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Med Monthly JUNE 2013



logy Dermato

Fraudulent Versions of Botox Found in the United States


pg. 50

eDerm Systems Announces the Launch of Cutting Edge Software Solutions for Dermatology Practices pg. 44

Red, Itchy Rash?

Get the Skinny on Dermatitis


pg. 46


Cosmetic Treatments for Aging Skin pg. 78





Conflicts Between Colleagues

46 RED, ITCHY SKIN? Get the Skinny on Dermatitus


50 FDA ALERT: Fraudulent Versions of Botox Found in the United States


research and technology




FDA ALERT: Fraudulent Versions of Botox Found in the United States





in every issue 4 editor’s letter 8 news briefs

60 resource guide 78 top 9 list

editor’s letter

Our June issue focuses on dermatology – everything from new technology to run your business more efficiently to new scams on the market to be aware of. Our skin is the human body’s largest organ and our first line of defense against disease - it deserves exploration, and MedMonthly is here to give you current information and insight. The feature “eDerm Systems Announces the Launch of Cutting Edge Software Solutions for Dermatology Practices” enlightens reader about a new iPad application that is engineered to make a dermatology practice more efficient. The technology is “extremely intuitive”, decreasing repetitious tasks, ordering prescriptions and coding billing. This app is a must for progressive dermatology clinics. Recently, the FDA has been warning medical practitioners that counterfeit Botox products have been circulating in the US. Our article “FDA Alert: Fraudulent Version of Botox Found in the United States” discusses the company selling these unsafe and ineffective drugs. The company has been sending out faxes to promote their product, and uses the website “Onlinebotox. com”. These “medications” are not approved by the FDA and should be reported immediately – contact information is at the end of the article. With the warmer weather, most people spend time outside. This means that some people also will be in contact with an allergen that causes their skin to break out. In our feature “Red Itchy Rash?” we discuss the skin’s properties, genetic makeup and symptoms of diseases that result in dermatitis. It is important to figure out what is causing the break out before picking up a cream in a drug store, because it could exacerbate the irritation. See a doctor if the rash starts to get worse. Many important dermatological issues are discussed in our June issue. This summer remember to protect your skin. August’s issue of MedMonthly revolves around Procedures to Enhance Your Practice.

Ashley Austin Managing Editor

4 | JUNE 2013

Med Monthly June 2013

Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Contributors Ashley Acornley, MS, RD, LDN Barbara Curtin Liz Ferron, MSW, LICSW Cynthia Leckman Laura Maaske Goran Medic Frank J. Rosello Robert Sayre Matthew Steinkamp, MSW, LICSW

contributors Liz Ferron, MSW, LICSW is a senior consultant and manager of clinical services with Workplace Behavioral Solutions, Inc. and its Midwest EAP Solutions and Physician Wellness Services divisions. She has been with the company for over 10 years, and has been in the employee assistance field for over 20 years. Liz has her MSW degree from the University of Minnesota and is a licensed independent clinical social worker. For more information, visit

Cynthia Leckman is a Denver, CO transplant with over 25 years in medical practice management experience as well as teaching Medical Assisting and consulting for numerous practices for operational efficiencies. Currently she is a Consultant for HSM Consulting, has a BS in Business Management and is completing her Master of Science in Organizational Leadership specializing in Health Administration.

Goran Medic, MPharm

Med Monthly is a national monthly magazine committed to providing insights about the health care profession, current events, what’s working and what’s not in the health care industry, as well as practical advice for physicians and practices. We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at

P.O. Box 99488 Raleigh, NC 27624 Online 24/7 at

is a pharmacist specialized in health economics with more than 6 years of hands-on experience in market access and reimbursement across Europe. He has developed numerous budgetimpact and cost-effectiveness models. He is writing documents to communicate health economics and other value messages, as well as performing systematic literature reviews and network meta-analysis. Website:

Rob Sayre is a marketing adviser and business coach specializing in providing solutions to companies of every description through improved performance and increased human effectiveness. Linkedin:

Matthew Steinkamp, MSW, LICSW is the Vice President for Service Delivery for Workplace Behavioral Solutions, Inc. and its Physician Wellness Services division. He is a Licensed Independent Clinical Social Worker and received his MSW degree in clinical social work from Arizona State University. He has over 20 years of experience working and consulting with individuals and organizations in mental health, business, health care and education settings, with broad-based expertise across a variety of topics and issues. MEDMONTHLY.COM |5

designer's thoughts

From the Drawing Board Healthcare is in the middle of a mobile revolution. Doctors are incorporating them into their practices to be more effective and efficient. Patients are using them to monitor specific aspects of their health, fill in gaps in their medical care, and take more responsibility for their well-being. Both doctors and patients are finding that mobile apps can provide a quick and valuable way to exchange information. Two articles in this month’s issue address new mobile technology, while a third explains the advantages of successfully adapting electronic health records (EHR) within your practice. Scientific Animations announces its new iPad division as reported in the News Briefs section of this issue of Med Monthly. Apps will focus on enabling interactivity around medical visuals that aid marketing and training efforts of Pharmaceutical and medical device companies. The new iPad division will service corporations looking to create custom applications which take advantage of the Scientific Animations’ high quality visuals. Laura Maaske’s article, “Textbooks Make a Leap: Breaking Into a New World” takes a detailed look at the popularity and the power of e-books. Besides listing the advantages and the shortcomings of using e-books, the cost effectiveness and their recognition among medical students, she has compiled several medical e-textbooks that are now available online. In the Research and Technology section, Frank J. Rosello’s “Key Operational and Financial Benefits Realized Through EHR Adoption” explains that successful EHR adoption can lead to more efficient workflows and cost savings within a practice in the areas of coding, chart analyses and completion, and records management. If there are medical technologies or research you would like to share with us for future issues, please contact us at

Thomas Hibbard Creative Director

6 | JUNE 2013


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news briefs

REAL-TIME DATA HAS LASTING IMPACT ON HEALTHCARE INDUSTRY All companies that go to great lengths to ensure data quality are able to reap tremendous benefits. By accumulating accurate knowledge of consumers, their finances and their demographic information, firms can leverage that data into advanced metrics that help them determine the future of their enterprises. Perhaps nowhere is data - especially real-time data - more useful than in healthcare, where firms can take information and channel it into instant results, helping them give each individual patient the care that he or she deserves. By pairing the best in data quality with the best in mobile health applications, physicians and their staffs can give better medical attention to people everywhere, according to the Healthcare Information and Management Systems Society (HIMSS). “Physicians will make treatment decisions based on the chest pain a patient is experiencing at the moment, from data being delivered real-time via mobile device to provider, rather than from symptoms several days prior reported during an office visit several days later,” Jiff CEO Derek Newell writes. “The healthcare system is moving from a world of inbound patients to inbound data - lots of data and it will be much better because of this.” Here are a few specific ways that real-time data can improve medical care.

of their service by drawing upon lessons learned from big data. As Yahoo Finance explains, when doctors are unsure about someone’s medical problem, they can sift through information on thousands of patient records to find a historical match that might improve their decision-making.

Better service providers


Healthcare providers can greatly improve the quality


u coming J In the up onthly’s e, Med M u s is 3 1 0 2 l be theme wil nce s to Enha Procedure tice Your Prac

8 | JUNE 2013

No more waiting rooms

HIMSS points out that the current American healthcare system is an inefficient one - patients show up to hospitals, they sit in waiting rooms for hours on end, and even when they do finally see a doctor, there’s no guarantee that it’s a specialist with the right medical expertise for their specific problems. By ensuring data quality, healthcare firms can match patients with the right medical professionals at the right times - no more sitting and waiting around.

Easy payments

Some healthcare firms are experimenting with payment systems that are based on health outcomes - meaning that if a patient receives a specific degree of treatment for a specific medical ailment, then there’s a set price for that treatment. By using medical data, firms can isolate individual patients’ conditions and their quality of medical care receive. Thus everyone can pay what they deserve to pay, no more and no less. 

Pharma and Biotech Industries Headed Toward an Era of Reduced Profit Margins In the face of reduced profit margins for the pharmaceutical and biotechnology sectors, an effective financial management strategy is central to maintain sustainable growth. New analysis from Frost & Sullivan’s (financialservices.frost. com) Financial Assessment of the Global Pharmaceutical and Biotechnology Industry research evaluates the financials of public companies in the global pharmaceutical and biotechnology industries, and ranks organizations based on their financial and risk management. This offers a comprehensive ratio analysis that includes profitability, activity (turnover), liquidity and solvency. The research identifies key trends and challenges that can impact the performance of industry participants over the next 12 months. The main reasons attributed to declining profitability in the pharmaceutical and biotechnology industries are expiring patents, delayed approvals, the advent of generic versions of drugs, measures to contain healthcare spending, and the increasing number of participants in the same profit pool. A restricted environment for new product entry, rising prices, and lower acceptance of products in newer therapeutic areas will further squeeze profit margins in the long term. “Companies with a diverse portfolio of drugs saw higher profitability in the pharmaceutical industry,” noted Frost & Sullivan Financial Analyst Dr. E. Saneesh. “The long timelines and accumulating expenditures incurred before a drug is commercialized is making the biotechnology industry less profitable in recent years, even resulting in negative margins for companies that are smaller in terms of revenue.” The pharmaceutical industry has generally witnessed smaller margins due to increasing competition from generics, pricing pressures, and decreasing healthcare spending. In the biotechnology industry, companies within a low revenue range and with relatively new products witnessed negative margins because of the heavy investment in R&D, as well as selling, general and administrative expenses (SG&A). In both industries, companies with lower revenue had poor turnover ratios because of the huge investments made in assets and product development. In terms of cash reserve, smaller pharmaceutical companies, as well as large and small biotechnology companies, showed an increase in their cash reserve as a percentage of their assets. Further, the pharmaceutical and biotechnology sectors did not witness a great variation in the R&D-to-sales ratio in recent years. Despite a general decline in overall sales in both industries, R&D expenses have not considerably reduced. “All these trends highlight the difficult times the pharmaceutical and biotechnology industries are going through,” concluded Dr. Saneesh. “To create sustainable growth, companies must undertake systematic and effective financial management strategies.” 

Scientific Animations Announce Launch of iPad Division to Bring High-quality Visuals With over 95% of Fortune five hundred companies having either tested or deployed iPads the iPad app development market is rapidly growing. The medical industry has stayed in lockstep with this trend. After almost a decade of serving the medical industry’s graphics and animation needs, Scientific Animations is proud to announce the inception of its iPad division. “When the iPad first came out we were all very excited about the possibilities, but found the market very opaque and hard to navigate. After experimenting for over 6 months, we have managed to figure out both what the client applications are as well as create our own delivery capability,” said Girish Khera, VP operations. “With over 300,000 apps for iPad the device and market are clearly established, but there is still a need for helping enterprises unlock the power of the iPad for their custom needs,” added Cibu Thomas, sales manager. Currently, the division will service corporations looking to create custom applications which take advantage of the high quality visuals that Scientific Animations is known for. Apps will focus on enabling interactivity around medical visuals that aid marketing and training efforts of Pharmaceutical and medical device companies. Collaboration and self-learning and exploration features are some of the unique aspects of the apps, according to Scientific Animations technical team. In the future, Scientific Animations will also unveil a consumer education app developed in conjunction with leading hospital networks. 

About Scientific Animations:

Started in 2004 by veteran Indian-American entrepreneurs, Scientific Animations ( has grown into a premier provider of 3d medical animations and graphics services. Scientific Animations have done work for over a hundred clients in almost every area of medicine. Source: news/128051



Skin Care for Incontinent Residents of LongTerm Care Facilities: New Nursing CE Monograph Available

10 | JUNE 2013

Wellness Nursing LLC has published a new monograph for independent study about Skin Care and Use of Products and Devices for longterm care residents. Designed specifically for nurses, the monograph is a practical guide for understanding the skin that provides valuable information on common perineal skin problems, elements of best practices for skin care, including recommended skin products, and prevention of associated skin breakdown from urine and feces.


ellness Nursing LLC has published a new monograph for independent study about Skin Care and Use of Products and Devices for longterm care residents. Designed specifically for nurses, the monograph is a practical guide for understanding the skin that provides valuable information on common perineal skin problems, elements of best practices for skin care, including recommended skin products, and prevention of associated skin breakdown from urine and feces. Nurses can obtain nursing education credits by studying the monographs and completing a post-test and evaluation at The monograph is one of four highly practical independent study monographslhowe@seekwellness. com combined as a new Bladder and Bowel Master Series for longterm care nurses. The series is intended to present a structured bladder and bowel rehabilitation program to help nursing home residents progress from incontinence to continence and from constipation to regularity through guided nursing management. According to author Diane Newman, DNP, FAAN, BCB-PMD, “incontinence exposes the skin to moisture, digestive enzymes, and microorganisms and alkalinizes skin pH; these conditions are thought to alter skin integrity and precipitate dermatitis. Individuals with severe intractable urinary or fecal incontinence are often immobile and

at major risk for skin breakdown. ” Learning objectives for Monograph II, Skin Care and Use of Products and Devices, include: 1. Describe the structures and functions of the skin. 2. Discuss the skin effects of excessive moisture, urine and feces. 3. Review signs and symptoms of perineal skin conditions, including pressure ulcers. 4. Discuss the components for perineal skin assessment. 5. Identify guidelines for maintaining skin health and preventing breakdown. 6. Customize skin care programs to meet the needs of individual residents at-risk for perineal skin breakdown. 7. Identify appropriate bathing regimens for individual residents. 8. Describe the use of catheters and devices for managing urinary incontinence. This continuing nursing education activity offers 1.0 contact hours for the participant and was approved by the Society of Urologic Nurses and Associates (SUNA), an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. “Bladder and bowel dysfunction as urinary (UI) and bowel (FI) incontinence, and associated bowel disorders, have major impact on residents in nursing homes,” says Newman. “Urinary incontinence is one of the main reasons for placement

of older adults into institutionalized care and it is the primary reason why many elderly are not accepted into the less expensive and less restrictive environment of assisted living facilities. “ The Bladder and Bowel Master Series complies with current regulations included in the Resident Assessment Instrument: Minimum Data Set (MDS) Version 3.0, Care Area Assessments (formerly known as Resident Assessment Protocols or RAPs) and Care Area Triggers. The Master Series also incorporates requirements of the Quality Indicators and Quality Measures, and the Centers for Medicare and Medicaid’s (CMS) guidance Tag F315. The Bladder and Bowel Master Series was supported through an unrestricted educational grant made available by SCA Personal Care.  About Seek Wellness, LLC and Wellness Nursing, LLC Owned by a group of professional health care providers and consumers, Seek Wellness, LLC and Wellness Nursing, LLC encourage, empower, and support health care consumers to improve their level of wellness by providing current, high-quality information, services, and products to them and to their health care providers. Source: http://www.pressreleasepoint. com/skin-care-incontinent-residentslongterm-care-facilities-new-nursing-cemonograph-available MEDMONTHLY.COM |11


