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July 2019 >> $5 ON ROUNDS

Living a Dream Jackson Clinic’s Chima Oleru, MD, has all he wanted Nicknames sometimes stick and sometimes they don’t. For Chima Oleru, MD, the one his secondgrade teacher gave him, ‘Dr. Chima’ seems to have stuck.

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Alex Trebek’s Cancer News Not All Hollywood Fluff Memphis physician examines surprising report In March of this year, the longtime host of “Jeopardy!,” Alex Trebek, made a brief, startling announcement before resuming his role of giving answers that beg questions from contestants.

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American Medical Students Less Likely to Choose To Become Primary Care Doctors Story on page 6. FOLLOW US

Anywhere Call

Jackson Clinic rolls out telehealth for wider, quicker reach By SUZANNE BoyD

and nowhere near a clinic. On SunFor patients of day morning, she one West Tennessee decided to cut her Clinic, access to mediweekend short and cal care can be as close head back to Jackas their phone, tablet son to go to Conveor computer. At the nient Care when she end of May, the Jackremembered an ad son Clinic, launched on Facebook about its telehealth video visit the clinic’s video program for its patients visit program. At the that, unlike some other very least, Amanda programs, utilizes only thought the online local clinic physicians medical visit may leading to better conprevent a trip to the tinuity of care for paclinic as well as the tients. wait to be seen. For Jackson Clinic “Once I logged With the Jackson Clinic’s VideoVisit, house calls are making a comeback as access to a primary care physician is patient, Amanda, the into my Follow My as close as your smart phone, tablet or computer. program could not Health Account on have launched at a betmy smartphone, I ter time. She had injured her leg jet skiing and while there was no requested a video visit. The system notified me when the doctor was bruise it was sore. A few days later she noticed some swelling and available, so I could do other things in the meantime rather than redness in the area that was injured but thought it was just cellulitis. just sitting and waiting,” said Amanda. “It was very professional. I By the next weekend, the pain had worsened but she was at the river (CONTINUED ON PAGE 4)

Taking a Deep Dive MGMA DataDive Helps Practices Benchmark, Stay Competitive By CiNDy SANDERS

“If you don’t know where you’re going, you’ll end up some place else” – Yogi Berra The late, great Yogi Berra was known for colorful, seemingly nonsensical, but oft quoted phrases. Yet, so many of his most memorable observations were firmly grounded in truth. For providers and administrators, the best way to stay on course is to have a clear picture of where the practice stands in comparison to their peers and insights into best practices for growth and efficiency. For nearly a century, the Medical Group Management Association (MGMA) has collected and disseminated actionable data and resources to help practices navigate that journey to operational success. While the national organization has been conducting cost surveys for close to 50 years and physician compensation studies for more than four decades, the information was in booklet form prior to the creation of


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JULY 2019




Living a Dream

Jackson Clinic’s Chima Oleru, MD, has all he wanted By SUZANNE BoyD

Nicknames sometimes stick and sometimes they don’t. For Chima Oleru, MD, the one his second-grade teacher gave him, ‘Dr. Chima’ seems to have stuck. His love of the medical profession started at a very early age and became the only career he ever wanted. Today as a nephrologist with the Jackson Clinic, PA, Oleru is truly living out his childhood dream. Hailing from a family of healthcare providers, Oleru grew up in the southeastern part of Nigeria. A great deal of his childhood was spent in the hospital where his mother worked as a registered nurse and where his interest in medicine began. “From the second grade on, I knew all I wanted to do was be a doctor,” said Oleru. “And that never changed.” After graduating medical school from the University of Nigeria, Oleru came to the United States in 1997 to complete his internal medicine residency at the Health Science Center at State University of New York in Brooklyn. In his first year as an intern Oleru’s first attending physician was Dr. Eli Friedman, a well-known and wellpublished nephrologist in the country, who left quite an impression on the intern. “He was a great teacher and really got me interested in the specialty,” said Oleru. “After my residency, I stayed in New York and did a two-year nephrology fellowship at Mount Sinai Beth Israel which exposed me to a wide range of nephrological issues, including a lot of patients with HIV and even one patient from Africa with Malaria. We had patients from all walks of life. I also had some works published, including authoring a chapter in the fourth edition of the Handbook of Dialysis.”

