MetroDoctors: Celebrating University of Minnesota Medicine

Referring your patients shouldn’t test your patience.

With the new mobile site from UMPhysicians, referring your patients has never been faster or easier.

Gain direct access to: s Clinicians s Referral coordinators who can help you admit a patient s Directory of services, conditions treated, and locations Wherever. Whenever.

Easy access to UMPhysicians is here.

AccessUMP.org

CONTENTS VOLUME 14, NO. 6

2

Index to Advertisers

3

IN THIS ISSUE

NOVEMBER/DECEMBER 2012

Celebrating Our University of Minnesota

By Gregory A. Plotnikoff, M.D.

4

PRESIDENT’S MESSAGE

Back to the Future — the University Version

By Peter J. Dehnel, M.D.

5

TCMS IN ACTION

By Sue Schettle, CEO

Page 6

U OF M MEDICINE

6

s

Colleague Interview: A Conversation With Aaron Friedman, M.D.

9

s

Finding Our Future Doctors

By A. Stuart Hanson, M.D.

11

s

A Medical Student’s Perspective of the U of M Medical School

By Laura Gorsuch

13

s

The Phillips Neighborhood Clinic: A Culture of Caring

By Anna Berglund, Autumn Chmielewski, and Brian Sick, M.D.

15

s

Page 25

Medical Education at Hennepin County Medical Center

By Michael B. Belzer, M.D., and Meghan M. Walsh, M.D., MPH

18

s

UMPhysicians — Relationship to Fairview, the Medical School and the Community

By Bobbi Daniels, M.D.

20

s

50 Years of Medicine: Past, Present & Future

By Marvin S. Segal, M.D.

21

s

1Health: Linking Changing Health Care and Education

By Barbara F. Brandt, Ph.D.

23

s

Update on the Rural and Metro Physician Associate Programs

By Kathleen D. Brooks, M.D., MBA, MPA

Page 32

Page 13 MetroDoctors

25

159th Meeting of the MMA House of Delegates

26

Eden Prairie Passes Healthy Eating, Active Living Resolution Senior Physicians Association Wraps Up 2012 Calendar

27

Senior Physicians Association Visits Weisman Art Museum Caring Hearts for Homeless People Supply Drive

29

New Members Career Opportunities

30

In Memoriam

32

LUMINARY OF TWIN CITIES MEDICINE

Amos S. Deinard, M.D. The Journal of the Twin Cities Medical Society

On the cover: The White Coat, a symbol of professionalism in medicine, is presented to first year medical students. TCMS is proud to participate in this annual ceremony. Articles begin on page 6.

November/December 2012

1

Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

November/December Index to Advertisers TCMS OfďŹ cers

President: Peter J. Dehnel, M.D. President-elect: Edwin N. Bogonko, M.D.

Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Gregory A. Plotnikoff, M.D., MTS Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Richard R. Sturgeon, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Katie R. Snow TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at St. Paul, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reect the ofďŹ cial position of TCMS.

Advanced Dermatology Care.........................14 Audiology Concepts ...........Inside Back Cover

Secretary: Lisa R. Mattson, M.D.

CrutchďŹ eld Dermatology.................................. 2

Treasurer: Kenneth N. Kephart, M.D.

Fairview Health Services .................................29

Past President: Thomas D. Siefferman, M.D.

Healthcare Billing Resources, Inc. ...............17

TCMS Executive Staff

Lockridge Grindal Nauen P.L.L.P. ...............12

Sue A. Schettle, Chief Executive OfďŹ cer (612) 362-3799 sschettle@metrodoctors.com Jennifer J. Anderson, Project Director (612) 362-3752 janderson@metrodoctors.com Nancy K. Bauer, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Andrea Farina, Executive Assistant (612) 623-2885 afarina@metrodoctors.com Barbara Greene, MPH, Community Engagement Director, Honoring Choices Minnesota (612) 623-2899 bgreene@metrodoctors.com Katie R. Snow, Project Coordinator (612) 362-3704 ksnow@metrodoctors.com For a complete list of TCMS Board of Directors go to www.metrodoctors.com.

Minnesota Epilepsy Group, P.A....................12 Minnesota Oncology........................................24 Minnesota Physician Services, Inc. ..............28 MMIC Health IT ........... Outside Back Cover Newman Long Term Care ..............................16 Saint Therese.......................................................16 South Country Health Alliance ....................31 Stillwater Medical Group................................30 Tinnitus and Hyperacusis Clinic.......................

Inside Back Cover University of Minnesota CME ....................... 7 University of Minnesota Physicians..................

Inside Front Cover U.S. Navy ............................................................31

&UXWFKÀ HOG 'HUPDWRORJ\ ´5HPDUNDEOH SDWLHQW VDWLVIDFWLRQ IURP TXDOLW\ VHUYLFH FRQYHQLHQFH DQG H[FHOOHQW UHVXOWV¾

Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.

Exceptional Care for All Skin Problems

'LEVPIW ) 'VYXGL½ IPH --- 1 (

For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Advertisements published in MetroDoctors do not imply endorsement or sponsorship by TCMS. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Katie Snow at (612) 362-3704.

2

November/December 2012

&SEVH 'IVXM½ IH (IVQEXSPSKMWX

4WSVMEWMW

%GRI 7TIGMEPMWX 8S[R 'IRXVI (VMZI 7YMXI )EKER 12

Your Patients will Look Good & Feel Great with Beautiful Skin.

%TTSMRXQIRXW

ZZZ &UXWFKĂ€ HOG'HUPDWRORJ\ FRP

MetroDoctors

%X ]SYV VIUYIWX [I LEZI WEQI HE] ETTSMRXQIRXW EZEMPEFPI JSV ]SYV TEXMIRXW [MXL EGYXI WOMR GEVI RIIHW

The Journal of the Twin Cities Medical Society

IN THIS ISSUE...

Celebrating Our University of Minnesota

DIRECT OR INDIRECT AFFILIATION with the renowned

University of Minnesota Medical School is an important thread that binds us TCMS members. We all benefit from ensuring that the University of Minnesota Medical School remains strong in its primary mission to teach our future colleagues and to advance care through research.

Yet across the country, academic medical centers and medical schools are struggling for many financial reasons. As a result, some critics have charged that students are overlooked as the search for research dollars and clinical revenues have had to take top priority. So how is the University fairing these days in its teaching mission? This issue’s intent is to provide some insights and understanding.

To begin, the Medical School Dean, Aaron Friedman, M.D., provides us with an overview of his thoughts on fulfilling the University’s teaching mission via curricular innovation for competence enhancement and cost reduction. He notes the medical school’s commitment to inter-professional, collaborative and coordinated care. To understand who will be taught, TCMS member A. Stuart Hanson, M.D., shares with us the process of admission and the work of the admissions committee. He is one of three volunteer TCMS members who represent the greater community on this crucial committee.

The U of M is committed to curricular innovation and admits exceptional students. What does this look like? Current fourth year medical student Laura Gorsuch shares with us an overview with her perspective on her experience with faculty and the curriculum. This issue then provides descriptions of some unique aspects of the curriculum. Fellow medical student Anna Berglund, along with U of M masters of health administration student Autumn Chmielewski and faculty mentor Brian Sick, M.D., describe for us the truly interprofessional student-run clinic in the Phillips neighborhood of Minneapolis. Kathleen Brooks, M.D., shares with us the robust community-university partnership in the RPAP program (Rural Physician Associate Program).

This is the world’s oldest longitudinal rural immersion program. And Barbara Brandt, Ph.D., describes the 1Health program that is the focus of the formal interprofessional, collaborative education. She notes that the U of M was recently named the National Coordinating Center for a $12.6 million national grant to advance Interprofessional Education and Collaborative Practice.

We cannot ignore the direct patient care context in which students learn. Michael Belzer, M.D., describes the important history of one crucial educational partner, Hennepin County Medical Center. Bobbi Daniels, M.D., represents UMP, University of Minnesota Physicians, and along with publicist Kristine Elias, describes the relationship between this clinical practice group and both the medical school and the greater community.

We conclude this issue with two celebrations. First, colleague Marvin Segal, M.D., shares with us his 2012 commencement address, delivered 50 years after his graduation from the U of M. His keen eye and wit provides us with a delightful commentary on what it all means 54 years after starting medical school. Second, this month’s luminary is Amos Deinard, M.D., distinguished pediatrician and inspirational role model for innumerable students, residents and fellows. Dr. Deinard’s selfless commitment to advancing health through teaching, practice and research places him among the very best of the medical school’s distinguished faculty. To sum up this issue: we have great reasons to be proud of our medical school. May we find the ways to keep it strong!

By Gregory A. Plotnikoff, M.D. Member, MetroDoctors Editorial Board

MetroDoctors

The Journal of the Twin Cities Medical Society

November/December 2012

3

President’s Message

Back to the Future — the University Version PETER J. DEHNEL, M.D.

W

hat will medical education look like in the year 2032 — a mere 20 years from now? It is almost inconceivable that the seismic changes occurring within medicine and the delivery of health care will not affect the priorities and curriculum of medical schools — including our very own University of Minnesota Medical School. Those who will be graduating from the University’s medical school with the class of 2032 — if current trends prevail — are just now entering kindergarten at their local schools. How hard is it to visualize those bright and shining faces not too long from now walking into an exam room and introducing themselves as “Doctor,” having graduated from medical school and are now firmly established in their residency program this November evening?

To see where we will be 20 years from now, my personal belief is that it is essential to look back and examine the foundations that served to get us where we are today as a medical community. It is then equally critical to closely inspect where we are today to see where we might be in 2032. Without a doubt, the University has served, and will continue to serve, a significant role for all of us in the Minneapolis-St. Paul area.

“I want to go to medical school.” If you are one of the physicians reading this journal, at some point you made the decision to act on this goal/dream and were able to get there successfully. Even if you did not go to medical school here, there is a good chance that the University has played a role in your training — residency, fellowship or some sort of other graduate medical education program. As being the leading source of medical education in the area, the University has a significant and enduring impact on the medical community in the Twin Cities as well as most of outstate Minnesota.

When considering the country as a whole, the value of an academically robust and leading edge teaching and research institution cannot be overstated. It is essential to discovering and helping to implement medical advances on behalf of patients who have challenging and as of yet unconquered diseases. It is invaluable in terms of training the “next generation” of clinicians. It also tends to create an environment where the profession as a whole operates at an enhanced level.

The University has definitely served that role up to this time. In order for it to continue in that role — and again, I believe it is in everyone’s best interest — it has a number of challenges to address. The Academic Health Center is strongly tied to the University of Minnesota Physicians (UMP) group and is under the watchful eye of the Regents of the University of Minnesota — a complicated relationship, to be sure. The University Hospital is owned and managed by the Fairview Health System. Nationally, academic medical centers, including the University, are under intense pressures to be more financially viable. Sources of funding for both medical research and residency training are diminishing without a lot of other creative options on the horizon.

A final challenge going forward that is under the control of the University at many different levels is a much closer collaboration with the broader medical community. As is pointed out in the articles contained in this edition of MetroDoctors, the University is intentionally working to be out in the broader community.

This is different than closely collaborating and being a true partner with the broader community. Working to minimize or even eliminate a “town and gown” separation must be seen as a priority if it is to happen.

My hope for the year coming up — regardless of who ends up winning the election — is that the Twin Cities medical community does overcome any barriers that currently exist to a more vital partnership. It is in everyone’s best interest. Most importantly, it is clearly in the best interests of the patients that we serve and care for on a daily basis. And they are the one with the most to lose by the medical community remaining in our own organizational silos.

4

November/December 2012

MetroDoctors

The Journal of the Twin Cities Medical Society

TCMS IN ACTION SUE A. SCHETTLE, CEO

Honoring Choices Minnesota receives Emmy recognition

On Saturday, September 29, 2012, the National Academy of Television Arts and Sciences awarded Honoring Choices Minnesota with the 2012 “Making a Difference” Award.

This award honors the measurable changing of someone’s life or lives in our communities with one piece of video storytelling.

We are sharing this award with our partners from Twin Cities Public Television.

From left: Bill Hanley, Katie Snow, Kent Wilson, M.D., Pam Palan, Barbara Greene, and Sue Schettle.

a presentation on “Total Cost of Care Measures” at the September 24 meeting of the TCMS Board of Directors.

