The Message, July 2011

message THE

A MON T HLY NE WS M AG A ZINE OF S P O K A N E C O U N T Y M E D I C A L S O C I E T Y – J U L Y 2011

George Novan, MD Recipient of the SCMS 2010 Physician/Citizen of the Year Award.

A Growing Health-Professions Ecosystem

By Brad Pope, MD SCMS President

July SCMS The Message Open2

2011 Board of Trustees Brad Pope, MD President Terri Oskin, MD President-Elect Anne Oakley, MD Vice President David Bare, MD Secretary-Treasurer Gary Knox, MD Immediate Past President Trustees: Fredric Shepard, MD Michael Cunningham, MD Paul Lin, MD Randi Hart, MD Gary Newkirk, MD Carla Smith, MD Rob Benedetti, MD Audrey Brantz, MD Louis Koncz, Jr. PAC David McClellan, MD

T a b l e o f C o n t e n ts

A Growing Health- Professions Ecosystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Increase Your Income with a Whitworth University MBA . . . . . . . . . . . . . . . . . . . . . . . . 1 Gonzaga U. School of Business Offers New MBA . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Health Informatics Program at Spokane Community College . . . . . . . . . . . . . . . . . . .

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Health Care Team Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Family Medicine through the Eyes of Our Medical Students . . . . . . . . . . . . . . . . . . . . . 8 May 21 Faculty Development Session Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 InCyte Pathology and Eastern Washington University Team Up For Education . . . . . . . . . . . 11 Project Access Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 George Novan, MD SCMS Physician/Citizen of the Year for 2010 . . . . . . . . . . . . . . . . . . 12 Major Healthcare Reform Becomes a Reality in Washington State This Year! . . . . . . . . . . . . 13 Preparing for Payment Reform and a Connected Health Care System . . . . . . . . . . . . . . . . 15 2011 Spokane Medical Student Essay - On Becoming a Physician . . . . . . . . . . . . . . . . . . 18 Turning Doctors into Leaders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Meetings, Conferences, and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 CME Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spokane County Medical Society Message Terri Oskin, MD, Editor A monthly newsletter published by the Spokane County Medical Society.

The annual subscription rate is $21.74 (this includes the 8.7% tax rate).

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Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Membership Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Advertising Correspondence Quisenberry Marketing & Design Attn: Jordan Quisenberry 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 jordan@quisenberry.net

"Our truest life is when we are in dreams awake.

Henry David Thoreau

All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

July SCMS The Message Open3

A Growing HealthProfessions Ecosystem

By Brad Pope, MD SCMS President

This May amidst a very tight budget session, the Washington Legislature allocated $35 million to build the Biomedical and Health Science Building Phase I at Washington State University Spokane (WSU). This was a huge win for our community.

While the new health building is priced at $70 million, we can now break ground on the project. And through the partnership between WSU and the University of Washington School of Medicine, the Spokane community can obtain all four years of medical studies in this building. Today only first, third and fourthyear medical students study in the Spokane region.

Let’s just celebrate this news for a moment. Many SCMS members deserve credit for their continued advocacy for the four-year medical school. Our physicians serve on the school’s curriculum advisory group and steering committee. Others have lobbied or are assisting with fundraising. Well done!

Having all four years of medical studies in Spokane will bring huge dollars and jobs to our community. Just as important, it’s another step toward solving our physician shortage because we expect some people who study and train here to choose to stay and practice in the region.

Spokane is already a regional center for healthcare, serving eastern Washington and the states around us. Many schools are preparing health professionals in our midst – including schools of dentistry, nursing, pharmacy and physical therapy at Eastern Washington University (EWU), MEDEX and Gonzaga.

Tomorrow’s leaders are studying healthcare management at Gonzaga and health administration at EWU and Washington State University. Together those schools contribute to a growing health-professions ecosystem that offers education, research and collaborative practice.

In this month’s Message, we will update you on some trends and research at our area schools. It’s important for us to know what’s going on in other disciplines because today’s healthcare practice is a team sport. No single profession can do it all to take care of our patients. I hope you enjoy the articles and learn something relevant to your practice.

In other news, your board and colleagues at SCMS continue to educate the community about our priorities. Recently SCMS CEO Keith Baldwin spoke to the Valley Sunrise Rotary Club about Project Access and about our role in promoting the four-year medical school.

In May Dr. Gary Knox, past president of SCMS, was among the leaders who approved the business plan for the medical school steering committee. The steering committee will continue to oversee five working groups to carry out different aspects of the plan.

Gary also facilitated a meeting of local physicians with Paul Umbach, a national consultant and expert on the economic impact for communities of medical schools. He encouraged physicians to participate in the expanded teaching, mentoring and clerkship opportunities that will be necessary for students.

All of those activities breathe fresh air into our health-professions ecosystem. Thanks for doing your part and for your continued leadership in our community.

Increase Your Income with a Whitworth University MBA

By Carla van Heerden SGCM Assistant School of Global Commerce and Management Do you know how to handle accounting for your office? Are you leaving your money in someone else's hands? Do you know how to market your practice? Invest in it? Build it? These are all expenses that can be easily mitigated if you effectively manage them, resulting in lower overhead costs and increased margins.

Yet it is commonly and incorrectly assumed that a physician successful in clinical practice can easily transfer those skills to managing and leading an organization. To effectively lead your business, a physician must bridge the business and medical worlds, which requires a wealth of business knowledge. Combing your clinical experience with business expertise acquired through an MBA program can help take your practice to the next level.

Earning your MBA can also help you boost your income by enabling you to do consulting work and increasing your chances of landing other management-related jobs.

