of faith. We have come to realize our niche of service is to utilize our mobility and the partnership with churches and church volunteers to serve the people who are falling through the cracks of the regular health system. And just like the ministry of CMDA, our purpose in mobile ministry is to see transformation in the lives of those we are serving and, in the process, see transformation in our own lives. 28 Today’s Christian Doctor Summer 15
The results of that transformation are starting to be plentiful within the communities we serve. Take G.H., for example. She is 49 years old. She is one of eight siblings and has always felt unloved. She was molested by her father. At age 18, she got married but found herself with an abusive husband who supplied her with drugs. She was afraid to leave, so she stayed with him until he died in 2010. To support her habit, she prostituted herself and shoplifted, which landed her in prison with a couple of felony charges. It was when she was at Eddie Warrior’s Correctional Facility that she met up with Pastor Dixie and found a whole new way of life. In 2014, G.H. was released from prison and connected with Pastor Dixie’s God’s Shining Light Church. During that critical first year, her medical needs were met at both the women’s clinic and one of our regular clinics. “Good Samaritan was there when I had no one else,” she said. Now she is employed and has insurance. She met us with a smile the day of the men’s clinic earlier this year, happily cleaning up after the outreach. She was excited because God made a way for her to have some tattoos removed—past relics of a life that was no longer hers. Pastor Jonathan Reichman of Riverside Baptist Church told us that a substantial number of new attendees/ members of his church have come through the clinic. It’s a blessing to see this ministry continue to grow and make an impact in our community.
The Challenges of a Mobile Ministry Just like with all ministries, we do face challenges in mobile ministry. One challenge is finding healthcare professionals. Busy healthcare professionals have “day jobs” that consume much of their time and energy. We do have volunteers working in our daytime and evening clinics, but we also hire a full-time physician and nurse practitioner to staff the daytime clinics. Second and third year residents in our residency program are required to “volunteer” at least once per month. Many volunteer to do
more, as do many first year residents who can work with a licensed healthcare professional as back-up. Because of the sheer volume of people needed, this entire outreach ministry does not work without faithful church volunteers. We believe the best situation is to get at least three churches to partner together so volunteers do not experience burnout. We now have a semi-annual pastors’ luncheon to recruit new church partners. We require a site coordinator from one of the churches for each site and volunteers undergo training and learn to use our medical protocols (confidentiality, disposal of biologic waste, needles, etc.). Our program is supported by a mixture of both paid and volunteer workers. Of course, there is the challenge of maintaining the vehicles: gas, maintenance for wear and tear and, for our large van, a Class A driver’s licensed person. Plus, there is the challenge of obtaining labs and imaging, as well as consultations for problems that can’t be managed in the van. Our St. John Health System partner for our residency has supported us with those types of services as well as financial support as part of their mission as well. Our work clearly helps to decrease the non-pay patients who go to their ERs and are admitted to the hospital. As our reputation for providing quality and caring care has been recognized by the community, we have enjoyed increasing support from foundations and individuals in the community. We, therefore, raise support from individuals, churches, foundations and hospitals. The hindrances for not starting a mobile medical van ministry include not having champions who really believe in this method. Vehicles do break down and have to be replaced. It might be considered expensive, but is it? The cost per patient is about $120 per visit, including doctor evaluation, labs, x-rays and most medications (we supply about 60 to 70 percent of the patients’ medications).
Conclusion
It’s easy to get bogged down by these challenges and hindrances. Laid out together, it might seem too overwhelming, too daunting to even begin considering starting such a ministry in your community. But it’s important to remember that alongside those challenges is a great host of benefits—benefits for you, your community and more. There are obviously great benefits for the patients who can be diagnosed and treated in their own community. In addition, our volunteers love this approach and find it a great opportunity for serving their own community with Christian love. Our healthcare professionals are also blessed by reaching out to the poor in Jesus’ name in this unique way. And churches
are not only expressing their compassion for the underserved in our community but have also found it to be a way to partner together. If you are interested in considering mobile medical vans to provide healthcare for the underserved in your community, I encourage you to learn more from Christian Community Health Fellowship at www.cchf.org. In partnership with CMDA, CCHF can help you learn about the mechanics of mobile medical clinics, serving the poor and more. You can also contact us at www.GoodSamaritanHealth.org. If you are giving serious consideration to mobile medical vans, we encourage you to pay us a visit so we can share even more about this important outreach ministry. As Jesus says in Matthew 25:40, “…inasmuch as you have did it to one of the least of these My brethren, you did it to Me” (NKJV).