TCMS leadership is recognized as Top 100 Influential Health Care Leaders Pete Dehnel, M.D., president of Twin Cities Medical Society was recognized by his peers as a Top 100 Influential Health Care Leader in Minnesota Physician magazine, August 2012. Sue Schettle, CEO of Twin Cities Medical Society was also recognized. Every four years, the magazine invites readers to nominate colleagues for this honor.

Throughout the summer and early fall, 15 first or second year medical students have been placed with practicing physicians through the TCMS sponsored “Shadow a Physician Program.” Additional mentors in all specialties are being sought. Contact TCMS if you are interested.

Advance Care Planning Facilitator Training Scheduled – January 22, 2013

Honoring Choices MN is pleased to announce a community-wide advance care planning training for parish nurses, chaplains, faith leaders, multicultural community representatives, health and human services staff members, human resource professionals and others.

TCMS

MN Community Measurement representatives Tina Frontera, COO, and Gunnar Nelson, Value Economist, provided

Carly Turgeon, 3rd year medical student and recipient of Thomas P. Cook Scholarship, with Nancy Bauer.

East Metro Medical Society Foundation

Matthew Larson, M.D., anesthesiologist (left), provided a shadowing opportunity for Y2medical student Matthew Wheelwright.

MetroDoctors has an opening on its editorial board. Contact Nancy Bauer at (612) 6232893, nbauer@metrodoctors.com for more information.

West Metro Medical Foundation News

Gunnar Nelson and Tina Frontera.

MetroDoctors

Friends Scholarship Luncheon on October 5. WMMF annually provides the Thomas P. Cook leadership scholarship to a medical student in recognition of the former executive director of the medical society.

Representing the West Metro Medical Foundation, Nancy Bauer, TCMS associate director, attended the Minnesota Medical Foundation’s Medical School Alumni and

The Journal of the Twin Cities Medical Society

On November 7, the East Metro Medical Society Foundation (EMMS Foundation) is hosting an Annual Meeting, in conjunction with a documentary screening for Honoring Choices Minnesota, a key initiative of the EMMS Foundation, and the presentation of the Boeckmann Community Service and Leadership Award.

The EMMS Foundation of the Twin Cities Medical Society serves medical students, residents, and practicing and retired physicians in the east metro area. The EMMS Foundation has a rich history of physician involvement and this event will give members and partners the opportunity to gather and hear stories, celebrate our successes and strengthen our voice.

November/December 2012

5

Medical U of M Medicine Care Organizations

Colleague Interview: A Conversation With Aaron Friedman, M.D.

A

aron L. Friedman, M.D., was appointed vice president for health sciences and dean of the Medical School in January 2011. He received his medical degree from SUNY Upstate Medical Center, Syracuse, NY; completed his internship/residency in pediatrics, including serving as chief resident in pediatrics, at the University of Wisconsin Hospitals, Madison, WI; and a pediatric nephrology fellowship also at the University of Wisconsin Hospitals.

A pediatric nephrologist and dedicated educator, Dr. Friedman has spent the majority of his career researching pediatric kidney disease. From 2008 - 2010 he served as the RubenBentson Chair of Pediatrics and the Pediatrician-in-Chief of the University of Minnesota Amplatz Children’s Hospital.

How is the medical school curriculum tailored to meet the unique needs of physicians entering the field today, making sure students receive the breadth of knowledge they need to succeed?

I believe our charge is clear. We need to prepare students for a new reality in health care.

Of course we need to train and educate in many of the traditional ways. Our eye is always on developing great practitioners first and foremost. But we also know that the definition of a great doctor is changing. We need to produce well-rounded physicians who are comfortable working in teams and coordinating care with other disciplines. We need doctors who can be both efficient and thorough. And we need to breed a passion for proactive care…our role is no longer to simply treat people who are sick. We need to keep people healthy.

Medical school training needs to evolve to incorporate elements well beyond science. We need to train leaders who can think creatively. We need to teach professionalism and we need to make sure our students never lose sight of what their role is…to have a laser focus on the unique needs of each patient.

I think it’s time we start evaluating where the gaps are in our curriculum as well. For example, end-of-life care.

We all know that end-of-life care is a reality of the profession no matter what field you enter. But it’s a topic that medical schools don’t talk about…leaving doctors to develop those skills on the job.

We can’t be afraid to address ethical and societal issues as a part of education. I believe we should introduce the topic of end-of-life care to first year medical students. We should help them understand the complexity of the topic, and the incredible opportunity they will have 6

November/December 2012

as physicians to help families through the most difficult times that a family can face.

Introducing end-of-life care as a topic for education will help us develop better doctors. It will also help us think about difficult issues that we need to consider, around proper decision-making and our role as a trusted advisor to patients.

This is just one example where I think curriculum needs to evolve to meet the challenges we face.

What is the medical school doing to help students and practicing physicians navigate and process the explosion of medical science and clinical information?

Never before have we had access to so much information, so quickly.

There has been an explosion in the amount of medical science and clinical information available to medical professionals AND, just as importantly, to the population at large.

Patients can do incredible amounts of research about medical conditions. They often come to the table with definite ideas about diagnosis, treatment options, and even the physicians they would like to have on their teams.

At the same time, physicians have access to endless amounts of information about clinical trials, new treatment options, and preventative medicine.

MetroDoctors

The Journal of the Twin Cities Medical Society

Wading through all of this information, and helping families make sense of their own research, requires new skills and sensitivities. We need to be able to distill the vast amounts of information out there to the key nuggets that will make a difference for each individual patient.

Make no mistake; for the most part having more information available is a good thing. We want patients to be educated and to be advocates for themselves. We want physicians to have quick access to the latest science and diagnostic advances. But without a skill set to help filter and use information correctly, this proliferation of information can be problematic…or even dangerous.

with the chance to cement the fundamentals into an individual’s clinical experience? After residency when MDs are in practice and the finances and administration of medicine are more commonly a part of their daily experience? We think it is all of the above but exactly how to accomplish this smoothly and effectively is still a work in progress.

What specifically is the medical school doing to prepare its students for the administrative aspects of medicine of the future, including the effects of PPACA, ACOs, etc.?

Inter-professional education should begin in medical school and continue throughout residency to help prepare new MDs to act in the changing clinical care environment.

Competence means more than producing physicians who are technically and scientifically sound. Our benchmark needs to be higher than that.

We need to produce excellent caregivers. We need people who understand both the art and the science of being a doctor. Our job is to make sure patients have access to the best possible care.

Part of promoting a high level of competence involves getting students more experience with patients early on in their education.

But our job doesn’t stop once our students enter the workforce.

This is an important question. Today our medical school provides some introduction to our health system and health finance. This includes some discussion of health insurance schemes, discussion of types of practices and considerable discussion about the Affordable Care Act both within the school and as part of seminars and lectures sponsored throughout the Academic Health Center and the University. Such coverage, while useful, still raises a basic question about education and training in medicine.

When should these aspects of medicine in the United States be covered and how? During medical school when the primary education mission is to teach fundamentals of medical science and clinical medicine? During residency when clinical medicine is front and center

2012-13 CME Activities

How do you teach physicians to be excellent caregivers and to work as part of an inter-professional team? And, how do you evaluate their abilities and help them become lifetime learners?

(Continued on page 8)

www.cmecourses.umn.edu

(All courses in the Twin Cities unless noted)

FALL 2012 Emerging Infections in Clinical Practice & Public Health November 16, 2012 Geriatric Orthopaedic Fracture November 29-30, 2012 Maintenance of Certification in Anesthesiology (MOCA) Training December 8, 2012

SPRING 2013 Maintenance of Certification in Anesthesiology (MOCA) Training January 19, 2013 WORLD Symposium - Orlando, FL February 12-15, 2013

Maintenance of Certification in Anesthesiology (MOCA) Training February 23, 2013 Lillehei Symposium April 4-5, 2013 Integrated Care Conference April 12, 2013 Topics & Advances in Pediatrics June 6-7, 2013 Chronic Pain: Challenges & Solutions for Primary Care Workshops in Clinical Hypnosis April 19-20, 2013 June 6-8, 2013 Cardiac Arrhythmias ONLINE COURSES (CME credit available) April 26, 2013 www.cme.umn.edu/online Global Health Training U Fetal Alcohol Spectrum (weekly modules) Disorders (FASD) May 6-31, 2013 U Global Health (7 Modules) Controversies in Cardiovascular Disease June 1-2, 2013 Office of Continuing Medical Education 612-626-7600 or 1-800-776-8636 email: cme@umn.edu

Promoting a lifetime of outstanding professional practice

MetroDoctors

The Journal of the Twin Cities Medical Society

November/December 2012

7

Medical U of M Medicine Care Organizations Colleague Interview (Continued from page 7)

Considering the pace of change in the medical industry, continuing education is more important than ever for making sure doctors are at the leading edge of care. We need to instill a passion for lifelong learning… not just as a prerequisite to maintaining licensure and certification… but also as a foundation for excellent health care.

We are working to instill this passion for learning into our students, and we are working to reform our continuing education programs to make sure they are relevant and compelling for practicing physicians.

We’re expanding our methods for offering continuing education… to be sure we are taking advantage of the latest technology. Options for continuing education range from lab courses to satellite meetings, and we are able to engage faculty from across the University as well as guest faculty from around the world.

This isn’t to say that we don’t have areas to improve. In the coming year I am putting an emphasis on upgrading our education technology… putting new energy into active learning. We will do everything we can to provide the best possible experience throughout the continuum of education, from engaging our undergraduates through providing excellent opportunities for practicing professionals.

One more element of importance for continuing education is an emphasis on skills and concepts that will help physicians embrace the new realities of health care. Our courses emphasize the importance of inter-professional training and collaborative work models. Health care is moving toward a coordinated care model, and doctors play a key role in facilitating the team approach on behalf of patients.

How is the school addressing and preparing for the funding of graduate and post graduate medical education in the future?

A very serious question that is being addressed throughout the country.

We need to do a better job educating our elected officials about the costs of medical education, and the need for Graduate Medical Assistance funds. If money for training doctors continues to be cut, the access we enjoy to health care will suffer. We need to draw that line clearly to protect funding and grow support for training.

Today, graduates from our school have an average debt burden that is higher than the national average. Throughout our country, tuition for medical education is rising and there does not appear to be an end in sight. Our school will need to hold costs down but at the same time we will need to find ways to help our students afford school, such as increasing scholarships and loan repayment programs. A similar issue is the funding for Graduate Medical Education (GME). Since the mid1960s residents have been paid by the federal government. The federal government also pays for some of the administrative costs for residency programs. This fundamental approach to paying residents is under question today in Congress. A sizable change in how we pay and who pays for residency training will have a profound effect on the workforce.

Our medical school plays a role in residency training but all should understand that the medical school serves an administrative function.

Our clinical departments host the training programs, but the funding from the federal government goes almost exclusively to hospitals to be 8

November/December 2012

paid to residents and to support the medical school’s and their own administrative costs. The Association of American Medical Colleges (AAMC), medical schools and many hospitals are concerned about the possibility of a radical change in residency payment support. If the system changes appreciably the issue will be one that affects all those in the medical system and our patients. It is a problem that will need a concerted effort. I am working with the AAMC and through our own Twin Cities council to examine options as well as open the discussions to include all parts of the medical community here.

We also need to put an emphasis on helping students complete their medical education in a timely manner, and doing what we can to help them enter the workforce without too great of a debt burden. We want students to choose a specialty based on need and passion, rather than on what areas will help them pay off their loans. This is an important step in making sure patients across the state have access to the specialty care that they need.

Describe your efforts to attract and develop a physician workforce that accurately represents the communities we serve.

Bringing more diversity into our physician community will be critical as we move into the future. We simply have to do a better job at attracting a more diverse workforce to better reflect the populations we serve. This is something that needs to be addressed on the undergraduate level… and actually much sooner.

We need to engage different populations with basic sciences, and inspire them about the possibilities that lie before them in the medical field.

As we put together programs to serve minority populations, we need to reach out to those same populations with messages about the importance of math and science training. Then, on the undergraduate level, we need to find ways to spark an interest and inspire students from all backgrounds to pursue careers in science, research and medicine.

The “face” of our workforce needs to change, and we are committed to helping usher in a new age of diversity in the medical profession.

This is a pivotal time for health care. The status quo is not an option. We need to recognize the challenges and the opportunities, and we need to be leaders so we can help shape the new models of care.