Many physicians want to know whether they should get an MBA, and if they should, what type of program would be best and what career paths would be available. MBA programs come in many forms and require a range of time commitments. Pursuing an MBA can be daunting, so we encourage you to contact our staff at Whitworth, who will help guide you through every step of this process.

Why choose Whitworth MBA Whitworth’s MBA program is designed to provide you with a range of managerial and financial competencies required in today's economy. Through innovative programming, the Whitworth MBA offers full- and part-time students the opportunity to advance their careers even while completing their business degree. We put our students first, so every effort is made to provide you with a hassle-free experience.

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July SCMS The Message 1

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Networking

Utilizing an eight-module, two-course-per-module concept, full-time students can complete the required 38 semester credits in as little as 12 months. Part-time students will generally finish their requirements in two years or less. Seminar-style courses are

The Whitworth MBA offers access to a network of students, alumni, faculty, business and community leaders. This network proves extremely useful when beginning a job search, developing a career path, building business relationships in your career, or pursuing expertise outside your current field. For example, entrepreneurs need access to capital, business partners, vendors, and clients. Arts-related businesses need access to funding and strategic management in order to position themselves to be relevant in the marketplace. Global businesses need access to local business cultures as they expand their enterprises to new territories. Physicians can utilize this network to exchange concepts and practical experiences in innovation, efficiency, quality and customer responsiveness. These critical areas of focus in the physicians practice will optimize the performance of the medical team in today’s complex health services environment.

Brand The Whitworth MBA is a recognized degree that signifies management and leadership training. The Whitworth MBA has brand associations that can help open doors based on our reputation. The strength of our school's brand is based on the program's history, its ability to provide students with technical skills and opportunities for personal growth, and the reach of its alumni and industry network. Whitworth’s powerful brand can also give you the flexibility to make changes throughout your future career.

taught in the evening by experienced faculty from Whitworth's School of Global Commerce & Management. In addition to a powerful learning experience, a Whitworth MBA will give you three main value propositions: skills, networking and brand.

Skills The Whitworth MBA will give you both the "hard skills" of economics, finance, marketing, operations, management, and accounting, as well as the "soft skills" of leadership, teamwork, ethics, and communication that are so critical to effective management. Our students acquire these skills inside and outside the classroom. Since we attract students from a variety of industries and cultures, our program is able to leverage these diverse perspectives and translate them into learning opportunities. In the past year, Whitworth's MBA program has drawn students from Malawi, Uganda, Turkey and Thailand, to name a few.

Whitworth’s MBA is ideal for physicians who enjoy the intellectual challenges of business administration and for those who proactively manage their own careers. Dr. John Hengesh from Rancho Mirage talks about how valuable his MBA has been in running his private practice. Dr. Hengesh received his MBA and describes it as a “life changing event.” His only regret was that he hadn’t done it sooner, because “it would have helped considerably, since in medical school, I was never exposed to accounting and spreadsheets.” When asked what advice he would share with physicians or their assistants who are still unsure about pursuing an MBA program, he said, “I’d encourage them to do it, even if it is later in their careers. It’s very valuable. Medical practice has changed considerably over the years and there are many more opportunities out there today.”

For more information: www.whitworth.edu/sgcm or contact Susan Cook (509) 777-4298

July SCMS The Message 2

Gonzaga U. School of Business Offers New Hybrid-Model MBA in Healthcare Management

“This program will equip them with financial and managerial tools that will help them add value to their organizations and improve the services they provide.”

By Peter Tormey, News Service Editor The Gonzaga University Graduate School of Business Administration has developed a new hybrid model for its MBA in Healthcare Management Program, which will go into effect fall 2011.

The new model will include courses with both online and weekend components. Each course will be delivered 50 percent online and 50 percent in the classroom. To complete the classroom portion, students will come to campus two weekends per semester.

Originally launched in 2007, the Healthcare Management Program was designed to serve an unmet need in the Inland Northwest for professionals trained to manage the businesses that deliver healthcare services. A task force of local healthcare professionals met with representatives of Gonzaga’s Graduate School of Business Administration for six months to create a program they believe will meet the needs of the healthcare community.

“The Inland Northwest has a tradition of excellent healthcare services. The graduate programs we offer complement very well this high quality industry we serve,” commented Bud Barnes, dean of the Gonzaga School of Business Administration.

Tamara Powers, MBA in Healthcare Management student. Tamara is also the Nurse Manager at Sacred Heart Children's Hospital.

The hybrid model is being instated to better accommodate the complex work schedules of the healthcare professionals the program seeks to attract. It will also make the program accessible to students throughout Eastern and Central Washington, North Idaho, and Western Montana.

“We are extremely pleased to be able to offer our MBA in Healthcare Management Program in this new hybrid format that will allow healthcare professionals to complete half of their coursework online and still enable them to build their network and create relationships in the classroom,” said Jinny Piskel, director of Graduate Business Programs.

Those accepted into the program must meet the standard entrance requirements for the MBA, including a minimum score of 500 on the Graduate Management Admission Test (GMAT), unless they hold a professional doctoral degree, such as M.D., D.D.S., or Ph.D. An additional requirement for admission to the Program is a minimum of two years of professional experience, with at least six months in the healthcare industry. Current students in the program come from a variety of fields, including hospital administration, nursing, pharmacy, and pharmaceutical sales, and most have more than five years of professional experience.

The program requires the same 33 credits as the traditional MBA program. Students take approximately half their course work in traditional MBA classes – such as marketing theory and practice and managerial accounting – and half in healthcarespecific courses, such as healthcare finance and management of medical groups.