About The Author
JOHN R. CROUCH, JR., MD, is currently the President of In His Image International, Executive Director of the In His Image Family Medicine Residency Program and President of Good Samaritan Health Services, Inc. He graduated from Southern Illinois University and the University of Illinois, Urbana, in 1963. He continued his education in medical school at Washington University School of Medicine and completed an internship and family medicine residency at San Bernardino County Medical Center in California. Dr. Crouch has had a variety of experiences in his medical career, including a tour as a Medical Officer and a Battalion Flight Surgeon for the U.S. Army in Vietnam, where he received the Bronze Star and Air Medal awards. He went on to practice emergency medicine and family medicine in San Bernardino. He then moved to Tulsa, Oklahoma with his family in 1978, joining ORU School of Medicine, holding a variety of positions until 1990. He then joined with other physicians to form Family Medical Care of Tulsa and In His Image Family Medicine Residency Program. Dr. Crouch previously served as President of CMDA from 2012 to 2014. Christian Medical & Dental Associations www.cmda.org 29
Back to the Future:
HOUSE CALLS by David Fisher, MD, MPH —Photos courtesy of David Fisher, MD, MPH
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“M
rs. Johnson was hoping you could visit her today.”
“Alright,” I tell my office assistant through a Bluetooth earpiece after a quick glance at the GPS. “I should be able to get to her home by 3.” I hang up the cell phone and park in front of my next stop. Mr. Carter has advanced amyotrophic lateral sclerosis (ALS) and requires continual support from a mechanical ventilator at home. A trip to the doctor is costly, difficult and risky. He and his wife have told me many times how grateful they are to have a physician who makes house calls. The house call was once a fixture of American healthcare. Prior to World War II, house calls accounted for 40 percent of all patient-physician encounters.1 By 1980, this number plummeted to 0.6 percent.2 When I tell people I make house calls, the usual response is: “I didn’t know doctors did that anymore.” The factors that led to the near extinction of house call practice are complex and ubiquitous, but house calls are making a comeback. After answering a patient’s email question on my iPad (sent through a secure patient portal), I grab my black bag and walk to the door. Mrs. Carter answers with a smile. “Jim’s been looking forward to your visit.” she says. I find Jim in his usual place in the first-floor bedroom. His ALS has now paralyzed him from the neck down, and he lies in a hospital bed. He is unable to speak due to the tracheostomy connected to his ventilator, but he manages a smile. I sit down next to his bed, open up the iPad and log in to the electronic record. Mr. Carter begins to relate his latest symptoms by gazing at a letter board and sequentially spelling out his words. Over the last two decades, house calls have become more popular among patients and healthcare professionals. The home health industry has steadily grown to keep up with rising demand. As the baby boomer generation enters retirement age and people are living longer with chronic illnesses, more people require long-term care assistance. Many patients and their families choose to seek this care in the home, rather than move to a senior living facility or nursing home. Home health agencies that provide nursing, physical therapy, occupational therapy and social services depend upon close communication with physicians for orders and direction. Medicare and other insurance carriers have increased the requirements for face-to-face interactions with physicians to certify these services, often making it difficult for office-based primary care physicians to meet the needs. Home care physicians are increasingly bringing primary care medicine into the home.