Combination Drugs Are the Future of the European Hepatitis B and C Therapeutics Markets By Frost & Sullivan The limited efficacy and negative side-effects associated with current therapeutics for Hepatitis B and C are highlighting the urgent need for new, improved alternatives. Combination therapies offering better clinical outcomes are coming to the fore and look set to transform the European market for Hepatitis B and C. New analysis from Frost & Sullivan (lifesciences.frost. com), Analysis of European Hepatitis B and C Therapeutics Markets, finds that the Hepatitis B market earned revenues of $1.26 billion in 2012 and estimates this to reach $1.89 billion in 2019, while the Hepatitis C market is projected to expand from $2.40 billion to $3.66 billion over the same time period. The therapeutic segments covered include interferons and nucleoside analogues for Hepatitis B, and Standard of Care (Peginterferon alfa and Ribavirin) and protease inhibitors for Hepatitis C. The side effects associated with interferon-based therapeutics such as fever, headache, fatigue, muscle and joint pain, shivering, and the ineffective response to Hepatitis C Virus (HCV) genotype 1 patients are motivating the development of combination therapies. “Improved drug efficiency, reduced pill burden and lower dosage frequency are among the common advantages related to the use of combination drugs,” notes Frost & Sullivan Healthcare Research Analyst Deepika Pramod Chopda. “For instance, the combined use of interferon and interferon-free treatments is expected to yield positive results among infected patients; ribavirin-long acting interferons combination is estimated to boost the therapeutic success rate by over 50-60%.” The market is responding swiftly to the demand for improved therapeutic offerings. There has been an increase in new classes of compounds such as protease inhibitors, NS5a inhibitors, and nucleotide polymerase inhibitors for interferon-free treatment of HCV and Hepatitis B Virus (HBV). 12 | JUNE 2013

At the same time, wider access to personalised medical treatment is encouraging the uptake of novel, improved therapeutics. The availability of drugs that target viral hepatitis infections according to distinct genetic strains is promoting market development. HBV and HCV are prevalent among illegal drug users and migrant populations across Europe. However, low awareness means that many affected patients remain untreated. “Wider access to national counselling programmes and enhancing awareness among high-risk populations such as drug users, infected mothers, and migrants is critical,” concludes Chopda. “Such initiatives, together with free screening and reduced treatment costs, will help limit the incidence and impact of Hepatitis B and C.” If you are interested in more information on this research, please send an email to Anna Zanchi, Corporate Communications, at anna.zanchi[.] Analysis of the European Hepatitis B and C Therapeutics Market is part of the Life Sciences Growth Partnership Service programme. Frost & Sullivan’s related research services include: European HIV Drugs Market, European Hepatitis B and C Diagnostics Market, U.S. Hepatitis C Market, and U.S HIV/AIDS Therapies Market. All research included in subscriptions provide detailed market opportunities and industry trends that have been evaluated following extensive interviews with market participants.  About Frost & Sullivan Frost & Sullivan (, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today’s market participants. Source:


compound noun: 1. The action of calling attention to medical goods or services for sale. Exclusively refers to advertising in Med Monthly.

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By Medical News Today 14| JUNE 2013


ydney researchers have discovered a new type of immune cell in skin that plays a role in fighting off parasitic invaders such as ticks, mites, and worms, and could be linked to eczema and allergic skin diseases. The team from the Immune Imaging and T cell Laboratories at the Centenary Institute worked with colleagues from SA Pathology in Adelaide, the Malaghan Institute in Wellington, New Zealand and the USA. The new cell type is part of a family known as group 2 innate lymphoid cells (ILC2) which was discovered less than five years ago in the gut and the lung, where it has been linked to asthma. But this is the first time such cells have been found in the skin, and they are relatively more numerous there. “Our data show that these skin ILC2 cells can likely supress or stimulate inflammation under different conditions,” says Dr Ben Roediger, a research officer in the Immune Imaging Laboratory at Centenary headed by Professor Wolfgang Weninger. “They also suggest a potential link to allergic skin diseases.” The findings have been published in the respected journal Nature Immunology. “There’s a great deal we don’t understand about the debilitating skin conditions of allergies and eczema,” says Professor Weninger, “but they affect hundreds of millions of people worldwide. Dermal ILC2 cells could be the clue we need to start unravelling the causes of these diseases.” The Weninger lab, which has developed techniques for marking different cells of the immune system and tracking them live under the microscope, actually discovered the new dermal cells some years back. “We just didn’t know what they were,” Roediger says. The Centenary researchers, however, suspected they might be associated with type 2 immunity, the part of the immune system that deals with infection by parasitic organisms. So they contacted Professor Graham Le Gros at the Malaghan Institute, one of the world’s foremost researchers into type 2 immunity. Not only did Professor Le Gros and his team confirm that the Centenary researchers had found a new form of ILC2 cell, but they


“There’s a great deal we don’t understand about the debilitating skin conditions of allergies and eczema, but they affect hundreds of millions of people worldwide. Dermal ILC2 cells could be the clue we need to start unravelling the causes of these diseases.”

were able to provide a new strain of mouse developed in the USA that provided insight into the function of these cells. “Using these mice, we found that ILC2 cells were the major population in the skin that produced interleukin 13, a molecule that has been linked to a number of allergic diseases, including eczema.” Roediger says. Using their sophisticated live imaging techniques, the Centenary researchers were also able to watch the behaviour of the ILC2 cells in the skin, where they moved in a characteristic way - in random spurts punctuated by stoppages. “A halt in movement usually indicates some sort of interaction with another cell,” Roediger says. In this case, the ILC2 cells always seemed to stop in close proximity to mast cells, which are known to play a key role in controlling parasitic infections and to be associated with allergies. As well as the interaction with mast cells, the Centenary team were able to show that ILC2 cells could be stimulated to spread quickly and were capable of generating the inflammatory skin disease. “We now have experiments underway in which we are actively looking for the direct involvement of these cells in the sort of skin diseases you would predict based on these findings,” says Roediger.  Source: releases/259507.php MEDMONTHLY.COM |15

practice tips

Key Factors in Staff and Practice Performance By Robert L. Sayre and Cynthia Leckman

16 | JUNE 2013

While many factors come into play in what makes an effective team or staff in a practice, we chose three key areas to focus on. Culture, cross training, and a review of patient surveys are key areas that drive performance as well as build the capability and capacity of any practice to function more efficiently. These factors also enable practices to adapt to constantly evolving requirements and to increase patient satisfaction by focusing on patient care first in the processes and communications with the doctors and their staff.

Culture Drives Performance The organizational culture of a practice heavily influences patient satisfaction. If the culture is warm and caring it can enhance the patients’ relationship with their provider. If the culture is cold and sterile, it can present an impenetrable barrier for patients to navigate. Although many managers in practices are less concerned with culture and more concerned with productivity, it is truly the culture that affects the productivity of the staff. Culture is the cornerstone of a successful medical practice. An integrative culture committed to providing excellence in patient care sets the foundation for best practices and organizational effectiveness and efficiency.


“An integrative culture committed to providing excellence in patient care sets the foundation for best practices and organizational effectiveness and efficiency.”

Typically this type of culture is focused on meeting the requirements of the mission statement and fulfilling the vision for the practice. Small practices generally do not have a mission statement or vision, and this can create uncertainty and ambiguity for the staff because there is a lack of focus. This lack of focus increases the risk of poor organizational culture development. When this occurs, staff becomes less engaged in their job, there is a lack of team effort, and negativity becomes more the norm than the exception. This culture unwittingly creates dissonance between the provider and the patient. Studies have shown that patients are less likely to be compliant with their treatment if their relationship with the provider is strained. Knowing this, it becomes important that practices implement strategic initiatives to increase patient satisfaction through staff interaction and action with patients and patient care. With this said, several key objectives can be achieved by changing the organizational culture and the focus of the practice. The cornerstone of a successful and positive organizational culture is reflected by how engaged the staff is in their work environment. If the staff are positive and engaged, they will also be happier in their work environment. Several initiatives can be accomplished to increase staff positivity, and thereby, increasing patient satisfaction. Although practices are inherently complex, these simple strategic initiatives can increase both employee and patient satisfaction. 1. Develop a mission statement and a vision statement to provide a focus for the staff. 2. Create a reward system based on performance, feedback, and development of staff. 3. Require a solid performance measurement plan for evaluating the progress and/or success of each employee in which a visual graph can allow them to plot their performance progress.

4. Remember, an integrative culture starts from the top down! Realign managerial and physician’s actions to illuminate the type of culture that is being strived for. Leading by example is perhaps the most influential way to achieve an integrated culture with wellengaged staff. 5. Encourage and provide education for staff regarding best practices for job performance. 6. Peer-mentoring is a valuable way to ensure that new employees align with the mission and vision of the practice. This helps develop the new employee to align with the best practices instilled by other employees.

Cross Training Builds Teamwork and Builds Your Bench Another factor of an effective and efficient medical practice is instituting cross-training for staff based on skills and abilities required for each job position. Medical Assistants are a valuable resource to use in crosstraining. This practice is another tool to developing a positive and engaged staff. When staff have the ability to change routines, this provides them with insight to the value of other job functions to increase the efficacy and efficiency of a practice and allows the staff to expand their own skills and abilities. It is important to note that cross-training is only as effective as those who have the skills and abilities to be cross-trained. It goes without saying that cross-training an employee to work outside their scope is inherently risky where patient safety is concerned. However, having a crosstrained team of individuals increases the ability of the practice to function as a synergistic team unit and through this collaboration, staff shortages are covered more efficiently by the staff trained in all positions. This is a costeffective as well as practical answer to covering for staff shortages. continued on page 18 MEDMONTHLY.COM |17

practice tips continued from page 17

Using Patient Input to Improve Care and Performance Obtaining accurate, timely and relevant feedback from patients is essential for the doctors and their staff to assess how well they are doing. We took a moment to interview Amanda Vigue about the types of surveys and information that can help improve staff and practice performance. Amanda Vigue began her career in healthcare working in Spring Harbor Hospital in Portland, Maine (a member of the MaineHealth system) and is now the PET Program Director for the Patient Performance Institute.

Q&A Session with Amanda Vigue Q-What do you see as the benefits and downsides of traditional patient satisfaction surveys? A-“The benefit of these types of surveys is that they do provide the doctors, other providers and health administrators a snapshot of how patients perceive their care and have experienced services from the providers. The downside is that they are more a tool to measure the performance of the staff, rather than the patient themselves. They do not provide a whole picture of the patient himself or herself, so there is not a lot to learn from them to improve the care of any specific patient. Also, the surveys are not actionable data, because they usually are conducted after the care has already been provided.” Q-What do you mean by actionable data? A-“Actionable data is information that gives the care team insights or a pathway to customize their care for patient in a way that leads to improved 18 | JUNE 2013

health outcomes. For instance, actionable data can provide a patient profile early in the care cycle that helps the entire care team in an office, an ACO or hospital setting to calculate patient risks and identify the kinds of resources that a patient needs to mitigate the risks.” Q-How is the Patient Performance Enhancement Tool (PET) actionable data? A-“The PET is an comprehensive patient self-assessment tool for health care providers to identify the non-medical factors which impact a patient’s ability to follow medical instructions and maximize overall outcomes. Patients take the survey around intake and then providers get a customized report with key risk factors and alerts for each patient. The key characteristics it tests are: 1. socioeconomic/financial factors; 2. health literacy; 3. personality/emotional intelligence; 4. lifestyle issues and substance abuse; and 5. family and social support. The PET provides this actionable information both early and in an efficient way, without using a lot of resources for the provider.” Q-What benefits would a doctor, an ACO or hospital have in using actionable data like the PET? A-“For doctors, they would have in every patient file a PET report that would allow them to understand the non-clinical issues that would likely affect their patients’ ability to respond to their instructions and care. For an ACO or hospital, it provides the ability to facilitate communication between nurses, case managers, physicians and others in the care team, and prioritize interventions for high risk patients that are identified early in the care process through the PET.” 

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practice tips



iven the stress of having lives hanging in the balance and the often ill-defined hierarchy of the multiple physicians and staff that might be “touching” each patient, the medical workplace can be a breeding ground for interpersonal conflict. Yet few medical professionals have the inclination or skill set to wade into difficult conversations when confronted with unacceptable behavior or situations, including: l Nurses and medical techs who are perceived as overstepping their bounds, inappropriately questioning medical decisions, having poor listening skills and repeatedly asking for clarification or unnecessarily disturbing on-call physicians. l Physicians who dismiss input or sarcastically respond to questions from colleagues, nurses and medical techs, or who engage in disruptive behaviors such as bullying, throwing items or abusing the power differential their MD provides them. l Health care administrators who provide arbitrary on-call schedules or work loads, productivity goals that compromise quality, introduce new systems (such as electronic medical records) without sufficient time for training, and who lack appreciation for physician and staff contributions. l Nurses who engage in what is often called “horizontal hostility” and are uncooperative or undermine their peers.

20 | JUNE 2013

l Physician

peers who refuse to return consult calls, have turf issues regarding care of patients and staffing, or who have unusually demanding or assertive personalities. l Medical professionals, in general, whose lack of competency, skills or work ethic impacts patient safety or continuity of care When medical professionals aren’t called on inappropriate behavior, it breeds fear, resentment and disrespect. Over time, employees will avoid certain co-workers even if their skill set is essential to patient care—for example, the night shift nurse who won’t wake an on-call physician who’s been abusive in the past. The research clearly demonstrates that when medical professionals can’t communicate effectively and honestly, the workplace becomes unnecessarily stressful and patient safety is put at risk. Physicians under stress have a tendency to act out in disruptive behaviors. According to a recent survey of more than 800 physicians conducted by the American College of Physician Executives 1: l More than 70% said that disruptive physician behavior occurs at least once a month at their organizations—and more than 10% said that such incidents occur on a daily basis. l More importantly, 77% of respondents said they were concerned about disruptive behavior at their organizations—

and 99% believed that disruptive behavior ultimately affects patient care. Nurses under stress are more apt to either suffer in silence—or engage in stealthy, passive-aggressive forms of disruptive behaviors that, while harder to detect than physician outbursts, can be equally damaging. l In a 2005 survey of more 1,700 nurses, physicians, clinical-care staff and administrators, more than half reported seeing their co-workers break rules, make mistakes, fail to support others, demonstrate incompetence, show poor teamwork, act disrespectfully or micromanage. 2 Most concerning—despite the risk to patients, less than 10% of physicians, nurses and other clinical staff directly confronted their colleagues about their concerns. However, silence isn’t an option anymore. Since 2008, when the Joint Commission issued Sentinel Event Alert #40 titled, “Behaviors that undermine a culture of safety,” health care organizations have became responsible for taking action when disruptive outbursts or workplace conflicts that put patient safety at risk.

