Round-up Magazine June 2015

IN EVERY ISSUE:

To learn more visit www.mcmsonline.com

What’s Inside?

Page 4

In Memoriam

Page 8

President’s Page

Page 10

Celebrating 60 Years

- 015 1955 2

MCMS Board Meeting Minutes Page 40

round-up Marketplace

Volume 61

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Number 6

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Page 42

June 2015

Providing news and information for the medical community since 1955.

MEMBER PROFILE:

Dr. Richard Heuser is optimizing his work-life balance, with no sacrifice to his patients or ability to innovate.

Page 18 PUBLIC HEALTH: The presentations on May 7th showed what three dedicated professionals can achieve when governments fail to support the needs of their people. What can we, as members of MCMS, do as we witness our state government reneging on its responsibility to preserve, promote and protect health education and the health service system for all our citizens, young and old?

Page 14

FEATURE ARTICLE: Faced with severe physician and provider shortages in an ever changing healthcare environment, the ability to retain established physician staff plays a critical role in the recruitment of new providers.

Round-up had the opportunity to discuss questions regarding the current employment trends and strategies with Joan Pearson, president of Catalina Medical Recruiters.

Page 24

EVENTS AND PROGRAMS: The Maricopa County Medical Society hosted a member event in the courtyard that brought together three world-class speakers to tell their stories of how they deliver care to those less fortunate. Read more and view photos from the event.

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EMPLOYMENT: The healthcare sector of the U.S. economy is expected to hire at a faster pace in 2015.

The outlook for growth in hospital employment is modest. Hiring at outpatient facilities and ambulatory surgical centers is expected to continue. And the hunt for qualified physicians interested in primary care will continue to dominate the physician employment landscape in 2015. Read more about the healthcare hiring forecast.

Page 36

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what’s inside?

What’s Inside?

June 2015: Employment

By Jay Conyers, PhD

Jay Conyers, PhD MCMS, Executive Director Contact Information: E: jconyers@mcmsonline.com P: 602-251-2361

T

his month, we focus on employment and the issues that physicians face today. Long gone are the days when a physician, either in moving to a new town or upon completing his or her residency program, simply ‘hangs their shingle’ to officially enter the workforce. No, it’s much more difficult in today’s world.

The business complexity of what’s required to now run a practice is greater than what existed prior to today’s regulatory environment. Physicians have to either be adept at understanding peculiar nuances that may – at least on the surface – appear to have no contributing value to patient care, or they have to hire someone to navigate it for them. Hence the burgeoning field of practice managers, which is predicted to grow by 22% from 2010 to 2020. Physicians are obviously seeing the value in employing practice managers to make their lives easier, and paying them well.

In 2014, the median salary for medical office managers running groups with no fewer than six physicians surpassed $90,000, and those running large groups (more than 25 physicians) exceeded $160,000. That’s nearly as much as the median salary for a family practitioner.

But what about employment for physicians? Hospital employment continues to be on the rise, with about half of all physicians in private practice. In 2013, the number of physicians who considered themselves self-employed was at 53%, but it wouldn’t be surprising if that number now hovers at or below 50%. Numerous reports suggest that migration towards hospital employment will continue over the next decade. However, some suggest that physician head counts will be reduced at many hospitals as less complex care is pushed towards secondary providers.

4 • Round-up •June 2015 • A monthly publication of the MCMS

what’s inside?

What is appealing to younger physicians about hospital employment? For one, work-life balance is an important factor, with many wishing to have a better handle on when they work, how long they work, how much they make, and how much time they have for their family.

Today, physicians fresh out of medical school owe an average of $175,000 in student loan debt, and several studies estimate the average cost of starting an independent practice at $150,000. When comparing average starting salaries for a hospitalist ($200,000) to that of an office-based physicians ($150,000), the economics point to one major reason why younger physicians are shying away from hanging their own shingle.

In this issue, we explore some of these trends in physician employment and shed some light on how Ari-

zona’s physician shortage is being addressed. We also examine how employers are getting creative at recruiting top talent, and profile a physician who’s figured out how to optimize work-life balance, with no sacrifice to his patients or ability to innovate.

What about next month? In July, we bring you our education issue and look at what concerns the medical schools and residency programs here in our state. The shortage of residency slots in Arizona has created an unfortunate problem where half of those students completing their MD or DO education here have to leave the state to find a residency program. Data suggests that physicians are more likely to secure employment closer to where they complete their residency, as opposed to where they’re from or where they completed medical school. We hope to delve into this in our next issue, so until then, try and stay cool in the heat! ru

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A monthly publication of the MCMS • June 2015 • Round-up • 5

round-up

june 2015

Providing news and information for physicians and the healthcare community since 1955.

Published monthly by the Maricopa County Medical Society.

4 8

10 14 18 24 30 36 40 42

what’s inside in memoriam president’s page Self-Employment: The Model of the Future?

public health Healing Communities: Lessons Learned from the MCMS Medical Philanthropy Forum member profile: richard heuser, md A Far-reaching and Innovative Career – A Sit Down with Inventor, Educator, and Cardiology Expert feature article The Changing Dynamics in Physician Employment events and programs “Philanthropy in Medicine”

employment Healthcare Hiring Boom Will Bypass Hospitals

mcms board of director’s meeting minutes marketplace

On the cover: Dr. Richard Heuser, his wife Shari, and their dogs.

Cover photo by Denny Collins Photography: www.dennycollins.com or 602-448-2437 6 • Round-up •June 2015 • A monthly publication of the MCMS

Round-up Staff

Editor-in-Chief Ryan R. Stratford, MD, MBA Editor Jay Conyers, PhD

Advertising, Design and Production Candice Scheibel Contributing Writer Dominique Perkins Advertising

To obtain information on advertising in Round-up, contact MCMS.

phone: 602-252-2015 advertising@mcmsonline.com Postmaster

Send address changes to: Round-up, 326 E. Coronado Rd., Phoenix, AZ 85004 mcmsonline.com

facebook.com/MedicalSociety twitter.com/MedicalSociety Periodicals postage paid at Phoenix, Arizona.

Volume 61, No. 6, June 2015.

Round-up (USPS 020-150) is published 12 times per year by the Maricopa County Medical Society, 326 E. Coronado, Phoenix, AZ 85004.

To subscribe to Round-up Magazine please send a check for one-year subscription of $42 to: Round-up Magazine 326 E. Coronado Rd. Phoenix, AZ 85004

Connect with your Society.

MCMS 2015 Officers President

Ryan R. Stratford, MD, MBA President-Elect

Adam M. Brodsky, MD

Vice President

John L. Couvaras, MD Secretary

Kelly Hsu, MD Treasurer

Mark R. Wallace, MD

Immediate Past-President Miriam K. Anand, MD Board of Directors 2013-2015

R. Jay Standerfer, MD

Steven R. Kassman, MD Shane Daley, MD

Anthony Lee, MD 2014-2016

Lee Ann Kelley, MD May Mohty, MD

Richard Manch, MD Anita Murcko, MD 2015-2017

Ross Goldberg, MD

Jennifer Hartmark-Hill, MD Tanja L. Gunsberger, DO Marc M. Lato, MD

Celebrating 60 Years - 015 1955 2

Round-up is a publication of the Maricopa County Medical Society (MCMS). Submissions, including advertisements, are welcome for review and approval by our editorial staff at roundup@mcmsonline.com.

All solicited and unsolicited written materials and photos submitted to Round-up will be treated as unconditionally and irrevocably assigned to and the property of MCMS and may be used at MCMS’ sole discretion for publication and copyright purposes and use in any publication, website or brochure. MCMS accepts no responsibility for the loss of or damage to material submitted, including photographs or artwork. Submissions will not be returned.

The opinions expressed in Round-up are those of the individual authors and not necessarily of MCMS. Round-up reserves the right to refuse certain submissions and advertising and is not liable for the authors’ or advertisers’ claims and/or errors. Roundup considers its sources reliable and verifies as much data as possible, but is not responsible for inaccuracies or content.

Readers rely on this information at their own risk and are advised to seek independent legal, financial or other independent advice regarding the content of any submission.

No part of this magazine may be reproduced or transmitted in any form or by any means without written permission by the publisher. All rights are reserved.

Letters and electronic correspondence will become the property of Round-up, which assumes permission to publish and edit as necessary. Please refer to our usage statement for more information.

Editor: Ryan R. Stratford, MD, MBA rstratford@mcmsonline.com

Managing Editor: Jay Conyers, PhD jconyers@mcmsonline.com

A monthly publication of the MCMS • June 2015 • Round-up • 7

in memoriam Paul Stanley Drinkwater, MD

Paul S. Drinkwater, MD, 68, of Phoenix, Arizona passed away on May 12, 2015.

Richard Wright Carlisle, MD

Dr. Richard Carlisle, 76, of Phoenix, Arizona passed away surrounded by his family and loved ones on May 17, 2015 after a long courageous battle with prostate cancer.