As a member of Doctors Making Housecalls in Durham, North Carolina, nearly all of my patient encounters are home-based. In a typical day, I will visit an assisted living or independent living facility and see 10 to 15 patients. After I complete my orders and documentation, I will then make one to three private house calls. Most of the physicians in my practice follow a similar pattern, working four to five days per week. Records are kept electronically, so the practice employs a growing support staff working out of a central office to manage scheduling, billing and other administrative duties. I joined the practice in 2010 as its 10th physician, when the practice geography was limited to the Raleigh-Durham area. Today, Doctors Making Housecalls employs more than 40 physicians, physician assistants and nurse practitioners who visit patients across the state of North Carolina. House calls bring numerous benefits to patients. While some choose house calls for convenience, most request them out of necessity. Older patients with dementia, stroke, ambulation problems and other comorbidities find it extremely difficult to leave the house. Traveling to the doctor’s office for a 15-minute office visit can turn into an all-day affair for patients and their caregivers. Frail patients may be inadvertently exposed to transmissible illnesses in the physician’s office. Falls can occur during transport. Patients with cognitive impairment may have difficulty waiting. Those with arthritis or other mobility-limiting problems may have trouble climbing onto an exam table. For physical reasons alone, house calls are often a safer and preferred method for interacting with vulnerable patients. Christian Medical & Dental Associations www.cmda.org 31
When a healthcare professional visits a patient’s home, it is much easier to evaluate the true nature of the patient’s health. In my experience, some patients, particularly those older than 70, tend to present the best-case scenario to their physician in the office. Some may be less than forthcoming about problems they have in the home, such as falls, medication management or other caregiving needs. When healthcare professionals directly lay eyes on the home situation, they can quickly deduce whether patients are taking their medications correctly, whether they are living in a safe environment and whether their daily needs are being met. As a result, physicians who make house calls can spend less time probing the patient about their home environment and more time focusing on meeting the needs they observe. In my experience, patients also tend to be more honest with their physicians when seen in their home environment. A healthcare professional who visits the home builds immediate trust. It takes a certain vulnerability to allow someone into one’s home, and this openness tends to translate to other aspects of the patient-physician interaction. Patients who trust their physicians also tend to follow instructions and adhere to their treatment plan. Many patients express a desire to receive “wholeperson” care when interacting with the healthcare community, and visiting patients in the home adds to that sense of continuity and conscientiousness. Recent data shows that patients who receive medical care in the home will visit the emergency room much less often and are hospitalized less frequently. House call physicians will often discover a problem before it progresses to the point that
requires hospitalization. Stable patients who feel they may need to go to the hospital can instead have their problems addressed in the home, without the inherent risks and inconveniences of an ER visit or hospitalization. Similarly, the benefits to healthcare professionals are numerous. House call practice offers a variety not typically seen in the office. Visiting different locations throughout the week provides a diverse experience that many physicians may prefer over the routine of officebased practice. House call practice also allows for increased flexibility in scheduling. While I remain busy Monday through Friday, I have some level of control over my schedule. I may attend a breakfast event with one of my children at school and then start my day later than normal. Or I may begin early so that I can finish seeing my patients in time to attend a child’s sporting event. I may carve out time in the middle of the day for a lunch meeting or an errand. Most of my patients who reside in assisted living do not insist on a specific time for their appointment; they simply know I will see them sometime during the hours I have scheduled to spend at the facility. This flexibility also allows me to spend more time with a complex patient who needs additional attention. Many healthcare professionals who make house calls report that they feel they deliver better quality healthcare. The limited time of an office visit often makes quality care difficult to provide, especially to seniors with multiple medical problems and complex histories. I often spend an hour in a patient’s home, investigating the various factors impacting the patient’s health, and I can take time to ensure the patient’s needs are met before I leave. Perhaps the most important benefit to physicians is the opportunity to connect with patients beyond their illnesses. In many cases, I feel like a part of my patient’s family. Visiting the home creates a natural intimacy that is difficult to cultivate in the office setting. I ask my patients about the pictures on their walls. I get to meet other family members who may not be able to come to the office. Some patients gratefully send me on my way with homemade baked goods. I have attended many of my patients’ funerals. The connection I inevitably develop with my patients has given me numerous opportunities to talk about spiritual matters. When I visit a patient who shares my faith background, it may be obvious by the decorations or items displayed around the home. I will frequently acknowledge these “faith cues,” and patients always appreciate knowing when their physician shares a similar
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House calls, once a prominent part of medicine’s past, are rapidly becoming part of medicine’s future. Practices like Doctors Making Housecalls consistently demonstrate that quality patient care can be delivered in the home, increasing patient satisfaction while dramatically reducing cost. Medicare and other payors have begun to take notice. Our group was one of 18 home care practices chosen to participate in the Independence at Home demonstration project, a feature of the Affordable Care Act. This three-year program seeks to prove that home care does indeed save money without sacrificing quality of care. Preliminary numbers are even better than expected, which may lead Medicare to expand home care benefits for its beneficiaries. House calls will likely become more accessible to both patients and healthcare professionals as a healthcare delivery model. House calls—it’s an idea whose time has come…back.