Negative Side Effects of Unresolved Conflict Conflict in and of itself isn’t bad—it often leads to new ideas, processes, continued on page 22


continued from page 21

improved communication and development of new skills. Refusal to acknowledge and address conflict is where the trouble begins. l When a staff member sees a colleague berating another staff member and doesn’t step in, there can be an assumption that they condone their colleague’s behavior, even if that’s not the case. l One disruptive physician or nurse can make the workplace feel hostile. Recruiting and retaining skilled staff often becomes more difficult—even if the majority of doctors and nurses are blameless. l Patients who sense conflict or witness disrespectful confrontations are apt to seek care from another source—at a time when HCAHPS scores are taking on increasing importance, and the health care environment is becoming more competitive. l Malpractice suits and insurance costs are typically higher for medical groups that refuse to confront disruptive behavior.


“When medical professionals aren’t called on inappropriate behavior, it breeds fear, resentment and disrespect. Over time, employees will avoid certain co-workers even if their skill set is essential to patient care—for example, the night shift nurse who won’t wake an on-call physician who’s been abusive in the past.”

22 | JUNE 2013

Given the demands on time that everyone experiences, at what point should an organization step in to address a workplace conflict? In general, a conflict rises to the point where there should be an intervention when: l Patient safety or satisfaction is compromised l The conflict is affecting the morale or changing the attitudes of staff or colleagues l Staff members are changing behavior or rearranging their schedules because of the conflict l Employees not directly involved in the conflict are becoming caught up in it (the smaller the medical group or work group, the more likely this is to happen) l Significant amounts of time and energy are being devoted to dealing (or not dealing) with the conflict

Best Practices: Productively Addressing Workplace Conflict There are a variety of approaches all staff members can take to address workplace conflicts, including: l Speaking up immediately whenever unacceptable behavior is witnessed l Engaging in a private conversation where you point out what you’ve witnessed and express concern l Having a consultation with Human Resources or submitting a formal complaint l Pushing for guidelines around civil communications at the next staff meeting For those who are uncomfortable dealing with conflict, are uncertain about which approach to take or don’t know how to begin a difficult conversation, there may be resources available to help. For organizations with an Employee Assistance Program (EAP), that can be a good starting point. Organizations can also provide

training, mentors, or identify someone in the office or practice as a go-to resource and coach.

Conflict Resolution: A Case Study A clinic that was part of a larger health system was experiencing increasing conflict between its physicians and nursing staff, and with concerns that the resulting breakdown in collaboration was having a negative impact on patient safety. They brought in consultants who could help pinpoint the major issues and then devise strategies to address both the specific issues that were identified, and help the clinic staff communicate and work more productively with each other. The clinic staff was invited to one of four 90-minute discovery sessions, ensuring that both doctors and nurses were represented in each group. After completing a brief survey designed as both a basis for conversation and a benchmarking tool, the session then turned to brainstorming and dialogue around the following topics: l The most important thing for doctors to know about working well with nurses l The most important thing for nurses to know about working well with physicians l What was working well on the team l What areas could benefit from improvement l Current stressors The small group sessions offered insight into the team’s perceptions of issues and potential solutions, and allowed participants to hear perspectives that differed from their own. Regarding the most important things each group wanted the other to know, several thoughts emerged. Nurses wanted the doctors to know: • They were working hard, although due to multiple work demands and

patient flow, this might not always be visible. l They needed respectful communication, ranging from “don’t shoot the messenger” to more constructive criticism and input on working better together— and giving positive feedback, too. l They needed better cooperation in things ranging from improved work flow to helping to train and educate new staff. The doctors, for their part, wanted nurses to know: l They tended to be more researchor process-driven, a result of being very conscientious about the possibility of litigation regarding patient care. l They wanted more proactive support, including anticipating patient needs and doing whatever was possible to keep them on schedule within the scope of the nurses’ jobs. l They made assumptions about nurses’ availability, lacking other ways of knowing what they were doing if not in the exam room. While there were shared expectations and assumptions about a focus on patient care and safety, competence and high standards, areas for improvement included some work processes and, more centrally to the conflicts, better communication and also clarity on roles, especially with regard to the nursing staff. Underlying it all was a perceived failure on the part of both the physicians and nurses to understand the scope of each other’s work, and stressors related to things which were largely outside of the clinic’s control. The clinic moved ahead with several of recommendations, which included: • Developing a multi-disciplinary team focused on strengthening communication, building staff resiliency and increased efficiencies

• Promoting the use of the EAP, including coaching and counseling to assist with stress management, conflict resolution and work/life balance • Developing more vehicles for communication, information exchange, relationship building, problem solving and team building, including: u Daily work team huddles to plan for the day ahead and/or debrief at the end of the day u One-on-one meetings between leaders and direct reports on at least a quarterly basis to manage individual issues and provide support u Quarterly all-staff meetings to discuss topics such as clinic issues, pending health system initiatives, teamwork and communications, and opportunities for improved operational efficiencies u Opportunities for social time (e.g., lunch)  MacDonald, Owen, et al, Disruptive Physician Behavior, ACPE American College of Physician Executives / Quantia MD, May 15, 2011, accessed http://www.quantiamd. com/q-qcp/quantiamd_whitepaper_ acpe_15may2011.pdf, April 1, 2012 1

Maxfield, David, Grenny, Joseph, Lavandero, Ramón and Groah, Linda, The Silent Treatment Why Safety Tools and Checklists Aren’t Enough to Save Lives, VitalSmarts, Association of periOperative Registered Nurses (AORN), & American Association of Critical Care Nurses (ACCN) 2010., accessed March 29, 2012. 2

Liz Ferron, MSW, LICSW, is Senior Consultant and Manager of Clinical Services and Matt Steinkamp, MSW, LICSW, is Vice President of Service Delivery at Workplace Behavioral Solutions, Inc. and its Midwest EAP Solutions and Physician Wellness Services divisions.

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NETHERLANDS Introduction

Europe is facing nowadays one of the toughest periods since the end of the World War II with unemployment rising to its highest records and budget deficits sky rocketing. Bail-outs of different EU countries are becoming a “normal” thing. Health care budgets are being scrutinized and price cuts of drugs are among the first ones to be hit by these reforms. Getting on the reimbursement list for new, innovative and expensive drugs is becoming more like a “mission impossible” for pharmaceutical companies than regular market access activity. In spite of all that, the Netherlands is still holding well. Standard & Poor’s rated the Netherlands with AAA grade. The Dutch economy is considered to be highly competitive and productive, with gross domestic product (GDP) per capita of $47,000 in 2012, and, despite rising layoffs since 2011, the Netherlands has one of the lowest unemployment levels in the EU, at 6.4% (March 2013).1 However, total health spending accounted for 12.0% of GDP in the Netherlands in 2010, the second highest among Organisation for Economic Co-operation and Development countries (OECD) and well above the OECD average of 9.5%. 2 The United States is, by far, the country that spends the most on health as a share of its economy (with 17.6% of its GDP allocated to health in 2010).2 The Netherlands also ranks well above the OECD average in terms of health spending per capita, with 24| JUNE 2013

spending of $5,056 in 2010 (adjusted for purchasing power parity), compared with an OECD average of $3,268. Health spending per capita in the Netherlands was fourth highest among OECD countries, behind the US (which spent $8,233 per capita in 2010), Norway and Switzerland.2 In the Netherlands, 85.7% of current health spending was funded by public sources in 2010, well above the average of 72.2% in OECD countries.2 But the question is what do the Dutch get for all this money? The Dutch health insurance system is a combination of private health plans with social conditions built on the principles of solidarity, efficiency and value for the patient. Health insurance in the Netherlands is mandatory for everyone and is designed to cover the cost of medical care. The basic package (Basisverzekering) in the Netherlands costs around 110€ ($140) per month for all adults, while children up to the age of 18 are insured free of charge.3

Conditional Reimbursement

Even though there are multiple private health insurance companies, the basic package is regulated by the government and all insurers must offer the same basic package for approximately the same price (+/- 10%). Health Care Insurance Board (College voor zorgverzekeringen – CVZ), is a national body that is responsible for providing advice on statutory health insurance (basic package) and is also responsible for its implementation. CVZ also plays an important role in maintaining the quality, accessibility

By Goran Medic and affordability of health care in the Netherlands. Health care in the basic package must comply with the ‘established medical science and medical practice’ criterion. This criterion demands a black-and-white answer; however, sometimes it would be desirable to have the possibility to say ‘yes, providing’. This would make it possible to reimburse drugs that do not fulfil the statutory criterion, on condition that data are collected about the effectiveness of that care. Conditional reimbursement can promote the collection of data that is missing and provide patients with access to potentially valuable care. In order to ensure access to new, innovative and expensive medicines and still to be able to maintain costs under control the Dutch government introduced “Conditional reimbursement” for medicines. Conditional reimbursement started in the Netherlands in 1996 4 and there were several changes and modifications in the legislation and practice, with the latest one in 2012. Criteria for inclusion back in 1996 were high costs, risk of inappropriate use, or the need for specific expertise in order to ensure appropriate patient selection. The major change in 2012 was that conditionally reimbursed drugs are now a part of the basic package, instead of conditional reimbursement outside the package. Conditional reimbursement is intended for inpatient drugs that do not comply with the established medical science and medical practice criterion.5

CVZ is the key stakeholder in the conditional reimbursement policy and is responsible for its implementation in daily practice. However, the success of the policy is highly dependent on the commitment and cooperation of health insurers, medical professionals, patient organisations and the pharmaceutical industry. This means that CVZ has to balance between policy goals set at a national level, and the feasibility of the policy measures in daily practice. Conditional reimbursement applies, nowadays, not only to innovative health care (care that is promising, but for which insufficient data are currently available to be able to get a positive advice), but also to care that is reimbursed via the basic insurance about which doubts exist (or have arisen) regarding its effectiveness or cost-effectiveness. Drugs can be conditionally reimbursed for a period of a maximum of four years. During this period the necessary data on effectiveness and cost-effectiveness must be collected for a decision on whether the care will be included in the basic package permanently or removed. The Minister of Health can subsequently remove health care from the package on the grounds of unfavourable cost-effectiveness data or their non-existence. The effectiveness requirement is statutorily anchored (the concept of ‘established medical science continued on page 26 MEDMONTHLY.COM |25

continued from page 25

and medical practice’ in the Health Insurance Law (Zorgverzekeringswet – Zvw), while cost-effectiveness is not. This means that the procedures for conditional reimbursement will differ with regards to effectiveness research and cost-effectiveness research. In principle, health care that is effective is included in the package, though it may be desirable to collect cost-effectiveness data. Even though cost-effectiveness is not a statutory requirement, it does play a role in the question as to whether care belongs in the basic package.6 The pharmaceutical companies, before immediately going for conditional reimbursement, must prove that it proved impossible to reimburse the care for which conditional reimbursement is being requested via the standard way. CVZ will itself decide whether a cost-effectiveness assessment is to be carried out. Naturally these procedures will be more flexible. After completing the costeffectiveness assessment, CVZ will formulate advice for the Minister. The Minister of Health decides, based on the advice from CVZ, once a year whether some drugs will be conditionally reimbursed, and these changes apply to the next insurance year. In 2006 the “acceptable” cost-effectiveness bandwidth (cost per QALY) was between €20,000-80,000 depending on the disease, although it has never been officially published by CVZ.7 Conditional reimbursement is only possible for medical care. This means that other forms of care, e.g., medical devices, dental health care and pharmaceutical care (‘outpatient’ medicines) will not be eligible. No clear argumentation has ever been given for this choice. The basic package and the list of conditionally reimbursed drugs is updated annually. CVZ proposes changes in the annual CVZ package advice, once a year, to the Minister of Health who then makes a formal decision which changes will be accepted. After a formal decision of the Minister and an alteration in the regulations, it now means it will take at least one-and-a-half years before (innovative) drugs can be conditionally reimbursed and accessible to patients. This does not create a dynamic environment and may lead to protests. On the other hand, it is important to take time to make a careful assessment. From 2006-2012, 45 medicine-indication combinations were evaluated under conditional reimbursement scheme.5

Apparently, conditional reimbursement is regarded as an important policy tool to promote the appropriate use of medicines. However, evidence about its effectiveness in daily practice is limited. The implementation is hampered by a lack of transparency of the system and doubts about the instrument’s legitimacy. Conditional reimbursement should be more dynamic – allowing updates at least every quarter, more transparent and ensuring that patients get access to innovative drugs faster in all settings (not just in an inpatient setting as it is now).  References: 1 htm 2 OECD Health Data 2012 3 4 Provision of Pharmaceuticals Regulation Schedule 2 geldigheidsdatum_31-12-2005 5 Conditional Reimbursement of Health care – CVZ – Diemen April 6th 2012 6 Package Management in practice (2), CVZ report – Diemen, June 2009. 7 RVZ report Sensible and sustainable health care, 2006.

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research & technology

Key Operational and Financial Benefits Realized Through EHR Adoption

by Frank J. Rosello, CEO, Environmental Intelligence LLC

28 | JUNE 2013

There has been several recent studies published that have illustrated the potential benefits of electronic health record (EHR) adoption. Of the many potential benefits cited in these studies, the two that seem to consistently surface are improvement in the clinical care process and the overall patient experience. While those benefits can be easily realized by successfully implementing EHR technology, a fully deployed EHR system can also drive significant operational efficiencies and create opportunities for healthcare organizations to leverage the same workflow automation capabilities to improve a number of cumbersome administrative processes and bottom line financial performance. Furthermore, the access to health information electronically opens up medical organizations to a broader labor force that can improve both turnaround times, as well as, the overall cost of delivering care to patients. Successful EHR adoption can lead medical organizations to realize more efficient operational workflows, quality, and cost savings in the following key areas:

1. Coding Quality coding drives case mix and ultimately, reimbursement levels for any healthcare organization. The two key elements medical organizations must have in place to achieve quality coding is a combination of excellent coders and excellent documentation. Without the best in both these areas, healthcare organizations run the risk of reduced or even lost compensation which would clearly have a negative impact to the bottom line. With a fully deployed EHR system in an inpatient environment, documentation is available in real-time thus enabling hospital administrative staff to begin the coding process prior to discharging patients. When hospitals combine an efficient scanning operation that captures any paper component of

the patient’s record within twelve to twenty-four hours post discharge, an EHR can provide a more holistic view of the patient encounter to drive the most accurate coding in the least amount of time. Furthermore, because all patient’s data now available electronically, medical organizations are no longer limited by the local market labor pool when finding coding resources. As a result, medical organizations have the flexibility to access the vast network of national coders to ensure they have the best coders and reduce personnel expense.