Born in Portsmouth, New Hampshire on New Year’s Day, 1947 to Edith and Stanley Drinkwater, he completed his Dr. Carlisle was born on Janmedical degree at the Universiuary 16, 1939 in Logon, Utah. dad Autonoma de Guadalajara He met the love of his life Pam medical school, his intern year at Rutgers Medical Peter and married her on December 28, 1963. They had School Hospital, and completed two residencies in five children.

Physical Medicine & Rehabilitation at the College of “The Good Doctor, Dick Carlisle, Papa,” was a fun Medicine & Dentistry Hospital and at the Veterans Adloving, spirited man who lived life to the fullest. A ministration Hospital. travel buff, he visited many countries of the world from As a physical medicine and rehabilitation physician New Zealand to the Seychelles Islands. He loved a good Dr. Drinkwater developed an outstanding reputation in adventure both professionally and personally. A talented the Phoenix valley. He began practicing in Phoenix in physician, he practiced Urology, Family Medicine and 1978. He was also a consulting physician for United Emergency Medicine in more than three states. A canHealthcare and other insurance companies since 1993. cer survivor for 15 years, he never let anything get in Dr. Drinkwater was recognized for being an extremely his way of living a decent, moral and principled life. He caring physician. His “rehab” family (including patients thoughtfully taught his five children to cherish every and colleagues) appreciated the time he took with his moment and remember these important words of wispatients to review treatment plans and advocate for their dom: “Work hard, be a good citizen. Have passion for care. As a medical director for United Healthcare, he whatever you do, and when you feel like you have was acknowledged for his thoughtful medical decisions given all that you can give, give more.” His motto is and unique ability to balance formal criteria with patient exactly how he lived his live. advocacy in mind. His physician colleagues knew him Dr. Carlisle was a proud member of many organizaas a good friend and colleague and valued him for his tions, Knights of Columbus, 4th Degree, Desert Cafiery independence and unbridled opinions. balleros Riders, Hospice of the Valley Pet Therapy and Dr. Drinkwater enjoyed working hard, but he had a Volunteer and the Wickenburg Elk’s Lodge #2160 fun side too. In addition to being a full-time (and then where he held the Position of Exalted Ruler and then some) physician, he loved traveling with his wife of moved up to the State of Arizona Elk’s Vice President, over 40 years, spending time with their dog Dusty and to name a few. His hobbies included golf, gourmet their antique car friends. He enjoyed working on his cooking, hiking, horseback riding, biking, skiing, and Model A Fords and the fun of taking them out for a spin playing the guitar. But most of all, his favorite hobby with his wife or on rounds between hospitals and nurs- was spending time with his family. ing homes.

He was preceded in death by his parents Ruth and He is survived by his wife, Becky; his brother and Thain Carlisle and survived by his wife Pam Carlisle, sister-in-law, Peter and Joanne Drinkwater; nephews and his five children Cathleen Carlisle-Detzel, ChristoAdam Bevelacqua and Nathan Drinkwater; cousin Sue pher Carlisle, MD, Ken Carlisle, Kimberly O’Leary and Beals, and numerous extended family members resid- Corinne Araza. ru ing in the New England area. ru 8 • Round-up •June 2015 • A monthly publication of the MCMS

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president’s page

Self-Employment: The Model of the Future?

By Ryan R. Stratford, MD, MBA

MCMS President 2015 Ryan R. Stratford, MD, MBA Dr. Stratford specializes in Urogynecology/Pelvic Reconstructive Surgery. He joined MCMS in 2005.

Contact Information: The Woman's Center for Advanced Pelvic Surgery 4344 E. Presidio Street www.TheWomansCenter.com P: 480-834-5111 E: rstratford@mcmsonline.com

A

re the days of self-employed physicians soon to be gone? In the American Medical Association’s (AMA) 2012 report, the number of physicians who work for a hospital or hospital-owned practice increased from 16% in 2008 to 29% in 2012. Recent data among the membership of the MCMS suggests that the number of hospital-employed physicians is rising in Arizona as well. Hospital employment may be the future and is certainly trending up, but still, the majority of physicians in the United States work in physician-owned practices (60%).

In last month’s Round-up, I shared my ideas about the business of medicine and the fact that whether employed or self-employed, medicine will always be a business, and that is a good thing. One of the differences between being employed and self-employed is the risk/reward ratio. It used to be that private practice physicians took only marginally greater risk than employed physicians and reaped much greater rewards specific to increased income. However, the margin has decreased in the last two decades and the risk/reward ratio has increased. This has led to the trend away from self-employment.

10 • Round-up •June 2015 • A monthly publication of the MCMS

president’s page Physicians by nature are generally not risk takers (they chose a job with fairly high job security), but they are usually independent thinkers. Working for oneself tends to best support independent thinking, but with ownership comes other responsibilities that physicians often consider onerous, such as staffing and human resource issues. There is no clear path to starting one’s own business and certainly no education in medical training to guide physicians’ interest in self-employment.

medical equipment, and obtain licensure and credentialing with government, hospitals and insurance companies. I had no experience in these matters. I quickly became a student of management and created spreadsheet after spreadsheet carefully calculating the risks and formulating a week by week plan.

One of the first steps I took to build referrals was to meet with physicians in the community. My specialty is not well known, so I visited nearly every practice in Tempe, Mesa, Chandler, Ahwatukee, Scottsdale and Is self-employment important enough to preserve or Gilbert to introduce myself and my specialty. I loved would we be better off working together under the same meeting physicians and learning how they practiced. I large umbrella of employers? took notes about the way they managed their practices and began adapting my business plan to include the In considering an answer to that question I thought things I saw were effective and in line with my ideals. back on my experiences in starting a practice. When I finished fellowship in 2005, there were only three The process was informative. I was slowly moving Urogynecology private practices in the country because forward. My first few referrals were clearly sent to test most Urogynecologists worked at academic centers. the water as the patients had complicated causes for Although there were many opportunities for employ- their symptoms, despite prolonged medical attempts to ment within academic centers outside of Arizona, there solve their problems. I was confident and excited to were no opportunities for employment within Arizona, help where I could and in time, with great effort, paincluding no opportunities to join private practices. I tients did well and reported back to their doctors, startpromised my wife that we would move wherever she ing a relationship of trust with patients and doctors that chose, and she loves Arizona where she was born and eventually blossomed into a busy practice. However, it raised, so we moved here knowing that there may be did not start quickly. I remember driving home and callonly one option – self-employment. I wanted to be in- ing my wife to report that I had not seen more than two dependent and had put tremendous thought into the patients in one day. She reminds me of that every time practice of medicine and the efficiencies I hoped to I complain that I am not as busy as I would like to be. achieve in how my practice would run, so private prac- “At least you saw more than two patients,” she will say. tice and self-employment did not seem unreasonable.

As I reflect back on the experiences of setting up my Knowing I would not have income for months, I own practice, I realize that I learned valuable lessons looked for opportunities to create business models that about what I wanted. I had to dig deep and consider would allow me to establish myself before taking on every part of my practice and how I wanted it to run. I the full risk of self-employment. I met with three hos- was creating more than just a practice – I was creating pital CEO’s in the Valley after presenting to them a a culture, and I wanted to make sure my ideals were rebusiness plan I hoped to implement that included a joint flected in that culture. If asked whether I would do it venture with the hospital. Each meeting was well re- again, in today’s world with the ACA and reduced received but the resources were not available. So, I hung imbursement, I unequivocally would say, “Yes!” I love up a shingle and started my own business. being able to create my own culture in how to practice medicine and I think the opportunities are just as great It was rough at first. I did not see my first patient for today as they were in 2005. The landscape has changed four months and did not perform surgery for six but the opportunities are still just as great. months. I had to build an office, hire staff, purchase A monthly publication of the MCMS • June 2015 • Round-up • 11

president’s page I believe that preserving self-employment in medicine is paramount to maintaining high quality healthcare in our community. If healthcare reform hopes to retain high levels of patient care, it will need private practicing doctors who have direct ownership of their practices as well as employed physicians. Much like any other sector of the market, allowing for competition improves the product or service. Physicians compete on quality of service, which includes how efficient, timely and effective their offices run. Ownership incentivizes providing high-quality care.

“As I reflect back on the experiences of setting up my own practice, I realize that I learned valuable lessons about what I wanted. I had to dig deep and consider every part of my practice and how I wanted it to run. I was creating more than just a practice – I was creating a culture, and I wanted to make sure my ideals were reflected in that culture. If asked whether I would do it again, in today’s world with the ACA and reduced reimbursement, I unequivocally would say, ‘Yes!’...”

of residency is a reluctance to seek a job that would ultimately provide for personal ownership. Almost all recently trained physicians prefer employment over ownership. They struggle to see the value in owning a practice, the culture and the outcomes because they prefer less risk and gladly accept less reward. To some extent, that surprises me.