This is a chance to test new models of coordinated care. We can find ways to increase efficiency and at the same time provide better outcomes to patients.

At a time when research funds are scarce, it’s up to us to find ways to tackle the big questions, deliver breakthrough science, and revitalize this country’s leadership in science and discovery.

And we can’t lose sight of our basic role as a medical school: training the next generation of doctors so everyone has access to the care they need.

There’s a lot of work to do, but Minnesota has always proven to be up to the task. We’re ready to write the next chapter for health care in this country…with research, education and care delivery that will be among the best in the world.

MetroDoctors

The Journal of the Twin Cities Medical Society

Finding Our Future Doctors

A

few years ago, a former dean of the University of Minnesota Medical School said the two most important committees of the school were the admissions committee, where the decisions on applicants were made, and the curriculum committee, where the education content is decided. If that is true, then physicians outside the University structure have significant input into who is invited to join the profession.

The Twin Cities Medical Society currently has three members on the Medical School Admissions Committee: Walter Bailey, M.D., a retired neurosurgeon from St. Paul, formerly representing Ramsey Medical Society and has served for over a decade; I am a recently retired pulmonary and critical care physician from Minneapolis who initially represented Hennepin Medical Society. This will be my ninth year on the committee; and Beth Baker, M.D. who joined the committee two years ago representing the Minnesota Medical Association. We three plus Gerald Hill, M.D., who represents the Association of American Indian Physicians, are the only representatives not from a medical school department.

The committee has 30 members which include four medical students (two from the third and two from the fourth year classes), the four “outsiders” mentioned above, and 22 department representatives. The University of Minnesota land grant institution and the Medical School has charged the committee to select the next class considering the diverse needs of the Minnesota community. This means

By A. Stuart Hanson, M.D.

MetroDoctors

seeking individuals who will eventually populate all specialties of medicine, those who might have urban or rural interests, researchers, educators and other medical leaders. Special consideration is given to candidates from Minnesota or who are likely to develop their careers in our state.

Another priority is to develop diversity within the class and we pay close attention to candidates representing ethnic or racial groups who are underrepresented in medicine (UIM). Currently the ethnic and racial groups underrepresented in Minnesota medicine are Hispanics, African and African Americans, American Indians and Hmong.

A third set of priorities are to select individuals who have personal skills that relate well to others. They need to be open and honest in communication with patients and colleagues, intellectually inquisitive, work well in teams and be committed to improving the human condition.

The process of evaluating candidates is comprehensive and holistic. They make an

The Journal of the Twin Cities Medical Society

application through the American Medical College Application System (AMCAS) and designate the schools to which they wish to apply. AMCAS verifies their credentials, such as GPA and scores on the Medical College Aptitude Test (MCAT). The applicant’s demographic data, legal residence, list of important activities such as volunteering, shadowing physicians, academic honors, leadership roles, letters of recommendation and their personal statement, are included in the general AMCAS application that is sent to multiple schools.

When we get an AMCAS application that meets minimal Minnesota standards, a supplemental application consisting of nine brief essay questions, which are important for our decision making, is sent to the applicant. We ask for their ties to Minnesota, if they are non-residents. They are asked to describe a difficult situation in their lives, how they dealt with it and what they learned. We ask them to explain any institutional actions, misdemeanors or felonies they may have and they are given a chance to elaborate on their AMCAS application or anything else they would like the admissions committee to know. All this information is collected electronically and available for committee members to review.

Two seasoned committee members review the above information to decide if the applicant should be interviewed. If they agree either yes or no, that becomes a decision and the applicant is notified.

If they do not agree, a third committee member reviews the file as an arbitrator.

Narrowing of the applicant pool is most stringent at this “first review” level. Last (Continued on page 10)

November/December 2012

9

Medical U of M Medicine Care Organizations Finding Our Future Doctors (Continued from page 9)

year, for the class beginning in August 2012, out of 3,669 applicants, 574 were invited for interviews.

A formal visit day is scheduled which includes tours, student meetings and two interviews. One structured interview is done by a committee member or another experienced faculty member in the morning and a second interview is completed by a trained medical student in the afternoon.

For the 2012 class, 549 interviews were completed.

Formal interview reports are entered into the all electronic application which is now ready for a second review and recommendation. Two committee members use an internal scoring system to rate the completed application and make a recommendation to the full committee. Some outstanding applicants are easily accepted by the committee, but all receive a full committee vote. Most of our every-otherweek committee meeting time is spent presenting and discussing applicants who are excellent and competitive, but not necessarily outstanding. Some are offered admission and others are put on a waiting list. The process goes on continuously from August to May each year. Accepted applicants make their choices by midMay. If a student turns down our offer, the next person on the waiting list moves up. By matriculation day in August, 170 students out of the applicant pool begin their road to becoming the future generation of physicians.

So much for the process. Here are some statistics for the 2012 entering class: Matriculated Regular M.D. M.D./Ph.D.

170 163 7

Residence MN Non Resident International

133 (78.2%) 37 (21.7%) 2 (00.1%)

Gender Female Male

91 (53.5%) 79 (46.5%)

Age Range Average

20-43 years 24 years

10

November/December 2012

Multicultural Total 41 (24.1%) UIM (total) 15 (8.8%) Amer. Indian 1 African or African Amer. 7 Hispanic 5 Hmong 2 Academic profile Average MCAT 32.4 (avg. of sums SD-2.92) Verbal reasoning 10.18 (SD-1.27) Physical science 10.96 (SD-1.64) Biological science 11.30 (SD-1.30) Average GPA 3.74 Highest Degree Bachelors Ph.D. JD PharmD Masters

152 1 1 1 15

Academic affiliations (total) 66 Minnesota colleges/ universities 17 Public universities 5 Private universities 12 Total # academic majors 48 As you can surmise, many hours go into this long process of selecting our future doctors. Not all will stay in Minnesota, but many do. The fall-out rate after matriculation is very low, in the 1-2 percent range. Every effort is made to identify students not performing well and to assist their progress. The feedback about the students from the faculty has been very positive. They are committed to human service, they are enthusiastic about medicine, they perform exceptionally well on national boards, and they match well for post-graduate residencies.

With thousands of applicants you can imagine there are many applicants who receive letters of rejection. They are all given the opportunity to get feedback from the admissions office, either by email, telephone or in person. Most who are rejected already know where their application is weak and less competitive. Many take one or more years to expand their experiences, improve their academic performance by

taking upper level science courses, take a degree program, such as a masters in public health, or improve their verbal and oral communication skills. They are allowed a maximum of three completed applications.

At the beginning of each application cycle in September, the dean for students and student learning participates in a committee meeting for discussion and feedback on student performance, including disciplinary actions. The dean also attends an early committee meeting to give an overview of the mission and vision for the school and the committee charge. New committee members, faculty and student interviewers are trained each fall. During the work year, when issues arise with the process we are using, we make a list to consider at the end of the cycle. Two meetings in May are set aside to discuss any changes that would improve the process the next fall. During the summer, several subcommittees meet to discuss improvements in areas such as recruitment, electronic file review, interviews, diversity, early decision admissions, delayed admissions, advanced standing and transfers. A scholarship subcommittee meets throughout the year as applicants are offered admission.

The work on the committee is not easy. We are dealing with peoples’ lives and life work. But we all find the work important and personally rewarding. It is an honor to be appointed by one’s colleagues and an honor to serve the medical society, the medical school and the profession.

A. Stuart Hanson, M.D. is a graduate of Dartmouth College and the University School of Medicine. He has worked as a consultant in pulmonary and critical care medicine at Park Nicollet Clinic since 1971.

Dr. Hanson has served in many leadership positions including: president and board chair, Hennepin Medical Society; president, Minnesota Medical Association; president of the Minnesota delegation to the American Medical Association House of Delegates; president and CEO of Park Nicollet Institute, Park Nicollet Health Services; president, Minnesota Smoke-Free Coalition; vice chair, Minnesota Partnership for Action Against Tobacco (MPAAT); and vice chair, Minnesota Health Data Institute.

MetroDoctors

The Journal of the Twin Cities Medical Society

A Medical Student’s Perspective of the U of M Medical School

W

ith over 150 accredited medical schools in the United States, choosing the right program four years ago was a daunting task. I could not possibly realize until now — as a fourth year medical student — how seemingly small components of the medical school system would be critical in preparing me for where I am today, diving into the residency application process and approaching graduation in a short few months.

The faculty, staff, and unique characteristics about the curriculum have been essential in priming my fellow medical students and me for our future careers.

The number of faculty members with whom a medical student comes in contact is tremendous, and no one single professor or physician can possibly be responsible for the extensive teaching we receive. Rather, it is the culmination of so many experts in so many fields that makes the University of Minnesota a phenomenal teaching institution. I cannot count the number of times in which I have worked with nationally and internationally renowned physicians, be it in geriatrics, Fanconi anemia, spine surgery, or ethics, to name just a few. Working with physicians at the U of M, therefore, allows an incredible opportunity to see patients with rare conditions and to see treatments on the forefront of medicine.

While the opportunity to work directly with experienced and well-known specialists no doubt contributes positively to our experience, the University of Minnesota also provides excellent faculty support through what are now called faculty advisors, previously “master tutors” when I began medical school in 2009.

These physicians build long-term relationships with the students they mentor and support throughout the entire four years of medical

By Laura Gorsuch

MetroDoctors

school. They taught us the essentials of taking a general history, the core skills of a physical exam, and discussed with us the tough ethical issues we would inevitably face at some point in our future careers. Faculty advisors and master tutors, serving much the same purpose, provide an essence of continuity in a stressful curriculum. They are often paramount in helping guide our future specialty choices, no matter their personal specialty. The advice I received from my own “master tutor” regarding residency programs as a fourth year has been very valuable, coming from a trusted mentor.

What I had not considered when I applied to medical school was the critical role the school staff, not just faculty, have in helping us progress through our four years. The staff names are well known to all medical students and their experience and expertise in the medical education system makes them an incredibly valuable resource. Studying for Step 1 was made much more manageable because I had a personalized study plan developed for me by a staff member who knows testing logistics and strategies inside and out. Applying to residency has been a smooth process thanks in great part to weekly emails reminding me of the next steps in the process and the upcoming deadlines.

Efforts on the part of the dedicated medical school staff have helped ensure a smoother transition through the phases of medical school and beyond.

The University of Minnesota Medical School not only offers exceptional faculty and staff, but also an exceptionally flexible and diverse curriculum. Unique to the U of M, the FlexMD program was a large selling point when I was researching medical schools. The program allows a student to finish in as little as three and a half years or as long as six years, giving students a rare period of time to pursue other educational ventures prior to beginning

The Journal of the Twin Cities Medical Society

residency. Given the strong international focus at the medical school and the deep ties with the School of Public Health, the FlexMD program has allowed my fellow classmates to participate in medical missions in almost every continent and experience first hand various other health care models through time spent rotating at hospitals abroad. Additionally, given the strong research emphasis in a university setting, students are able to dedicate longer periods of time to research, both contributing to the overall medical community and strengthening their residency applications. The FlexMD program was one-of-a-kind when I applied to medical school and no doubt makes our graduating classes more well-rounded and more competitive.

Also making the University of Minnesota Medical School unique, the great range of hospital settings and patient populations was one of the most significant factors in my decision to choose the U and, I have come to realize, one of the greatest strengths in our program.

With almost every possible hospital setting represented, from private to community to university to government-run, students graduating (Continued on page 12)

November/December 2012

11

U of M Medicine A Medical Student’s Perspective (Continued from page 11) Minnesota Epilepsy Group is the largest and most comprehensive epilepsy program in the Midwest. As a regional referral facility, we are the recognized leader in treating epilepsy and other seizure-related conditions in patients of all ages, from infants to the elderly. We also offer comprehensive neuropsychological assessment for a broad range of acquired or developmental neurological conditions in both adult and pediatric patients.