2. Chart Analyses and Completion All current ONC-ATCB 20112012 certified complete EHR systems, with their inherent trait of being data-driven systems, have the ability to automatically generate workflows that in the paper world would require human intervention. From a health information management (HIM) perspective, one of the areas where the most efficiency can be realized by the adoption of EHR technology is the function of chart analyses and completion. In most cases, the process involves the review of hundreds of paper records, flagging deficiencies in a tracking system, and the use of colored adhesive flags to point physicians to the appropriate place in the record for review. The fact is that chart analysis and completion is a process that both physicians and HIM staff are not very fond of and typically don’t look forward to doing. Through the adoption of specific workflow rules based on the type of document, certified EHR’s can automatically assign documents to physician work queues for review and electronic signature. The manual process of chart analysis is brought online and focuses only on the documents that can’t be systematically assigned to physicians, resulting in significantly increasing the efficiency of the staff. As a result of having all of


“Furthermore, the access to health information electronically opens up medical organizations to a broader labor force that can improve both turnaround times, as well as, the overall cost of delivering care to patients.”

the records available online, healthcare organizations can look at utilizing a lower cost rural workforce to perform the chart analysis function thus reducing operating expense.

3. Records Management Performing the role of custodian of the health record is one of the key responsibilities of HIM. With careful planning, healthcare organizations can significantly streamline their entire internal and external records management process by effectively implementing an EHR. With the ability to design effective security controls and audit logs, the EHR provides healthcare organizations with the opportunity to open up access to the medical record to both clinicians and internal user groups, such as business office and risk management, thus significantly reducing turnaround times resulting in a positive impact on both patient care and revenue cycle. Medical organizations that successfully adopt a certified EHR system will position themselves to ultimately realize reduced personnel costs and an improved revenue cycle while delivering higher quality care to their patients.  MEDMONTHLY.COM |29

research & technology

Textbooks Make a Leap Breaking Into a New World

“The most important development in the world of literature after Gutenberg is the electronic book, or e-book.� -Siriginidi Subba Rao, 20051


30 |JUNE 2013

The Love of Turning Pages It’s not a fair choice to have to make, between digital and printed books. And overall as readers, we are choosing both in different ways. But how? Both print and ebook sales are on the increase.2 But the ebook rate accelerates faster because its market is newer.3 Traditional books are objects we know well: we use them and manipulate them intuitively. We can feel how much we’ve read through a book, using our fingertips, and without having to search for any number or dial on a screen. Books can last ages and they are printed in a way that lasts. They do not need to be charged at night in order to function. They may even endure some floods and high temperatures. Words form a path, a stream, and you follow that path straight and true from beginning to end. There is beauty, elegance, and simplicity in the design of a book.

E-book Advantages: Design Flexibility, Ease of Use, Cost But e-books offer an added way to explore. As children, we’ve imagined that the pictures move and that we can dive into them. This is closer to reality now. With an e-book images can become more dominant, and images can become a more intuitive metaphor for exploration, rather than a traditional table of contents. For example, we might enter an anatomy book with an image of the body. This is fun, interesting, educational, and intuitive. This way, too, we can see what the book covers in an instant. What if you are a wanderer and you don’t want to follow the chained letter? What if you enjoy listening? What if it is a surgical procedure and you want to see how it is being performed, or how it was performed in the past? Might it even be possible for a reader to choose their own navigational approach, when learning? There are also use considerations. E-books are lightweight and easy to carry and they do not waste a tree4. Librarians I spoke with told me that medical students express joy, simply because they can hold their entire required booklist in their lab-coat pockets. Before Apple’s new mini-iPad, in fact, some medical schools had specifically sewn full iPad sized pockets into their students’ lab-coats to make carrying iPads easier. And then, finally but most drivingly, there’s the practical considerations. Digital books are a great deal less expensive than traditional books, sometimes a third to a quarter of the cost of a tradition book. They can be published more rapidly and can be changed and updated frequently, as needed, unlike with printed books. This difference is significant for medical students in developed nations. But it an even more profound difference for students in developing nations, and may improve access to medical

information around the world. Students at UWI found the conversion to e-books a significant financial relief.5 It is unfortunate but necessary first step, that for the most part in their current format, medical textbooks are not much more than text files converted into a digital form. And the reader’s movement through the information is still a strictly linear one. Truly interactive content offers the option for other paths of learning. Inkling offers some of the most dynamic e-textbooks available. But there is more potential for interactivity and breaking the linearity of books than has yet been realized. Inkling CEO Matt Macinnis points out that living up to the dynamic potential of e-books is expensive, initially, and will take time to incorporate as readership improves. Inkling has taken the first steps to offer useful interactive features, such as “Test Yourself ” sections, a sophisticated search engine, highlighting, and the ability to save notes into a notebook. Also, readers can buy just the chapters they need for a fraction of the cost of the book. This is the very beginning of exploring the possibilities of etextbooks.

Which Comes First, Innovation or Leadership? Ebooks are not always the favorite way to read because they are not entirely intuitive or easy to use, not yet.6 They have not yet lived up to their potential, but ebooks are the cheapest and therefore, students are choosing them more. Professors are enthusiastic too, but for a different reason. Professors know that a third of students do not buy the current version of the recommended course books. These students use outdated versions or go without. Universities can obtain cheaper ebooks for students by purchasing continued on page 32 MEDMONTHLY.COM |31

continued from page 31

outright a digital copy for each enrolled student. This is a “forced” way for professors to offer students books for the course, but it is also far cheaper per book.7 And this has created a momentum that has encouraged both students and professors to adopt ebooks. The first question to ask in seeking the source of innovation and risk is, “Who has been making the decision to offer ebooks?” Publishers, to begin with, choose the option to offer. An ebook is cheaper than a print book, so there is a smaller profit margin, but more can be sold. Professors like this because it means their authorship has a wider base. University libraries cannot afford to purchase rights to all the required medical books, but they can offer their students a list of vendors, each of whom chooses a book list. Occasionally a publisher, such as Inkling or Kno, might offer themselves directly to a medical school library. But typically a vendor will create an aggregated list from various medical publishers. Students may then have some choice about where to purchase their books. Additionally, there are Barnes & Nobel, Amazon, and Apple, offering competitive prices on eBooks, each with their own proprietary book formats. Speaking with librarians at the medical schools, I heard about what students want most in ebooks. Students want ease of access. Some libraries, for example, offer textbooks but there can be obstacles like the doubleentry of a password to access both the library and the vendor or publisher. At the simplest level of user design, there are kinks to be worked out. Students frequently request better highlighting capabilities. A highlighting tool should be a simple as a marker. But it often requires awkward manipulation and makes gaps when it is created in a vector-based tool. And then, the highlighting may be deleted when the book is updated. Students want to be able to depend on their highlighting and notes not disappearing. Innovative publishers like Know and Inkling are repeatedly praised by students. And these companies are both beginning to break boundaries of the traditional text file.

Where to Find Medical e-textbooks There are roughly a dozen major access providers of medical e-textbooks, which service over fifty medical publishers. It is a list that is rapidly changing, as new companies form and merge, and others are pushed aside. Below is a list of the major vendors and publishers who provide direct medical e-textbooks access to readers. While accessed by medical students and universities, most of these medical e-textbooks are available for individual purchase directly via the links provided: 32 | JUNE 2013

• AccessMedicine, provided through Mcgraw Hill. http://

• AccessSurgery, provided through Mcgraw Hill.. http://

• Apple. Apple offers iBooks bookshelf app for access to e-textbooks. Many books cannot be viewed on personal computers. • Amazon. In addition to its own Kindle device, Amazon offers the free Amazon bookstore app for IOS devices, and the free Kindle bookshelf app through iTunes. • Barnes & Noble. In addition to its own Nook device, Barnes & Noble offers the B&N bookstore app through iTunes, and the Nook app through iTunes.

• Elsevier Mosby Saunders. com/category.jsp?id=EHS_US_BSDIS-1&dmnum=48843& elsca1=sem2012&elsca2=google&elsca3=me dicine&gclid=CN-kt8K10rYCFaxaMgodun4ALQ

• Inkling. iphone Inkling bookshelf app.

• Kno, Inc. is an education software company. http:// Offers iPad bookshelf app but no iPhone bookshelf app.

• Ovid, provided Wolters-Kluwer parent company of LWW medical publisher. http://www.ovid. com/webapp/wcs/stores/servlet/ category_ Surgery_13051_-1_9013052_50029430 • Springer. • R2 Digital Library (Rittenhouse) . https:// rbd/web/contentpage. aspx?con”g=r2library • STAT!Ref. •Thieme Electronic Book Library : TEBL. http://ebooks.

• Jaypeedigital. aspx?Opt=Title

• Unbound Medicine (uCentral for medical schools). continued on page 34 MEDMONTHLY.COM |33

continued from page 33

• Vitalsource Technologies, Inc. access portal provided by Ingram. http:// • Wiley. • Wolters Kluwer | Lippincott Williams & Wilkins. estore. 11851_-1_9012052_50011653_50011653_Y

E-textbooks are at the early stages and will be evolving as the very definition of a book undergoes some serious re-positioning. It is an exciting time to be a reader and an author.  Electronic Books: Their Integration into Library and Information Centers. Siriginidi Subba Rao. 2005. Electronic Library 23, no. 1: 116–140. http://www. 2 Print book sales rise hailed as a sign of a fightback in a digital world. Zoe Wood. e Guardian 28 December 2012. books/2012/dec/29/print-book-sales-rise-digital 3 As E-Book Sales Rise, Apple iPad Bests Amazon Kindle. Laura Hazard Owen. Bloomberg Businessweek. as-e-book-sales-rise-apple-ipad-bests-amazon-kindle 4 How Many Trees Does it Take to Make a Book? Candy Baker. http:// 5 UWI med students save big with ebooks. November 15, 2012. http:// 6 For Many Students, Print Is Still King. Jennifer Howard. e Chronicle of HIgher Education. January 27, 2013. 7 Should College Students Be Forced To Buy E-Books?. Janet Novack. Forbes Personal Fiance. May 18, 2012. janetnovack/2012/05/18/should-college-students-be-forced-to-buy-e-books/ 1

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research & technology

Flu in Pregnancy May Quadruple Child’s Risk for Bipolar Disorder


regnant mothers’ exposure to the flu was associated with a nearly fourfold increased risk that their child would develop bipolar disorder in adulthood, in a study funded by the National Institutes of Health. The findings add to mounting evidence of possible shared underlying causes and illness processes with schizophrenia, which some

36 |JUNE 2013

studies have also linked to prenatal exposure to influenza. “Prospective mothers should take common sense preventive measures, such as getting flu shots prior to and in the early stages of pregnancy and avoiding contact with people who are symptomatic,” said Alan Brown, M.D., M.P.H, of Columbia University and New York State Psychiatric Institute, a

grantee of the NIH’s National Institute of Mental Health (NIMH). “In spite of public health recommendations, only a relatively small fraction of such women get immunized. The weight of evidence now suggests that benefits of the vaccine likely outweigh any possible risk to the mother or newborn.” Brown and colleagues reported their findings online May 8, 2013 in JAMA

Psychiatry. Although there have been hints of a maternal influenza/bipolar disorder connection, the new study is the first to prospectively follow families in the same HMO, using physician-based diagnoses and structured standardized psychiatric measures. Access to unique Kaiser-Permanente, county and Child Health and Development Study databases made it possible to include more cases with detailed maternal flu exposure information than in previous studies. Among nearly a third of all children born in a northern California county during 1959-1966, researchers followed 92 who developed bipolar disorder, comparing rates of maternal flu diagnoses during pregnancy with 722 matched controls. The nearly fourfold increased risk implicated influenza infection at any time during pregnancy, but there was evidence suggesting slightly higher risk if the flu occurred during the second or third trimesters. Moreover, the researchers linked flu exposure to a nearly sixfold increase in a subtype of bipolar disorder with psychotic features. A previous study, by Brown and colleagues, in a related northern California sample, found a threefold increased risk for schizophrenia associated with maternal influenza during the first half of pregnancy. Autism has similarly been linked to first trimester maternal viral infections and to possibly related increases in inflammatory molecules. “Future research might investigate whether this same environmental risk factor might give rise to different disorders, depending on how the timing of the prenatal insult affects the developing fetal brain,” suggested Brown. Bipolar disorder shares with schizophrenia a number of other suspected causes and illness features, the researchers note. For example, both share onset of symptoms in early adulthood, susceptibility genes, run

in the same families, affect nearly one percent of the population, show psychotic behaviors and respond to antipsychotic medications. Increasing evidence of such overlap between traditional diagnostic categories has led to the NIMH Research Domain Criteria (RDoC) project, which is laying the foundation for a new mental disorders classification system based on brain circuits and dimensional mechanisms that cut across traditional diagnostic categories. The research was also funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit http://  About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih. gov. Source: health/may2013/nimh-13.htm MEDMONTHLY.COM |35


Skin Cancer Remains the Most Common Cancer in US,

EPA Urges Americans To Take Action

By the U.S. Environmental Protection Agency The U.S. Environmental Protection Agency (EPA), joined by the National Council on Skin Cancer Prevention, the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC), in recognizing the Friday before Memorial Day as “Don’t Fry Day”, to encourage Americans to take a few simple steps to protect their health and prevent skin cancer throughout the summer. “While we’re making progress toward restoring the Earth’s ozone layer, Americans need to take steps now for extra protection from harmful UV rays and skin cancer,” said Janet McCabe, deputy assistant administrator for EPA’s Office of Air and Radiation. “Americans can stay safe under the sun and enjoy the outdoors by taking simple steps such as using sunscreen and wearing UV-blocking sunglasses.” “If current trends continue, one in five Americans will get skin cancer in their lifetime, and many of these skin cancers could be prevented by reducing UV exposure from the sun and indoor tanning devices,” said CDC Director Tom Frieden, M.D., M.P.H. “Of particular concern is the increase we are seeing in rates of melanoma, a potentially deadly form of skin cancer. In the United States, melanoma 38| JUNE 2013

is one of the most common cancers among people ages 15 to 29 years.” “Spending time in the sun increases the risk of skin cancer. Everyone can get sunburned and suffer harmful effects of exposure to UV radiation from time spent outdoors,” said FDA Commissioner Margaret A. Hamburg, M.D. “Consumers can protect themselves by choosing a sunscreen that is right for them, wearing protective clothing and limiting time in the sun.” To make it easier for people to choose products that effectively reduce the health risks of UV overexposure, the FDA has issued new labeling rules for sunscreen products. These include: • Sunscreens proven to protect against both ultraviolet A (UVA) and ultraviolet B (UVB) rays can be labeled “Broad Spectrum.” Both UVB and UVA radiation contribute to the sun’s damaging effects. • Sunscreen products that meet the criteria for being called “Broad Spectrum” and have a Sunscreen Protection Factor (SPF) of 15 or higher may state that they reduce the risk of skin cancer and early skin