Courses unique to the Healthcare Management degree will be taught on a two-year rotating cycle until demand warrants they be taught more frequently. Students will be able to complete the program part time in two to four years. All courses will be available through the new hybrid model beginning fall 2012.

For more information contact Colleen Mallon, Marketing and Recruiting Specialist for Graduate Business Programs, at (509) 313-7047 or via e-mail at mallon@gonzaga.edu or Jinny Piskel, Director of Graduate Business Programs at (509) 313-3414 or via e-mail at piskel@gonzaga.edu.

The program’s Web site can be found at www.gonzaga.edu/mbahcm.

ATTENTION ALL PHYSICIANS AND PHYSICIAN ASSISTANTS

KEEP YOUR INFORMATION WITH SCMS CURRENT. Please send any changes to your address, email, personnel (specifically physicians and physician assistants) or certification to Tammy Gaiser at tammy@spcms.org or fax to (509) 325-5409.

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July SCMS The Message 4

Health Informatics Program at Spokane Community College

By Mysti Reneau, Graduate Placement Manger for Health & Environmental Sciences Spokane Community College is at the forefront of workforce development for health care communities in the Inland Northwest. The Health Informatics Program at SCC is offered for Fall Quarter 2011 as an 8-week program conducted entirely online – no textbook required - however, students will need access to a computer. Coursework begins Monday, September 26, and the instructors encourage participants to attend a faceto-face meeting the first night of class to familiarize themselves with SCC’s distance learning system and course expectations.

After completing the program, students will be prepared to: • Assist providers in implementing electronic health records to improve quality of care, safety and cost-effectiveness.

• Understand the new ONC meaningful use requirements for medical reimbursements.

• Maximize practice workflow utilizing information redesign; as well as training other staff on meaningful use requirements.

The intensity of the Office of the National Coordinator for Health IT curriculum requires that students have at least 3 years recent experience in either health care or information technology and be prepared to spend a minimum of 12-15 hours per week on the online coursework. The program is designed for dislocated IT and/ or health care workers, as well as incumbent workers in the health IT industry, who just want to upgrade skills or their understanding of the new meaningful use requirements.

Multi-practice clinics, critical access and tertiary hospitals are encouraged to contact the college for assistance in getting multiple employees signed up for the program. For more information about the Health Informatics program at SCC, visit the website at www.scc.spokane.edu/?informatics or contact Mysti Reneau, graduate placement manager for Health & Environmental Sciences, at (509) 533-7213.

This program is funded by the Office of the National Coordinator for Health IT, Department of Health & Human Services support, ARRA Grant #90CC07701.

Health Care Team Challenge

By Barb Richardson, RN, PhD, Director Riverpoint Interprofessional Education Programs The Riverpoint Inter-professional Education and Research (RIPER) student group hosted our region’s first Health Care Team Challenge (HCTC) on April 11, 2011, to learn and demonstrate how patient-centered care can be managed in a collaborative fashion. The competition, an extracurricular activity, was modeled after similar events currently held at universities across Canada, Japan and Australia.

Three teams of nine students, comprised of one representative from each of the health science programs on the Riverpoint Campus, were given a complex case study, structured to ensure there was relevant content for all professions. This collaborative inter-professional event featured students from Washington State University’s pharmacy, nursing, speech and hearing, and WWAMI medical programs, Eastern Washington University’s physical therapy, occupational therapy, dental hygiene, RIDE (dentistry) and communication disorders programs, and the University of Washington’s MEDEX physician assistants program. Dr. Brad Pope, SCMS President, assisted with judging the teams.

“Health Care Team Challenge events are held in other countries, but typically, all students are from one university,” said Barb Richardson, director of the Riverpoint Interprofessional Education and Research Department. “We have a very unique situation on the Riverpoint campus, where students are enrolled in programs at WSU, EWU and the UW. The important concept to take away from the competition is that the most effective way to deliver patient centered care is through collaborative team work. For one person to think he or she has all of the resources and all of the answers is not realistic.”

Team participants collaborated on a health care plan for a real patient, Dan, who has amyotrophic lateral sclerosis (ALS), better known as Lou Gehrig’s Disease. The competition offered reallife practice in team-based problem solving. The teamwork skills developed in the pre-competition phase were fundamental to success at the event, where each team was challenged with an additional round of previously unknown information in the clinical scenario.

“As a team, we learned what other practitioners do. Each of us brought our ideas to the table to develop a comprehensive plan of care for a patient with a very complex degenerative disease,” said Christine Olsen, a graduate student in EWU’s physical therapy program. “As grad students, we learn about the importance of team work. Participating in the HCTC allowed us to practice being a part of a health care team. I feel like we all worked really well together.”

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Continued from page 5 With the increasing prevalence of chronic diseases, new advancements in health care treatments, and the growing complexity of health care delivery systems, the need for coordination and integration of clinical care through a multidisciplinary approach has become essential. Recognizing this issue, the Institute of Medicine has called for a redesign of health professions educational programs in order to provide health care professionals, both in academic and practice settings, the knowledge, skills and attitudes to work effectively in interprofessional teams. Such programmatic redesign warrants the implementation of inter-professional education (IPE) across health care disciplines.

The Health Care Team Challenge is one model being used internationally to promote team work and greater understanding of inter-professional roles. This multidisciplinary team approach helps provide work-force ready health care graduates. Most students receive little training in how to function within an inter-professional teamwork context. Competent patient care increasingly requires practitioners to know how each of the different health professions contributes to the goal of optimizing health outcomes. Dr. Richardson notes, “the goal on the Riverpoint campus is to infuse interprofessional learning opportunities throughout all of the health science programs, in order for our graduates to be familiar with the roles of other health professionals, be skilled communicators, and be able to work collaboratively as team members for the benefit of patients.