Adult Epileptologists Deanna L. Dickens, MD Julie Hanna, MD Patricia E. Penovich, MD Pediatric Epileptologists Jason S. Doescher, MD Michael D. Frost, MD Frank J. Ritter, MD Functional Neuro-Imaging Wenbo Zhang, MD, PhD Neuropsychologists Elizabeth Adams, PhD Robert Doss, PsyD Ann Hempel, PhD Donna Minter, PhD Gail Risse, PhD

Appointments (651) 241-5290

(717) 377-1616

225 Smith Avenue N St. Paul, MN 55102 www.mnepilepsy.org

1610 Maxwell Drive Hudson, WI 54016 www.mnepilepsy.org

4HE ,AWYERS ,OBBYISTS

4HAT $OCTORS 4RUST ,OCKRIDGE 'RINDAL .AUEN HELPS OUR HEALTH CARE CLIENTS MEET THE CHALLENGES POSED BY TODAY S RAPIDLY CHANGING HEALTH CARE ENVIRONMENT 4HE FIRM S ATTORNEYS AND LOBBYISTS PROVIDE REPRESENTATION IN s'OVERNMENT RELATIONS s,ITIGATION AND ADMINISTRATIVE LAW s"USINESS STRUCTURING s#ONTRACTS SALES MERGERS JOINT VENTURES s%MPLOYMENT MATTERS s#OMPLIANCE AND REIMBURSEMENT ISSUES

&ROM THE #OURTROOM TO THE #APITOL ¸

12

November/December 2012

from the University of Minnesota are better prepared for residency and more comfortable with different medical systems. With the large immigrant populations present in the Twin Cities, the patient experiences at the U are unlike anywhere else. Classmates have commented that during away-rotations in other cities, they have come to realize that the diversity of the patients we see here is unparalleled and should not be taken for granted.

How medical students schedule their diverse clinical rotations is in and of itself a unique process. While the majority of medical schools either assign a particular rotation schedule to each student or at least dictate that all required core rotations are completed during the ďŹ rst clinical year, the University of Minnesota allows freedom to schedule required and elective rotations at our own discretion, for better or worse. The negative side of this system is that some core competencies may not be learned until late in our training and that essential rotations may not have been taken prior to Step 2 of our board exams. The “perfect scheduleâ€? is hard to obtain. Yet, this rare scheduling system also allows us to dabble in specialties early enough in our education to pursue research, mentors, and advanced rotations in the ďŹ eld prior to when residency applications are due. Further, it allows us to adapt our schedules to our changing interests as we discover our niches and what excites us, ultimately making this a desirable method, despite its potential downfalls.

When I ďŹ rst applied to medical school, I could not foresee the true importance of choosing a medical school with the right faculty, the right staff, and the right opportunities to help me achieve that ultimate goal of matching in my specialty of choice. The U of M, however, has provided my classmates and me with the support and experiences we need to be competitive in our chosen ďŹ elds. The curriculum has prepared us well, the people have guided us, and because of the exibility and diversity in our program, we are beginning this application process with the conďŹ dence that we will be successful and will be able to make a positive impact wherever we may ďŹ nd ourselves after we leave the University of Minnesota Medical School.

Laura Gorsuch is a fourth year medical student at the U of M. MetroDoctors

The Journal of the Twin Cities Medical Society

The Phillips Neighborhood Clinic: A Culture of Caring

E

very week dozens of graduate students from the University of Minnesota gather in a church basement in South Minneapolis to run a free medical clinic for anyone in need. The students come from a wide variety of backgrounds and experiences, as do the patients they serve. Aside from the fact that every person working at Phillips Neighborhood Clinic is a volunteer and that all services and visits are provided to patients free of charge, there are many things that make this clinic special.

One of the first things you’ll notice about the Phillips Neighborhood Clinic (PNC) is its strong emphasis on interprofessional service and education. The clinic provides a dynamic learning environment for students from six different schools housed at the University of Minnesota: Medical, Nursing, Pharmacy, Physical Therapy, Public Health and Social Work. Under the guidance of over 70 volunteer preceptors from various health care organizations, 300+ students learn to provide the highest standard of health care services to their patients. These services include (but are not limited to) preventative physical exams, women’s health, contraception, lab tests, blood pressure checks, hypertension and diabetes management, pharmacy care and prescriptions, physical therapy, nutritional education and mental health counseling.

Patients are seen on a first come, first serve basis and many line up hours before the clinic opens to ensure they’ll be seen. PNC welcomes patients from all parts of the metropolitan area who are uninsured, underinsured, or otherwise burdened by poor medical access. Volunteer interpreters are always available to assist the many Spanish-speaking patients and volunteers also utilize an on-call interpreter service,

By Anna Berglund, Autumn Chmielewski, and Brian Sick, M.D.

MetroDoctors

which enables them to provide care to patients from all cultural backgrounds.

PNC is open two evenings per week serving an average of 12 patients each night — totaling over 1,200 patients per year.

Patient visits begin with an eligibility assessment for various state and federal aid programs.

Volunteers help patients complete and Interdisciplinary students “huddle” with preceptor to discuss patient submit paperwork findings. and aid applications; this is a vital step because it helps patients access eight years because of his fundamental distrust more stable, long-term health care services. Afof traditional medical care. Medical, nursing, ter patients are registered and assessed for state pharmacy and public health students have and federal aid programs, a core team comhelped him with a new diagnosis of diabetes prised of a medical student, pharmacy student by providing medications, laboratory moniand patient advocate visits with the patient. toring, and nutrition counseling. Social work This core team brings the patient’s story and instudents have helped him with community formation back to a large meeting room where referrals for mental health concerns and adthey discuss the case and develop a compreditional low cost health care services. Physical hensive care plan with preceptors and students therapy students have helped him with wrist from the other disciplines listed above. This inpain. In 2007 when he presented with chest terdisciplinary approach helps students underpain, volunteers performed an EKG and, seestand how each discipline can work together to ing the impending heart attack, called 911 to create a more holistic care plan. Some patients’ bring him to the hospital where he underwent needs are beyond the scope of PNC’s services cardiac bypass surgery. After more than 40 and a referral system is in place to help them visits to the PNC, he has seen every profession access additional low cost medical providers. in the clinic and remains a dedicated patient.

A case study of one of PNC’s most regular Volunteering at the clinic is a unique oppatients helps illustrate the clinic’s interproportunity for students to develop skills to effessional approach to patient care. PNC has fectively and compassionately serve patients. served as this patient’s primary care clinic for (Continued on page 14)

The Journal of the Twin Cities Medical Society

November/December 2012

13

Medical U of M Medicine Care Organizations Phillips Neighborhood Clinic (Continued from page 13)

Volunteers report that PNC provides an opportunity for them to “apply classroom knowledge,” “develop communication and time management skills,” and “gain practical experience in leadership, teamwork and interdisciplinary care.” Volunteers also help build a stronger community by committing to 10-15 hours of community outreach per semester.

Serving nutritious meals to the hungry at a local church, providing homework help for youth at a local library, engaging children in wellness education programs, and participating in legislative advocacy are a few examples of how PNC volunteers engage in the community. With a stronger understanding of the many challenges that PNC patients face and the resources available in the community, volunteers are better equipped to serve patients within the clinic.

Today the PNC is the only clinic in the Twin Cities metropolitan area run solely by students. An administrative board comprised of 13 student representatives and PNC’s medical director make decisions about clinic operations and guides the overall direction of the clinic.

EXPERIENCED, PROFESSIONAL EXCELLENCE IN DERMATOLOGY SINCE 1993 ALL CONSULTATIONS SEEN WITHIN ONE WEEK SAME DAY APPOINTMENTS FOR URGENT OR ACUTE CARE PER PCP REQUEST UP TO DATE DIAGNOSTIC AND PROVEN TREATMENT MODALITIES OFFERED. ROUTINE DERMOSCOPY, BIOLOGICS...

FULL SERVICES OF MEDICALLY PROVEN COSMETIC AND LASER TREATMENTS

OJ RUSTAD, MD

BOARD CERTIFIED DERMATOLOGIST MEDICAL DIRECTOR MPLS/ST PAUL TOP DOC MOHS CERTIFIED SURGEON RUTH RUSTAD MD TRESSA ESTY PA-C HEATHER KILL PA-C SHELLY LARSON PA-C WENDY TIMMONS PA-C JULIE CARSON PA-C

ADVANCED DERMATOLOGY CARE Medical, Cosmetic and Surgery P.A.

WHITE BEAR LAKE 6TILLWATER )2RE6T LAKE

651) 484-2724

WWW A'& 'ER0 &20

14

November/December 2012

Students outside the Phillips Neighborhood Clinic.

The administrative board is supported by an associate board whose members help with a variety of jobs such as grant writing, process improvement, data management, website maintenance, and scheduling volunteers and preceptors. The administrative board is also supported by a Community Advisory Board (CAB) comprised of individuals from the larger community who meet three times per year with the administrative board to offer guidance and assistance regarding the direction and operations of the PNC. CAB members have played a key role in opening new doors to greater opportunities for the PNC and are paving the road to a more viable and stable future for the clinic.

The PNC is officially classified as a Campus Life Organization through the University of Minnesota and with the Minnesota Medical Foundation as the fiscal sponsor donations to the clinic are tax-deductible. The PNC operates under the guidance of the Medical School with professional and technical support from University of Minnesota Physicians. The PNC operates on an annual budget of about $40,000 raised from grants, donations and events including an annual Silent Auction. The average total cost to treat a patient at the PNC is $31.00. That includes the cost of labs, clinic supplies, prescriptions, software support, rent and phone. Prescriptions are the largest expense

for the clinic and consume 52 percent of the annual budget. The large base of student volunteers, volunteer preceptors, and supporting organizations helps keep costs down and allows the clinic to offer all of its services for free.

As the PNC approaches its 10 year anniversary its mission remains unchanged: to provide accessible, culturally appropriate, interprofessional, high quality health care services to those in need and to cultivate compassionate health care leaders. Our ability to fulfill our mission to our patients and to our students rests largely on the generosity of our donors.

We invite new donors, preceptors and partners to join with us as we grow and evolve.

Through continued service and outreach, we strive to make PNC’s presence in the community indispensable. We will continue to work in a collaborative and innovative manner to improve the lives of those most in need and to build a stronger community for everyone.

Anna Berglund, University of Minnesota medical student and PNC board co-chair; Autumn Chmielewski, University of Minnesota MHA student and PNC board co-chair; and Dr. Brian Sick, assistant professor at the University of Minnesota, medical director for the University of Minnesota’s Primary Care Center and PNC medical director.

MetroDoctors

The Journal of the Twin Cities Medical Society

Medical Education at Hennepin County Medical Center

H

ennepin County Medical Center has a long, rich history of contributions to graduate and undergraduate medical education. The original City Hospital founded in 1887 had a bed capacity of 61 and was located in a deteriorating building at 724 Eleventh Avenue South. The City Hospital was largely dependent upon student interns for much of the patient care during the initial years. The original staff consisted of four nurses, two interns, a matron and a general handyman.

Traditionally, the public hospital had been the center of medical education in the United States. By 1908, there were 12 interns serving at Minneapolis City Hospital. The internship year first became a requirement for the degree of Doctor of Medicine at the University of Minnesota in 1911. With the official act, the University of Minnesota became the first medical school in the United States to require an intern year prior to the granting of a degree.

In 1914, the intern’s service would lengthen from one year to 18 months and the number of interns at the Minneapolis City Hospital increased to 18. Diversification of the medical services provided by the hospital began early and by the 1920s, the Minneapolis City Hospital had achieved a national reputation not only for its quality care, but also for the high quality of medical education it provided. In 1924, there were 39 members on the resident staff, none of whom were paid. It was the same year that the privilege of serving as an intern in the hospital was officially extended to female medical students.

From its beginnings more than a hundred years ago, the medical center has always enjoyed a special relationship with the University

By Michael B. Belzer, M.D., and Meghan M. Walsh, M.D., MPH

MetroDoctors

Michael B. Belzer, M.D.

Meghan M. Walsh, M.D., MPH

of Minnesota. The original buildings of the University of Minnesota medical school were located across the street from Minneapolis City Hospital. The official relationship with the University of Minnesota was cemented in 1909 when the superintendent of Minneapolis City Hospital preferentially assigned University of Minnesota faculty as attending physicians during the winter months. This was done to increase the patient base for the first “teaching service.”

The continued successful expansion of the medical center’s teaching programs was officially acknowledged and incorporated into the long-range plan adopted by the County Board in 1979. This incorporated the following philosophies and responsibilities associated with medical education: “The medical center encourages the improvement of existing relationships and maintenance of new ones to improve the effectiveness, efficiency, and affordability of patient care and education programs. Medical

education enhances quality patient care. The hospital will continue to serve as a primary source of medical education for the country, state and region by maintaining a strong and mutually beneficial affiliation with the University of Minnesota and supporting and strengthening the medical education programs of other complexes and institutions.”