Being comfortable with risk ought to be something physicians are very good at, but it turns out that while most physicians are very comfortable with medical risk, they are much less comfortable with economic risk. However, ownership of economic risk is a compelling reason to consider self-employment. Owning economic risk is the driving force for positive physician behavior. Consider the struggle many practices have with covering call schedules. Those with ownership of economic risk usually are more willing to take less desirable call nights if it improves reputation and increases opportunity for economic growth, something that an owner of a practice sees as great worth. Ultimately, ownership of economic risk is rewarded when physicians are able to provide the type of care they hoped to provide when they set out to become physicians.

In sharing my biases about private ownership, I do not wish to demean or disregard the benefits of hospital employment. I simply hope that In addition to offering high-quality care, ownership as physicians we keep a balanced outlook of both ways lends itself to diversity. In all my visits to doctors’ ofof practicing. I believe diversity benefits patients, and fices, I noticed the huge variety of office decors, office ownership, whether wholly owned or partially owned, staff, and office philosophies among all of the different ultimately provides patients with better care. doctors. The diversity of cultures among practices is refreshing. Clearly, there is a doctor that fits every paI hope the grim future portrayed by the media and tient’s needs in their approach for delivering that care. disgruntled physicians does not dampen the spirit of I hope that the opportunity for ownership of practice re- new physicians. I also hope that there will continue to mains strong in Maricopa County. be a great number of self-employed physicians because there is something appealing about creating a practice The biggest threat to preserving self-employment in that reflects an individual’s ideals and personality. It medicine is not government interference, but rather a adds diversity to how healthcare is delivered and pushes shift in attitude of those who are entering the workforce. the envelope in providing greater care. ru What I have seen in training residents in their last year 12 • Round-up •June 2015 • A monthly publication of the MCMS

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public health

Healing Communities: Lessons Learned from the MCMS Medical Philanthropy Forum

By Jonathan B. Weisbuch, MD, MPH

Jonathan B. Weisbuch, MD, MPH Dr. Weisbuch specializes in Public & Health General Preventive Medicine. He has been a MCMS member since 1997; serving on the Board of Directors from 20072012.

He is retired and living in Phoenix.

T

he Maricopa County Medical Society presentations on May 7 were outstanding. Three society members shared their experiences in providing services to underserved populations both in Arizona and the underdeveloped world. Dr. David Beyda, on the staff of the Phoenix Children’s Hospital, and Dr. Candace Lew, a specialist in OB-Gyn, described their activities providing community medical care and education in the third world. Dr. Randal Christensen, also on the Children’s Hospital staff, discussed his work providing primary care to homeless and impoverished children of Maricopa County using a medically equipped 40-foot motorhome.

We all came away with a sense of awe for the gifts our colleagues have provided to destitute individuals and communities, and a recognition that their most important contributions are what each has left behind: trained health workers, viable clinics, and patients educated about their environment, their health risks, and what they can do to prevent illness. Our colleagues demonstrated what is possible, both here and abroad, when physicians are committed to using their professional skills outside of their offices or hospitals in order to serve individuals and communities unable to access the care they need, and with inadequate resources to promote health. Their work demonstrates what each of us might do to improve the health status of entire populations.

14 • Round-up •June 2015 • A monthly publication of the MCMS

public health The third-world problems described by Drs. Beyda and Lew, and the gaps in our local health system described by Dr. Christiansen are extensive. The public health infrastructure in many nations is inadequate. It does not monitor disease, assess risk, or intervene quickly when critical health problems arise. Health education is frequently absent, and integrated systems of clinical care are unavailable. Academic programs designed to train nurses, aides, pharmacists, emergency workers, primary care physicians and medical specialists do not meet their goals. In the underdeveloped world, systems to meet basic health needs may lack government support, relying on religious groups and other charitable organizations to serve the public; but Dr. Christiansen’s work shows this is also true in Maricopa County.

We know insufficient governmental investment in community health can produce expensive consequences throughout the world. The recent Ebola outbreak in West Africa is only one example. Infectious diseases like HIV/AIDS still ravage millions. Malnutrition is a

major cause of death. Infant mortality, maternal mortality, tuberculosis, malaria, and myriad other diseases, the prevention and care of which are possible with appropriate resources, still exist throughout much of Africa, South America, Asia and the Middle East. The work of physicians like Drs. Beyda, Lew and Christiansen have created resources that serve children and adults, teach about disease, and provide access to integrated health systems with trained, qualified health professionals. Their work has lowered the risk of disease, disability and death, and improved public health in communities of need.

But while we listened to the exploits of our colleagues both in Maricopa County, and abroad at this wonderful evening presented by our Society, we seem unaware that a similar disregard for the public’s health may be occurring in Arizona. Problems of the underdeveloped world can also be found in America. Over the past several years, our legislature has reduced public investment in public education, public health and health services. Hundreds of millions of dollars have

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A monthly publication of the MCMS • June 2015 • Round-up • 15

public health been cut from public education pre-K through 12. The budgets of community colleges, universities and for professional training have also been drastically reduced.

State funds for Arizona Health Care Cost Containment System (AHCCCS) and the Arizona Department of Health Services (ADHS) have also been sheared, and some Federal funds for indigent care withheld from distribution.

mary source for physicians, nurses, LPNs, and other medical specialists. Continuing college and university budget cuts will impact the number of trained professionals available to meet the health needs of an expanding Arizona population.

Arizona has a physician shortage. With 15,000 practitioners to serve 7 million residents, our doctor to population ratio is only 2.14 per 1000 people.

The national figure is 2.76 per 1000. Outside Maricopa and Pima Counties, the “...What can we, as members of the Maricopa deficit is worse. To keep pace with an anCounty Medical Society, do as we witness our nual population growth of 100,000, Arizona state government reneging on its responsibilmust add over 300 doctors and 1000 nurses ity to preserve, promote and protect health each year. Forty percent of new physicians education and the health service system for should be trained in a primary care speall our citizens, young and old? Can we do for cialty, yet only 25% of our graduates now Maricopa County and for Arizona, what our choose primary care. Educational debts encolleagues have done for poverty regions courage the choice of more lucrative speacross the world?...” cialties. As tuitions rise to offset reductions in state funding, student debt will increase, further inhibiting the choice of a primary Public schools have been forced to eliminate many care specialty, exacerbating our medical shortage. positions, including school nurses, which are a critical Training health professionals, whether doctors, first line of healthcare for our children. School nurses nurses, pharmacists or medical technicians, is expenrespond to acute in-school health events and diagnose sive. But as Drs. Beyda, Lew and Christiansen have early problems. They often provide emotional support shown, the absence of trained professionals is both exfor anguished teens, as well as age-appropriate health pensive, and devastating to any community. Shaving education and advice to our children, helping to lower funding to lower taxes or expand private business is not teen pregnancy rates, sexually transmitted diseases, and an answer to meeting the educational, clinical and pubprevent adolescent suicide. In both this country and lic health needs of Arizona residents. abroad, knowledge is prevention.

The presentations from Drs. Beyda, Lew and ChrisSimilar cuts to state and county health department tiansen showed what three dedicated professionals can budgets have also reduced professional nursing staffs. achieve when governments fail to support the needs of Public health nurses immunize children, follow at-risk their people. What can we, as members of the Maricopa families, trace infectious disease outbreaks, staff public County Medical Society, do as we witness our state health clinics, educate patients, and much more. As government reneging on its responsibility to preserve, these positions disappear, the services nurses provide promote and protect health education and the health are denied to the community, forcing a decline in comservice system for all our citizens, young and old? Can munity health status. we do for Maricopa County and for Arizona, what our Massive budget cuts to community colleges, univer- colleagues have done for poverty regions across the sities and graduate training programs result in tuition world? Or will we allow the slow degradation of the increases, and limitations in health professional training health status of our community continue through the programs. Arizona colleges and universities are our pri- death by a thousand cuts? ru 16 • Round-up •June 2015 • A monthly publication of the MCMS

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member profile

A Far-reaching and Innovative Career – A Sit Down with Inventor, Educator, and Cardiology Expert:

Richard Heuser, MD Article photos: Denny Collins Photography www.dennycollins.com 602-448-2437

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his month, as Round-up focuses on physician employment in Arizona, we took the opportunity to sit down with Richard Heuser, MD, to discuss his extensive experience and perspective.

18 • Round-up •June 2015 • A monthly publication of the MCMS

member profile Heuser first moved to Arizona when he was recruited by Dr. Ted Dietrich to become the new Director Dr. Heuser remembers being attracted to the idea of of Research and Education at the Arizona Heart Instia career in medicine at a young age. tute. Following his time there, he decided he wanted to “Like most young men of my generation, watching take up his own practice, and began working at the Ben Casey and Dr. Kildare, it appeared that this was a Phoenix Heart Center in 1997. very prestigious profession,” he said.