We hope every student will have multiple chances to work with other health professionals in both classroom and practice settings before they graduate.”

The Health Care Team Challenge was very successful from the participants’ points of view. One student in the communication disorders program commented, “The experience of participating in the challenge has been one of the highlights of my first year in graduate school. I got to meet and work with some very bright students from other programs who were as passionate about

their subjects as I am about my own. I loved that everyone had something to add to the discussions regarding our patient’s health care and well being. It was nice to see how our treatment and care intertwined with that of PT and OT, the benefits of understanding pharmacy and dental, as well as hearing why physicians do what they do in order to treat. I was able to make a difference through communicating reasons and rationale to my team who otherwise wouldn't have understood the purpose of our swallowing treatments. I feel that it was a great learning experience!”

The HCTC would like to thank the SCMS Foundation for their financial support of this interprofessional event. If you would like to be involved in next year’s HCTC please contact Barb Richardson, RN, PhD, Director, Riverpoint Interprofessional Education and Research, phone #509-358-7582 or barichardson@ wsu.edu.

Members of an interprofessional student team give their presentation during the Health Care Team Challenge.

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The counseling center at St. Joseph Family Center has a fully-licensed counseling staff treating individuals, couples, seniors and families.

Licensed psychiatric nurse practitioner for medication management and medical consults with physicians.

Parenting and anger management classes, relationship and family mediation.

EMDR for trauma and PTSD. Conveniently located in the U-District by Gonzaga.

Most insurances accepted. Fee assistance available.

All faiths welcome

Call 509-483-6495 or visit us at www.sjfconline.org

Kristin Townsend Psychiatric Nurse Practitioner July SCMS The Message 6

Cancer evolves at a rapid speed.

So do our physicians.

They have chosen the fields of oncology and hematology to specialize in and are the region’s leading board certified, fellowship-trained cancer experts. Pushing the limits, they conduct hundreds of clinical trials every year, publish articles for world-recognized scientific journals and customize treatment plans for every patient. Because no two cancers – or patients – are exactly alike.

Meet the physicians of Cancer Care Northwest.

View their full profiles at: cancercarenorthwest.com/doctor-profiles

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July SCMS The Message 7

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Family Medicine through the Eyes of Our Medical Students

By Tom Schaaf, MD This summer Group Health Cooperative completed its first year of offering Family Medicine clerkships to third-year medical students. It’s been an investment of time and care, handled capably by our site coordinator Nan Smith, MD. She had great mentors in Dr. Mike Metcalf of Associated Family Physicians and Dr. Anne Montgomery of Family Medicine Spokane. We thank them for sharing their wisdom as we put the program together.

I asked Nan how the rotation made an impression on the students. Here’s what she said:

1. Family Medicine is manageable because of systems and methods In medical school, students learn that family doctors do everything. It can be overwhelming. The overriding message is that nobody can do it all. However through the clerkship students discovered that family practitioners use reliable methods and approaches to patient care, just as other specialties do.

They experienced our medical home model firsthand and observed how continuity of care is possible in an outpatient setting. For example by following patients with diabetes and hypertension, students participated in primary care office visits, set goals with the patients, worked with nurses who do patient teaching, and consulted with pharmacy, laboratory and specialists. Because many of our doctors practice obstetrics, they also experienced prenatal, labor and delivery and postpartum care.

2. They used technology, in a patient-centered manner While most students have used electronic medical records, they hadn’t really used them in a patient-centered way in the exam room prior to this rotation. So students learned to orient their computer screen to the patients, connected patients to online resources to teach them self-care and assessed their patients’ comfort levels with technology. Students used secure messaging to receive home blood sugar and blood pressure information sent by their chronically ill patients over several weeks. They participated in phone visits with patients and eventually led their own (always with disclosure to the patient and full supervision).

Sometimes they discovered that technology can’t fill a need—that was useful too.

were involved when we consulted with our specialty colleagues.

Not only would the student listen in on the phone consultation, but also our contracted medical partners in the community went beyond the call of duty to explain their rationale with our students.

Again and again, the students witnessed continuity of care: the primary physician reviewing test results with their patient, mapping out the care plan together, and then arranging follow up or specialty consultation as needed. They observed the back-end coordination that also takes place so all the vital clinical information is shared.

How was it? Frankly awesome Over six weeks students learned that Family Medicine is a demanding, intellectually stimulating profession—yet manageable. Students said patients were surprisingly complex and the clerkship was busier than they had expected. As one student wrote: “Experiencing the medical home, the huddle, and the team approach to care was valuable, and frankly awesome.” and “Being honest, I now love outpatient medicine.”

Why it’s worth it Medical education in Spokane is taking off. At Group Health our role of teaching students is a huge responsibility and a huge opportunity. It keeps our doctors on their toes and they find teaching rewarding. The students gain a snapshot of a medical practice and the medical home model for which we are known.

We get to show that primary care is a viable, highly rewarding career. They get to see that family medicine in a coordinated system is really an opportunity to do their best work. *************** Tom Schaaf, MD, is the assistant medical director for Group Health Cooperative’s Eastern Washington/North Idaho District. Boardcertified in Family Medicine, Dr. Schaaf has practiced at Group Health in Spokane since 1992, and founded its hospitalist program in 1997.