The U.S. Environmental Protection Agency (EPA), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) National Council on Skin Cancer Prevention provide sun safety tips.

aging when used as directed with other sun protection measures. • Any product that is not “Broad Spectrum,” or has an SPF below 15, must have a warning stating that the product has not been shown to help prevent skin cancer or early skin aging. • New water resistance claims on the front label must indicate whether the sunscreen remains effective for 40 minutes or 80 minutes while swimming or sweating. In addition to using Broad Spectrum sunscreen, here are some tips to help enjoy the outdoors safely this summer. • Seek shade, not sun: Seek the shade when the sun’s rays are strongest; avoid sunburns, intentional tanning, and use of tanning beds; use extra caution near reflective surfaces like water and sand. • Wear protective clothing: Wear sun-protective clothing, a wide-brimmed hat, and UV-blocking sunglasses. Check the UV Index: EPA and the National Weather Service offer the UV Index--an hourly forecast of UV

radiation that allows Americans to plan outdoor activities in ways that prevent overexposure to the sun. Download EPA’s free UV Index app at Nations across the globe have made steady progress toward restoring the Earth’s protective ozone layer through the groundbreaking environmental treaty called the Montreal Protocol. Signed by 197 countries, including the U.S. government, the Protocol is successfully working to phase out ozone-depleting substances. Scientists predict that the ozone layer will recover later this century. According to the CDC, the states with the highest melanoma death rates include Alabama, Arizona, Colorado, Idaho, Indiana, Iowa, Montana, Oregon, Utah, and West Virginia. Americans are encouraged to learn more about skin cancer in their states at sunwise/skin-cancer-facts-your-state. More on EPA sun safety tips is available at: http://www2.  Source: MEDMONTHLY.COM |39


N.C. Department of Health and Human Services Investigating Measles Outbreak NC Department of Health and Human Services PHOTO CREDIT: James Gathany, Centers for Disease Control and Prevention

Public health officials from the N.C. Department of Health and Human Services are working with local health departments to investigate an outbreak of measles. To date, seven cases have been identified in residents of Stokes and Orange Counties. Local public health departments are contacting other people who might have been exposed to these cases and providing vaccine to limit the spread of infection. “Measles is very uncommon in North Carolina, so many people aren’t aware of the symptoms,” said Dr. Laura Gerald, State Health Director. “Measles spreads quickly, particularly in children and adults who aren’t vaccinated. We want to make the public aware of this outbreak so individuals can take steps to protect themselves and their families.” Measles is a highly contagious disease that is spread through the air 40| JUNE 2013

by coughing and sneezing. It also can be transmitted through contact with secretions from the nose or mouth of an infected person. Initial symptoms may include fever, runny nose, watery red eyes and cough. After a few days, a rash appears on the head and spreads over the entire body. Measles can lead to pneumonia and other complications, especially in young children. The disease poses serious risks for pregnant women, including miscarriage and premature birth. Although the early symptoms of measles can be similar to those of many other infections, Dr. Gerald recommends that anyone with fever, runny nose, watery red eyes and a cough, should stay at home and limit contact with others to avoid spreading illness. If you develop a rash or if your symptoms worsen, call your doctor or seek medical care. If you do seek

medical care, call your doctor’s office or health care facility before you go so they can prepare for your visit and protect other patients from exposure. Measles can be prevented by the combination MMR (measles, mumps and rubella) vaccine. It is important for all individuals 12 months of age and older to be vaccinated. “Vaccine is readily available,” said Dr. Gerald. “Anyone interested in getting vaccinated should contact their primary health care provider or their local health department.” More information about measles is available at http://epi.publichealth.  Source: pressrel/2013/2013-04-18_measles_ outbreak.htm

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The FDA recently issued a proposed rule to allow the use of stand-alone symbols (i.e., not adjacent to a text explanation) on the labels of medical devices. Under the current regulation, 21 C.F.R. 801.15, graphics, pictures, or symbols in labeling that represent required information must be accompanied by explanatory English text adjacent to the symbol in order to “appear thereon in the English language.” The proposed rule would allow use of recognized symbols without explanatory text under certain circumstances. The medical device industry had asked FDA for permission to use stand-alone symbols in device labeling, offering two rationales. First, symbols would make labels more user-friendly by replacing small, difficult-to-read text with pictorial information. 42 |JUNE 2013

Second, allowing the use of standalone symbols would harmonize the labeling requirements of U.S. and foreign regulatory agencies. In response, FDA is proposing to revise several regulations to expressly allow for the use in medical device labeling of certain stand-alone symbols that are permitted in Europe and elsewhere. Under the proposed rule, the symbols can be used under two conditions. First, the symbols must be contained in a standard that FDA recognizes under the Food, Drug & Cosmetic (FD&C) Act. Internationally, voluntary standards such as ISO 15223 have standardized, commonlyused symbols that are often used in U.S. device labeling with adjacent explanatory text, and in limited instances, without adjacent text for in vitro diagnostic devices. FDA states

that it will maintain a list of approved symbols on its website (which already includes a list of recognized standards). Second, a “symbols glossary” must contemporaneously accompany the device. The term “symbols glossary” means a compiled listing of each symbol used in the labeling of the device and of the meaning of or explanatory text for the symbol. The proposed rule will also continue to allow the use of symbols, including standardized symbols, on device labeling when the symbols are accompanied by explanatory adjacent text.  Source: http://www.natlawreview. com/article/fda-issues-proposed-ruleto-allow-use-stand-alone-symbolsmedical-device-labels


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eDerm Systems Announces the Launch of Cutting Edge Software Solutions for Dermatology Practices

44 | JUNE 2013

eDerm Systems, a leading cloud based (EHR) Electronic Health Records software for dermatologists and dermatology practice management systems, unveiled its revolutionary new iPad EHR software solution at the American Academy of Dermatology’s annual meeting, March 1-5, 2013 in Miami Beach. The innovative new eDerm Systems iPad EHR has been designed by dermatologists for dermatology practices. The software has been developed with the goal of making a dermatology practice more efficient. “We have spent almost 3 years and millions of dollars developing this EHR. “It is truly revolutionary”, said Andrew Queen, CEO eDerm Systems. “The eDerm EHR is extremely intuitive. In one day the dermatologist and staff can be trained and start using the EHR as no setup is required. An added benefit, as clinical staff changes, new staff is up and running almost immediately without extensive training. The system is that intuitive. We accomplish this by presenting to the dermatologist or staff the information they need when they need it”, added Queen. The new eDerm Systems EHR iPad solution is focused on significantly speeding up the patient encounter. One way the company achieved this was by eliminating repetitive tasks using Smart Learning™. For example, if a patient presents for moderate acne, in one simple touch, the dermatologist can document impression, anatomic location, plan of care, include eRx, provide patient instructions and any other repetitive task. eDerm dermatology software operates similar to the way dermatologists currently use paper charts, but with greater efficiency and increased speed. Similar to paper, the eDerm iPad EHR can work offline and does not require the internet for a patient encounter. The iPad syncs to the cloud when internet is available. Truly mobile, the dermatologist has the ability to see patients, sign out charts, send/refill prescriptions and view pathology reports from wherever they are. Practice profitability and efficiency is maximized using the built-in Smart Coder™ with billing expertise to code correctly. No more undercoding or overcoding. The documentation supports the billing automatically and seamlessly with the generation of the Super-bill with E/M and CPT/ICD9/ICD10 codes. The system is ready for future ICD10 codes. eDerm scheduler is specifically designed for dermatology. One example of this feature rich scheduler is that patients with an untreated cancer that are not on the calendar are automatically placed on the recall list for your staff to easily schedule their cancer treatment. The patient with a history of cancer is recalled per the American

Academy of Dermatology (AAD) guidelines. The first year after a history of cancer, the patient is recalled four times a year, during the second year two times, and three years and beyond the patient is recalled once per year. “We are laser focused exclusively on dermatology. Everything we do must drive efficiency to the dermatology practice. If it is not going to speed up the Dermatologist or staff, we do not do it”, noted Queen. To launch this new product, eDerm Systems is offering dermatologists an opportunity to become an Ambassador Practice. The Ambassador Practice program provides 3 new iPads per practitioner and one year free subscription.  About eDerm Systems Located in Boca Raton, Florida, eDerm is a world class developer of cloud based EHR empowering Dermatology practices. Innovative solutions designed by Dermatologists for Dermatology. For more information or product demonstration of the new eDerm Systems iPad EHR visit or call 877.877.4500. Source: prweb10487641.htm




Get the Skinny on Dermatitis

46 | JUNE 2013

You’ve probably had a rash at some point or another, whether from poison ivy or the chickenpox or something more unusual. Why does your skin break out in red blotches like that? More important, is there anything you can do about it? We often think of the skin as a barrier—it keeps the insides of our bodies in, and it keeps the outside world out. But our skin is also filled with special cells of the immune system. These cells protect the skin and body against viruses, bacteria and other threats. Whenever these cells detect a suspicious substance, they begin a chain reaction in the skin that leads to inflammation. The medical name for this reaction is dermatitis. But it’s more commonly known as a rash. There are many different types of dermatitis, and each has a distinct set of treatments. Sometimes the skin’s immune cells react to something that directly touches the skin. Other times, the immune system flares in the skin because of a whole-body infection or illness. The symptoms of these different types of rashes often overlap. “Itching is a common symptom for all these problems,” says Dr. Stephen I. Katz, director of NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases. Many rashes are red, painful, and irritated. Some types of rash can also lead to blisters or patches of raw skin. While most rashes clear up fairly quickly, others are long lasting and need to be cared for over long periods of time. Eczema, or atopic dermatitis, is a dry, red, itchy rash that affects up to 1 in 5 infants and young children. It often improves over time, although it can last into adulthood or start later in life. In this condition, the water-tight barrier between skin cells gets weak, which lets moisture out and other things in. That’s why people with atopic dermatitis have to moisturize their skin, and they’re more susceptible to skin infections. Researchers have recently identified specific genes that are involved in maintaining the skin barrier. People with certain versions of these genes are more likely to get atopic dermatitis. “The skin is the outermost sentinel for fighting off bacteria and noxious agents,” says Katz. “If the barrier is broken somehow, you can become more allergic to things.” A skin allergy, or allergic contact dermatitis, produces a red, itchy rash that sometimes comes with small blisters or bumps. The rash arises when the skin comes in contact with an allergen, a usually harmless substance that the immune system attacks. Allergens trigger allergic reactions. Allergens can come from certain soaps, creams and even pets.


Your immune system might not react the first time you encounter an allergen. But over time, your immune system can become sensitive to the substance. As a result, your next contact may lead to inflammation and an allergic rash.

Your immune system might not react the first time you encounter an allergen. But over time, your immune system can become sensitive to the substance. As a result, your next contact may lead to inflammation and an allergic rash. “The most common form of dermatitis that is seen anywhere is an allergic contact dermatitis to nickel,” says Katz. “Why? Because of ear piercing.” Many inexpensive earrings are made of nickel, and over time, wearing nickel earrings can cause an allergic reaction to the metal. Other common causes of allergic dermatitis are poison oak and poison ivy. The stems and leaves of these plants produce a chemical that’s likely to cause allergies. If you touch one of them, wash your skin as soon as possible. The chemical can also remain in clothing for a long time, so it’s important to wash any clothes or shoes—or even pets— that come into contact with these plants. Mild cases of allergic contact dermatitis usually disappear after a few days or weeks. But if the rash persists, is extremely uncomfortable or occurs on the face, it’s important to see a physician. A doctor can prescribe medications that will tone down the immune reaction in the skin. This eases swelling and itching and will protect your eyes and face. The immune cells of the skin can also produce rashes when they react to invading germs—like bacteria, fungi and viruses. Bacterial and viral infections within your body can cause your skin to break out in spots as well. The chickenpox virus, for example, can cause itchy spots in children. Years later, in older adults, the same virus may continued on page 48 MEDMONTHLY.COM |47

continued from page 47

reappear as shingles, bringing a painful rash and high fever. Vaccines can prevent several rash-causing diseases, including chickenpox, shingles and measles. Certain drugs, including antibiotics like amoxicillin, may also cause itchy skin rashes. If you’re allergic to a drug, a rash can be the first sign of a serious reaction. As with other allergies, a reaction to a drug may not occur the first time you take it. It could show up after several uses. Not all drug rashes are due to an allergy, however. If you break out in itchy spots after starting a new drug prescription, contact your doctor right away. While most rashes get better with time, some can last a lifetime. Psoriasis, a condition where skin cells build up into thick red patches, tends to run in families. “It’s a complex genetic disease, in that there’s not one gene that causes psoriasis but many,” says Katz. Even though none of these genes alone has a great effect on the disease, knowing which genes are involved can help researchers design potential new treatments. Other long-term diseases that can produce rashes include autoimmune diseases, such as lupus, and some forms of cancer. If you notice an itchy or painful rash on your skin, think twice before going to the drugstore and getting some cream if you don’t know the cause. “The creams that you buy can produce problems that make your original problem even worse,” Katz says. Because rashes can be caused by many different things—bacteria, viruses, drugs, allergies, genetic disorders, and even light— it’s important to figure out what kind of dermatitis you have. “If you have any significant rash, you should see a dermatologist,” says Katz. A dermatologist, or skin doctor, is specially trained to figure out what’s causing a rash and help you get the right treatment. Your skin is your protection. It’s not just the covering that keeps your body in; it’s also your first line of defense against germs and chemicals. Take care of your skin so your skin can take care of you.  Source: apr2012/feature1 48| JUNE 2013

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FDA Alert:

Fraudulent Versions of Botox Found in the United States

50 | JUNE 2013

FDA is alerting health care practitioners and the public that fraudulent versions of Botox that are not approved by the FDA are being sold to U.S. medical practices. The outer carton is counterfeit, while the vial inside is labeled as a foreign version of Botox, which is not FDA-approved for sale in the United States. These products are being sold by unlicensed suppliers who are not part of the legitimate U.S. supply chain. FDA cannot confirm that the manufacture, quality, storage, and handling of these products follow U.S. standards. These fraudulent products are considered unsafe and should not be used. The company selling the fraudulent versions of Botox goes by the names “Online Botox Pharmacy,” “,” and “Onlinebotox.” At the time this alert was issued, the company did not appear to be selling its products over the internet. Instead, the company has been using “blast faxes” to solicit sales from medical practices, typically selling products at prices below those of FDA-approved products. As is the case with many companies that sell fraudulent products, Online Botox Pharmacy uses a U.S. return address when sending packages to medical practices, even though the products are from foreign sources. Medications purchased from foreign or unlicensed sources may be misbranded, adulterated, counterfeit, contaminated, improperly stored and transported, ineffective, and/or unsafe. Medical practices that purchase and administer illegal and unapproved medications from foreign sources are putting patients’ health at risk, as patients may not be getting proper treatment. FDA-approved Botox for injection (100 units/vial), manufactured by Allergan, displays the active ingredient as “OnabotulinumtoxinA” on the outer carton and vial. Currently, there is no indication that Allergan’s FDAapproved version is at risk, and this product should be considered safe and effective for its intended and approved uses. Suspect fraudulent products can be identified as follows: • the outer carton displays the active ingredient as “Botulinum Toxin Type A”; or • the lot numbers and expiration dates on the outer carton and accompanying vial do not match. Thus far, the following examples have been confirmed as fraudulent Botox. Products with any of these lot numbers and expiration dates should be considered suspect.