In 2005, Oleru completed his fellowship, was married and had two children under the age of two, which meant that family life was becoming a big factor in his decision in where he would practice. “My wife is also a physician so it was important to us to find a place where we could both practice as well as raise our kids. We both felt a small town would be the best fit,” said Oleru. “We found the Jackson Clinic was just what we were looking for. The decision to come here was probably the second biggest decision I have ever made in my life and it has worked out so well. We have been here 14 years, which is the longest I have ever been in one place since leaving Nigeria.” Coming to West Tennessee definitely came with challenges and plenty of changes for Oleru. “There was a small bit of a communication barrier on both sides. My accent was a little hard for patients to understand at first, but I worked hard to

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master how to talk to patients and now it seems we all understand one another,” he said. “The patient mix was also different from New York since there are more diabetes and obesity related issues in the South. Here, I tend to see more patients that have kidney issues from diabetes, disease and high blood pressure. People may think that dialysis is a large part of my practice but, on the contrary, I try to prevent them from ever getting to that point. Primary care providers are great about referring patients to us earlier so that we can help slow down the progression of the disease and stave off dialysis.” For patients in kidney failure, Oleru says they have three options: transplant, hemodialysis or peritoneal dialysis. “The best is transplant and when we have a patient with advanced kidney disease, we try to get them evaluated for a transplant before dialysis. We send most of our transplant patients to Vanderbilt or to UT-Memphis program,” he said. “For hemodialysis patients, there are different ways it can be administered, either at a center or at home. The home option is one we see increasing in popularity because it can be more convenient than coming into a center and patients typically do much better on it. The home option costs about the same as the other and is covered by insurance.” Not all patients are candidates for home therapy, says Oleru, so dialysis centers will never become obsolete. “Patients have to be trained and be able to administer their therapy. There also has to be a support person in the home that can also be trained to assist the patient,” he says. “We also have to look at the home environment to ensure that it is supportive of this type of therapy.” Oleru’s practice is spread across West

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Tennessee. He sees patients in clinic in Jackson four days a week as well as runs a monthly outpatient kidney disease clinic in Selmer. For dialysis patients who are not on home therapy, Oleru sends patients to DCI centers in Paris, Lexington, Brownsville, Humboldt and Jackson as well as DaVita Centers in Jackson, Selmer and Bolivar. While his practice here may not be as busy as when he was in a resident and fellow in New York, Oleru feels that it and his time in the hospital with his mom at an early age prepared him to not only be a doctor, but to be one in West Tennessee. “My mother would take me into the maternity section of the hospital, and I saw women giving birth at an early age. It exposed me to people who would come in sick then go home well which made it easier for me in medical school because it was something I was used to,” he said. “When I came to New York, I was in the biggest public hospital. As an intern I would be on for 24-hours with no sleep and exposed to all kinds of patients. We were always busy. I think that prepared me very well for whatever came after that.”

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Anywhere Call, continued from page 1 could hear and see the doctor well despite fact that I don’t always have the best cell reception at the river. I told her about my injury and issues from it, showed her the injured leg as well as the other one for comparison and even my assessment that it may be cellulitis which she confirmed. She gave me the option of having my prescription called into a pharmacy at the river or at Amy Smith home. I went with home and by the time I got back into town, it was ready. The whole experience took maybe 15 minutes out of my day and I never had to leave the house.” While having telemedicine as an option for care was something the Jackson Clinic had been investigating for some time, there were two main issues to offering the service to its patient base: cost and providers. “When we first started looking at vendors, not only could the cost of the technology required be hefty, most of the programs utilized a pool of providers that may or may not include our own so our patients may be seeing a physician outside the clinic for care. We knew this type of program could increase access to care while also decreasing costs, but it was important that we utilize our physician base so that quality and continuity of care would be maintained,” said Amy Smith, Director of Business Operations for the Jackson Clinic. “When our patient portal Follow My Health added a telehealth component to its platform, it was the answer we were looking for. Not only was it cost-effective and did not require additional technology, but it also allowed us to use our own physicians. Since there were no major changes or updates required in terms of technology or vendors, the project had a relatively short timeline for implementation. “The biggest elements that needed to be addressed were workflow and staffing. The staffing was simple since it only requires a doctor. It is primarily staffed by our convenient care providers. One exam room in our convenient care office is outfitted with a web camera for the program, but it is somewhat underutilized since many physicians can access this program from their home office,” said Smith. “We piloted the program internally, first to streamline it for our needs, and discussed how best to market it in terms of what ways patients would utilize it.” Not all medical issues are suited for a