faith. With their approval, I often end our interactions with prayer. I have also been able to share my faith with nonChristians, particularly when patients and families are facing an end-of-life situation. As a geriatrician with certification in hospice and palliative medicine, I frequently care for dying patients. A certain proportion of any house call practice will likely include these opportunities. Patients and families facing death often seek answers and meaning in their hardship. Scenarios like this frequently create opportunities for me to reveal my personal hope in Jesus Christ, without feeling as though I am forcing my religious views on someone who might resist them. Dying patients are often cared for by a team of nurses, aides and therapists, and I have also have opportunity to share my faith with these members of the healthcare team as they watch me interact with patients and families. As Christians, we are called to minister to “the least of these” (Matthew 25:40, NIV 2011). House call practice has opened my eyes to an often overlooked people group. There are more than 3.6 million homebound adults in the United States.3 The suffering of the homebound patient goes beyond physical; those who are isolated in their homes frequently become disconnected from church and other social connections. As a home care physician, I bring physical healing to my patients in their homes, but I can also bring spiritual and emotional healing through my presence. Some of my favorite Scripture passages tell of moments when Jesus enters the homes of those in need, whether to bring physical healing to Jairus’ daughter in Mark 5:38-42 or to spiritual restoration to Zacchaeus in Luke 19:1-9.
For more information about house call practices, please visit Doctors Making Housecalls at www.doctorsmakinghousecalls.com or the American Academy of Home Care Medicine at www.aahcm.org. Bibliography 1 Leff B. & Burton, J.R. The future history of home care and physician house calls in the United States. The Journals of Gerontology. Series A. Biological Sciences and Medical Sciences (2001). 56 (10): M603-M608. doi: 10.1093/gerona/56.10.M603 2 Driscoll CE. Is there a doctor in the house? Am Acad Home Care Physicians Newsletter (1991). 3:7-8. 3 Qiu, Wei Qiao, et al. Physical and Mental Health of the Homebound Elderly: An Overlooked Population. J Am Geriatr Soc. 2010 Dec; 58(12): 2423–2428.
About The Author
DAVID FISHER, MD, MPH, is a “housecallogist” with Doctors Making Housecalls in Raleigh-Durham, North Carolina. A graduate of Rush Medical College in Chicago, Illinois, he completed his residency in family medicine and a fellowship in geriatric medicine at Wake Forest University Baptist Medical Center. He is the author of How to Keep Mom (and Yourself) Out of a Nursing Home and he blogs at doctorfisher.com. David and his wife Jean have been married 19 years, and they have six children. They are active members of The Summit Church in Durham, North Carolina. David believes joyful laughter is the best medicine, and his favorite activity is laughing with his wife and kids. Christian Medical & Dental Associations www.cmda.org 33
classifieds Miscellaneous Ministry Opportunity – Dallas, Texas. Wycliffe’s clinic is looking for Texas licensed doctors, dentists and dental hygienists as part-time volunteers. Possibly a clinic administrator. Contact the clinic at 972-708-7408 or clinic_dallas@sil.org. Director, Medical Campus Outreach (MCO), Philadelphia, Pennsylvania - MCO ministers to medical and healthcare students and professionals in the Philadelphia area and is a ministry of Tenth Presbyterian Church. The successful director candidate will have a passion for one-on-one discipleship with students in the healthcare professions, administrative skills and the ability to fundraise. For more information, please visit www.mcophilly.org or contact MCO at mco.smi.tenth@gmail.com.