3. They witnessed collaboration between primary care and consultant physicians The students also learned how to proceed when the family doctor doesn’t have the answer. They saw us research questions during a busy clinic day, using evidence-based resources, and they July SCMS The Message 8

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May 21 Faculty Development Session Report - How to Have Fun Teaching

By Deb Harper, MD UWSOM Assistant Dean for Regional Affairs Clinical Medical Education Coordinator Eastern & Central Washington Dr. Ken Roberts received a grant from the Empire Health Foundation to do faculty development in our region. Our first conference was on Saturday morning, May 21. We had over 90 physicians and four physician assistants sign up for the 3.5 hours of CME. Physicians came from Spokane, Wenatchee, the Tri-Cities and Walla Walla. The audience was very energetic, interactive and engaged. Oh, and I did mention this was a Saturday MORNING. Anne Eacker, MD, came over from the UW Seattle to talk about giving students feedback. She was able to get this large audience to break up into small groups and practice feedback techniques.

Her only problem was trying to get them to stop talking.

Dr. Ken Roberts and Dr. George Novan started the conference off with an update on our expansion of three years ago and plans for a second year pilot, as well as information from a survey we had done about why physicians choose to teach.

Dr. Henry Mroch, a local nephrologist spoke about how to teach without losing too much productivity (hint: keep a copy of the Krebs cycle in your pocket).

A panel of four third-year students gave their points of view and answered the audience’s questions on various issues related to teaching in the clinical setting.

Finally, Dr. Matt Hollon gave a primer on how to navigate the UW library system’s Healthlinks. Many physicians who have been teaching but never bothered turning in a faculty application have started filling them out.

Several more faculty development activities are being planned for the coming academic year.

Winner of the Karry Home a Kindle Kontest Announced!

Congratulations to Dr. Lawrence Schrock, winner of the recent SCMS “Karry Home a Kindle Kontest.” Dr. Schrock’s name was drawn from among the entrants correctly indentifying a Harvey-Loomis centrifugemicroscope from the 1930s that was used for observing living cells at speeds of 1000 to 4000 rpms.

(509) 747-6194 If your patient needs wound care: We specialize in difficult wound care We offer comprehensive assessment, treatment & wound management The primary provider is informed of the patient's progress towards healing Our providers previously practiced at the Sacred Heart Outpatient Wound Clinic We coordinate wound care with community agencies for care continuity throughout the healing process

InCyte Pathology and S u r g i c aInCyte l S p e c i a lPathology ists of Spokane Eastern SHDB Clinic (509) 747-6194 | 105 W 8th Ave. Ste 7010 and Easetern w w w. s p o k aWashington n e s u r g e r y. c om July SCMS The Message 10

InCyte Pathology and Eastern Washington University Team Up For Education

By Kim A. Hagerty InCyte Pathology Corporate Communications Officer Eastern Washington University (EWU) visited InCyte Pathology’s Spokane Valley lab for assistance developing an online course highlighting technology used in healthcare for administrative, clinical and facility needs. The course will illustrate the breadth and scope of technology in healthcare as well as its impact on patients, providers and payors. Students enrolled in Health Services Administration and Health Informatics Technology programs will take the online course. Staff members from each department were asked to explain how InCyte Pathology uses information technology in their daily tasks including how state-of-the-art technology such as electronic medical records and barcoding are used to process a patient’s specimen from accessioning to when a diagnosis is reported back to the ordering physician. After that, the billing department uses technology to process approximately 17,500 insurance claims a month and the IT staff is responsible for keeping it all working seamlessly.

EWU videographer taping a session in our Gross Room, where histology specimens are initially examined by Pathologist Assistants.

Project Access Update

By Lee Taylor Director, Project Access Spokane This month I want to share information about Project Access’ capacity in the various medical specialties, and encourage our community to find ways to increase capacity where we fall well short of the community need for services.

The list below shows the approximate portion of the total value of specialty medical services provided through Project Access in each medical specialty. (The list does not include hospital services and lab work that account for more than two-thirds of the total value of services that are provided free to qualified Project Access patients.)

Project Access Specialty Medical Services

By Percentage of Total Value of Specialty Services

Video taken of the accessioning process at InCyte Pathology.

Accessioning is where all of our specimens are received from couriers and checked in.

“It is important for students to understand the extent that information technology is used throughout the healthcare industry,” said Gary Gemar, InCyte Pathology’s Chief Operating Officer and EWU alumni. “The staff at InCyte Pathology enjoyed helping EWU with this valuable project.

Cardiology

18.2%

Physical Med. & Rehab. .7%

Dermatology

7.8%

Podiatry .7%

Family Medicine

1.5%

Pulmonary Disease .2%

Gastroenterology

1.2%

Radiology

Endocrinology

1.9%

Speech Therapy

0.3%

Medical Oncology

2.9%

General Surgery

6.9%

Neurosurgery

1.5%

Vascular Surgery

1.7%

Ophthalmology

3.5%

Urology

2.9%

Otolaryngology

6.1%

Wound Care

0.8%

39.0%

he available capacity for donated services in the above listed T specialties varies significantly. Some specialties have enough capacity for us to provide medical assistance to many people quite quickly. The capacity for donated services in other specialties is far below the community need.

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Continued from page 11 Our goal at Project Access is to serve as many qualified applicants as we can, up to the capacity of our donor network, while we continually try to increase the capacity of the network.

Which specialty areas have limited capacity? You may have guessed . . .

Gastroenterology -- Neurosurgery -- Neurology -General Surgery -- Urology In the specialty areas where capacity is below the community need, patients are waiting six months or longer and many more patients are turned away. If services from those specialties can be provided at the level closer to the community need, they will be a much larger portion of our services in the list above.