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JULY 2019

video visit and it still does not ensure you will avoid a trip to the clinic. Telehealth is available to treat nonemergency situations such as sinus infections, colds, flu, pink eye, sore throat, mild allergic reactions, bladder or urinary tract infections, arthritis, minor cuts and burns. If a prescription is needed, it can be sent directly to the pharmacy of your choice. Video visits are held to the same privacy standards of a regular office visit. Telehealth Video Visits are not currently covered under many health insurance plans and the cost of $49 is payable online. If the proMark Allen vider is unable to treat the symptoms through Telehealth, the patient is asked to come into the clinic and the cost of the video visit is applied to their account. “The Jackson Clinic has been the healthcare innovator in West Tennessee for decades: first Convenient Care walk-in clinic, first hospitalist program, first comprehensive electronic medical record. We have been studying telehealth for the past 5 years, and we know our patients want the service for its convenience. But we held back until we could get it right,” said Mark Allen, Jackson Clinic CEO. “Users won’t get a strange doctor in some distant state who doesn’t know anything about the patient. Our telehealth service will be for Jackson Clinic patients, using a Jackson Clinic provider and supported with the patient’s Jackson Clinic medical record. This provides the structure for a trusted, highquality telehealth service.” “With the program staffed by clinic physicians and only available to established clinic patients, continuity in care can be improved because the doctor can access the patient’s medical record and get a complete picture,” said Smith. “While the advent of the internet has made patients more in touch with their own health and better educated as to how to speak with their doctor, the physician still has to be well-trained in asking right questions but not leading the patient. It is high touch medicine in a high-tech environment because the physician has to really listen to the patient to best ascertain what is going on.” The response to the program has been outstanding so far and Smith thinks they have only begun to scratch the surface of how it can be utilized. “We definitely want to expand access to the program,” she said. “We are just starting to unlock the program’s potential. Right now, we are only using it as an ondemand service, but we do plan to open it to clinical pharmacists, care coordinators, social workers, etc. as a way to help intervene in the lives of chronically sick or elderly patients to make sure they are being followed up on. We are really excited as to what this module can open up for us and what we can offer our patients.”

Taking a Deep Dive, continued from page 1 DataDive a little more than a decade ago. “DataDive is an interactive, online platform,” explained Meghan Wong, MS, director of Data Solutions for MGMA. She noted the data repository has thousands of metrics that can be filtered and scaled locally, regionally and nationally. Wong said four main annual reports are rolled out from mid-May through midAugust. The benchmarking data captured in DataDive are: • Provider Compensation & Production (mid-May), • Management & Staff Compensation (mid-June), • Cost & Revenue (mid-July), and • Practice Operations (mid-August). “We also have the supplementary Research & Analysis reports that are a curated look at the data,” Wong said of the comprehensive insights by MGMA subject matter experts. “I think what sets us apart is the wealth of education we have around DataDive,” she continued. “We have a dedicated team of analysts who will answer questions.” Access to the data is available at two levels. “If you participate in our surveys, you get a limited look at the data,” she said of no-charge access. However, survey participants have the opportunity to pay a fee for full access to the benchmarking data that allows them to do a deep dive. For example, she explained, the basic data set would allow a practice manager to look at provider compensation information across four geographic regions – East, Midwest, South and West. The full access level allows administrators to drill down to the state or local area for comparisons. “You have the opportunity to add a lot more detail,” Wong noted. The recently released Provider Compensation & Production Report looked at 147,000 physician and non-physician providers across more than 5,000 organizations throughout the country. The survey data revealed median compensation for