Hennepin County Medical Center is a major affiliate of the University of Minnesota in health sciences education and has significant involvement in both graduate and undergraduate medical education programs. Full-time faculty at Hennepin County Medical Center are required by the University of Minnesota affiliation agreement to hold academic appointments at the University of Minnesota.

Each of the four oldest and continuous Hennepin County Medical Center-based residency training programs has a diverse and interesting history. Below is a brief history of

The Journal of the Twin Cities Medical Society

(Continued on page 16)

November/December 2012

15

U of M Medicine

It’s like preventative medicine for your retirement.

An exciting new benefit for members of:

1 in 2 people who reach 65 are expected to need long term care at some point in their lives.

When you need care, what is your plan?

/ RQ J 7HUP &DUH

,QVXUDQ FH

Learn about the funding options now available to you with the Minnesota Medical Association (MMA) Long Term Care Insurance Program.

h e out t ts b a

n Lear d discoun A an plans ble to MM a l i ava CMS and T ers. b m em

Learn more at www.mmaltc.com/metro

(612) 454-4400

Cardiac Care at Saint Therese Strengthening the Heart for a Healthier Life Blending specialized skilled nursing with supervised exercise and education, Cardiac Care at Saint Therese gives your patients the confidence and tools to be successful at home.

Cardiac Care at Saint Therese offers... ‡ ,ntegrated programming connecting doctors, nurses, rehab specialists, clinical nutritionist and on-site pharmacists ‡ Specially trained staff skilled in cardiac rehab ‡ 2n-site (.* ‡ )ee-for-service Cardiologist ‡ 3ost-discharge coordination to help prevent hospital readmissions

To learn more call 763.531.5028 or visit sttheresemn.org SA I N T TH E R E S E of N E W H O P E

Bass /ake 5oad ‡ 1ew +ope, 01

16

November/December 2012

Hennepin County Medical Center (Continued from page 15)

the Family Medicine, General Surgery, Internal Medicine and Emergency Medicine programs followed by a status update of our residency programs in 2012.

The Family Medicine Residency Program was instituted at HCMC in 1969 under the directorship of Department Chair Dr. Eldon Berglund. The original training site included the former Deaconess Hospital while some clinics were located on the main campus at HCMC. In June, 1986, the program moved its clinic practice and consolidated all ambulatory training in a building on West Lake Street near Nicollet Avenue South where it thrived for over 24 years. The Family and Community Medicine training program now has approximately 32 residents in their three year program and a brand new clinic building on 2810 Nicollet Ave, newly named the Whittier Clinic.

The Hennepin County Internal Medicine Residency Program began in 1959 with only a single resident, under the leadership of Dr. Frederick Hoffbauer, chair of Medicine (1958-1965). The program blossomed in 1965, expanding to nine residents. In 1989, it joined the Metropolitan-Mount Sinai program to become a single categorical internal medicine track with 20 residents based at HCMC. Since then it has continued to grow and now trains 60 residents per year. In 2010, a combined Emergency Medicine-Internal Medicine program was created and now trains 10 residents in its ďŹ ve-year program.

In 1955, Professor Owen Wangensteen, chair of the Department of Surgery at the University of Minnesota, assigned one of his surgeons, Claude R. Hitchcock (1920-1994), to the Minneapolis General Hospital to be chief of the Department of Surgery. The program began as a four-year training program but was later expanded to ďŹ ve to include a year of laboratory training. Today the program is ďŹ ve years but offers the opportunity for an additional year dedicated to research or fellowship training, if desired. This has allowed the program the exibility to train its 25 residents for many different types of clinical practice.

The Emergency Department was initially run by a Surgery Department that consisted of academically-inclined community surgeons who donated their time to teach and supervise. At that time, the ED was largely staffed MetroDoctors

The Journal of the Twin Cities Medical Society

by interns and one first year surgery resident.

In 1971, Dr. Hitchcock appointed Dr. Ernest Ruiz, a general surgeon four years out of his surgery residency, to run the ED. In 1972, Dr Ruiz created the Emergency Medicine Residency Program and quickly recruited two second-year surgery residents. At the time it was only the second residency program available in the United States, thus remains one of the oldest emergency medicine residencies in the nation. Forty-one years after its beginning, over 260 emergency medicine physicians have graduated from the HCMC. At any given time, nearly 95-100 medical students from the University of Minnesota are training on our campus every day. Hennepin County Medical Center has freestanding residency programs in Emergency Medicine, Family Medicine, Internal Medicine, Surgery and Transitional Year residencies. Additionally, it is the sponsoring program for a combined residency program with Regions Hospital in Psychiatry and sponsors non-MD residency training programs in Dentistry and Podiatry.

Subspecialty training is also available through one of the five ACGME-accredited fellowships which inlcude Critical Care Medicine, Geriatric Medicine, Hyperbaric Medicine, Sleep Medicine and Cardiology.

In addition to the nearly 215 residents that train in programs sponsored by HCMC, we are also the training site for many specialties and subspecialties for the University of Minnesota Graduate Medical Education Programs. Included are approximately 100 university residents and fellows training in a myriad of specialties ranging from Anesthesiology to Radiology.

Residents may spend anywhere from several months to a third of their residency training at HCMC. During this time they gain crucial experience in trauma, critical care, and acute care while working with a diverse patient population in a cooperative learning environment.

Residents training at the affiliate hospitals are training under the compliance rules and regulations as well as the supervisor oversight of the host hospital and its medical staff. The only payment that occurs is that for resident salary and benefits which are handled through the various affiliation agreements the University Medical School has with its affiliate hospitals.

Although there are many independent residency training programs in the metro area, there are also many shared programs and MetroDoctors

resources that exist in the Twin Cities area.

The common thread is the affiliation with the University of Minnesota Medical School. One of the most significant collaborations between hospitals began as the Minnesota Association of Public Teaching Hospitals (MAPTH) in 1980. This was initially created as a consortium whose role it was to enhance and develop GME operations of the public teaching hospitals. The initial focus of MAPTH was legislative advocacy. In 1999 the consortium changed its name to the Community Council on Graduate Medical Education (CCGME) and quickly centralized the information systems necessary for graduate education resident tracking and payment. Currently known as the MMCGME (Metro Minnesota Council on Graduate Medical Education) the organization continues to coordinate processes that are critical to the future of graduate training. Its Board of Directors is comprised of representatives from all of the major training sites in the area; and its subcommittees range from the GME Advocacy Committee to the Joint Administrative Oversight Committee to a newly formed, community-wide, resident committee.

The MMCGME currently is one of the most

The Journal of the Twin Cities Medical Society

innovative, cooperative GME organizations in the nation.

The metro area training programs are integrated with the University in ways beyond the MMCGME. In 2001, the University appointed Dr. Michael Belzer, Dr. Carl Patow and Dr. Jack Druker as associate deans at the affiliate hospitals. Residents have collaborated on a variety of shared needs including electronic heath record training, pager policy, simulation training and other quality and safety programs.

In a spirit of cooperation and mutuality, the affiliate hospitals greatly value their association with the University Medical School. The University in turn, continues to provide the anchor and linkage to allow the integration of many varied clinical rotations at affiliated hospitals into their undergraduate and graduate training medical education programs.

Michael B. Belzer, M.D. serves as chief medical officer and medical director, Hennepin County Medical Center, and associate dean, University of Minnesota Medical School.

Meghan M. Walsh, M.D., MPH is chief medical education officer, Hennepin County Medical Center.

November/December 2012

17

Medical U of M Medicine Care Organizations

UMPhysicians — Its Relationship to Fairview, the Medical School and the Community

F

or over 100 years, physicians at the University of Minnesota have been providing clinical service to patients and referring physicians. While much has changed since the University of Minnesota’s Elliott Memorial Hospital opened in 1911 as the first teaching hospital on an American university campus, the University’s enduring commitment to advancing clinical care, training the next generation of health professionals and bringing innovative research to the bedside has been sustained. Formed in 1997, University of Minnesota Physicians (UMPhysicians) is the integrated, multi-specialty group practice for the roughly 800 full-time physician faculty of the medical school, 100 non-faculty physicians devoted exclusively to patient care, and 150 advanced practice providers. Together, we provide nearly one million patient visits per year throughout the Twin Cities and the region.

How is the University engaging its physicians and expanding its presence in the community?

The perspectives and leadership of physicians will be critical as health care systems, both national and local, respond to current challenges. UMPhysicians, together with medical school leadership, has taken a variety of steps to engage physicians and strengthen the voice of physicians to further enhance the focus on patient care and outcomes.

1. The medical school department chairs have publicly committed that the leadership of their departments will embrace “patients are first,” an

By Bobbi Daniels, M.D.

18

November/December 2012

important step in transforming our clinical practice and focusing faculty attention.

2. Our governance structure includes nine elected department chairs, nine elected faculty, and five independent community members, resulting in enhanced “ownership” of our performance outcomes. We have developed a board committee structure that engages all clinical care providers in the oversight of operational and clinical performance.

3. Physician leadership is apparent throughout all layers of management both internally within UMPhysicians, as well as in our partnerships with hospitals and health systems, linking physician and administrative leaders in all service lines, hospital services, and hospital unit and clinic management. Our focus is on achieving the clinical triple aim (quality, cost, service) and connecting it to our education and research missions.

4. Each department’s clinical practice is overseen by an elected governing board of faculty. These groups are charged with the stewardship of the clinical practice, including financial oversight, in each department.

The matrix between the medical school departments and the clinical delivery structure is an important mechanism for broadly engaging physicians in clinical leadership and also linking to the academic structure of the medical school, in particular the research and education missions that continue to follow the 18 traditional department units.

Our services range from delivering

primary care in underserved areas of the Twin Cities to highly complex care, such as blood and marrow transplantation, where therapies originate in faculty laboratories.

Engagement of faculty across all levels of the organization is central for innovation and growth of our clinical services.

UMPhysicians provides medical care throughout the Twin Cities and the region. Not only do we provide service at many sites, with a variety of health system partners, our patients on campus come from many different health systems and locations. Since the sale of the University Hospital in 1997, Fairview Health Services has been a key partner, and recently, our services have become more broadly

MetroDoctors

The Journal of the Twin Cities Medical Society

available throughout the Fairview system.

Examples include specialty care at the Fairview Maple Grove Medical Center, and cardiology and cardiovascular surgery services through UMPhysicians Heart at Fairview. This integrated cardiovascular service line brought together 23 community and 20 university cardiologists in 2008, and is excelling in meeting the clinical triple aim of quality, cost and service, and providing highly specialized services, such as advanced heart failure, in health systems throughout greater Minnesota.

In addition to our important relationship with Fairview, we are partners with Park Nicollet at TRIA Orthopaedics, providing both physician leadership and a significant portion of the physician services. The innovative care model at TRIA, a passion of Marc Swiontkowski, M.D., professor of Orthopaedic Surgery and CEO of TRIA, has delivered on the promise of high quality, efficient care with extraordinary patient satisfaction. The ability of faculty to develop programs where there is need and desire is important for our success. We also continue to provide tertiary care outreach services, gynecologic oncology and renal transplant management, to a variety of health systems throughout the state. Nearly 20 percent of our clinical practice occurs through relationships like these.

It is probably apparent that our relationships with other health systems are diverse and our sites for providing services are varied. We seek to collaborate with physicians and health systems to best meet mutual outcomes, and recognize the need for flexibility in the nature and structure of those relationships.

Describe the current relationship between UMP and the physicians of the private practice community.

UMPhysicians highly values the outstanding clinical care provided by the private practice physician community, and sees our role as working collaboratively with physicians and patients to help solve clinical problems. That collaboration can take many forms. For patients, second opinions can provide reassurance and access to novel

MetroDoctors

therapies available through research protocols. For referring physicians, a consultation most often reinforces the view of the original treating physician and provides confidence in the best type of therapy. At a system level, our physicians have developed new care models that have demonstrated significant advances in outcomes, quality and cost, such as has occurred in our partnership with Park Nicollet at TRIA. We sometimes experience tension with community physicians regarding the 20 percent of our patients who are “self-referred” and seek another opinion — sometimes without the knowledge of the original treating physician. In those cases, it is our goal to place the desires of the patients first, and assist the patient in receiving as much care as possible close to their home at a time when the patient is most comfortable with that arrangement.

We’re open to hearing about current concerns, whatever they might be, and have an organization-wide commitment to collaboration with the community.