“I wanted to teach fellows as well as perform basic While Heuser’s introduction to the idea of medicine and clinical research in a true center of excellence,” he may seem fairly run-of-the-mill, his career certainly said. tells another story. An internationally recognized expert “We are privileged to treat patients from not only in cardiovascular care, Heuser has published hundreds Arizona, but around the world with cardiovascular techof medical articles, developed ground-breaking treatniques and devices that we have introduced to the State ments, and served on many societies and editorial and in many cases to the world at our center. We see boards. many patients that have had no other options, and we His medical journey began at the University of Wis- have been able to successfully manage their cardiovasconsin, where he completed his medical degree. After cular problems.” graduating, he travelled to Baltimore, Maryland and In addition to his practice at the Phoenix Heart Cencompleted his residencies in general practice and interter, Heuser currently serves as the chief of cardiology nal medicine at Johns Hopkins Hospital, where he at St. Luke’s Medical Center, where he has pioneered would select the specialty that would shape his notemany innovative treatments and technologies. worthy career.

In addition to medical practice, research, and inven“At Hopkins, I was exposed to the top cardiology tion, Heuser also plays his part in education, serving as researchers worldwide, so I naturally pursued cardiolthe professor of medicine at the University of Arizona ogy as a specialty,” he said. And he hasn’t looked back.

College of Medicine, as well as working with other universities to promote progress.

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member profile “I am passionate about clinical research as well as and enticing them to stay. Heuser has a few ideas about the development of medical technology. I have worked the causes, and potential solutions, of the shortage. with the state and both Univesity of Arizona and Ari“The problem in our state is that we need more adzona State University to develop programs to train othvanced training programs for residents and fellows, parers in developing new technology,” he said. ticularly in Phoenix,” he said. “Most people stay in the In addition to his hard work as a cardiovascular spe- city where they do their advanced training.” cialist on all fronts, Heuser devotes a considerable “The limited resident and fellowship positions make amount of time to his family and home life. He and his it imperative to continue to develop the University of wife, Shari, have one daughter, Alexandra, and one Arizona College of Medicine – Phoenix. With so many grandchild, Anastasia. of Arizona’s medical students leaving the state for their Balance is important to any healthy lifestyle, and he advanced training, we produce far more medical proand Shari, along with their two dogs, enjoy staying ac- fessionals than we get to keep. A more robust educative together by hiking, running, and cross training. tional scene, as well as some new ideas, could help tip Heuser still competes in distance races, where he rep- that balance,” said Heuser. resents very well in his age group.

“I am passionate about helping Phoenix to become “I have a great spouse,” Heuser said. “So I only have a true university town,” he said. to worry about work.”

“I have been fortunate to live in other parts of the country where there were a myriad of national and Battling a Physician Shortage world experts in various fields of medicine. We have Thanks to the breadth and variety of his career, not achieved this yet in Phoenix. I would like to be part Heuser has gained a fair amount of perspective on the of the solution to this one thing lacking in this vibrant physician employment landscape in Arizona. And even city and state. One of the things that would make the though that scene certainly looks a little different than University of Arizona College of Medicine – Phoenix it did when he was first starting out, he believes there unique would be to develop an innovation center.” is plenty of hope for these looking to make their own “I have been intimately involved with BioInspire in mark on the field.

Peoria and have helped develop two companies from “I think people are still moving here, and I think a scratch in these organizations. One of the ways to keep skilled physician will also have opportunities in Aritop physicians and scientists in this State would be to zona,” he said. “For a well trained physician with expand programs to allow academic physicians to deunique skills, there is always an opportunity.” velop proprietary technology in a true, private, public These opportunities, however, will certainly not environment,” he said. come without a fair amount of work, and perhaps even Another, perhaps unexpected, possibility to better a little hustle. There is plenty of competition. the physician employment scene could come from the “I think physicians who bring nothing unique to a Affordable Care Act (ACA). The ACA seems to have practice or community are going to have to sell them- an impact on every corner of the medical practice. selves to consumers as well as referring doctors. This While the program is not without its faults and frustrations, widespread participation could expand Arizona’s is no different than any other business.” patient-base.

That competitive market results partly from Ari“If we truly will have more patients in the program, zona’s known physician shortage. There are, of course, many different factors affecting this shortage, and con- this could result in more physician employment opportributing to Arizona’s difficulty in attracting physicians tunities,” Heuser said.

20 • Round-up •June 2015 • A monthly publication of the MCMS

member profile

However, despite the various potential benefits, Heuser believes the ACA is a sign of a negative turn in the direction of the medical practice: one where medical providers are no longer calling the shots on what should be their areas of expertise.

“This could have been developed with medical leaders as well as insurance carriers and some government oversight. I am afraid the ACA was a program set up for strictly political reasons and has little to do with healthcare. However, there is no way that anybody suffering a catastrophic illness in the United States should Shaping Change go bankrupt because they cannot pay their medical The Affordable Care Act is just one example of how bills.” politics is shaping the medical scene, and the physician “I really wish the politicians would have involved voice is needed now more than ever. healthcare workers rather than pollsters when they set “I think it is laudatory to develop a catastrophic up a national health system program.” healthcare insurance program available to all US citiWith so many politically driven regulations, Heuser zens,” Heuser said. “If all of us are paying the bills, in is afraid the resulting medical culture could be standing order to cover all citizens, of course there would be limin the way of the best medical care possible. itations.”

A monthly publication of the MCMS • June 2015 • Round-up • 21

member profile

“With the regulatory environment in the United “I am also very involved with the European Society States, it is very difficult to treat many patients that I of Cardiology and am one of the few Americans who could treat with technology and techniques that I utilize lecture at various international meetings to try to disin other countries,” he said. seminate technology that we have developed or invented in Arizona,” he said.

“Twenty years ago when I had a patient who had a medical problem, I could document that either the techHeuser has also lectured and demonstrated technique or device I used was the best to be utilized. In my niques around the world for treatment of Chronic Total opinion, that is no longer possible because of the regu- Occlusion (CTO) and is a member of the CTO Club. latory environment in American medicine.”

He previously co-directed the club’s meeting in Washington, D.C., where physicians from around the globe With so many reasons for physicians to start speakparticipated in discussions of the treatment technique, ing up and being heard, it is little wonder that Heuser is which has been referred to as the “final frontier” of so heavily involved with multiple medical organizacoronary artery disease treatment. tions.

Closer to home, Heuser has been a member of the “I was fortunate to be involved with the American Maricopa County Medical Society since 1994, and Heart Association (AHA) and the American College of serves as the program director of the 3rd Annual Cardiology (ACC), nationally representing Arizona and Symposium Cardiovascular Disease Management: A presenting papers on topics and devices developed in Case-Based Approach. The event will be held October Arizona,” Heuser said.

1-3, 2015, in Phoenix. More details can be found on He has also been on the Board of AHA, Arizona, and page 2. ru is a former State President of the AHA. 22 • Round-up •June 2015 • A monthly publication of the MCMS

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feature article

The Changing Dynamics in Physician Employment

By Joan Pearson

Joan Pearson For over 20 years, Joan, the president and founder of Catalina Medical Recruiters, has worked exclusively in the physician search and locum tenens industry. As an active member of the National Association of Physician Recruiters (NAPR), Joan served on the Board of Directors from 2002 to 2005.

Joan is also a member of the National Association of Locum Tenens Organizations.

Joan has been guest speaker for medical organizations including the Arizona Medical Group Management Association, the Arizona Chapter of ACP, the University of Arizona Family Medicine Residency Program, the Arizona Osteopathic Medical Association, and the Arizona Chapter of Professional Healthcare Office Managers.

Contact Joan by email to joan@catalinarecruiters.com.

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aced with severe physician and provider shortages in an ever changing healthcare environment, the ability to retain established physician staff plays a critical role in the recruitment of new providers. Established and content physicians can bring a sense of longevity and stability, as well as indicate a healthy and robust organization. Ideally, a new physician coming on board pictures himself or herself practicing for years to come when they see an organization where the morale is high. Everyone benefits when organizational relationships are healthy – the practice, the providers and the community of patients. Healthcare organizations that explore innovative ways to position themselves to meet the changing needs of providers throughout their career will have a competitive advantage for recruitment and retention of providers in the years ahead.

Round-up had the opportunity to discuss questions regarding the current employment trends and strategies with Joan Pearson, president of Catalina Medical Recruiters.

24 • Round-up •June 2015 • A monthly publication of the MCMS

feature article Q: With the Physician Shortage, especially in certain specialties, what trends are you noticing with physician employment?

• The increased complexity and the potential liability involved in billing and coding

• Fear and uncertainty in dealing with regulatory burdens contained in the Affordable Care Act

Recent studies indicate that a growing number of physicians are considering employed positions over pri• Financial realities making it difficult to recruit vate practices, which have been the cornerstone of newly trained physicians to private practice American medicine. Traditionally, 75% of physicians Physicians in private practice who are interested in have been in office-based, independent practice situations. There are a few key issues causing physicians to merging or selling their practice have several options.

They include: joining an Independent Practice Associbe open to the employment model: ation, merging with another practice, selling to a hos• Fee discounts by insurance companies and lower pital or healthcare system, or selling to an insurance Medicare and Medicaid reimbursements carrier.