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established providers rose across most specialties since the last report was published (2019 report looked at changes from 2017 to 2018). Wong said, “We actually saw some pretty substantial increases for established providers.” She added there was a 6-7 percent increase for several specialties including diagnostic radiology, obstetrics/ gynecology, neurosurgery, general neurologists and noninvasive cardiology. Overall, specialty physicians saw a 4.4 percent increase, primary care physicians a 3.4 percent bump up, and advanced practice providers a 2.9 percent increase. “If groups are looking to hire new physicians, we have a separate data set for new doctors,” Wong explained, adding data is available for both established physicians making a move and those who are just completing their training. The latest report found practices looking to add physicians to their roster are facing increased market competition, particularly in areas where there are shortages. As a result, many practices recruiting new doctors are offering higher salaries. For example, between 2017 and 2018, guaranteed compensation for newly hired cardiologists grew 21.5 percent from $400,000 to $485,000. In addition to total compensation, the report includes details on work RVUs, total RVUs, professional collections and charges, and benefit metrics. “It’s great for individuals to see the information year-over-year to see if they are remaining competitive,” Wong noted. Similarly, the Management and Staff Compensation data, released last month, provides benchmarking information for administrators, CEOs and other executives, and medical assistants. “We grew that report to 162,000 individuals,” Wong said of the latest information. “Our Cost & Revenue data set launches mid-July,” she said of the next report to roll out. Staffing ratio, cost-structure comparisons, impact of payer mix and collections and accounts receivable data help administrators better understand the factors influencing a practice’s bottom line. “The last one is Practice Operations in August,” Wong said of MGMA’s newest report, which originally launched in 2016. “It’s the result of an unmet need in the industry,” she continued of looking at general operations information her team couldn’t easily find in the marketplace. Although not financial in nature, Wong said the report highlights data across a broad operational spectrum – from hours of operation, staff turnover rates and wait times for patients to the time it takes to pick up a phone call and the duration of calls. “Benchmarking is crucial and critical to any practice being successful,” Wong said. “You can look internally and benchmark what is happening within the practice, but if you don’t understand what the market is doing, you can’t stay competitive and won’t be successful,” she concluded. WESTTNMEDICALNEWS


Alex Trebek’s Cancer News Not All Hollywood Fluff UTHSC physician examines surprising report By LAWRENCE BUSER

In March of this year, the longtime host of “Jeopardy!,” Alex Trebek, made a brief, startling announcement before resuming his role of giving answers that beg questions from contestants.  The popular, 78-year-old Canadian told viewers that he had been diagnosed with stage 4 pancreatic cancer, one of the deadliest of cancers, which leaves as few as nine patients out of 100 still alive after five years.  Perhaps equally stunning, however, was Trebek’s follow-up announcement on the show just three months later. He said he is in “near remission” and that chemotherapy treatments have shrunk some of his cancer tumors by more than 50 percent. The announcement received widespread media attention, including a cover story in a recent copy of People magazine. “I think it would be a stretch to say that someone is in remission from pancreatic cancer, but if his tumors had down-staged or shrunk, that would not be terribly surprising to me,” said Dr. Stephen Behrman, a pancreatic cancer surgeon at Stephen Behrman the University of Tennessee Health Science Center. “It’s a deadly disease, and in the metastatic setting it would be extremely uncommon for someone to be cured just with chemotherapy alone. In reality, he’s eventually going to die from that, but having said that, many of our newer chemotherapeutic agents will allow the disease to sometimes regress tremendously and allow patients to live a fair amount of time even though the disease is not completely eradicated.” Dr. Behrman acknowledges that he is not privy to the exact treatment Trebek is receiving, but notes that some newer treatments have shown success, such as immunotherapy which uses a person’s immune system to attack cancer cells. “If he has a mutation that’s targetable with these new therapies, then a lot of times people can have dramatic responses to that,” Dr. Behrman added. “That occurs in a minority of patients with pancreatic cancer, but some do have those mutations that will respond to immunotherapy. “He would be in the population that we would test because we generally test for mutations in patients who have had either metastatic disease or a disease that is not amenable to surgical removal. That would be the patient population that we would typically study.”   