Example 1

Lot# C3016 C3 (carton) C3121 C3 (vial)

Example 2

Lot# C3060 C3 (carton) C3121 C3 (vial)

Exp Date 10-2014 04-2015 Exp Date 01-2015 04-2015

FDA is asking the public to report suspect Botox products obtained from Online Botox Pharmacy or other questionable sources: • Call FDA’s Office of Criminal Investigations (OCI) at 800-551-3989, or • Report to OCI at email/oc/oci/contact.cfm, or • Email - Health care professionals and patients should report adverse events related to the use of any suspect medications to FDA’s MedWatch Safety Information and Adverse Event Reporting Program either online, by regular mail, by fax, or by phone. Health care professionals and consumers can either: • Complete and submit the report online: MedWatch/report.htm, or • Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178. FDA has issued a series of alerts and letters to practitioners about the risk of buying medicines from foreign or unlicensed sources. ( DrugSafety/DrugIntegrityandSupplyChainSecurity/ ucm330610.htm and DrugSafety/DrugIntegrityandSupplyChainSecurity/ ucm299920.htm).  Source: htm

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the arts

Retired Doctor Finds an Artistic Life After Medicine

By Barbara Curtin, Janet Neuburg’s fused-glass creations are as whimsical and colorful as their creator. A rose-colored salmon swishes over an aqua platter. Waves splash across a plate in several shades of blue. Palmsize wasabi dishes sport bright circles within squares, a tricky process that looks easy when Neuburg does it. Students and customers could easily mistake her as a career artist rather than what she is: a retired doctor reveling in new skills and free time. Since leaving her medical career 52| JUNE 2013

in 2007, the 65-year-old has plunged into creating art, volunteering and a combination of the two. The Salem Art Fair & Festival chose her last summer as one of two “emerging artists” given perks and mentoring. She left the prestigious show with better sales than some veteran craftspeople. When first contacted for this story, she was busy cooking dinner for 30 for her church’s Foster Parent Night Out program, which she founded. She’s also an avid river rafter.

“You can guess that I don’t fit the mold of being a doctor very well,” she said cheerfully.

Photography awakens skills Long before Janet thought about medicine, her grandfathers, both photographers, kindled her interest in art. “I grew up in a time where all kids picked strawberries,” she said. “I spent my strawberry money on a camera, and we all took music lessons.

“The message was, ‘These are avocations. You will not earn a living with this.’... But it’s a great way to add depth to your life.” After graduating from Reed College, she went on to study biochemistry at the University of Arizona. That’s where she started the art collection that now fills her compact home near Bush’s Pasture Park. Each item has a story: her own photographs and glass, plus others’ handcrafted furnishings, felted hats, carved wooden sculptures, paintings. The little rug she bought as a starving student still holds a place of honor. After two years in grad school, studying alongside future doctors, she mustered the courage to apply to medical school. “If I don’t try, I’ll always look back with regret,” she said, describing her thoughts at the time. “And I got in, probably by the skin of my teeth.” During her family-practice residency during the 1970s in Rhode Island, she spent a rotation at the Hopi reservation in Arizona. She later returned for an eight-month stint. Her time immersed in that culture still shows in the woven rugs on her walls and in the vivid color combinations of her fused-glass creations. She proudly points out a photo of her younger self in full Hopi regalia at a cultural festival. In 1980 she signed on with Kaiser Permanente in Salem, a decision that would shape the rest of her life. She spent a decade in family practice, a demanding specialty. Then her life changed in an unexpected way: She married and gave birth at 42 to her daughter. That milestone spurred Janet’s switch to occupational medicine. “I thought, ‘How am I going to do (family practice) with evening and weekend shifts and night calls?’ ” she said. Occupational medicine provided the needed flexibility — plus more time to create art. Just as hanging out with medical students had shaped Janet’s career

choice, meeting Salem-area artists influenced her creative side. She resumed taking photographs and printing them, using rented darkroom space in Portland. She took classes in fused glass from a patient who became Janet’s mentor in that craft. Janet loved the science of it: the many colors and forms of glass; the way it behaved when cut and when heated; the fact that she could imagine a design and turn it into practical, affordable art. When she and her husband, a potter, bought a kiln together, that spurred a “three-quantum leap” in her production. Between them, they covered every wall and every surface in the house with ceramics and glass. They began holding open-house art sales to clear space to create more work. Kaiser commissioned her to create fusedglass works as prizes for longstanding workers. By the time she retired from medicine in 2007, she had not only restored a sense of balance to her hurried life; she had gained the skills to stay busy and happy in a life beyond medicine.

Art-fair newbie Over many years living in Salem, Janet had watched the Salem Art Fair & Festival grow from a local event to one attracting national entries. Now she became intrigued by the challenge of gaining a coveted spot there. Her first fair application, about four years ago, was unsuccessful. But just as she had mastered other fields — moving from family practice to occupational medicine, learning to hike and raft in the Southwest —she set about learning this new skill. She re-read the entry guidelines (“One year I messed up the deadline; how dumb is that?”) She studied how successful artists marketed their work. The payoff came last year, when fair organizers chose her as one of two “emerging artists.” The designation brought a tent, reduced fees and

special mentoring by another glass artist. Jim Hamers, a lawyer and woodworker, helped Janet create the needed shelving to display her work at the fair. A board-buying trip to a Mehama mill summed up one of his friend’s key traits, he said: “Within 10 or 20 minutes, she was thinking in terms of what wood would she like, how we would design it and work with it. She started seeing how we could match this up with that, how we could use the grain here. She is nimble in her thinking.” Hamers appreciates how Janet combines a physician’s precision with an artist’s openness to experimentation. “I would put her as a gifted artist,” he said. “She doesn’t think inside the box.” The fair came at a bad time for Janet: She was in the process of divorcing, moving to her own home and creating her own studio. But she stuck with it. She sold about $2,000 of the $11,000 inventory she had brought — not bad for a hobbyist, but short of what another person would need to earn a living. “You have compassion for how hard people work and what a scramble it is,” she said. For her, the payoff came in socializing with old friends and former patients. She doesn’t plan to become a regular on the art-fair circuit. Instead, she’ll continue to teach her skills and create items for causes that interest her — most recently, the Salem Art Center’s Clay Ball and the foster-parent program, which is funded by sale of her glass stars. She’ll also keep buying art for gifts and her home. “Art has always made money burn a hole in my pocket,” she said. “I’ll drive a decrepit old car, and I’d be perfectly happy to shop Goodwill for clothes.”  Source: http://www.statesmanjournal. com/article/20130303/NEWS/303030068/ Sunday-Profile-Retired-doctor-finds-anartistic-life-after-medicine MEDMONTHLY.COM |53

healthy living

Summer Squash and Tomato Pizza

By Ashley Acornley, MS, RD, LDN

It’s summertime, which means it’s prime time for grilling! Instead of grilling the traditional steak, burgers, and hot dogs (which are all high in sodium, cholesterol, and saturated fats), try this recipe for a grilled vegetable pizza. You can use all zucchini or yellow squash for this grilled pie, or even opt to choose different vegetables. This creative pizza is filled with protein, fiber, and chock full of vitamins and minerals. Serve one slice as an appetizer or two with a salad or soup for a quick and easy dinner. Servings: 8 servings

Ingredients: Cooking spray (like Pam) 1 teaspoon olive oil 1 teaspoon balsamic vinegar 1/8 teaspoon salt 1/8 teaspoon freshly ground black pepper 1 medium zucchini, cut lengthwise into (1/4-inch-thick) slices 1 medium yellow squash, cut lengthwise into (1/4-inch-thick) slices 1 (12-inch) packaged whole-grain pizza crust (such as Mama Mary’s or Boboli) 2 plum tomatoes, cut into (1/8-inch-thick) slices 1/4 cup (1 ounce) finely grated Romano or Parmesan cheese 2 tablespoons thinly sliced fresh basil 1/2 teaspoon finely chopped fresh oregano

Preparation: 1. Prepare and heat up grill.

2. Combine oil, vinegar, salt, pepper, zucchini slices, and yellow squash slices in a large bowl, tossing gently to coat. Place squash mixture on grill rack coated with cooking spray; grill 2 minutes on each side or until tender. 3. Reduce grill temperature to medium. 4. Lightly coat pizza crust with cooking spray; grill 1 minute on each side or until lightly toasted. Arrange zucchini and squash over crust. Arrange tomatoes over squash; sprinkle with pecorino Romano cheese. Grill 5 minutes or until thoroughly heated. Remove from grill; sprinkle with basil and oregano. 54| JUNE 2013

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Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 ophth/ New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 Certificates/ProfessionsNewReneworUpdate/DispensingOptician.aspx


U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 Delaware Cannon Building, Suite 203 861 Solver Lake Blvd. Dover, DE 19904 (302)744-4500 Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 56 | JUNE 2013

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 licensing/occupational/dentist/about/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650,4601,7154-35299_28150_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 Missouri 3605 Missouri Blvd. P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 boards/den_board/board_page.asp

Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 crl_medical_dent_hygiene_board.aspx

Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580

Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044

Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037

New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561

Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828

New York 89 Washington Ave. Albany, NY 12234 (518)474-3817

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599

North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223

South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282

North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600

Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 MEDMONTHLY.COM |57

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 58| JUNE 2013

Florida 2585 Merchants Row Blvd. Tallahassee, FL 32399 (850)245-4444 DesktopDefault.aspx?tabid=115

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601

Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 (808)587-3295

Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000

Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200

Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918,4601,7154-35299_28150_27529_27541-58914-,00.html

Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY  40222 (502)429-7150

Minnesota University Park Plaza 2829 University Ave. SE, Suite 500  Minneapolis, MN 55414 (612)617-2130 Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 Missouri Missouri Division of Professional Registration 3605 Missouri Blvd. P.O. Box 1335 Jefferson City, MO  65102 (573)751-0293

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 p

North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 (701)328-6500

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010

Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 state-licensing-boards/nebraska-boardof-medicine-and-surgery

Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 (614)466-3934

Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220

Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700

Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400

Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105  (717)787-8503 pt/community/state_board_of_medicine/12512 Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111

Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 asp?boardid=35&locid=0 Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053


medical resource guide ACCOUNTING

Ajishra Technology Support

Boyle CPA, PLLC 3716 National Drive, Suite 206 Raleigh, NC 27612 (919) 720-4970


PO Box 15130 Scottsdale, AZ 85267 (602)370-0303


Ring Ring LLC

6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)819-6838

ANSWERING SERVICES Corridor Medical Answering Service

3088 Route 27, Suite 7 Kendall Park, NJ 08824 (866)447-5154

Docs on Hold

14849 West 95th St. Lenexa, KS 66285 (913)559-3666

BILLING & COLLECTION Advanced Physician Billing, LLC

PO Box 730 Fishers, IN 46038 (866)459-4579

60| JUNE 2013

Applied Medical Services 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (919)477-5152

Sweans Technologies 501 Silverside Rd. Wilmington, DE 19809 (302)351-3690

VIP Billing

PO Box 1350 Forney, TX 75126 (214)499-3440

Axiom Business Solutions

Find Urgent Care

PO Box 98313 Raleigh, NC 27624 (919)747-9031

3562 Habersham at Northlake, Bldg J Tucker, GA 30084 (866)473-0011

4704 E. Trindle Rd. Mechanicsburg, PA 17050 (866)517-0466

Frost Arnett 480 James Robertson Parkway Nashville, TN 37219 (800)264-7156

CAREER CONSULTING Doctor’s Crossing 4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545

Gold Key Credit, Inc. PO Box 15670 Brooksville, FL 34604 888-717-9615

Horizon Billing Specialists 4635 44th St., Suite C150 Kentwood, MI 49512 (800)378-9991

CODING SPECIALISTS The Coding Institute LLC 2222 Sedwick Drive Durham, NC 27713 (800)508-2582

Management Services On-Call 200 Timber Hill Place, Suite 221 Chapel Hill, NC 27514 (866)347-0001

Marina Medical Billing Service 18000 Studebaker Road 4th Floor Cerritos, CA 90703 (800)287-8166

Mediserv 6451 Brentwood Stair Rd. Ft. Worth, TX 76112 (800)378-4134

Practice Velocity 1673 Belvidere Road Belvidere, IL 61008 (888)357-4209

COMPUTER, SOFTWARE American Medical Software

1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300


300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239

Instant Medical History

4840 Forest Drive #349 Columbia, SC 29206 (803)796-7980


DENTAL Biomet 3i

Medical Credentialing

(800) 4-THRIVE

Medical Practice Listings

8317 Six Forks Rd. Suite #205 Raleigh, NC 27624 (919)848-4202

24 Cherry Lane Doylestown, PA 18901 (888)348-1170

Physician Wellness Services 5000 West 36th Street, Suite 240 Minneapolis, MN 55416 888.892.3861

Synapse Medical Management

18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143

4555 Riverside Dr. Palm Beach Gardens, FL 33410 (800)342-5454

Dental Management Club

4924 Balboa Blvd #460 Encino, CA 91316

DocuTAP 4701 W. Research Dr. #102 Sioux Falls, SD 57107-1312 (877)697-4696

Integritas, Inc. 2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486

The Dental Box Company, Inc.