• An aging physician workforce seeking financial The most common acquisition we have seen today stability and preparation for retirement is a hospital buying a physician’s practice. This was a trend in the 1990s and has become even more common • Increased administrative responsibilities in since the Affordable Care Act regulations were released. private practice including balancing efficiency, However, some are exploring the other option for sellstaffing and patient access with demands for care

A monthly publication of the MCMS • June 2015 • Round-up • 25

feature article ing their practice. According to a Kaiser Health News report, an increasing number of large health insurance companies are purchasing physician practices. The focus of these takeovers is usually primary care practices, a market which hospitals are also aggressively trying to control since primary care is the foundation of the new healthcare legislation.

Insurers acquiring practices employ the use of sophisticated accounting and management skills to improve efficiency, saving the patient money while providing better care and making a profit for the insurance company. Insurance companies may also have the experience and tools to tackle the many statistical aspects required for Accountable Care Organizations, which would be difficult for many physician practices to handle on their own.

Depending on where physicians are in their career path, they may respond to different incentives. Residents and fellows are typically more interested in retaining a lifestyle balance; a work environment with set hours, attractive call schedule, and access to cutting edge technology; and potential for salary growth. With an average debt of $200,000+, many residents/fellows are also interested in opportunities that offer loan repayment.

An article in American Medical News reported physicians who have been practicing for a few years may feel salary/bonuses and the opportunity to become a partner or shareholder are important.

Established physicians may be more concerned with flexibility in hours and freedom from the administrative details of a practice. Offering some flexibility and inWhile there are potential advantages to this option, dividualization in your compensation package may there are some unanswered questions regarding the make the difference in signing your top candidate. trend of insurers buying practices. One primary concern Today a standard compensation package includes: is how referrals to specialists will be handled and there• Base salary that is appropriate for the candidate’s fore, how regulatory requirements will be met. Also, specialty and level of experience how will physicians who treat patients with competing • Productivity bonus with a benchmark for quality health insurance continue to serve their needs while and volume working for a competitor?

• CME – paid time off of 1 week and $1,500+ CME expense allowance Q: How are your clients attracting talent?

What trends are you seeing in compensation • Four weeks paid time off packages?

• Malpractice Insurance With the changing dynamics and uncertainty in • Health Insurance for candidate and ability to healthcare, we are seeing many changes in medical purchase insurance for the family provider compensation. As a hospital or a medical • Relocation expense group, developing a competitive recruitment package • Signing bonus or stipend requires knowing the market and your competition.

And, with the critical physician shortage and the mobility of the population, today that competition is nationwide. Physicians know they are in demand and in most cases are simultaneously exploring several different opportunities. Consequently, medical organizations have found it is necessary to recruit from a national pool of physicians not just those with ties to their geographic area.

A recent article by Becker’s Review noted that “signing bonuses are nearly a given.” Becker’s report says roughly 88% of placed physicians received a signing bonus with the average signing bonus topping $20,000.

Along with signing bonuses, stipends are being offered to residents/fellows during their last year of training. It is obvious organizations are already experiencing a physician shortage and are incentivizing physicians to make solid commitments.

26 • Round-up •June 2015 • A monthly publication of the MCMS

feature article

Changing Dynamics in Healthcare

Locum Tenens

Technology

Compensation

Medical Provider Shortage

Employment Trends

Advanced Level Practitioners

A monthly publication of the MCMS • June 2015 • Round-up • 27

feature article Multiple factors will impact provider compensation in the future including healthcare reform, the development and evolution of Accountable Care Organizations and the continuing physician shortage. Competitive, flexible compensation packages will be an important part of recruitment and retention strategies for every organization.

Q: What about Locum Tenens work? How are you seeing it utilized?

Locum tenens is a cost effective solution to the medical provider shortage. As the integrated care and medical home movements have brought primary care back to the forefront, there is a critical shortage of Internal Medicine and Family Practice physicians. As the demand and competition for providers increase, maintainQ: What kind of additional employee strateing an adequate physician workforce becomes more gies and resources do you recommend to your challenging. Locum tenens physicians provide continuclients? ity of care while facilities implement strategic plans, We recommend implementing advanced practice maintain a revenue stream until a permanent physician providers into your practice to increase practice produc- is recruited, assist while an employed physician is away, tivity. The benefit of using advanced practitioners and help treat increased patient loads. within a practice is three-fold: Another important but often overlooked advantage • Saves physician time and increases their to using locum tenens providers is the benefit to indiproductivity vidual physicians. It has been reported that physician burnout is at an all-time high. Using the services of a • Patients are happier because they can be seen locum tenens provider can both help alleviate provider sooner burn-out and allow your practice to continue providing • Revenue to the practice increases and has a the quality medical care your patients have come to expositive impact on the bottom line pect. Consider locum tenens as an important component Advanced practice providers take care of routine of- of your short-term and long-term provider recruitment fice visits, overflow patients, help with on-call duties, strategies. and frees up a physician’s time to care for patients who require a physician visit. This is a ‘win-win’ for the Q: What are the financial implications of includpractice, physician, advanced practitioner, and patients. ing this sort of strategy?

Advanced practitioners, specifically nurse practitioners and physician assistants, can take medical histories, perform physicals, diagnose and treat illnesses, prescribe medications, order labs and X-rays, educate patients, and take call. They can handle the routine medical visits allowing physicians more time to treat patients requiring a higher level of care.

By having an advanced practitioner in your practice, patients who may have to wait 4-6 weeks to see a physician can see a nurse practitioner or physician assistant the same week. Knowing they can receive prompt medical care, patients are more apt to return to the practice.

Advanced practitioners are not only valuable to the physicians by freeing up their time, but they also allow the practice to increase the volume of patients seen daily.

The financial impact of having proper physician coverage should not be ignored. Being one physician short has a direct impact on your bottom line. For those healthcare executives who are concerned about physician retention and patient satisfaction, locum tenens is a solution for consideration. A locum provider will augment your medical staff, provide quality medical care to your patients, and maintain your revenue stream.

Daily rates for locum tenens coverage are determined by provider specialty. A daily rate is charged to the organization and all fees generated by the locum tenens provider are retained by the organization. Your organization is not responsible for reimbursing the physician, providing malpractice insurance, vacation, health insurance, or other benefits. A reputable locum

28 • Round-up •June 2015 • A monthly publication of the MCMS

feature article tenens firm will take care of reimbursement to the compliance with all the entities involved. Being unprephysician and arranging for the malpractice insurance. pared may result in the denial of claims and payments causing a severe cash flow issue for your organization.

Q: Although there have been several delays in Because ICD-10 codes are much more specific than ICD-10 implementation, the October 1 dead- ICD-9 codes, payers may modify terms of contracts, line has everyone scrambling. What can you payment schedules or reimbursement. At a recent Arizona Medical Group Management Association meeting, tell us about preparing for implementation? it was suggested medical organizations obtain a line of Patient care is the priority and technology requirecredit to prepare for any unseen problems. Don’t forget ments and regulations are next in line. Extensive trainthe Boy Scout Motto….Be Prepared! ru ing is necessary for the clinical staff involved in treatment, administrative staff and professional coders.

In addition, CMS suggests being proactive in working with your clearinghouses, billings services, other venFor more information on the above topics, dors and payers. You may feel your organization is prepared but it is important to discuss readiness and contact Catalina Medical Recruiters, Inc.

Stand up. Stand Strong. Stand United.

The challenges facing today’s physician are staggering.

Now, more than ever, MCMS needs you to be part of its collective strength so we can work towards implementing positive change.

Let us help you continue deciding what care your patients need — and when they need care. Let us help you navigate the complexity of a changing national healthcare system that puts more and more pressure on our physicians.

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Call: 602-252-2015 Click: ww.mcmsonline.com Connect: mcms@mcmsonline.com A monthly publication of the MCMS • June 2015 • Round-up • 29

event/programs — medical philanthropy

event/programs — medical philanthropy

Dr. Candace Lew, MPH

Dr. David Beyda

Dr. Randal Christensen, MPH

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n May 7th, the Maricopa County Medical Society hosted a member event in the courtyard that brought together three world-class speakers to tell their stories of how they deliver care to those less fortunate. Themed “Philanthropy in Medicine,” local physicians Candace Lew, David Beyda, and Randy Christensen gave powerful presentations that captivated those in attendance and led to a thought-provoking Q&A session at the end of the event.

Candace Lew, MD, MPH, shared with the audience her experience providing contraceptive and maternal health services in economically disadvantaged regions of the world. Serving as Pathway International’s Senior Technical Advisor for Contraception since 2012, Dr. Lew has led training programs and clinics in locations such as Nepal, Malawi, Ethiopia, Afghanistan, and Senegal, among others. She presented a series of captivating images of her time in these remote parts of the world, and discussed the impact that she and her team left on the local provider community through training, education, and delivery of care.