Dental Newport News, Virginia - Associateship position, with ownership potential, available in Christ-centered multi-doctor practice. Applicants must have either two years of practice experience or else a GPR. Facility is well-equipped and practice offers a wide range of services, including CEREC restorations, sedation, implant placement and restoration and orthodontics. Our multi-doctor team gets along well and enjoys what we do. Senior doctor, a member of the CDA Dental Advisory Council, would like more time for CDA activities, mission trips and other ministries. We are an hour from the beach and two hours from the mountains. For more info, go to www.citycenterdentalcare.com. Address replies to William Griffin, DDS at dentalmissiontrips@gmail.org.
Medical Family Medicine – We seek a board certified family physician to join us in our mission “to develop competent and compassionate family physicians who reveal the healing presence of God through exceptional healthcare and Christlike character.” St. Anthony Family Medicine Residency is a community-based, dually-accredited program in Oklahoma City, Oklahoma. You will be able to supervise residents in outpatient and inpatient settings. OB skills are preferred but not mandatory. Experience the joy of passing on what you have learned to men and women who will carry God’s healing presence to hurting people. Cheyn Onarecker, MD: 405272-8394 or cheyn_onarecker@ssmhc.com. Family Medicine – Family Care Network is seeking board certified family physicians to join our clinic teams at Lynden Family Medicine in Lynden, Washington. We practice fullspectrum family medicine, including obstetrics, urgent and wellness care, sports medicine, minor procedures and geriatrics. In addition to our outpatient practice, we have an inpatient services program and medical testing center. Be part of a team of independent practitioners who put excellence in patient care first, while enjoying the healthy lifestyle available in the beautiful Pacific Northwest. We are a locally
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To place a classified advertisement, contact communications@cmda.org.
owned, physician-led practice, where you can balance earning potential and quality of life. Please submit cover letter and CV to human resources at fcnhr@hinet.org. We will review your qualifications against our current needs and contact you if there is a potential match. We sincerely appreciate your interest in Family Care Network. www.familycarenetwork.com. FP/OB Faculty Opportunity – Bon Secours Medical Group, part of a major Catholic healthcare system in Richmond, Virginia, is actively recruiting an FP/OB faculty member for their family medicine residency program. This ACGME accredited program is also certified as an NCQA Level 3 Patient Centered Medical Home. Each faculty member has the opportunity to see patients and precept residents in the outpatient practice, while also participating in the hospital service rotation. Ideal candidates will either be board certified in FP with OB fellowship training or be double boarded in FP and OB. Must be willing to take OB call. If interested contact Danielle_Roach@bshsi.org or call 804-237-5523. Family Practice – Family practice with OB and sections in scenic Southern Indiana. This is a unique opportunity in a non-profit, faith-based family medicine group. Enjoy the full range of family practice including outpatient, inpatient and OB, preferably with C-section training. Rural community with outdoor recreation available including skiing, hiking and boating. Easy driving access to medium and large urban areas. Please send CV to ValleyHealth@gmail.com for further information. Family Practice – Come join a collegial group of family physicians providing full spectrum care to an underserved area of Northern New Mexico! The opportunity includes providing prenatal care and low risk deliveries. Call is 1:4 for OB and peds only (there is a hospitalist for adults). Great OB back up for consults or sections. About 20 deliveries a year. Clinic schedules are flexible to allow for balance of work and family. Espanola is a community of 10,000 and is 30 minutes to Santa Fe. Contact Lucille.montoya@ecfh.org or call 505-470-5841. Orthopedic – Kearney Orthopedic & Sports Medicine seeks general orthopedists and sub-specialties in hand and sports medicine. Our well-established practice is committed to delivering excellent orthopedic care treating our patients as honored guests, providing compassionate care and acknowledging their uniqueness and value to God. Located in Kearney, Nebraska, a family-oriented city with low cost of living, local university, on site surgery center and two hospitals. Contact: Administrator: Greg Gangwish at 308-865-2512 or greg@kearneyortho.com. Pediatrician – Faith-based pediatric opportunities at mission-minded practices in Southwest Michigan. Southwestern Medical Clinic, Niles and Stevensville adding full-time, employed pediatricians to faith-based teams in Southwest Michigan. Two-year guaranteed salary –