Are University physicians engaged in significant primary and secondary care?

Yes, University physicians are involved in both. We provide primary care throughout the community and on the University campus; these sites provide essential education for medical students and residents. s 4HE "ROADWAY #LINIC IN .ORTH -INneapolis (in partnership with North Memorial), the Phalen and Bethesda Clinics in St. Paul (in partnership with HealthEast), and the Smiley’s Clinic in the Phillips Neighborhood of South Minneapolis (in partnership with Fairview) serve dual roles of providing clinical care to historically underserved populations and training medical students, as well as generations of family medicine physicians. s ! PRIMARY CARE CLINIC ON THE 5NIVERsity campus serves the needs of both University employees, as well as patients seeking specialty care. s 4HE -ILL #ITY #LINIC NEAR THE 'UTHRIE Theater in downtown Minneapolis, provides family medicine, internal

The Journal of the Twin Cities Medical Society

medicine and pediatric care to an urban population, and offers an alternative to primary care on campus.

Regardless of where our specialty physicians see patients, a significant portion of our practice is secondary care, rather than tertiary care. It is essential for meeting our student, resident, and fellow teaching needs, as well as a necessary element to maintain faculty skills and those services that are highly sought after by referring physicians.

Do University physicians refer cases to the private practitioners of the community?

Yes, we do, and we greatly value that collaboration. Collaboration can occur related to capacity, expertise or patient desire. If we place the needs of our patients first, then such referrals are win-win for everyone.

The Future: We welcome the increasing attention to fulfilling the triple aim and acknowledge our responsibility in both the care we deliver as well as how we use our clinical environment to educate the next generation of health care providers. We anticipate further alignment of health systems and payers, particularly for primary and secondary care, and intend to continue to partner with patients and physicians, and health systems and payers to develop innovative solutions for the current and future health care needs of the state.

Bobbi Daniels, M.D., is CEO of University of Minnesota Physicians, where she provides strategic direction to over 750 physicians practicing in more than 100 specialties and subspecialties. Previously, she served as UMPhysicians’ chief medical officer. A nephrologist and vice dean of Clinical Affairs for the University of Minnesota Medical School, Dr. Daniels’ research expertise has been recognized by an American Heart Association Established Investigatorship as well as funding from the National Institutes of Health.

November/December 2012

19

Medical U of M Medicine Care Organizations

50 Years of Medicine Past, Present & Future (An address to the University of Minnesota 2012 Graduating Class – May 4, 2012) Good afternoon and congratulations, fellow physicians.

50 years ago, I and 127 of my classmates and our families and friends were ďŹ guratively sitting where you are now. I am honored to be representing them today.

I suspect the thoughts and emotions of my colleagues then were very much the same as those you are feeling now‌ s 2ELIEF ˆ RELIEF THAT THIS CHAPTER IN OUR LIVES is ďŹ nished. s 4HANKFULNESS ˆ THANKS THAT WE WERE provided with a superb medical education mainly because of the talented and dedicated faculty and administration of our outstanding medical school. s 'RATEFULNESS ˆ GRATITUDE TO THOSE CARING friends, supportive family members and classmates who stood by us during both the good and the inevitable difďŹ cult times of those four years. s %XPECTATION ˆ EXPECTATION AND EXCITEment about the future as we move into our residencies and the next chapters of our careers. s 0RIDE ˆ PRIDE AT lRST SETTING THE LOFTY GOAL of becoming a part of our noble profession‌and then of achieving it.

50 years ago John Kennedy was our President, the Beatles hadn’t yet been discovered, Harmon Killebrew was swatting home runs out of Metropolitan Stadium and John Glenn orbited the Earth. Many things have changed in those 50 years — including striking advances in our profession.

So many of those developments that today we view as common-place and may even take for granted were then just a “sparkle in our eye�

By Marvin S. Segal, M.D.

20

November/December 2012

or hadn’t even entered into our consciousness.

Our school played a pivotal role in many of them. Just to name a few: s 4HE EXPANDING UTILIZATION OF PROSTHETIC joint replacements — Gramps and Grandma now need not spend their remaining days in a wheel chair. s 4HE REMARKABLE DECLINE OF CARDIOVASCULAR disease morbidity and mortality‌and at the other end of the spectrum the fact that there are now more adults with congenital heart disease than there are children with it — both of these developments were due to emerging surgical and medical and lifestyle advances. s 4HE INVENTION AND SOPHISTICATION OF IMAGing techniques such as CT and MRI — allowing us to peer more precisely into the human body. s (UMAN 'ENOME -APPING s 3OLVING THE CAUSATION DILEMMA OF THE UNfortunate plague that we now call AIDS and the engagement of moderately effective treatment. s 4RANSPLANTATIONS OF KIDNEYS LIVERS BONE

marrow and stem cells, hearts and other organs. s -ONOCLONAL ANTIBODY UTILIZATION FOR VARIous malignancies. s ANDxTHE LONG OVERDUE EMERGENCE of women in medicine — occupying their rightful places next to their male counterparts.

I have an idea that medical science so far has just scratched the surface, and amazing as past achievements have been, as the future unfolds advancements will come about logarithmically.

These great, and many times technical, advancements shouldn’t allow us to lose sight of another area that hasn’t appreciably changed through the years‌and hopefully never will the doctor-patient relationship and physicianto-physician collegiality. There may, in medicine, be no more intangibly gratifying activity than meeting face-to-face with a patient and explaining a difďŹ cult diagnosis or plans for a successful treatment — or to “noodleâ€? with a colleague over the most efďŹ cient and effective approach to a clinical problem. Now that’s the “joy of medicineâ€?!

The promise is bright — of medicine‌ and of you, young physicians. Together you’ll move forward and realize great potential.

For those of us — my fellow alumni and faculty — who have been fortunate enough to have played a role in our wonderful profession for some time‌it’s been a really great ride. I suspect that soon, we can comfortably move into the back seat, as you — our conďŹ dent and competent graduate physician successors — take over the wheel and make that ride even better.

Marvin S. Segal, M.D., University of Minnesota Medical School, class of 1962, clinical professor of medicine, retired.

MetroDoctors

The Journal of the Twin Cities Medical Society

1Health: Linking Changing Health Care and Education

O

n September 10, U.S. Health and Human Services Secretary Kathleen Sebelius announced that the University of Minnesota Academic Health Center (AHC) will serve as the lead organization for the newly created National Coordinating Center for Interprofessional Education and Collaborative Practice. This announcement followed a rigorous peer-review process to designate the AHC to lead the development of a new $12.6M public-private partnership funded by the Health Resources and Services Administration and four foundations — the Josiah Macy, Jr., Robert Wood Johnson, John A. Hartford and Gordon and Betty Moore.

Why is there interest in interprofessional education (IPE) now? Across the United States, health systems are sending the message that higher education’s graduates must

By Barbara F. Brandt, Ph.D.

MetroDoctors

be “collaboration-ready” when they enter the workforce. Momentum is building internationally, nationally and at the University of Minnesota to advance interprofessional education (IPE) as the standard for health professions education, including medical education. According to the World Health Organization, “Interprofessional education occurs when learners from two or more professions learn about, from and with each other to enable effective collaboration (to) improve health outcomes.”

(World Health Organization, 2010) Nationally, there is considerable experimentation but no template for how to design IPE, or even to understand what definitively works. After a 40 or more year history of IPE, the documentation of its relevancy to practice is limited. Recently, new evidence that team approaches in practice work to assure patient safety, improve patient and health outcomes, and may reduce the total cost of care is assisting educators on how to design curriculum.

These drivers are stimulating thinking that the professions need to learn together to enhance performance and achieve better outcomes as an integral component of the education of health professionals as well as clinical care delivery and public health. IPE, extending into lifelong learning, needs to impart a common base of knowledge, attitudes, skills, and experience to continue the development of interprofessional collaborative care in redirecting the process of care toward improving health.

Since 2010, the Association of American Medical Colleges leadership has collaborated with five other educational associations in dentistry, nursing, osteopathic medicine, pharmacy, and public health to form the Interprofessional Education Collaborative (IPEC). In February

The Journal of the Twin Cities Medical Society

2011, IPEC released a set of national interprofessional core competencies for collaborative practice around the areas of values/ethics for interprofessional collaboration, roles/responsibilities, interprofessional communication, and interprofessional teamwork and team-based care. Since the release of the competencies, an explosion of national interest and activities across the education and practice communities have focused on IPE. Many professions, including medicine, are writing the IPEC competencies into the standards for accrediting schools. These new requirements will assure that education for collaborative practice will become the norm rather than marginal activity.

Why Minnesota? The AHC is one of the world’s most comprehensive organizations for educating health professionals (dentistry, medicine, nursing, pharmacy, public health, veterinary medicine, and allied health). Since the 1970s, a number of AHC courses and programs have promoted the concept of teams.

Many physicians as medical students participated in the University’s Center for Health Interprofessional Programs, or CHIP. But it wasn’t until 2010 that deans and faculty committed to creating a framework, now called 1Health, requiring IPE to guide curriculum development and assessment of competency required in practice. The 1Health vision is to require that all graduates demonstrate interprofessional competencies prior to graduation.

Full implementation will take time but tangible progress is being made.

The 1Health initiative includes three curricular phases designed to support sustainable, longitudinal student development of competencies for interprofessional collaboration, (Continued on page 22)

November/December 2012

21

Medical U of M Medicine Care Organizations 1Health (Continued from page 21)

spanning the professional curricula of AHC Schools. The most robust implementation to date is the Foundations in Interprofessional Communication and Collaboration (FIPCC) course. Now beginning its third year, more than 900 early-stage AHC students on four campuses are required to take this six module course focused on awareness of the IPEC competencies. Discussions are facilitator-guided, student-led, case-based exercises that expose students to the IPEC competencies. For medical students at an early stage of professional identity development, FIPCC provides them with an introduction to the other health professions and background that they will be expected to practice in teams in the future.

In follow-up to FIPCC, the faculty is working to structure existing educational activities and courses and create new ones to assure that the students are ready for their experiential

rotations when they enter practice sites to learn in the “real world.” An example is the Phillip Neighborhood Clinic — a student operated free clinic which allows post-FIPCC but pre-clinical rotation students to provide supervised care to patients as an interprofessional team with AHC faculty. Students who elect to participate in this experience register for a course within their individual programs.

The Fergus Falls “Right Side Up,” is another example of how the 1Health curriculum will be incorporated into the community in the Twin Cities. This program, which is focused on falls prevention among elderly and other atrisk patient groups identified through hospital visits related to stroke or other events, utilizes a home visit structure to deploy faculty-led interprofessional student teams consisting of medicine, pharmacy, physical therapy, occupational therapy, and nursing to evaluate fall risk and provide practical interventions to minimize risk. This program has become such a valued

component of the community partnership with the health system, that family members are now requesting home visits through the Otter Tail County Health Department.

Currently, each AHC school has many opportunities for students and residents to learn new skills such as quality improvement, teamwork and communication in addition to their profession-specific clinical competence. With notable exceptions, however, these courses are taught in isolation from other professional students at the University. The national and University movement is geared toward changing these “siloed” approaches.

The capable team of the Medical School’s Brian Sick, M.D. and Jim Pacala, M.D. with the College of Pharmacy’s Amy Pittenger, Pharm.D, PhD. is leading a growing group of faculty, clinicians and other professionals in the 1Health “Phase III” implementation. Students increasingly will be included in designing new educational models. With the guidance of the University of Toronto Centre for Interprofessional Education, this team is creating strategies with practice sites to support the development of team skills as students learn in practice.

The approach is focused on how to integrate students into practice to enable them to have meaningful experiences while contributing to patient and community outcomes.

The goals for the National Center and educating health professionals for Minnesota’s changing health environment will become one.

Minnesota may not have all of the answers, but we are well-known for our innovation and willingness to take risks to do the right thing.

Traditionally, Minnesota is high on most national rankings for health and health care. On the other hand, the University of Minnesota is known in national educational spheres for working on IPE. Until recently the two systems have been working independently on similar goals. Look for Minnesota to be national leaders as we create new and cutting edge pathways for inter-system collaboration for health with IPE as a foundation.

Barbara F. Brandt, Ph.D., associate vice president for education; director, Minnesota Area Health Education Center; professor, Pharmaceutical Care and Health Systems.