David Beyda, MD, told his story of how as a young boy he was exposed to the health challenges of the world through his time living abroad, as his father served as a foreign service officer for the State Department in the 1950s and 1960s. Dr. Beyda shared with the audience his early fascination with global medicine as far back as his time as a senior resident in Louisville, KY, when he took time to oversee a pediatric unit at a Cambodian refugee camp in 1980. Currently a Pediatric Critical Care Specialist at Phoenix Children’s Hospital and a Professor of Bioethics at the University of Arizona College of Medicine – Phoenix, Dr. Beyda described the work performed by the organization he founded, Medical Mercy, and shared with those in attendance what he’s experienced through the 61 trips he’s taken abroad since 2004 performing medical assessments and developing healthcare worker training courses in Africa, Asia, and Central America.

Randal Christensen, MD, MPH, presented the story of how he created a mobile clinic for the homeless and at-risk youth throughout our local community. As a staff physician at Phoenix Children’s Hospital, Dr. Christensen led the development of the Crews’n Healthmobile in 2000, converting a 40-ft RV into a fully functional mobile medical unit that has served the valley for nearly 15 years. He shared with the audience the day-to-day challenges of caring for such a unique patient population, and described some of the troubling cases he sees on a regular basis.

The Society thanks the three speakers for their time and for sharing their stories with those in attendance. We invite you to continue on to pages 32-35 to view select photos from the event. For a full photo album, visit the MCMS Facebook page: www.facebook.com/medicalsociety. To download presentations from the event, log onto www.mcmsonline.com (the event slide is the third one on the home page) then click on “View Now.” ru A monthly publication of the MCMS • June 2015 • Round-up • 31

event/programs — medical philanthropy

left to right: Lisa Watkins, Aditya Paliwal, Dr. May Mohty, Dr. Kelly Hsu, Dr. Jonathan Weisbuch, and Diana Schron

Derek Chinn and Katie Cho, medical students at Midwestern University.

32 • Round-up •June 2015 • A monthly publication of the MCMS

Drs. Shane (left) and Timothy Daley.

Shane is a current board member and Timothy a former board member and officer.

event/programs — medical philanthropy

Dr. Ryan Stratford, MBA, MCMS President, delivering opening remarks.

The introduction of Dr. Debra Rose, MCMS Philanthropy Committee.

Dr. Mark Lockett asking the panel a question.

The audience listening with rapt attention to the informative and fascinating presentations.

A monthly publication of the MCMS • June 2015 • Round-up • 33

event/programs — medical philanthropy

Attendees enjoying the evenings festivities. The courtyard was decked out, the weather was mild, delicious appetizers and deserts were served, and the evening enjoyed by all.

34 • Round-up •June 2015 • A monthly publication of the MCMS

event/programs — medical philanthropy

The Q & A session. Dr. Jonathan Weisbuch is asking the panel questions.

Dr. Lee Ann Kelly speaking of the MCMS Philanthropy Committee’s mission and vision.

Dr. John Middaugh and Dr. Diana Petitti.

The audience thanked Dr. Petitti for the beautiful decorative boxes presented to the speakers.

The distinguished panel answering audience questions.

A monthly publication of the MCMS • June 2015 • Round-up • 35

employment

Healthcare Hiring Boom Will Bypass Hospitals

By Melanie Evans

Melanie Evans Melanie Evans writes about hospital management and governance issues. She has been part of the Modern Healthcare staff since 2004. Earlier in her career she covered healthcare and not-for-profits as a reporter at the Duluth (Minn.)

News Tribune.

She received a bachelor's degree in international relations from Boston University and a bachelor's in journalism from the University of Minnesota.

Reprinted with permission.

Modern Healthcare, January 17, 2015 © Crain Communications, Inc.

T

he healthcare sector of the U.S. economy will be hiring at a faster pace in 2015 as a healthier economy and shrinking uninsured population fuel an uptick in demand for routine and discretionary services. The era of hiring restraint — fueled by the recession and the steady rise in high-deductible plans — appears to be ending.

The hiring binge will be uneven, though. The outlook for growth in hospital employment — healthcare's largest employer — is modest at best. Many hospitals will be reducing head counts. Others are holding the line on adding new employees since the federal government plans to keep a tight rein on reimbursement while private insurers are pushing more participation in risk-based contracts.

Hospital margins shrank over the past year as rising labor costs ate into a slower-growing top line.

Hiring at outpatient facilities and ambulatory surgical centers, on the other hand, is expected to continue its rapid growth as technological changes and financial pressures push the locus of care from inpatient to outpatient settings. Home healthcare’s need for personal aides will continue to mushroom.

And beneath it all, healthcare human resource departments will continue to face a major skills gap, especially when it comes to filling nursing positions. That problem will worsen as hundreds of thousands of aging baby-boomer nurses retire. New delivery models, which are expanding the need for people steeped in population health management, patient outreach and care coordination, exacerbate the problem.

Hiring across healthcare grew at less than 2% a year since the 2009 recession because of a long, anemic recovery. But the pace picked up as 2014 drew to a close. The sector’s monthly hiring more than doubled

36 • Round-up •June 2015 • A monthly publication of the MCMS

employment over the course of the year, finishing with 14.9 million jobs, up 2.1% from the end of 2013.

The year-end pace of hiring will likely continue this year, said Ani Turner, deputy director of the Center for Sustainable Health Spending at the Altarum Institute. “I don’t see any reason why it’s going to drop off,” she said, citing the Patient Protection and Affordable Care Act creating more households with health insurance and a falling unemployment rate giving people more income to spend on healthcare.

But healthcare’s largest sector — hospitals — is the outlier. Facing continued financial pressure from public and private payers, hospitals are intensifying their efforts to reduce their largest expense: labor. “I think we’re going to see pockets of layoffs,” said Jennifer Stewart, managing director of research and insights at the Advisory Board Co.

million new registered nurses by 2022, according to personnel placement firm NAS Recruitment Innovation.

Carolinas HealthCare, based in Charlotte, N.C., increased by 15% the number of advanced-practice nurses and other practitioners last year as the system worked to expand its primary-care capacity. The number of advanced practitioners Carolinas employs has doubled in the past five years to 741.

It’s already happening at Denver-based Catholic Health Initiatives, which in December announced it “We’re focused on meeting our patients where they would eliminate about 1% of its 90,500-person work- want to receive assistance,” said Debra Plousha force. The 92-hospital system said the move was in re- Moore, chief human resources officer for the 22-hossponse to its poor financial performance. “The CHI pital system. workforce reduction was limited to about 1,000 posiWhile it has no overall projection for hiring this year, tions,” the system said in a statement.

Carolinas did eliminate 100 executive and manageIt’s a microcosm of the sector-wide trend. The Bu- ment-level jobs as part of an effort to reduce operating reau of Labor Statistics projects hospital employment expenses by $110 million annually. will grow by 815,000, or 17%, over the next decade.

“There is clearly increased pressure for hospitals to But overall healthcare employment will grow signifiimprove their bottom lines,” said John Klare, a mancantly faster — 29.4% — with the much smaller home aging director and healthcare practice leader for Navihealth and skilled-nursing facility sectors each adding gant Healthcare. almost as many jobs as hospitals. Hospital employment will fall to 25.5% of the sector’s jobs in 2022 compared FirstLight HomeCare, a Cincinnati-based provider with 28.2% in 2012. with more than 120 franchises across the country, added 500 caregiver jobs last year and expects to add a similar That leaves hospital recruiters with a new problem number this year.

— a growing shortage of experienced registered nurses to replace older nurses and to fill slots in care coordi“Our outlook for hiring is very bullish, both at new nation, a fast-growing specialty. The nation will need a offices and at existing offices,” said CEO Jeff Bevis.

A monthly publication of the MCMS • June 2015 • Round-up • 37

employment “Demand has certainly increased the latter part of To Obsidian Research’s Toby Wann, that translates 2014 going into 2015 compared to where we were this to very different recruitment pressures on the home time last year.” health and nursing-care segments of post-acute care.

Skilled-nursing and residential-care facilities — which saw anemic growth of only 1% last year, bringing total employment in the sector to 3.3 million jobs — face a mixed employment picture in 2015. While home care is often touted as being more cost-effective, it increases the demand for nurses and nurses’ aides.

“The hunt for qualified physicians interested in primary care will continue to dominate the physician employment landscape in 2015.

The Bureau of Labor Statistics projects total physician employment will grow only 18% to 814,700 positions in 2022, significantly below healthcare as a whole...”

“Home care is less efficient than skilled nursing because you have a one-on-one care model,” said Fred Benjamin, chief operating officer at Medicalodges, a Coffeyville, Kan.-based long-term-care provider.

“Therefore, you need more people.”

But given the overall shift toward home care — the American Health Care Association, which represents long-term care and post-acute providers, projects 27 million people will be receiving long-term care, including home health services, in 2022, up from 6 million currently — the hiring pace at nursing homes may slow.

“You probably will see a little pressure to raise wages on the home-health side,” he said. “Conversely, on the skilled-nursing side, I don’t see much upward pressure in terms of wage rates in the skilled-nursing facilities.”

The hunt for qualified physicians interested in primary care will continue to dominate the physician employment landscape in 2015. The Bureau of Labor Statistics projects total physician employment will grow only 18% to 814,700 positions in 2022, significantly below healthcare as a whole. But filling those extra slots will be exacerbated by the baby boomer retirement wave among doctors, just as it will be with nurses.