The key goal of Project Access is to serve more people by increasing the capacity of the donor network in all specialty areas and particularly in the areas where capacity is limited. There are many factors that make increasing the network capacity very challenging. However, that is the goal of Project Access and we are up for the challenge.

If you would like to discuss ideas about increasing the capacity of donated specialty services I definitely want to talk with you.

Please call me at 220-2651 or email me at lee@spcms.org.

George Novan, MD SCMS Physician/Citizen of the Year for 2010

coordinator for the University of Washington third-year medical students doing their internal medicine training in Spokane. In 2009, Dr. Novan was named to Associate Director of the WWAMI first year medical education program at WSU-Spokane serving both the residency and medical school programs.

In his nomination of Dr. Novan, Dr. John McCarthy of the WWAMI program wrote, “Over the last twenty years, he has trained hundreds of physicians and through this mentoring has advanced understanding of what an excellent doctor can bring to the doctor-patient relationship. The public at-large is the ultimate beneficiary of his training because of what he demands from his students/residents: integrity, patient focus and best practices.”

Dr. Novan has garnered numerous awards. He has received the University of Washington Department of Medicine WWAMI Excellence in Teaching award three times and the UW School of Medicine WWAMI Distinguished Teacher Award twice. In 2009, he received the WSU Spokane WWAMI Teacher of the Year award. In 2008, the Washington Chapter of the American College of Physicians awarded him their Laureate Award for commitment to excellence in medical care, education and service to the community.

Since 1990 Dr. Novan has belonged to the Spokane County Medical Society and the Washington State Medical Association.

He is also a member of the American College of Physicians, the Spokane Society of Internal Medicine and Alpha Omega Alpha Honor Medical Society.

The Medical Society is proud to award the honor to Dr. George Novan.

Dr. George Novan of Internal Medicine Residency Spokane and Associate Director of WWAMI Medical Education at WSU-Spokane was named Spokane Physician/Citizen of the Year for 2010 by the Spokane County Medical Society on June 10, 2011. A plaque was presented to Dr. Novan by Brad Pope, MD, President of the Medical Society, for his outstanding contributions to the medical profession and the community.

Dr. Novan received his medical degree from the University of California Los Angeles in 1973. He completed his internal medicine residency, chief residency and infectious diseases fellowship at the University of California Irvine School of Medicine from 1973 – 1978. Dr. Novan worked in private practice from January 1978 to July 1990 in Orange, CA. Starting in March 1983, he also became the Director of the Internal Medicine Residency Program at St. Joseph Hospital in Orange, CA. Since August 1990 Dr. Novan has been with the Internal Medicine Residency Program in Spokane. In 1991, Dr. Novan became the clerkship

Dr. Brad Pope, SCMS President, presenting the 2010 Physician/ Citizen of the Year Award to Dr. George Novan.

July SCMS The Message 12

Major Healthcare Reform Becomes a Reality in Washington State This Year!

By James M. Nania MD, FACEP Medical Program Director Spokane County EMS & Trauma Care Council Co-Medical Director Northwest MedStar This year Washington State will implement a profound change in our healthcare delivery system. After three years of assessment of our current care of acute cardiac and stroke patients, a technical advisory committee to the Governor’s EMS and Trauma Steering Committee made sweeping recommendations for a formal statewide system of care for acute stroke and acute coronary syndromes (ACS ) patients. These recommendations were deemed necessary based upon the magnitude of the epidemic of premature death and disability from heart disease and stroke as well as the extreme variability identified in patient outcomes.

Furthermore, it was anticipated that with the aging of the 'baby boomer' generation, the occurrence of (ACS) and stroke will significantly increase.

These recommendations were unanimously adopted by the steering committee and in March of 2010 the Governor signed SSHB 2396. Representative Dawn Morrell was the bill's primary sponsor and our own John Driscoll, MD was one of the bill's co-sponsors. The legislation established a framework for the categorization of cardiac and stroke centers across our state and empowers EMS systems to deliver patients to the highest level of care within their service area. The bill also supports uniform guidelines for the prehospital care of these patients as well as statewide triage and destination standards. All of the recommendations are to be implemented in 2011 in a stepwise regional fashion with allowances for the region’s best prepared to begin in July and others to follow as implementation plans become formalized.

Hospital participation is voluntary but, 64 of our state’s hospitals have already applied for categorization in these new systems.

All of Spokane's major community hospitals have elected to participate. Hospitals are required to provide the essential elements of care, as identified by the state, within the level of their categorization. These systems of care are similar to our successful state trauma system. In each case the patient outcome is significantly impacted by the timeliness of the delivery of key hospital based elements of care. Early prehospital notification of the receiving hospital and 'activation' of a cardiac and stroke team have been proven to significantly reduce the time to definitive care. Saving time improves outcomes for patients with an ACS or stroke even more than the well-established "golden hour" for trauma patients. When minutes matter the lack of a formal pre-planned approach to emergency care has previously often resulted in providing time critical interventions too late. It is

the intent of these systems to better assure that we get the right patient, to the right place in the right time.

An important difference from our trauma system, where the vast majority of our patients arrive by ambulance is the need for our hospitals to rapidly assess and triage those patients who frequently arrive at the ER outside of the EMS system. Patients with a stroke or ACS often arrive by private vehicles and with vague symptoms that place a real emphasis on ER triage to attempt to sort out those whose symptoms are likely to be from a stroke or an ACS. Once the diagnosis is made, or even strongly suspected, an in-house activation of the appropriate team should be initiated. .

There are some unique elements to this attempt to reduce early death and disability in our state.