22

November/December 2012

MetroDoctors

The Journal of the Twin Cities Medical Society

Update on the Rural and Metro Physician Associate Programs: Collaborations Between Community Physicians and the Medical School

T

he University of Minnesota Medical School’s Rural Physician Associate Program (RPAP) enters its 42nd year this fall as an outstanding collaboration between rural communities and the medical school. Approximately 40 third year medical students each year spend nine months living and learning in rural communities where they complete core clinical clerkship requirements. Close to 300 community physicians each year serve as teaching preceptors in the disciplines of family medicine, surgery, obstetrics and gynecology, pediatrics, urology, orthopedic surgery, emergency medicine and internal medicine. The students become an integral part of the community health care team.

They learn how to manage professional boundaries when their neighbors are also their patients.

RPAP students complete the same basic requirements for clerkships as students on campus, including discipline specific standardized exams, surgical skills exams, etc. However, they complete the clerkships in a community where they can follow patients more longitudinally through each of the disciplines, offering the opportunity to learn clinical care in a more integrated fashion. Each student completes a community health assessment project, analyzing a salient health care issue and joining with community stakeholders to address these issues. Over the past years students have completed projects addressing childhood obesity, migrant worker health, HIV in rural Minnesota, breastfeeding, education for Somali obstetrical patients and many

By Kathleen D. Brooks, M.D., MBA, MPA

MetroDoctors

other topics. Students have observed the changing face of rural Minnesota as new immigrant populations have arrived, followed employment opportunities and established lives in various rural communities. As electronic health records have been implemented across the state, RPAP students have participated in care delivery, often bringing their generational expertise to the challenges of managing new systems while making sure patients are cared for in timely ways. Hospital and clinic mergers, acquisitions and integrations have created real life experiential learning for students, as they consider the future of rural medical practice.

The medical school has tracked RPAP student performance over many years to assure faculty, students and the community that this program prepares students for residencies comparably to traditional clerkships on campus. RPAP students perform

The Journal of the Twin Cities Medical Society

very comparably on national board exams, both discipline specific ones and USMLE exams.(1, 2) They are successful in residency matching, and are sought after in family medicine residency programs around the country.

Over 1,400 physicians have completed RPAP since 1972, undoubtedly including some readers of this metro publication.

In the hallway outside my office I view photos of all RPAP graduates, regularly reminding me of the breadth of physician experience collectively accrued by RPAP graduates and their impact on Minnesota health care. Our statistics reveal that of over 1,000 RPAP graduates in practice currently, approximately three-quarters practice primary care, two-thirds practice family medicine and over 50 percent practice in rural settings.

Many graduates have described the profound impact the program had upon them, whether they pursued rural primary care of not. They discuss the value of establishing a long-term mentoring relationship with a family physician and the opportunity to gain the respect and trust of patients they worked with over time.

Over one-third of our primary preceptors are former RPAPers. Our medical school relies on our rural physician colleagues to serve as teachers and role models for our students without receiving compensation from the school. Typically the practices and communities engage in this commitment for the love of teaching and to encourage our students’ interest in potentially becoming a future colleague in rural

(Continued on page 24) November/December 2012

23

U of M Medicine Rural and Metro Physician Associate Programs (Continued from page 23)

Minnesota Oncology is pleased to announce the opening of their 10th metro cancer clinic located in the WestHealth Medical Building in Plymouth. The clinic will operate under the direction of Dr. Nicole Hartung.

Dr. Hartung is board-certified in Medical Oncology. She received her medical degree from the University of Missouri and completed her Fellowship in Medical Oncology at Scripps Green Hospital, La Jolla, CA. She is transferring from her practice in Woodbury where she has served the east metro community for more than ten years.

Dr. Hartung treats all types of cancer, with a special interest in breast, colon and lung cancer, and an emphasis on Women’s Health.

WestHealth Clinic 2805 Campus Drive, Suite 485 Plymouth, MN 55441 Appointments: 612-884-6300 “My philosophy is to offer compassionate, evidence-based medical oncology care to my patients, while educating them and their families about their disease, treatment, and overall care.”

Nicole Hartung, MD

mnoncology.com

24

November/December 2012

communities. In visiting RPAP practices, it is clear that the commitment to students extends beyond the physicians to include the whole health care team and the patients who are community members. Patients regularly volunteer to be videotaped being interviewed as a learning exercise for students, and allow students to become a significant member of their care team.

RPAP is the oldest known longitudinal rural immersion program in the world.

Many medical schools in the U.S., Canada and Australia have visited our campus and then replicated key elements of the program. We are founding members of the international Consortium of Longitudinal Integrated Clerkships and this academic collaboration has raised the visibility of the program for the medical school.

Medical schools starting programs like RPAP often inquire about the robust collaboration between the rural community practices and the medical school. I believe this is explained by understanding the rich historical connection between rural family physicians and the medical school that serves as the foundation for this program.

The medical school strives to foster this relationship with regular visits to the communities, face time with our preceptors, preceptor sessions at Minnesota Academy of Family Physician annual meetings, MN Medical Foundation alumni meetings, etc.

The medical school engages with the MN Area Health Education Centers (AHECs) in their connection with rural communities to build sustaining relationships around health profession education, including RPAP student opportunities.

We have now implemented an urban version of RPAP, termed Metropolitan Physician Associate Program (MetroPAP) to nurture student interest in urban underserved health care. Piloted at the Broadway Family Medicine Residency Clinic in North Minneapolis and at North Memorial Medical Center Hospital in Robbinsdale, this program utilizes the curriculum and infrastructure of RPAP, moving the setting to the inner city. Preceptors include

family medicine faculty at the North Memorial residency program and community physicians who see patients at North Memorial hospital. The program has garnered much enthusiasm from medical students who value the learning opportunities in becoming part of an urban health care team. As we begin our third year of MetroPAP, we hope to continue to establish this program in the metro region.

Both of these programs rely on the partnership between community physician teachers and the medical school to educate our future physicians. Students applying to these programs are passionate about their interest in serving their communities, whether rural or urban, and very committed to becoming outstanding physicians. They are individually and collectively impressive future physicians. The community preceptors who work with our program are similarly committed to educating for excellence.

If you have questions or comments about RPAP or MetroPAP, please contact me at kdbrooks@umn.edu.

Dr. Kathleen Brooks is a family physician, director of the Rural Physician Associate Program at the University of Minnesota Medical School and assistant professor in the Department of Family Medicine and Community Health. Her work focuses on medical education and health policy workforce issues in Minnesota. She serves on several committees in the medical school focused on curriculum transformation. She received her undergraduate and medical degrees from the University of Minnesota, and completed her family medicine residency there. She has done administrative consulting for health systems, state governmental agencies and served as Minnesota’s medical director for the federal Medicare program.

References: 1) Zink T, Power D, Finstad D, Brooks KD. Is there equivalency between students in a longitudinal rural clerkship and a traditional urban-based program? Family Medicine, 2010; 42 (10):702-6.

2) Zink T, Power D, Olson K, Harris IB, Brooks KD. Qualitative differences between traditional and rural-longitudinal medical student OSCE performance. Family Medicine, 2010; 42 (10):707-11.

MetroDoctors

The Journal of the Twin Cities Medical Society

159th Meeting of the MMA House of Delegates The annual meeting of the MMA House of Delegates was held September 14-15, 2012 at the Minneapolis Marriott City Center. TCMS was well represented with 69 physicians, residents and medical students attending the events as Lyle Swenson, M.D., passed the Presidential Medallion to Daniel Maddox, M.D. Twenty-one resolutions were submitted

by TCMS members; 15 were forwarded for reference committee review and testimony.

Receiving the most discussion was a resolution

Renee Koronkowski, M.D. offers testimony to eliminate duplication of prescription reďŹ lls in the automated prescription reďŹ ll and electronic eprescribing systems.

Peter Dehnel, M.D. provides testimony in support of the Healthy Eating, Active Living resolution.

MetroDoctors

submitted by the MMA Governance Task Force proposing changes to the overall structure and governance of the MMA. For a report of all the actions taken by the House of Delegates, visit the MMA website at www.mmaonline.org.

In addition to Dr. Swenson moving to the position of MMA past-president, the following TCMS members were elected: s 2OBERT -ORAVEC - $ n 3PEAKER OF THE House; s "ENJAMIN #HASKA - $ n 4RUSTEE s 6 3TUART #OX - $ n 4RUSTEE s 2OGER +ATHOL - $ n 4RUSTEE s $AVID 4HORSON - $ n 4RUSTEE s +ENNETH #RABB - $ n $ELEGATE TO THE American Medical Association; s "ENJAMIN 7HITTEN - $ n $ELEGATE TO the American Medical Association; s 7ILLIAM .ICHOLSON - $ n !-! !LTERnate Delegate Congratulations to Kent S. Wilson, M.D., recipient of the Community Service Award, honoring MMA members who are actively engaged in the practice of medicine and have an outstanding record of community service.

Dr. Wilson, a retired otolaryngologist from St. Paul, is currently serving as the medical director of Honoring Choices Minnesota, a community-wide advance care initiative of the Twin Cities Medical Society.

The photos highlight TCMS delegate participation.

First time delegate, David Anderson, M.D., discusses a resolution calling for endorsement of a state-wide system to optimize care for time critical cardiovascular conditions.

Carol Grabowski, M.D. served as chair of Reference Committee B.

Medical students actively participate in discussions at TCMS Caucus and MMA House of Delegates.

The Journal of the Twin Cities Medical Society

November/December 2012

25

Eden Prairie Passes Healthy Eating, Active Living Resolution

A

s 2012 begins to wind down, the Twin Cities Obesity Prevention Coalition is thrilled to share another success story of a community who has put healthy eating and active living strategies at the forefront. Eden Prairie is the second city in Minnesota to pass a healthy eating, active living resolution at their recent city council meeting. With full support, the city will begin working to develop and implement a healthy vending

By Jennifer Anderson, MA Project Manager

machine and concessions policy for all city-owned and city-operated concessions in facilities, parks and programs; continue development and sustainability of edible playgrounds, community gardens and local farmers’ markets; inventory unused land owned by the city that could be made available for additional community gardening; identify and take active steps to resolve any public transportation barriers that inhibit community access to full-service grocery stores, supermarkets, corner stores, farmers’ markets and community gardens; and finally, develop and implement a healthy

Senior Physicians Association Wraps up 2012 Calendar The Senior Physicians Association welcomed Save the Date!

Doug Jensen, AIG program coordinator The first luncheon of 2013 is set for May 7, of the University of Minnesota Sea Grant 2013 featuring Carol Falkowski as our guest Program, as the guest speaker at their fall presenter speaking about the drug scene in luncheon Tuesday, October 9. Mr. Jensen’s Minnesota. Luncheons are held at Broadway presentation, Great Lakes and Threats to Ridge, 3001 Broadway Street NE, MinneMinnesota Waters, was full of fascinating facts apolis, MN 55413. Cost: $25.00 per person. and information about the variety of species threatening Minnesota lakes.

This was the last Senior Physicians Association event for 2012. It was a fun year of socializing, great food and exciting speakers. We wish our members a great rest of the year and we look forward to seeing Doug Jensen, AIG program coordinator of the University of Minnesota Sea Grant Program spoke at the October 9 meeting everyone again in 2013! of the Senior Physicians Association.

26

November/December 2012

food and beverage policy for city meetings and facilities, including city-operated food and beverage vending machines.

We congratulate Mayor Nancy Tyra-Lukens and the Eden Prairie city council for their commitment and leadership while ensuring a healthy future for Eden Prairie residents.

Beginning in October, each city passing a resolution will receive window clings that can be placed at city building entrances and on city vehicles designating that city as a healthy eating, active living community. To date, two communities can proudly display these clings. Congratulations Eagan and Eden Prairie! Which city is next?

EDEN PRAIRIE has been designated a

A healthy eating, active living community

MetroDoctors

The Journal of the Twin Cities Medical Society

Senior Physicians Association Visits Weisman Art Museum

T

he Senior Physicians Association visited the Weisman Art Museum in September for their 2012 Annual Event. The members took part in an engaging tour around the building (inside and out), learning of its rich architectural history as well as hearing stories about the variety of art in the Weisman collection. After the tour, members enjoyed a lunch in the Shepherd room with their colleagues.

Photos of the event can be viewed on the TCMS Facebook page (http://www.facebook.com/TCMSMN).

Visit www.MetroDoctors.com to stay informed of 2013 meeting dates.