The pancreas is an abdominal organ – about six inches long and shaped like a flat pear – that secretes enzymes that aid digestion and hormones that help regulate the metabolism of sugars. Signs and symptoms of pancreatic cancer often do not appear until the cancer is well advanced, but early warning signs include unexpected weight loss or onset of diabetes, back pain, itching and yellowing of the skin (jaundice). “The pancreas sits in tight quarters around the major blood vessels in our abdomen that go to our liver and our intestines, so it doesn’t take a very large tumor to potentially grow around these vessels to the point we can’t remove it surgically,” Dr. Behrman said. “It’s also just a very aggressive cancer. The natural history of the cancer is to metastasize very readily and very commonly as well. Oftentimes, by the time we diagnose it, it’s too advanced for us to do anything.” According to the American Cancer Society, 56,770 Americans will be diagnosed this year with pancreatic cancer and 45,750 will die. In Tennessee, some 1,220 new cases are expected, as are 980 deaths. Apple founder Steve Jobs (2011) and actor Patrick Swayze (2009) both died from pancreatic cancer. Though it is on track to become the second deadliest of all cancers, Dr. Behrman says there also are reasons for optimism. “I think it’s important that over the last five years, the cure rate has gone up by 1 percent per year, so we have essentially improved the cure rate by 5 percent,” he said. “If you look at it historically, up until the last five years we were dead in the water, and now we’re making very rapid advances in pancreatic cancer in terms of earlier diagnosis and treatment. I think we can look forward to clearly dramatic improvements going forward, though it’s still a very tough cancer to work with.” The causes of pancreatic cancer are not well understood, though it is hereditary and can run in families where there is a genetic predisposition. Excessive smoking and alcohol intake, as well as dietary influences and environmental factors, also are believed to play a role. Treatment generally involves a collaboration of specialists, including a radiation specialist, a surgeon, a medical oncologist and a genetic counselor. “Most often with pancreatic cancer we start with chemotherapy, even if it looks like it can be removed with surgery, and sometimes we complement that with radiation,” Dr. Behrman said. “Then hopefully we can get as many people in surgery as possible, and then after surgery we recommend more chemotherapy since it is an aggressive cancer.

“A big problem and frustration with pancreatic cancer is that we don’t have a good screening test for it. For instance, we don’t have a good blood test to screen people, so there’s much, much research focused on what we call biomarkers or things we can test in the bloodstream or even on the pancreas itself to assess for pancreas cancer and catch it even before it turns into a cancer. Those are avenues of very aggressive research in 2019.” He said there is a vital need for more funding to support the research, and he applauds Alex Trebek for going public and raising awareness and getting the word out.  “He has been a great ambassador in that regard,” Dr. Behrman continued. “I think awareness is one means in which we can increase funding in that area, whether it be donations or philanthropy, and

hopefully we can spur the government on to increase funding as well.” Trebek has said the love, prayers and support he has received from family, friends and fans have played an important role in his turnaround. “I say he’s absolutely right,” said Dr. Behrman. “I think attitude, when you’re facing any cancer, is huge. I tell my patients that it’s important to continue your life, and I applaud Alex Trebek for continuing to do his work because no individual patient with pancreatic cancer, any cancer, can control that. That’s the job of the healthcare providers.   “I think the job of the individual afflicted with cancer is really to continue to live their life and not let the cancer consume that because otherwise cancer wins. I think that people who maintain a positive attitude and always continue to fight, that always carries them the furthest.”

Family Establishes Foundation in Kosten’s Honor In 2003 Memphis and the tennis community lost one of its stalwarts when Herb Kosten died of pancreatic cancer at age 67. Soon after his death, Kosten’s family set out to do something about fighting the disease and supporting those afflicted with it. Headed by his brother, Alan Kosten, and his son-inlaw, Jeffrey Goldberg, they formed the Herb Kosten Pancreatic Cancer Research Foundation which has raised nearly $2 million for research and hosts monthly support group meetings for Herb Kosten patients and families. The organization also hosts annual tennis tournaments, holds the Kick It 5K walk/run every spring and presents a yearly symposium featuring top names in the field of cancer treatment and research. “We have the Kosten Foundation Pancreatic Cancer Research Endowment Fund at the University of Tennessee Health Science Center that has donated well over a million dollars to our research,” says Dr. Stephen Behrman, the foundation’s medical adviser. “For people who have no medical background at all, Herb’s family has just done an amazing job of helping the greater Memphis area patients with pancreas cancer face their disease and deal with it with a positive outlook. “Once you know or hear or see or have a relative who has pancreas cancer, all of a sudden you become aware of all these other people who have pancreas cancer. There are some very nice people in our community who are dealing with this right now and I think awareness is one means to help increase funding for research.”