The ACS pre-hospital triage and destination tool includes cardiac arrest patients and "high risk patients in addition to those with obvious EKG evidence of an acute myocardial infarction. Given the limited sensitivity of the EKG and in recognition of its lack of availability in certain EMS systems we will attempt to bring 'risk profiling' to the field to help capture a greater number of ACS patients. Cardiopulmonary arrest (CPA) represents the most common specific pathway to premature death in our state and few communities, ours included, have been able, thus far, to equal the successful resuscitation rates of Seattle. Nationally there is widespread recognition of the need to renew our efforts to make 'sudden death' from heart disease a critical focus of our efforts. Finally, perhaps, our greatest opportunity for improved outcomes relates to patients diagnosed with unstable angina and non ST segment elevation myocardial infarctions ( UA/NSTEMI ). Although progress has been made in reducing death rates for patients with ST segment elevation myocardial infarctions ( STEMI ) the mortality of UA/NSTEMI patients is largely unchanged and of an equal magnitude. Recent evidence supports the importance of early, aggressive evaluation and treatment.

The destination portion of the 'tool' provides guidance for a key contemporary question relating to how much further an ambulance should travel to bring appropriate patients to an interventional facility( cath lab and cardiologist). The point of equipoise between fibrinolysis and angioplasty is a very complex issue. The current state recommendation takes into account EMS levels of care, state demographics, and the consequences to EMS systems of prolonged transport times.. Properly applied it should result in a greater number of patients having timely access to a cardiologist and cath lab. Consideration of early activation of aeromedical transport is a very important companion theme to increase patient access to the highest levels of care available within all of our regions.

All participating hospitals are required to provide therapeutic hypothermia for appropriate patients post cardiac arrest. This recommendation was made in direct recognition of the need to

July SCMS The Message 13

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Riverpoint Rx.pdf

1/20/10

10:55:21 AM

A Personalized Approach to Your Health Riverpoint Pharmacy is one of the few remaining pharmacies that can still offer customized medications through pharmaceutical compounding.

We can provide: • Individualized strengths, combinations and flavorings • Specialized dosage forms such as topical gells and slow release capsules • Sterile compounds such as preservative-free eye drops, injectibles and custom nebulizer solutions • Veterinary compounding Our specially trained pharmacists also offer personalized consultations in: • Nutrition evaluation and planning for improved health • Bioidentical Hormone Replacement Therapy for men and women • Review of medications and supplements • Pain management options for chronic pain and special needs

R iverpoint P

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(509) 343-6252 | 528 E. Spokane Falls Blvd. #110 www.riverpointrx.com

July SCMS The Message 14

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WAMPAC Board Names New

increase the use of this proven and very valuable intervention.

This recommendation, as well as many others came from participating physicians within the Spokane medical community.

Finally, participating hospitals are required to submit data to a local, regional or national registry to provide an objective foundation for an ongoing quality improvement process. It is through this process that we will be able to best assess the results of our system design and implementation. Beyond mortality, alone, it is hoped that currently available measures of disability will allow us to be the first state in our nation to set benchmarks for quality of life measures of the survivors of stroke and ACS. Given the depth and breadth of our state ACS and Stroke system this information will be critical to future revisions and modifications of our approach to reduce the epidemic of death and disability from heart disease and stroke in Washington State.

Whatever course the evolution of our health care system takes, as physicians, we should seek to advocate for a continuing focus on those disease processes which hurt our citizens the most and for which we have the greatest opportunity to improve the care we provide.

In the News John H. Clark, M.D. Leadership Award Samuel Selinger, M.D., Immediate Past Chair on the Executive Committee for the Washington State Medical Quality Assurance Commission, was honored by the Federation of State Medical Boards of Samuel Selinger, MD the United States, Inc. for his leadership in the field of medical licensure and discipline and commitment to advancing the public good. Dr. Selinger was appointed to the Medical Quality Assurance Commission in 2002 and has served as Commission Chair, Policy Committee Chair and on numerous task groups. During his tenure as Chair, Dr. Selinger worked to establish the commission’s Strategic Plan and Performance Measures for 2009 to 2013. He also served as Chair of the Washington Prescription Drug Assistance Foundation, appointed by the governor of Washington for two three-year board terms.

The foundation is helping people across the state obtain needed medicines from pharmaceutical programs and copay foundations. Currently, Dr. Selinger serves as an advisor to the Spokane County Medical Society Foundation’s Project Access – an innovative project he founded in Spokane to offer healthcare to area residents without health insurance. Dr. Selinger worked to obtain participation from more than 850 physicians, two hospital systems, labs, and treatment facilities and the support of the county and seven cities for basic medicines.

Members

James Mellema, MD

Four new political action committee board members were recently approved by the WSMA Executive Committee.

The following recommendations from the WAMPAC Board were accepted:

Dr. James Mellema (5th Congressional District, Spokane, PCC) Dr. Mitchell Garrison (4th District, Wenatchee, ON) Dr. Viral Shah (Federal Way, 9th District, HOS) Avi Hecht, MS4, University of Washington School of Medicine.

They join the following WAMPAC Board members: Dr. Susana Harvey (2nd District, Seattle, OBG) Dr. Fernando Proano (3rd District, Vancouver, OM), Dr. Daniel Ginsberg (6th District, Tacoma, IM) Dr. Judy M. Kimelman (8th District, Seattle, OBG), Dr. Leonard B. Alenick (9th District, Tacoma, OPTH) PA Jason Hussey (at large, Puyallup).

Officers of the WAMPAC Board are Drs. Kimelman, chair; Ginsberg, vice chair; Proano, secretary-treasurer, and Alenick, past chair. WAMPAC now operates on an election cycle budget of about $380,000, making it a significant player in political action.