Plan Now for Clinic & Hospital Participation:

Caring Hearts for Homeless People Supply Drive Caring Hearts for Homeless People is an annual drive for health and hygiene items and overthe-counter medications for homeless adults and children in the Twin Cities area.

During February 2013, clinics and hospitals simply put out a collection box and signage and encourage staff and/or patients to donate an item(s). At the end of the month, all donations can be brought to either St. Joseph’s Hospital in St. Paul or the Twin Cities Medical Society ofďŹ ce in Minneapolis.

Have your site representative contact Katie Snow, EMMS MetroDoctors

The Journal of the Twin Cities Medical Society

Foundation, at (612) 362-3704 or KSnow@metrodoctors.com to express your interest and ensure that advertising materials will be sent to you in January.

All donated items are distributed to the homeless through the following three programs: Health Care for the Homeless, Listening House of St. Paul, and SafeZone Drop-In Center.

Sponsored by HealthEast Care System and East Metro Medical Society Foundation.

November/December 2012

27

Search for Twin Cities Medical Society on Facebook

Proceeds from MPS help to support the operations of TCMS. Please consider our business partners listed below as you look to reduce your operational costs.

Postal Form

Our Partners Include: ◆ AmeriPride Services (linens and apparel) ◆ Berry Coffee (beverages and food) ◆ Gallagher Benefit Services (group insurance)

To Learn More, Call (612) 362-3704

28

November/December 2012

MetroDoctors

The Journal of the Twin Cities Medical Society

Anthony J. Pfaff, M.D. (EALTH0ARTNERS n #OMO #LINIC Ophthalmology

David S. Spight, D.O. Institute for Low Back & Neck Care Neurological Surgery

New Members

Jeffrey S. Pinto, M.D. Institute for Low Back & Neck Care Orthopedic Surgery

Daniel A. Trajano, M.D. Park Nicollet Clinic Family Medicine

Steven A. Beckley, M.D. Anesthesiology, P.A. Anesthesiology

Laura E. Rathe, M.D. Central Lakes Physicians Internal Medicine

Michaela L. Tsai, M.D. Minnesota Oncology Hematology, P.A. General Preventive Medicine

Alison M. Brophy, D.O. South Lake Pediatrics, Ltd. Pediatrics

Sara G. Ray, M.D. Partners in Pediatrics Pediatrics

Joseph R. Van Camp, M.D. North Memorial Heart & Vascular Center Surgical Critical Care, Thoracic Surgery

Zeina A. Dajani, M.D. Skin Care Doctors, P.A. Dermatology

Gaurang S. Shah, MBBS St. John’s Hospital Internal Medicine

Mary D. Wagner, M.D. Park Nicollet Clinic Family Medicine

Geoffrey G. Emerson, M.D. Retina Center, P.A. Ophthalmology

Mark L. Solfelt, M.D. North Memorial Heart & Vascular Center Thoracic Surgery

David A. Wiley, M.D. Valley Family Practice, P.A. Family Medicine

Benjamin A. Gilloon, M.D. St. Paul Radiology, P.A. Radiology/Neuroradiology Michael J. Grogan, M.D. St. Paul Radiology, P.A. Radiology

CAREER OPPORTUNITIES

See Additional Career Opportunities on page 30.

Tracy G. Hall, M.D. South Lake Pediatrics, Ltd. Pediatrics Yasha Kadkhodayan, M.D. Consulting Radiologists, Ltd. Radiology Lyla M. Kamsheh, M.D. Minneapolis Clinic of Neurology Neurology Reza Khodaverdian, M.D. North Memorial Heart & Vascular Center Thoracic Surgery R. Michael King, M.D. North Memorial Heart & Vascular Center Thoracic Surgery Lucas B. Ludeman, M.D. St. Paul Radiology, P.A. Radiology Doug McMahon, M.D. Midwest Ear, Nose & Throat Specialists, P.A. Otolaryngology

MetroDoctors

The Journal of the Twin Cities Medical Society

November/December 2012

29

In Memoriam RAINIS BERZINS, M.D., age 91, passed away on Saturday, August 11, 2012. Dr. Berzins attended medical school at the University of Münster in Germany and practiced family medicine.

Dr. Berzins became a member in 1968.

JOHN A. CICH, M.D. passed away at the age of 78. Dr. Cich graduated from the University of Minnesota Medical School in 1961. Following his service in the Army Medical Corps, Dr. Cich became a pediatric oncologist and hematologist practicing at the St. Louis Park Medical Center and Minneapolis Children’s Hospital. Dr. Cich became a member in 1964.

MARIO C. GARCIA, M.D., passed away September 15, 2012. Dr. Garcia practiced internal medicine at the Dakota County Internal Medicine Clinic and at St. Paul HealthPartners. He also was the medical director of several nursing homes and founded Prevent Products, Inc. Dr. Garcia developed several products for his nursing home patients. He became a member in 1974.

FREDERICK C. GOETZ, M.D. passed away August 28, 2012 at the age of 90. Dr. Goetz graduated from Harvard Medical School in 1946 and served as an Army physician in Korea. Dr. Goetz later joined the University of Minnesota in 1955 as director of the diabetes clinic devoting his career to diabetes research. Dr. Goetz became a member in 1956.

DAVID B. KISPERT, M.D., age 62, passed away in early September. Dr. Kispert graduated from the Mayo Medical School in 1976, completed his residency in diagnostic radiology in 1980, and a fellowship in neuroradiology in 1982. He joined St. Paul Radiology in 1987 becoming their first sub-specialized radiologist. Dr. Kispert became a member in 1988.

ANDREW J. LEEMHUIS, M.D., passed away September 19, 2012. Dr. Leemhuis graduated from the University of Minnesota Medical School and completed a residency in neurology and psychiatry beginning private practice in the late 1940s. In addition, Dr. Leemhuis held positions of both chief of staff and president of the medical staff at Abbott Northwestern Hospital. He became a member in 1950.

School in 1943, and received his masters in radiology in 1947. He was the founder of Suburban Imaging Consultants (now known as Suburban Imaging). Dr. Mixer became a member in 1994.

THOMAS M. RECHT, M.D., age 81, passed away on Monday, August 27, 2012. Dr. Recht graduated from the University of Nebraska Medical School and practiced at Park Nicollet for over 30 years. In addition to his practice, Dr. Recht served as medical director for Medicare Minnesota, and at Walker Methodist. Dr. Recht became a member in 1961.

DAVID R. PHILP, M.D., age 87, passed away on September 5, 2012. Dr. Philp attended the University of Louisville Medical School and worked as a family physician for 42 years in Watertown, MN. Dr. Philp became a member in 1986.

CAREER OPPORTUNITIES

See Additional Career Opportunities on page 31.

Internal Medicine?

Family Medicine?

Yup.

NEW clinic in Mahtomedi, MN? Internal and Family Medicine Opportunities Stillwater Medical Group is an 90+ provider multi-specialty group practice affiliated with Lakeview Hospital. For more than 50 years we have been providing comprehensive healthcare services with locations in the St. Croix Valley, just east of the Twin Cities metro area.

Internal and Family Medicine Physician Opportunities: Stillwater Medical Group has exciting new Internal and Family Medicine Physician opportunities at our NEW Mahtomedi, MN clinic opening Fall 2012! Additional opportunities also available in Stillwater, MN. Mahtomedi, MN? (Ma-toe-me-dye) So what if you can’t pronounce it? We can help with that. Mahtomedi is located in Washington County, on the east shore of White Bear Lake. Residents appreciate the community’s small town charm, lakeside flavor, and close proximity to the Twin Cities Metropolitan Area. In addition, the Mahtomedi School District and other area colleges offer excellence in education.

For further information please contact: Patti Lewis, Director Human Resources 1500 Curve Crest Blvd, Stillwater MN (651) 275-3304, plewis@lakeview.org stillwatermedicalgroup.com

HARRY W. MIXER, M.D., MS passed away at the age of 92 on August 3, 2012. Dr. Mixer graduated from the University of Minnesota Medical 30

November/December 2012

We’ll make it all better.

MetroDoctors

The Journal of the Twin Cities Medical Society

CAREER OPPORTUNITIES

Please also visit www.metrodoctors.com

Visit TCMS at www.metrodoctors.com

With just one click you will find information on the latest TCMS news, events and legislative issues; Board and committee actions;

Be more than a great physician.

Be a health care innovator.

If you’re ready for a change of practice, call us. We’re offering the right physician an opportunity to make a difference in rural health care as a medical leader for our small, yet innovative health plan.

past issues of MetroDoctors; and new career opportunities!

1-866-722-7770 (ask for Andrea Mohammad)

www.mnscha.org

Recruit With

MetroDoctors!

Rates starting as low as $185—call today!

Options for website listings available as well. www.metrodoctors.com

Betsy Pierre, ad sales (763) 295-5420 betsy@pierreproductions.com

MetroDoctors

The Journal of the Twin Cities Medical Society

November/December 2012

31

LUMINARY of Twin Cities Medicine

By Marvin S. Segal, M.D.

AMOS S. DEINARD, M.D. It was late summer, 1958 — the very first U of M lecture class of Medical School…gross anatomy. A tall, bright-eyed freshman entered the lecture hall from the left with a green book bag slung over his shoulder. His serious gaze focused on a seat in the second row, which he quickly occupied.

Soon after, a demure female student entered and sighted a friend next to our freshman’s seat. Our chap noted the issue, motioned to the young lady, quietly rose, relinquishing his seat and found another nearby — settling in and ready for “business.” Little did the young future physician know that he’d be carrying on that “business” on that very same campus for the next 54 years!

Amos Deinard, M.D. grew up in Minneapolis.

After achieving his B.A. at Harvard University, he returned to Minnesota to complete medical school, a pediatrics residency and research fellowship, and obtain a Masters degree in Public Health — all at the U of M. His long career at the U saw him rise in academic rank and occupy a number of positions of responsibility including directorships of the Outpatient Clinic Program and the Office of Research Ethics and Regulatory Compliance in the Graduate School — and for 15 years as the director of the Community-University Health Care Center/Variety Club Children’s Clinic… perhaps his most prominent endeavor.

Other U of M responsibilities that highlight his interests included committee participation and leadership on the Sports Medicine Committee, the Excellence Through Diversity Task Force and the Medical School Admissions Committee and the University Senate.

Amos’ numerous community activities included involvement with the Hopkins High School Improvement Council, the Neighborhood Health Care Network and the Phillips Neighborhood Collaborative.

Far ranging academic and research activities played an important role in Dr. Deinard’s career as he advised and mentored many students and residents through the years, most of whom have been assimilated into the fabric of our medical community, and he authored nearly 50 papers on a wide and meaningful range of topics including neutrophil survival, myelogenous 32

November/December 2012

leukemia treatment, adoptive children, child abuse, pediatric emergency care, Hmong/Somali/refugee characteristics and care, and pediatric dental health.

Amos’ numerous contributions have not gone unnoticed.

He is a proud member of Delta Omega (honorary society for graduate studies in Public Health) and received honors from many organizations and institutions such as the City of Minneapolis (Minneapolis Award), the U of M (Outstanding Community Service), the American Academy of Pediatrics (Outstanding Achievement), the Children’s Law Center of Minnesota (Justice for Children Award), Twin Cities Medical Society (2010 First A Physician Award), and the American Association of Public Health Dentistry recently conferred the President’s Award reflecting his contributions to oral health of children. He is most proud of his groundbreaking efforts in maternal and child care for the Minneapolis Health Department, his successes in promoting dental health in children and in developing a long-standing pro bono legal clinic to serve his needy population.

It’s obvious that Dr. Amos Deinard has never stopped giving (he continues to do so) — to his University, his community, his profession, the disadvantaged and as an advocate for children — just as he gave that seat to his fellow student on that first day of medical school so many years ago. We are honored to have him as a Luminary of Twin Cities Medicine.

This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine.

Please forward names of physicians you would like considered for this recognition to Nancy Bauer, managing editor, nbauer@metrodoctors.com.

MetroDoctors

The Journal of the Twin Cities Medical Society

+HDOWK ,7 EULQJV SRZHU WR WKH SHRSOH And power to your practice.

Take five and find out how MMIC Health IT can help you use technology to make better practice decisions and deliver higher-quality health care.

Join the Peace of Mind movement at PeaceofMindMovement.com.

Visit MMICHealthIT.com to learn more.