PO Box 101430 Pittsburgh, PA 15237 (412)364-8712

FINANCIAL CONSULTANTS Sigmon Daknis Wealth Management

DIETICIAN Triangle Nutrition Therapy 6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 (919)876-9779

701 Town Center Dr. , Ste. #104 Newport News, VA 23606 (757)223-5902

Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063


Urgent Care America

17595 S. Tamiami Trail Fort Meyers, FL 33908 (239)415-3222

Urgent Care & Occupational Medicine Consultant Lawrence Earl, MD COO/CMO ASAP Urgentcare Medical Director, 908-635-4775 (m) 866-405-4770 (f )

Utilization Solutions (919) 289-9126

ABELSoft 1207 Delaware Ave. #433 Buffalo, NY 14209 (800)267-2235

Acentec, Inc 17815 Sky Park Circle , Suite J Irvine, CA 92614 (949)474-7774


INSURANCE, MED. LIABILITY Aquesta Insurance Services, Inc.

Michael W. Robertson 3807 Peachtree Avenue, #103 Wilmington, NC 28403 Work: (910) 794-6103 Cell: (910) 777-8918

Medical Protective

10011 S. Centennial Pkwy Sandy, UT 84070 (800) 825-0224

5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776 medical-protective


MGIS, Inc.

201 E. Pine St. #1310 Orlando, FL 32801 (888)348-8457

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447


medical resource guide INSURANCE, MED. LIABILITY

Nicholas Down

Martin Fried

Professional Medical Insurance Services

16800 Greenspoint Park Drive Houston, TX 77060 (877)583-5510

Wood Insurance Group

4835 East Cactus Rd., #440 Scottsdale, AZ 85254-3544 (602)230-8200

LOCUM TENENS Physician Solutions

PO Box 98313 Raleigh, NC 27624 (919)845-0054

Bank of America

Barry Hanshaw 18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038

MMA Medical Architects

520 Sutter Street San Francisco, CA 94115 (415) 346-9990

Laura Maask 262-308-1300

Marianne Mitchell (215)704-3188


1295 Walt Whitman Road Melville, NY 11747 (888)862-4050

Biosite, Inc

9975 Summers Ridge Road San Diego, CA 92121 (858)805-8378

Deborah Brenner

877 Island Ave #315 San Diego, CA 92101 (619)818-4714

800 Shoreline, #900 Corpus Christi, TX 78401 (888)246-3928

Pia De Girolamo

62| JUNE 2013

391 Technology Way Winston Salem, NC 27101 (336)722-8910

Robert Sayre Marketing Adviser/Business Coach


PO Box 98313 Raleigh, NC 27624 (919)747-9031 WhiteCoat Designs Web, Print & Marketing Solutions for Doctors (919)714-9885

Tarheel Physicians Supply 1934 Colwell Ave. Wilmington, NC 28403 (800)672-0441

Medical Practice Listings

8317 Six Forks Rd. Ste #205 Raleigh, NC 27624 (919)848-4202


Dicom Solutions 548 Wald Irvine, CA 92618 (800)377-2617

High Performance Network


Carolina Liquid Chemistries, Inc. Brian Allen




Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193


ALLPRO Imaging




PO Box 99488 Raleigh, NC 27624 (919)846-4747

medical resource guide



Greenbranch Publishing 800-933-3711


Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193

CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077


Ethicon, Route 22 West Somerville, NJ 08876 (877)984-4266


1430 Decision St. Vista, CA 92081 (760)727-1280


Arup Laboratories

500 Chipeta Way Salt Lake City, UT 84108 (800)242-2787

Chimerix, Inc. 2505 Meridian Parkway, Suite 340 Durham, NC 27713 (919) 806-1074 Clinical Reference Laboratory 8433 Quivira Rd. Lenexa, KS 66215 (800)445-6917

Sanofi US

55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491

Scynexis, Inc.


York Properties, Inc.

Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350 Commercial Sales & Leasing (919) 821-7177

STAFFING COMPANIES Additional Staffing Group, Inc. 8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601

31778 Enterprise Dr. Livonia, MI 48150 (800)447-5050

Gebauer Company

4444 East 153rd St. Cleveland, OH 44128-2955 (216)581-3030


15 Barstow Rd. Great Neck, NY 11021 (877)566-5935



3501 C Tricenter Blvd. Durham, NC 27713 (919) 933-4990


BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157

PO Box 98313 Raleigh, NC 27624 (919)747-9031

Subscribe to receive Med Monthly e-news Click here to join our e-news subscribers and get current medical news as it happens Visit us online anytime at MEDMONTHLY.COM |63

classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina GP Needed Immediately On-Going 3 Days Per Week at Occupational Clinic . General Practictioner needed on-going 3 days per week at occupational clinic in Greensboro, NC. Numerous available shifts for October. Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: 3-5 days per week in Durham, NC . Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina. General Practitioner with a knowledge or interest in addictive disease. Needed in October on-going 1-3 times per week. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: Primary Care Physician in Northwest NC (multiple locations). Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm. Outpatient only. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email:

64| JUNE 2013

Immediate need for full time GP/FP for urgent cares in eastern NC. Urgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent placement. Physician Solutions, PH: (919) 845-0054, email: General Practitioner Needed in Greensboro. Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week. Adults only. 8 am-5 pm. No call required. Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail. com Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC. Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/on-going/full-time. The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill this position immediately. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: County Health Department in Fayetteville, NC seeks GP/IM/FP Full-Time, On-Going Shifts. GP/IM/FP Needed Immediately at County Health Department in Fayetteville, NC. Approximately 20 patients per day with hours from 8 am -5 pm. Call or email for more information. 919-845-0054 Occupational Clinic in Greensboro, NC seeks FP/GP for On-Going Shifts. Locum tenens position (4-5 days a week) available for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/ day. Excellent staff. Outpatient only. Diabetic Clinic 1 hour from Charlotte seeks FP/GP/ IM for On-Going Shifts.Primary care physician needed immediately for outpatient diabetic clinic one hour outside Charlotte, NC On-going. Hours are 8 am -5 pm with no call. Approximately 15-20 patients a day. Call or email for more information. 919-845-0054 Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing. A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. email:

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.) Addictive Disease Clinic in Charlotte, NC and surrounding cities seeks GP/FP/IM for on-going shifts An addictive disease clinic with locations with locations in Charlotte, NC and surrounding cities seeks a GP with an interest in addictive medicine for on-going shifts. This clinic has 15-25 open shifts every month and we are looking to bring on a new doctor for consistent coverage. The average daily patient load is between 20 and 25 with shifts from 8 am - 5 pm and 6 am - 2 pm. If you are interested in this position please send us your CV and feel free to contact us via email or phone with questions or to learn about other positions. Physician Solutions, PH: (919) 845-0054, email: Child Health Clinic in Statesville, NC seeks pediatrician or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-8450054 or Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in January. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Call or email for more information. 919-845-0054 FT Mid-Level Provider needed for Wilmington practice immediately. Small private practice 45 minutes outside Wilmington seeks mid-level provider starting January. M-F 8:00-5:00, PT or FT. This practice also is looking for a PA permanently in April. Accommodations, PLI, and mileage provided. Please contact Physician Solutions at 919-845-0054 or

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in March. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Call or email for more information, 919-845-0054 or physiciansolutions@ FT/PT Mid-Level Provider needed for Wilmington practice immediately. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8:00-5:00. Possible permanent placement. Call or email for more information. 919-845-0054 physiciansolutions@gmail. com Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or Asheboro Family Practice and Urgent Care seeks GP for intermittent coverage. Family Practice and Urgent Care seeks general practitioner for intermittent days beginning in March from 8a-8p. Provider will see about 35 patients with no call. Please contact Physician Solutions at 919-845-0054 or Greensboro occupational health care clinic seeksgeneral practitioner for intermittent shifts. Primary care physicians needed for occupational medicine. Adults only. Hours are 8am-5pm. Large corporation, no call required. Please contact Physician Solutions at 919-8450054 or IM/FP needed in Fayetteville health department immediately. Fayetteville health department needs coverage March through June full or part time. Clinics are adult health and women’s health. Adults only. No call 8a-5p. Please contact Physician Solutions at 919845-0054 or

continued on page 67 MEDMONTHLY.COM |65

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients. FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff. Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

evaluation of patient on admission and development of a comprehensive treatment plan, serve on medical staff committees, complete court papers, documentation of patient progress in medical record, education of patients/families, provision of educational groups for patients.

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email:

Internal Medicine Practice for Sale Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments. The average patients per day is 20-25+, and the gross yearly income is $555,000. Listing Price: $430,000

Call 919-848-4202 or email 66| JUNE 2013



ROANOKE RAPIDS, NC In mid December, a pediatrician or family medicine doctor comfortable with seeing children is needed full time in Roanoke Rapids (1 hour north of Raleigh, NC) until a permanent doctor can be found. Credentialing at the hospital is necessary.

Call 919- 845-0054 or email:

classified listings


continued from page 65

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.) Geriatric physician needed immediately 2 to 5 days per week, on-going eastern NC. Nursing homes in Durham, Fayetteville and Rocky Mount seek GP/IM/ FP with geriatric experience to work full or part time. Nursing home focuses on therapy and nursing after patients are released from the hospital. 8a-5p, no call. Please contact Physician Solutions at 919-845-0054 or email Nursing home in Durham seeks PT/FT NP/PA for immediate ongoing scheduling. Durham nursing home seeks part time or full time mid-level for ongoing locums. Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email COLUMBUS IM FT/PT Mid-Level Provider needed for practice near Wilmington. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8-5p. Possible permanent placement. Please contact Physician Solutions at 919-845-0054 or email Fayetteville occupational health care clinic seeks GP for May 5-9. Primary care physicians needed for occupational medicine. Adults only. 8-5p. Large corporation, no call required. Intermittent dates in the future and second office in Greensboro with ongoing scheduling. Please contact Physician Solutions at 919-845-0054 or email Health Dept 45 min NE of Raleigh seeks MD coverage Tues/Thurs ongoing May 14. GP/FP/IM/Peds doctor needed for the following clinics in Louisburg: Adult, Family Planning, Peds, STD for ongoing scheduling or intermittent shifts. 8-5p.Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail. com. Community Health Dept in Washington, NC (1 h 45 min E of Raleigh) seeks FP for coverage June 15 FT/PT ongoing. Family practitioner sought for eastern Carolina community health center in Washington, NC. Must see all ages, 8-5p. Start June 15 ongoing. Please contact Physician Solutions at 919-845-0054 or email

Nursing home in Durham seeks PT/FT Geriatrics doctor for immediate ongoing scheduling. Durham nursing home seeks part time or full time MD for ongoing locums. Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email Family Practice 1 h SE of Raleigh seeks July 6-7 coverage. Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919-845-0054 or email Pediatric clinic near Greensboro needs 10 weeks of 3 day a week coverage beginning June 1. Burlington pediatric clinic seeks coverage June 1 3 days a week for 10 weeks. 8-5p. Please contact Physician Solutions at 919-845-0054 or email Greenville Clinic seeks GP May 20-22. GP/IM needed for May 20-22 and intermittent shifts. Must have experience or be willing to do pain management and trigger point injections. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@ Raleigh practice seeks BC FP for permanent placement in new facility summer 2013. Board Certified Family Practitioner sought for FT permanent placement in new clinic in Raleigh to start summer of 2013. Please contact Physician Solutions at 919-845-0054 or email Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing . A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. Please contact Physician Solutions at 919-845-0054 or email Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or email

continued on page 69 MEDMONTHLY.COM |68

classified listings


continued from page 67

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.) IM/FP/Peds needed in Fayetteville health department immediately. Fayetteville health department needs immediate coverage for the following clinics: adult health, women’s health and STD. No call 8a-5p. Please contact Physician Solutions at 919-845-0054 or email Pediatrician Needed MD June-Aug, Burlington NC 3x week for 10 wks starting June 1st, 8-5 Mon-Fri Burlington, NC: located 1 hour west of Raleigh. Please contact Physician Solutions at 919-845-0054 or email Pediatrician, IM & FP needed, Fayetteville NC Urgent Need for immediate MDs - Pediatrics, Family Practice or Internal Medicine - PT/FT, 8-5 Mon-Fri. Ongoing. Please contact Physician Solutions at 919-845-0054 or email Locum & Permanent MD Needed , Kinston NC Urgent Need for immediate MD placement, 8-5 MonFri. Must be able to do family planning & light maternity, Kinston, NC: 1.5 hours outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email PT MD needed for Occupational practice, Greensboro NC. Urgent need for PT MD to do disability physicals 2-3 days weekly, 8-5, on-going scheduling. Greensboro, NC. Please contact Physician Solutions at 919-845-0054 or email Permanent Family Practice doctor needed for Summer 2013, Raleigh, NC Need FP/BC MD for June-Sept MonFri , 8-5, New Facility in downtown Raleigh, NC. Please contact Physician Solutions at 919-845-0054 or email Permanent PA or MD needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5, Goldsboro, NC: 1 hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email Family Practice MD needed 2-3x/w in July, Goldsboro July 6 & 7 and intermittent dates, 8-5p,Goldsboro, NC 1h SE of Raleigh. Please contact Physician Solutions at 919-845-0054 or email 68| JUNE 2013

FULL TIME MD needed for Family Practice in Washington, N.C. Family Practitioner needed for FT MD June 15-Sept 1 on-going Mon- Fri 8-5, Washington, NC, 1 hour 45 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email Geriatric Experienced Mid Level or MD, Durham NC Must have geriatric experience, PT/FT, Locations in Durham, Rocky Mount & Fayetteville, NC. Please contact Physician Solutions at 919-845-0054 or email MD needed for June 6 & intermittent dates, Charlotte N.C. June 6 & Intermittent weekdays, 8-5 in Charlotte, NC. Please contact Physician Solutions at 919-845-0054 or email

Physicians needed South Carolina A family and urgent care in Little River, SC seeks an FP/EM physician for 1 to 2 days per week, on-going shifts. The practice is a one-physician facility and is looking for a physician to come in regularly. The practice is small and does not have a large patient load. The qualified physician will have experience in Family or Emergency medicine. If you have any availability and a SC medical license contact us today and we will do our best to work around your schedule. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email:

Physicians needed Virginia Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: continued on page 70

Hospice Practice Wanted Practice for Sale in South Denver Neurofeedback and Psychological Practice Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputation based on 30 years experience in Denver. Private pay and insurances, high-density traffic, beautifully decorated and furnished offices, 378 active and inactive clients, corporate clients, $14,000 physical assets, good parking, near bus and rapid transit housed in a well-maintained medical building. Live and work in one of the most healthy cities in the U.S.