JULY 2019



American Medical Students Less Likely to Choose To Become Primary Care Doctors Despite hospital systems and health officials calling out the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields. A record-high number of primary care positions was offered in the 2019 National Resident Matching Program -- known to doctors as “the Match.” It determines where a medical student will study in their chosen specialty after graduation. But this year, the percentage of primary care positions filled by fourthyear medical students was the lowest on record. “I think part of it has to do with income,” said Mona Signer, the CEO of the Match. “Primary care specialties are not the highest paying.” She suggested that where a student gets a degree also influences the choice. “Many medical schools are part of academic medical centers where research and specialization is a priority,” she said. The three key primary care fields are internal medicine, family medicine and pediatrics. According to the 2019 Match report, 8,116 internal medicine positions were offered, the highest number on record and the most positions offered within any specialty, but only 41.5% were filled by seniors pursuing their M.D.s from U.S. medical schools. Similar trends were seen this year in family medicine and pediatrics. In their final year of medical school, students apply and interview for residency programs in their chosen specialty. The Match, a nonprofit group, then assigns them a residency program based on how the applicant and the program ranked each other. Since 2011, the percentage of U.S.trained allopathic, or M.D., physicians who have matched into primary care positions has been on the decline, according to an analysis of historical Match data by Kaiser Health News. But, over the same period, the percentage of U.S.-trained osteopathic and foreign-trained physicians matching into primary care roles has increased. 2019 marks the first year in which the percentage of osteopathic and foreign-trained doctors surpassed the percentage of U.S. trained medical doctors matching into primary care positions. Medical colleges granting M.D. degrees graduate nearly three-quarters of U.S. students moving on to become doctors. The rest graduate from osteopathic schools, granting D.O. degrees. The five medical schools with the highest percentage of graduates who chose primary care are all osteopathic institutions, according to the latest U.S. News & World Report survey. Beyond the standard medical curric6


JULY 2019


By Victoria Knight, Kaiser Health News

area of the country, said Dr. Tyree Winters, the associate director of the pediatric residency program at Goryeb Children’s Hospital in New Jersey. “The trend has been more so thinking about the amount of debt that a student has, compared to potential income in primary care,” said Winters. “But that’s not considering things like medical debt forgiveness through state or federal programs, which really can help individuals who want to choose primary care.” KHN data correspondent Sydney Lupkin contributed to this report. Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

ulum, osteopathic students receive training in manipulative medicine, a hands-on technique focused on muscles and joints that can be used to diagnose and treat conditions. They are licensed by states and work side by side with M.D.s in physician practices and health systems. Although the osteopathic graduates have been able to join the main residency match or go through a separate osteopathic match through this year, in 2020 the two matches will be combined. Physicians who are trained at foreign medical schools, including both U.S. and non-U.S. citizens, also take unfilled primary care residency positions. In the 2019 match, 68.9% of foreign-trained physicians went into internal medicine, family medicine and pediatrics. But, despite osteopathic graduates and foreign-trained medical doctors taking up these primary care spots, a looming primary care physician shortage is still expected. The Association of American Medical Colleges predicts a shortage of between 21,100 and 55,200 primary care physicians by 2032. More doctors will be needed in the coming years to care for aging baby boomers, many of whom have multiple chronic conditions. The obesity rate is also increasing, which portends more people with chronic health problems. Studies have shown that states with a higher ratio of primary care physicians have better health and lower rates of mortality. Patients who regularly see a primary care physician also have lower health costs than those without one. But choosing a specialty other than primary care often means a higher paycheck. According to a recently published survey of physicians conducted by Medscape, internal medicine doctors’ salaries average $243,000 annually. That’s a little over half of what the highest earners, orthopedic physicians, make with an average annual salary of $482,000. Family

medicine and pediatrics earn even less than internal medicine, at $231,000 and $225,000 per year, respectively. Dr. Eric Hsieh, the internal medicine residency program director at the University of Southern California’s Keck School of Medicine, said another deterrent is the amount of time primary care doctors spend filling out patients’ electronic medical records. “I don’t think people realize how involved electronic medical records are,” said Hsieh. “You have to synthesize everything and coordinate all of the care. And something that I see with the residents in our program is that the time spent on electronic medical records rather than caring for patients frustrates them.” The Medscape survey confirms this. Internists appear to be more burdened with paperwork than other specialties, and 80 percent of internists report spending 10 or more hours a week on administrative tasks. The result: Only 62 percent of internal medicine doctors said they would choose to go into their specialty again -- the lowest percentage on record for all physician specialties surveyed. Elsa Pearson, a health policy analyst at Boston University, said one way to keep and attract primary care doctors might be to shift some tasks to health care providers who aren’t doctors, such as nurse practitioners or physician assistants. “The primary care that they provide compared to a physician is just as effective,” said Pearson. They wouldn’t replace physicians but could help lift the burden and free up doctors for more complicated care issues. Pearson said more medical scribes, individuals who take notes for doctors while they are seeing patients, could also help to ease the doctors’ burden of electronic health record documentation. Another solution is spreading the word about the loan forgiveness programs available to those who choose to pursue primary care, usually in an underserved