productivity bonus opportunities! Stevensville offers established, remodeled practice. Primarily commercial insurance. Onsite lab, x-ray. Clinical-trial participation. Seeking leaders and additional hospitalist coverage. Niles is a rural health clinic. Care for underserved! Higher reimbursements. Loan repayment opportunities. Epic EHR. Serve Jesus Christ. Be missionary! Visit www.lakelandhealth.org/swmc. Contact Lisa Scheer at lscheer@lakelandhealth.org or 269-927-5224. Pediatrician – Northwest Pediatric Center, located in beautiful Western Washington, is seeking a full-time board certified/board eligible pediatrician for a growing pediatric practice. Currently Northwest Pediatric Center consists of four offices, nine pediatricians, one psychiatrist, five ARNPs and one dietitian. All the facilities are rural health clinics. Main location is Centralia, Washington, which is situated halfway between Seattle and Portland along the I-5 corridor. For more information, please contact Lisa McKay. Phone: 360-736-6778, Fax: 360-7366552, Email: lmckay@nwpeds.com. Visit our website at www.nwpeds.com. Physician – Family Medicine – Out Patient Traditional Practice Setting - Excellent practice opportunities for full-time BC/BE family medicine physicians, no OB in Salem, Oregon area. Recognized Patient Centered Primary Care Homes Tier 3 status with Meaningful Use achievement. Four clinics: practice size varies from two to three physicians with one to three mid-level providers. These are very well established practices that have been a part of our communities for decades. Join a group of providers that enjoy the same activities that you enjoy such as hiking, sailing, snow sports, gardening, fishing, photography, church activities, kayaking, quilting, water sports and mission work. Full-time (four days per week), employed positions. NextGen EPM and EMR. Clinics open Monday through Friday; hours range from 7:30 a.m. to 5 p.m. to 8:30 a.m. to 5:30 p.m. Call varies from one day a week, once every three weeks to one week at a time, once every two months. Call is telephone only. Use hospitalist system. Cannot support visas. Very competitive salary and comprehensive benefits package. Recruitment incentives available including relocation assistance, signing bonus and student loan forgiveness/repayment. For further information, please send CV to jobs@mvipa.org. Primary Care – Rewarding and purposeful opportunity for physician BC/BE in family medicine, internal medicine and/or pediatrics as well as PA/NP to join a team starting Hope Christian Health Center in summer 2015. Vision is for gospel-centered, multidisciplinary practice to integrate onsite medical, emotional and spiritual care to an underserved, under-insured population in North Las Vegas. Clinic is PCMH model and pending FQHC approval. Contact Ethan Zimmerman at 828-788-1166 or ethan@hopehealthvegas.org.
CMDA PLACEMENT SERVICES
BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other providers and practices. We have an established network consisting of hundreds of opportunities in various specialties. You will benefit from our experience and guidance. Every placement carries its own set of challenges. We want to get to know you on a personal basis to help find the perfect fit for you and your practice. P.O. Box 7500 •Bristol, TN 37621 888-690-9054 www.cmda.org/placement placement@cmda.org
IT MAKES A BIG DIFFERENCE “It makes a big difference having a Christian organization searching for us. They understand and care about our needs and finding those with a shared mission and vision.” - Lydia Best, MD; Detroit, Michigan
AN ANSWER TO PRAYER “Placement Services helped me navigate a complicated process and advocated for me when I was too busy or naïve to do so by myself. I am excited to work at a clinic with providers who share my values.” - Marlana Li, MD
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In His Image is a place of excellent training in medicine, spiritual care and leadership. During residency, I learned how to incorporate my Christian faith in the practice of medicine. I also gained competence and confidence with inpatient and outpatient procedures and learned obstetrics from IHI family medicine faculty. Through unparalleled mentoring by IHI attending physicians, I received leadership training and lifelong learning habits that enable me to now serve in a teaching role. Residency training at IHI gave me a firm foundation and launched me into a life of medicine and ministry.