Phillip Miller, vice president of the Irving, Texasbased physician-recruitment firm Merritt Hawkins, notes 66% of oncologists are 55 or older, as are 60% of psychiatrists, 54% of cardiologists and 52% of orthopedic surgeons.

“Now that the stock market has rebounded, we do anticipate an unprecedented wave of retirements that the industry is not prepared for,” he said. “It’s like a tsunami lurking off shore.”

Yet specialist recruiting isn’t the major problem faced by Dr. Matthew Gibb, chief medical officer at the Carle Foundation, an integrated health system with a 393-bed hospital in Urbana, Ill. “We’re seeing the biggest difficulties in our primary-care recruiting,” he said. “There’s a lot more competition for primary-care physicians both nationally and regionally.”

“We don’t foresee any reductions in our workforce His solution? Signing bonuses, educational loan rein 2015,” said Gerald Coggin, senior vice president for National Health Corp., a Tennessee-based operator of payments and a $10,000 to $20,000 boost in the current 73 skilled-nursing facilities in 10 states. “By the end of starting salary of $190,000. the year, once we get all of our new building projects “We’ve placed a high emphasis on coordinated care, completed, we could add approximately 250 to 400 new team-based care and population health,” which is atemployees.” tracting candidates, he said. “The employed model doesn’t seem to bother our recruits.” ru 38 • Round-up •June 2015 • A monthly publication of the MCMS

Don’t miss your chance

Re sp ser ac ve e to you da r y!

IN EVERY ISSUE:

to advertise in Round-up Magazine!

From the Exec. Director

Page 4

In Memoriam

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Celebrating 60 Years

-2015 1955

MCMS Board Meeting Minutes Page 33

To learn more visit www.mcmsonline.com

round-up Marketplace

Volume 61

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Number 4

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Page 34

April 2015

Providing news and information for the medical community since 1955.

MEMBER PROFILE:

August: Legal

Dr. Christine Harter’s dedication to patient empowerment and community outreach. Page 26 PRESIDENT’S PAGE: Empowering patients through open dialogue, providing patient-specific information and helping them assimilate the information to make an informed decision is a fascinating experience and just as uplifting to a physician as much as it might be to the patient. Page 12

September (Special Issue): Insurance October: Community

PUBLIC HEALTH: See Me Smoke-Free — The first multi-behavioral smart phone app designed to empower women to quit smoking. Page 16

December: Ranking For more information and rates, contact Candice Scheibel, Advertising Director cscheibel@mcmsonline.com 602-251-2363

Event sponsored by Arizona Central Credit Union.

Details on Page 13

From the Exec. Director

Page 4

New Members

Page 9

In Memoriam

Page 10

Celebrating 60 Years

-2015 1955

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Number 3

Page 42

March 2015

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Providing g news and information for the medical community since 1955.

MEMBER PROFILE: Meet Diana Petitti, MD, MPH and learn about the path she has walked as an epidemiology researcher and public health advocate. Page 30

FEATURE ARTICLE: Senator Bill Frist, MD reflects on a trip to Cuba and compares its public health system to the United States. Page 20

PRESIDENT’S PAGE: Dr. Stratford believes that all physicians can find a way to participate in public health through committees, by guiding businesses to affiliate with public health issues, and through example by living healthy lives. Page 12 PUBLIC HEALTH: The resurgence of measles transmission in the US after being almost eradicated several years ago provides a teachable moment to re-examine public health strategies and personal and community responsibilities. Page 16

A PARENT’S PERSPECTIVE: Dr. Tim Jacks takes off his Pediatrician hat and puts on his “Papa Bear” hat with an open letter to a parent of an unvaccinated child. Page 24 A MEDICAL STUDENT’S PERSPECTIVE: An A.T. Still University and a University of Arizona College of Medicine – Phoenix student share their thoughts on Public Health. Pages 26 & 28

MCMS OPEN HOUSE: On March 12, 2015 MCMS hosted an open house celebrating the Society’s building facelift. As you will see by the photos a great time was had by all!

Page 36 VIEWPOINT: Happy Anniversary to the SS, M&M, ADA & ACA! Page 41

Save the date for “Philanthropy in Medicine” Details on page 13

IN EVERY ISSUE: From the Exec. Director Announcements Marketplace Board of Directors Meeting Minutes

Volume 61

For more information, visit www.mcmsonline.com Call: 602-252-2015 Email: 602-252-2844

May 7, 2015, 6-8:30 pm at the Maricopa County Medical Society.

IN EVERY ISSUE:

To learn more visit www.mcmsonline.com

Round-up is produced by the Maricopa County Medical Society.

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“Philanthropy in Medicine”

A MEDICAL STUDENT’S PERSPECTIVE: A.T. Still University and University of Arizona College of Medicine – Phoenix medical students share their thoughts on how they plan on helping their patients feel empowered. Pages 22 & 24

To learn more visit www.mcmsonline.com

Volume 61

November: Membership

FEATURE ARTICLE: A number of medical schools are adding coursework on clinical empathy into the curriculum. With the growing trend of hospitals incorporating patient satisfaction in their determination of physician compensation, clinical empathy looks to be a vital resource for better connecting with patients and improving the doctor-patient relationship. Page 18

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Number 2

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MCMS Members: Join us for cocktails and hors d’oeuvres as we celebrate the Society’s building facelift with an Open House on March 12. Details on page 3.

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February 2015

Providing news and information for the medical community since 1955.

Dr. Paul Berggreen is keeping pace with technology.

Page 16

PRESIDENT’S PAGE: Technology has transformed a physician‘s ability to discover, diagnose and treat their patients.

However, with great advancements come great responsibility.

Page 8

PUBLIC HEALTH: The causes of childhood obesity are many, and as such, more than one approach to treating it is important.

Page 12

A CLOSER LOOK: We bring you a summary of a recent initiative led by the AMA to help improve the cumbersome EHR certification process for physicians.

Page 25

FEATURE ARTICLE: Senator Bill Frist, MD shares his thoughts with Round-up readers on how our nation’s health IT framework needs to adapt.

Page 26

TECHNOLOGY: The legal pitfalls of documentation shortcuts when using EHRs and steps to take to ensure that your practice is properly securing electronic records.

Pages 28 & 32

mcms board of directors meeting minutes The Maricopa County Medical Society & Medical Society Business Services

Board of Directors Meeting Minutes March 24, 2015 • 6 pm BOARD MEMBERS

Drs. Ryan Stratford, John Couvaras, Adam Brodsky, Kelly Hsu, Mark Wallace, Miriam Anand, Shane Daley, Ross Goldberg, Tanja Gunsberger, Lee Ann Kelley, Marc Lato, Anthony Lee, Richard Manch, and Anita Murcko were present.

BYLAWS

The Board discussed the designation of Officers & Directors as described in the bylaws. Dr. Stratford laid out his vision for how the Board should be structured.

The Board discussed some concerns with the proposed structure, and reviewed the current bylaws section for Officers & Directors.

The Board asked to see how other county medical Jay Conyers was present. Sitting in for Dr. Stratford, societies and specialty societies structure their Boards.

Dr. Couvaras called the meeting to order at 6:10 pm.

Jay agreed to tabulate this information for the next Board meeting for further consideration.

OLD BUSINESS STAFF

Jay updated the board on the May 7th Medical Philanthropy event.

ArMA HOUSE OF DELEGATES

Jay described the House of Delegates meeting on May 29th & 30th. A motion was made to elect Anita CONSENT AGENDA Murcko and Tony Lee as delegates to the ArMA HoD, A motion was made to approve the consent agenda, with John Couvaras as the alternate. The motion carried. comprising February 2014 board minutes, the February 2014 membership report, and the 2014 year-end finan- ARIZONA MEDICAL BOARD PROJECT cials for the Society and the Business Services. The moJay updated the Board on the status of the contract to tion carried. Dr. Stratford arrived following passage of audit medical licenses. He also summarized the legislathe consent agenda. tive components of SB1258 and some of the concerns with future licensing.

COMMITTEE ASSIGNMENTS Dr. Stratford again reminded the committees of their charges for the year, and encouraged each to convene a meeting before the April board meeting. He also requested the following committees to be prepared to present in the coming months – Membership (May), Education & Quality (April), Mentorship (June), Philanthropy (April), Public Health (June), and Policy (July). Jay agreed to send out committee charges to each committee.

NEW BUSINESS

Jay updated the Board on a proposed settlement to offset deferred compensation for a former MCMS executive. The Board agreed with the proposed settlement terms.