Hospice Practice wanted in Raleigh/ Durham area of North Carolina. Medical Practice Listings has a qualified physician buyer that is ready to purchase. If you are considering your hospice practice options, contact us for a confidential discussion regarding your practice.

List Price: $150,000 | Established: 2007 | Location: Colorado For more information contact Dr. Jack McInroy at 303-929-2598 or

To find out more information call 919-848-4202 or e-mail

FAMILY PRACTICE FOR SALE A beautiful practice located in Seattle, Washington This upscale primary care practice has a boutique look and feel while realizing consistent revenues and patient flow. You will be impressed with the well appointed layout, functionality as well as the organization of this true gem of a practice. Currently accepting over 20 insurance carriers including Aetna, Blue Cross and Blue Shield, Cigna, City of Seattle, Great West and United Healthcare. The astute physician considering this practice will be impressed with the comprehensive collection of computers, office furniture and medical equipment such as Welch Allyn Otoscope, Ritter Autoclave, Spirometer and Moore Medical Exam table. Physician compensation is consistently in the $200,000 range with upside as you wish. Do not procrastinate; this practice will not be available for long. List price: $255,000 | Year Established: 2007 | Gross Yearly Income: $380,000

Medical Practice Listings Selling and buying made easy | | 919.848.4202

classified listings


continued from page 68

To place a classified ad, call 919.747.9031

Physicians needed

Practice wanted


North Carolina

Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail:

Pediatric Practice Wanted in Raleigh, NC Medical Practice Listings has a qualified buyer for a pediatric practice in Raleigh, Cary or surrounding area. If you are retiring, relocating or considering your options as a pediatric practice owner, contact us and review your options. Medical Practice Listings is the leading seller of practices in the US. When you list with us, your practice receives exceptional national, regional and local exposure. Contact us today at (919) 848-4202.

Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email

Practice for sale

Nurse Practitioners needed

North Carolina

North Carolina

Primary Care Practice Only Minutes East of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. The Gross revenue is about $235,000 yearly. Contact Cara or Philip at 919 848 4202 or email: to receive details.

Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte. 8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte. 8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email 70| JUNE 2013

Family Practice located in Hickory, NC. Well-established and a solid 40 to 55 patients split between an MD and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues average $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email:

Classified To place a classified ad, call 919.747.9031

Practice for sale North Carolina (cont.) Impressive Internal Medicine Practice in Durham, NC: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four wellequipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: Primary Care Practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider.  Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several wellappointed exam rooms throughout. New computers and medical management software add to this modern front desk environment. This practice is being offered for $435,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or send an email to Internal Medicine Practice located just outside Fayetteville, NC is now being offered. The owning physician is retiring and is willing to continue working for the new owner for a month or two assisting with a smooth transaction. The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice that is modern, tastefully decorated and well appointed with vibrant art work. The practice, patient charts, equipment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email:

Modern Vein Care Practice located in the mountains of NC. Booking seven to 10 procedures per day, you will find this impressive vein practice attractive in many ways. Housed in the same practice building with an internal medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at

South Carolina Lucrative ENT Practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery. Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when you want. Physician will to stay on for a smooth transition. Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@

Washington Family Practice located in Bainbridge Island, WA has recently been listed. Solid patient following and cash flow makes this 17-year-old practice very attractive. Contact Medical Practice Listings for more details. email: or (919) 848-4202. 


PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually. Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information. The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well. For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today. List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000

Medical Practice Listings Selling and buying made easy | | 919-848-4202


or family medicine doctor needed in


Primary Care Practice For Sale Wilmington, NC Established primary care on the coast of North Carolina’s beautiful beaches. Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients. Excellent exam room layout, equipment and visibility.

Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email:

Contact Medical Practice Listings for more information.

Medical Practice Listings 919.848.4202 |


Practice for Sale in Raleigh, NC Primary care practice specializing in women’s care

By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients.

Raleigh, North Carolina The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider.  Exceptional cash flow and profit will surprise even the most optimistic practice seeker.  This is a remarkable opportunity to purchase a well-established woman’s practice.  Spacious practice with several well-appointed exam rooms and beautifully decorated throughout.  New computers and medical management software add to this modern front desk environment.   

Contact one of our advertising agents and find out how inexpensive yet powerful your ad in Med Monthly can be.

List price: $435,000

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings visit | 919.747.9031

Primary Care Practice for Sale Hickory, North Carolina

NC MedSpa For Sale MedSpa Located in North Carolina

Established primary care practice in the beautiful foothills of North Carolina The owning physician is retiring, creating an excellent opportunity for a progressive buyer. There are two full-time physician assistants that see the majority of the patients which averages between 45 to 65 per day. There is lots of room to grow this already solid practice that has a yearly gross of $1,500,00. You will be impressed with this modern and highly visible practice. Call for pricing and details.

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings vist

We have recently listed a MedSpa in NC This established practice has staff MDs, PAs and nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, fractional laser resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process. Contact Medical Practice Listings today to discuss the practice details.

For more information call Medical Practice Listings at 919-848-4202 or e-mail


Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina Well-established practice serving the Greensboro and High Point areas for over 15 years. Five exam rooms that are fully equipped, plus digital X-Ray. Extensive corporate accounts as well as walk-in traffic. Lab equipment includes CBC. The owning MD is retiring, creating an excellent opportunity for a MD to take over an existing patient base and treat 25 plus patients per day from day one. The practice space is 2,375 sq. feet. This is an exceptionally opportunity. Leased equipment includes: X-Ray $835 per month, copier $127 per month, and CBC $200 per month. Call Medical Practice Listings at (919) 848-4202 for more information.

Raleigh North Carolina This is a great opportunity to purchase an established ophthalmic practice in the heart of Raleigh. Locate on a major road with established clients and plenty of room for growth; you will appreciate the upside this practice offers. This practice performs comprehensive ophthalmic and neuro-ophthalmic exams with diagnosis and treatment of eye disease of all ages. Surgical procedures include no stitch cataract surgery, laser treatment for glaucoma and diabetic eye disease. This practice offers state-of-the-art equipment and offer you the finest quality optical products with contact lens fitting and follow-up care & frames for all ages. List Price: $75,000 | Gross Yearly Income: $310,000

Asking price: $385,000

Contact Cara or Philip 919-848-4202 for more information or visit To view more listings visit us online at

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business. of the oldest Locums companies l Large client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner

Wanted: Urgent Care Practice

l One

Urgent care practice wanted in North Carolina. Qualified physician is seeking to purchase an established urgent care within 100 miles of Raleigh, North Carolina. If you are considering retiring, relocations or closing your practice for personal reasons, contact us for a confidential discussion regarding your urgent care. You will receive cash at closing and not be required to carry a note.

Medical Practice Listings Buying and selling made easy

Please direct all correspondence to Only serious, qualified inquirers.

Call 919-848-4202 or e-mail


Pediatrics Practice Wanted Pediatrics practice wanted in NC Considering your options regarding your pediatric practice? We can help. Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina.

Are you educated in the medical and health care field and looking to showcase your exceptional writing skills?

Contact us today to discuss your options confidentially.

Med Monthly

To become a contributing writer in Med Monthly magazine, contact MedMedia9 at

Medical Practice Listings Call 919-848-4202 or e-mail

Contact us:


Editorial Calendar: June 2013 - Dermatology l July 2013 - Procedures to Enhance Your Practice

Unfortunately, its motor is inside playing video games. Kids spend several hours a day playing video games and less than 15 minutes in P.E. Most can’t do two push-ups. Many are obese, and nearly half exhibit risk factors of heart disease. The American Council on Exercise and major medical organizations consider this situation a national health risk. Continuing budget cutbacks have forced many schools to drop P.E.—in fact, 49 states no longer even require it daily. You can help. Dust off that bike. Get out the skates. Swim with your kids. Play catch. Show them exercise is fun and promotes a long, healthy life. And call ACE. Find out more on how you can get these young engines fired up. Then maybe the video games will get dusty. A Public Service Message brought to you by the American Council on Exercise, a not-for-profit organization committed to the promotion of safe and effective exercise

American Council on Exercise


ACE Certified: The Mark of Quality Look for the ACE symbol of excellence in fitness training and education. For more information, visit our website:



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8 2 5 - 3 6 3 6


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A M E R I C A’ S A U T H O R I T Y O N F I T N E S S


Modern Med Spa Available

Located in beautiful coastal North Carolina Modern, well-appointed med spa is available in the eastern part of the state. This Spa specializes in BOTOX, facial therapy and treatments, laser hair removal, eye lash extensions and body waxing as well as a menu of anti-aging options. This impressive practice is perfect as-is and can accommodate additional services like; primary health or dermatology. The Gross revenue is over $1,500.000 during 2012 with consistent high revenue numbers for the past several years. The average number of patients seen daily is between 26 and 32 with room for improvement. You will find this Med Spa to be in a highly visible location with upscale amenities. The building is leased and the lease can be assigned or restructured. Highly profitable and organized, this spa POISED FOR SUCCESS. 919.848.4202

Adult & pediAtric integrAtive medicine prActice for sAle This Adult and Pediatric Integrative Medicine practice, located in Cary, NC, incorporates the latest conventional and natural therapies for the treatment and prevention of health problems not requiring surgical intervention. It currently provides the following therapeutic modalities: • • • • •

Conventional Medicine Natural and Holistic Medicine Natural Hormone Replacement Therapy Functional Medicine Nutritional Therapy

• • • • • •

Mind-Body Medicine Detoxification Supplements Optimal Weigh Program Preventive Care Wellness Program Diagnostic Testing

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20 Gross Yearly Income: $335,000+ | List Price: $125,000

Call 919-848-4202 or email

Woman’s Practice in Raleigh, North Carolina.


We have a established woman’s practice in the Raleigh North Carolina area that is available for purchase. Grossing a consistent $800,000.00 per year, the retained earnings are impressive to say the least. This is a two provider practice that see patients Monday through Friday from 8 till 6. This free standing practice is very visible and located in the heart of medical community. There are 7 well appointed exam rooms, recently upgraded computer (EMR), the carpet and paint have always been maintained. The all brick building can be leased or purchased.

Physician Solutions has immediate opportunities for psychiatrists throughout NC. Top wages, professional liability insurance and accommodations provided. Call us today if you are available for a few days a month, on-going or for permanent placement. Please contact Physican Solutions at 919-845-0054 or For more information about Physician Solutions or to see all of our locums and permanent listings, please visit

Contact Cara or Philip for details regarding this very successful practice. Medical Practice Listings; 919-848-4202

PRIMARY CARE PRACTICE East of Raleigh, North Carolina We are offering a well established primary care practice only minutes east of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. Currently operating on paper charts, there is no EMR in place. The Gross revenue is about $235,000 yearly. We are offering this practice for $130,000 which includes all the medical equipment and furniture. The building is free standing and can be leased or purchased. Contact Cara or Philip at 919-848-4202 to receive details and reasonable offers will be presented to the selling physician.

Medical Practice Listings Selling and buying made easy | | 919-848-4202

the top


We spend billions of dollars every year on over-the-counter products, prescription creams. fillers, and, most drastically, cosmetic surgery so we won’t look older. Here are the top 9 treatments to consider.



Topical retinoid creams, derived from vitamin A, are the only thing that’s been proven to get rid of wrinkles that you already have. You can buy an OTC retinoid for under $20. Dermatologists can also prescribe stronger retinoid creams than what you’ll find on store shelves, like Retin-A.



Creams containing peptides can be useful for reducing the appearance of wrinkles and fine lines, but they haven’t been shown to work as well as retinoids. As skin ages, it loses collagen and becomes wrinkled and thin; creams containing peptides are supposed to encourage the skin to make new collagen. Some creams can be pricey, but Oil of Olay Regenerist at around $20 is as effective as the more expensive creams.

78 | JUNE 2013

3 4


Microdermabrasion uses tiny, fine particles or a very hard diamond-tipped wand to slough off cells from the top layer of the skin and encourage new skin growth. The procedure is usually not painful, though it can be uncomfortable, and you may require multiple procedures spaced a few weeks apart. The average cost is around $165.


Laser resurfacing uses high-intensity light to zap and improve the look of wrinkles and scars by tightening loose skin. The effect of your treatment and recovery time vary, you may see redness from one day to two weeks, depending on how aggressive the treatment is. The average cost is around $2,700, but the benefits usually last between two to five years.



Used dull sk aroun remo enco evenl $700. The benefits but deep peels ha

tic Treatments for Aging Skin


to address mild acne scars, age spots, kin texture, skin discoloration, or wrinkles nd the eyes or mouth, chemical peels ove the outer layers of the skin and ourage the growth of new, smoother, more ly colored skin. The average cost is around s of superficial peels last about a month, ave results that can last several years.

6 7


Injections of Botox paralyze tiny facial muscles, smoothing out the appearance of lines or wrinkles. The cost of Botox averages about $450 with the effects of injections lasting three to six months, depending on whether you’re a repeat customer. The more injections you’ve previously had, the longer the results last.



Injections of fillers containing hyaluronic acid can fill in lines and wrinkles and add volume to skin. Hyaluronic acid is a “naturally occurring sugar that gets lost when you age,” and injecting it into wrinkles effectively plumps them up. The average cost is around $620 and the effects can last between six months to a year.


Lifting the skin on the face, neck, eyelids, and forehead can give a tighter appearance. The procedure uses small incisions strategically placed in difficult-to-detect areas, such as under the hairline. The procedures run thousand dollars and are the most expensive cosmetic procedure. The effects of cosmetic surgery are permanent.



If all this sounds extreme (and expensive), remember that you can start immediately to prevent any further damage: Start wearing sunscreen every day you’re exposed to the sun. If weight is the problem, weight loss programs can be less expensive than surgical procedures. 


It’s Time to Get Online! Showcase your practice and develop the right image.

Our website packages are custom designed and affordable.

Scan this QR code with your smartphone to learn more.

Increase your patient volume and profitability with a website from


Visit us today at to find out how we can make your practice grow. Click on the “Web Design” tab for more details and view the sample website.

Call MedMedia9 today at 919-747-9031.

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Med Monthly June 2013  

The Dermatology issue of Med Monthly magazine