PUBLISHER Pamela Z. Haskins EDITOR Pepper Jeter CREATIVE DIRECTOR Susan Graham GRAPHIC DESIGNERS Susan Graham Katy Barrett-Alley CONTRIBUTING WRITERS Suzanne Boyd Lawrence Buser Victoria Knight Cindy Sanders All editorial submissions and press releases should be sent to Subscription requests can be mailed to the address below or emailed to West TN Medical News is now privately and locally owned by Ziggy Productions, LLC. P O Box 1842 Memphis, TN 38101- 1842 President: Pamela Z. Haskins Vice President: Patrick Rains Reproduction in whole or in part without written permission is prohibited. West TN Medical News will assume no responsibility for unsolicited materials. All letters sent to West TN Medical News will be considered the newspaper’s property and unconditionally assigned to West TN Medical News for publication and copyright purposes.



GrandRounds West Tennessee Medical Group Welcomes Claude Pirtle, M.D.

JACKSON - West Tennessee Medical Group recently welcomed Claude Pirtle, M.D., internal medicine physician and Associate Chief Medical Information Officer. Dr. Pirtle comes from Nashville, where he completed a clinical informatics Claude Pirtle fellowship at Vanderbilt University. He received his medical degree and completed his internal medicine residency at the Louisiana State University Health Sciences Center in New Orleans. In addition, he completed his Master of Science in Applied Clinical Informatics at Vanderbilt. Dr. Pirtle will work with physicians to improve their experience and efficiency with the electronic health record. “I am excited to be part of the West Tennessee Healthcare family, and I look forward to working with patients and clinicians to make their experience with our system the best that it can be,” said Dr. Pirtle. He is committed to providing comprehensive care for men and women. In addition to preventive medicine, Dr. Pirtle is experienced in the diagnosis and treatment of chronic health conditions,



including diabetes, heart disease, high blood pressure and high cholesterol. He offers annual exams, sick visits and health screenings.

Opioid Prescriptions Continue Decline in Tennessee

A recent report shows a 13.3 percent decrease in opioid prescriptions in Tennessee between 2017 and 2018, and a 32.3 percent drop in the five-year period since 2013. According to the data, Tennessee performed slightly better than the national average during the most recent 12-month period and is on par with other states for the five-year downward trend. More  state-by-state data  from the American Medical Association Opioid Task Force also showed a dramatic increase in the number of queries to Tennessee’s Controlled Substance Monitoring Database (CSMD), rising from 8.6 million in 2017 to 11.4 million in 2018. CSMD information is used to identify and address overprescribing and prevent patients from “doctor shopping” for prescriptions. According to the AMA report, CSMD queries in Tennessee have increased every year since 2014, when state officials reported 5 million queries. Nearly 51,000 physicians and other healthcare providers are now registered to use the Tennessee CSMD, up from

about 39,000 in 2014. “Our focus in the Tennessee medical community for the past several years has been – and continues to be – controlling what we can control with opioid prescribing and getting better at nonopioid pain management,” said Elise C. Denneny, MD, a Knoxville otolaryngologist and president of the Tennessee Medical Association. “We continue to focus on appropriate opioid reduction while creating best team-led practices to address pain. This data affirms that we are moving the needle in the right direction and progressing in areas where physicians can make a real difference fighting the epidemic.”

Qsource Selects Benjamin Heavrin as Chief Medical Officer

Benjamin S. Heavrin, MD, is the new Chief Medical Officer (CMO) at Qsource, a Tennessee-based not-forprofit consultancy that oversees federal, state and commercial healthcare quality improvement programs in a 12-state region. Dr. Heavrin will Benjamin S. Heavrin provide clinical and administrative leadership across healthcare settings while working closely with Qsource staff to help define and

achieve the organization’s corporate goals. Heavrin is a board certified emergency medicine physician practicing in middle Tennessee. Dr. Heavrin brings about two decades of clinical experience to Qsource. He served as a faculty member at Vanderbilt University Medical Center, the University of Tennessee St. Thomas Rutherford Hospital and TriStar Skyline Medical Center He completed his undergraduate studies in economics at Princeton University and relocated to Tennessee to complete degrees in business and medicine. He earned a Master of Business Administration with an emphasis in healthcare from Vanderbilt University’s Owen Graduate School of Management and a Doctor of Medicine degree from Vanderbilt School of Medicine.

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