ADJOURNMENT

40 • Round-up •June 2015 • A monthly publication of the MCMS

The meeting was adjourned at 7:47 pm. ru

mcms board of directors meeting minutes The Maricopa County Medical Society & Medical Society Business Services

Board of Directors Meeting Minutes April 21, 2015 • 6 pm BOARD MEMBERS

PHILANTHROPY COMMITTEE

Drs. Ryan Stratford, John Couvaras, Adam Brodsky, Jay described the agenda for the May 7th event, and Kelly Hsu, Mark Wallace, Shane Daley, Ross Goldberg, discussed some of the logistics (program, order of Tanja Gunsberger, Lee Ann Kelley, Marc Lato, An- speakers, etc.). The Board was encouraged to reach out thony Lee, May Mohty, and Anita Murcko were pres- to the other members to encourage them to attend. ent. Jay Conyers, MCMS staff, was also present.

ANNUAL POLICY COMMITTEE MEETING Dr. Stratford called the meeting to order at 6:08 pm.

Jay updated the Board on the discussions of the Dr. Stratford reminded the Board about confidentiality Committee, and presented their recommendation for and properly disclosing conflicts of interest.

MCMS to host an event in the fall before the LegislaOLD BUSINESS ture’s annual stakeholder meeting in January. The idea supported by the committee was to convene a round Jay updated the Board on the status of the Medical table discussion with some members of the House Board Project and shared some metrics for the project. and/or Senate Health Committees, and discuss with them some of the hot topics that may become legislative CONSENT AGENDA topics in the next Session.

A motion was made to approve the consent agenda, Jay agreed to explore the idea with committee and comprising March 2014 board minutes and the March discuss logistics with elected official interested in par2014 membership report. The motion carried. ticipating.

FINANCE COMMITTEE ANNUAL EVENT COMMITTEE Dr. Wallace reviewed the 2014 year-end financials Jay presented feedback from the Committee meetreported on the profit/loss for each of the entities – Society, BME, and GACCP. He also presented an analysis ings. They recommend having a guest speaker, to hold of quarter one (January-March) financials, assessing the the event at a venue centrally located, sell tickets for the performance of the businesses. Profits were shown for event, and incorporate a philanthropic theme. all financial entities.

The Committee agreed to present their final recommendations at the July Board meeting.

BYLAWS – OFFICERS & DIRECTORS

The Board continued its previous discussion of the NEW BUSINESS various Officers and Directors that comprise the Board No new business was presented. of Directors for the Society. After a lengthy discussion, it was determined that the existing Board structure ADJOURNMENT would be maintained, but that the position of Vice PresThe meeting was adjourned at 7:46 pm. ru ident no longer served a viable need. A motion to eliminate the Vice President position in 2016 was put forth.

The motion carried.

A monthly publication of the MCMS • June 2015 • Round-up • 41

marketplace EMPLOYMENT MEDICAL OPHTHALMOLOGIST NEEDED Medical ophthalmologist urgently needed to join busy, well established comprehensive private practice in Scottsdale, Arizona.

Practice currently includes two ophthalmologists (one surgical and one medical) and one optometrist.

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Full time or at least 24 hours per week commitment. Must be BC/BE. Can expect to see 25-30 patients per day to start.

Practice primarily services north Scottsdale, a resort city known for its climate, golf, outdoor activities and all the cultural amenities of metropolitan Phoenix. Would consider recently retired ophthalmologist wishing to relocate to the Southwest.

Please call and e-mail CV/resume to 480-947-4493 or beverly@tozereyecenter.com.

BE/BC GASTROENTEROLOGIST NEEDED BE/BC GASTROENTEROLOGIST & NP OR PA NEEDED

Estrella Gastroenterology, a rapidly expanding private practice in metro Phoenix, is actively recruiting a BE/BC gastroenterologist as well as an NP or PA.

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YOU’RE INVITED TO ATTEND ASPA’S VENDOR FAIR This is a great opportunity for physicians, office managers, and practice administrators to network with vendors who offer products and services designed to make your life easier. TUESDAY, AUGUST 11, 2015, 10 am - 3 pm. RSVP by email to Maria Sanchez at Maria@azspa.com FREE parking and FREE food served during the event!

STAT Transcription Accurate, On-Time Reports We focus on transcriptions, so you can focus on your patients. It is that simple.

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To start a free trial call 602.350.6501 www.stattranscription.co 42 • Round-up •June 2015 • A monthly publication of the MCMS

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Contact LIGHT ARIZONA, your LED Lighting Specialist.

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TRAVEL CLINIC/IMMUNIZATIONS

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Global Medical Solutions Contact: Don Creedon TEL. (480) 874-0333 www.igogms.com Member AIUM.

A monthly publication of the MCMS • June 2015 • Round-up • 43

marketplace OFFICE SPACE FOR LEASE OR SALE

MEDICAL OFFICE SUITE TEMPE-MESA AREA For lease in beautiful garden office complex. Includes covered doctor parking. Excellent location with easy access to 101 & 60 freeways and close to Desert Samaritan & Tempe St. Luke’s Hospitals.

Contact 602-625-6298.

BEAUTIFUL OFFICE SPACE AVAILABLE WITHIN SUITE Atrium building in N. Scottsdale near 101 & Raintree. Perfect for Psychiatrist or other mental health professional looking for space without having to rent a suite. $800/mo firm.

Call 480-483-8986.

CUSTOM DESIGN YOUR SUITE AT 301 S. POWER ROAD! Custom design your suite at 301 S. Power Road and join Southwest Kidney in this first class project. Directly across from Banner Heart Hospital and Banner Baywood Medical Center.

Enjoy Power Road frontage and easy access from Loop 202 and US 60.

Call Marina, Tracy or Autumn at Ensemble Real Estate Solutions, 602-277-8558.

DESERT MEDICAL I-II-III Join over 120 practicing physicians on the campus of Banner Desert Medical Center and Cardon Children’s Medical Center. Up to two full floors available. Contact Marina or Tracy at Ensemble Real Estate Solutions, 602-277-8558.

BROADWAY EAST MEDICAL CENTER Leasing medical space at Broadway & Sossaman, Mesa, near the 60 & 202.

Anchored by primary care practices.

Located between 3 E. Valley hospitals.

Incentives & tenant improvements.

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MAJOR RENOVATIONS JUST COMPLETED Beautiful medical building located just minutes from Scottsdale Healthcare Shea Medical Center. Excellent visibility from 90th Street and Mountain View Road. First floor space opportunities. Contact Marina or Autumn at Ensemble Real Estate Solutions, 602-277-8558.

SURPRISE MEDICAL PLAZA has up to 6,476 SF shell space which can be custom designed to meet your needs. It is anchored by Banner Health Women’s Center, Primary Care Center and Affiliated Dermatology.

Contact Tracy at Ensemble Real Estate Solutions, 602-277-8558.

Round-up Magazine’s Marketplace provides local classifieds for full-time or part-time jobs, office space for sale or lease, services, community events, and much more!

For rates, specs and deadlines, contact Candice at cscheibel@mcmsonline.com or call 602-251-2363.

44 • Round-up •June 2015 • A monthly publication of the MCMS

Your dream home is waiting to be built in Pinetop!

Attractive wooded residential lot for sale in Pinetop. On cul-de-sac, easy access main road, near 2 country clubs.

Architect’s prelim schematics for 2 car garage, 3-5 bdrm, 2,495-2,567 SF design available. 0.31/AC. $109,500 Call Jan Mullins, Spill Realty 928-369-4300

PRACTICE FOR SALE

UROLOGY PRACTICE FOR SALE Well established East Valley Urology Practice, who owns their 3,600 SF beautifully-designed suite (6 exams plus 2 procedure rooms, 4 restrooms, etc.) offering practice for sale.

Primary physician plans to retire in approximately 2 years. Opportunity to: acquire practice and have immediate presence, or structure a future acquisition, or simply lease suite.

Located in 100% occupied medical office park near Banner Baywood Medical Center. Other tenants in complex include: internal medicine, lab, dermatology, cardiology and imaging.

Practice established 30+ years ago, physician has 40 years of experience.

Contact Ryan Reynolds (602) 224-4502 x2.

Please Volunteer Vol Yo Time at the Your 25t Annual ACT 25th A Kids Health Fair Every year the need for health fair volunteers is tremendous.

Please consider volunteering and making a difference on: Saturday, September 26, 2015 7:30 am - 3:00 pm The Salvation Army Ray & Joan Kroc Community Center 1375 E. Broadway Rd., Phx, AZ 85040

All volunteers are welcome: actively practicing and retired physicians, medical students, residents and other healthcare providers, and non-medical volunteers.

Especially needed are individuals who are bi-lingual in English/Spanish.

Proud supporter of the ACT Kids Health Fair for over 20 years.

To volunteer call (602) 370-7049 or visit/register online at www.actkidshealthfair.org

Did you know?

MICA is a mutual company that is owned by the policyholders we insure. Our Board of Trustees is comprised primarily of physicians, and their decisions are based on the interests of our policyholders.

Medical Professional Liability Insurance (602) 956-5276 (800) 352-0402 www.mica-insurance.com

The policyholder benefits presented here are illustrative and are not intended to create or alter any insurance coverage. They should not be relied on and may differ from actual MICA policy language. Coverage provided by MICA is always subject to the terms and conditions of your policy, and MICA strongly encourages you to read your policy in its entirety.