Preparing for Payment Reform and a Connected Health Care System

By Jac Davies, MS, MPH Director, Beacon Community of the Inland Northwest Inland Northwest Health Services Understanding the current issues facing medical practices, clinics and hospitals and how to most effectively prepare for payment reform were the subjects of a learning session held at the Davenport Hotel on June 10. Co-hosted by the Spokane County Medical Society and the Beacon Community of the Inland Northwest (BCIN), national speakers were on hand to inform and engage physicians, administrators and other stakeholders on the various federal and regional policy and health information initiatives.

The speakers for this community-wide event included Nancy L. Fisher, MD, the Chief Medical Officer for Region 10 Center for Medicare and Medicaid Services (CMS); Niall Brennan, Acting Director, Office of Policy, CMS; Craig Brammer, Deputy Director of the Beacon Community Program, Office of the National Coordinator for Health Information Technology; L. Gordon Moore, MD, President of Ideal Medical Practices; and Jac Davies, Director of the Beacon Community of the Inland Northwest.

July SCMS The Message 15

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When it comes to your special delivery, we’ve got you covered.

We believe new moms and babies should be surrounded with comfort and care. That’s why we bring you:

• Suites designed so mom and baby can remain in the same room throughout their stay • Spacious suites with cozy amenities, a private bath and accommodations for an overnight guest • Trained OB nurses plus a Special Care Nursery for infants with more complex medical needs • Support for all types of birth plans, from natural to planned C-sections • A waiting room exclusively for families of OB patients

To schedule a tour of The Birthing Center and Special Care Nursery at Valley Hospital, call (509) 473-5475.

To find an OB physician based in the Valley, visit www.spokanevalleyhospital.com/physicians.

12606 East Mission • Spokane Valley

P e r s o n a l i z e d OB C a r e . R i g h t H e r e .

July SCMS The Message 16 53203_VHMC_OB_7_5x10c.indd 1

1/14/11 5:01 PM

Continued from page 15 “There seem to be an overwhelming number of federal initiatives affecting the nature of the health care system and the daily lives of everyone who works in it, including Meaningful Use, HIEs, ACOs and bundled payments,” said Jac Davies, director of the BCIN project. “While each of these initiatives imposes significant challenges, collectively they are serving as building blocks to help move our region toward a different kind of health system where payments are made based on outcomes and the overall health of a patient population.”

Dr. Fisher spoke about the Patient Protection Affordable Care Act and the CMS National Quality Strategy. The intent of the national quality strategy is to move from cure to prevention and from quantity to quality. To that end, she described the strategy in detail, including decreasing adverse events; ensuring patient and familycentered care; promoting effective communication and coordination of care; and care transition to avoid patient readmission.

Niall Brennan spoke further on the national initiative to define CMS as a data-driven organization. He explained the need for data to set benchmarks for better care and lower cost and the work being done to meet those goals. For those interested in health indicators, Mr. Brennan referred to www.healthindicators.gov which shows CMS data categorized by topic, geography, and initiative.

Craig Brammer addressed payment reform and a connected health care system in the context of health transformation. He explained some of the provisions of the HITECH Act, such as accelerating the use of technology and meaningful use incentives and how the Beacon Communities bring the HITECH Act to life.

The 17 Beacon Communities located from Maine to Hawaii are focusing on specific and measurable improvement goals in the three vital areas for health systems improvement: quality, costefficiency, and population health in order to demonstrate the ability of health IT to transform local health care systems. The goals of each Beacon Community vary according to their specific community need and priority, but each will demonstrate how costs can be reduced and patient care improved through the collection, analysis, and sharing of clinical data.

Gordon Moore, MD provided the primary care physician perspective on the potential of the Beacon Communities. Dr. Moore spoke of electronic data as a value-added resource and about the national movement toward supplying primary care physicians with the electronic data and care coordination under payment reform. He also eloquently articulated a physician’s frustration at trying to balance all of the competing pressures affecting practice today, including the pressures to incorporate information technology into patient care. Dr. Moore noted that he would welcome such technology only if it will improve his workflow and his ability to care for his patients.

Jac Davies showed how two projects in the region are helping local providers connect and share health information and prepare for payment reform. After one year of planning and development, the BCIN has moved into implementation mode. A group of hospitals, clinics, physician offices, laboratories, imaging centers, long term care facilities and pharmacies in the Spokane area are being connected to the BCIN infrastructure and receiving care coordination training this summer in the first phase of implementation. Other facilities around the region are being identified for implementation later this year.

In addition to an update on the BCIN, Ms. Davies provided an overview of the Virtual Lifetime Electronic Record (VLER). The Spokane VA Medical Center and Fairchild Air Force Base in Spokane have partnered with Inland Northwest Health Services (INHS) to securely exchange electronic health record (EHR) information using the Nationwide Health Information Network to provide a VLER for active duty and retired military personnel in the region. Physicians at pilot clinics in Spokane can now electronically view medical information for military personnel that was obtained at Department of Defense (DOD) or VA facilities, and military physicians can view information obtained at civilian clinics.

For more information on the VLER project, please visit www. inhs.org. For more information on the Beacon Community of the Inland Northwest or to view a video of “Preparing for Payment Reform and a Connected Health Care System” please visit www.beaconcommunity.org or call (509) 232-8148.

Visit our updated website • View "The Message" Online

• Legislative updates

-Full current and past issues available

-Connect with SCMS on Facebook and stay informed

• Membership information

• Connect to Medicor

-Information about credentialing, committees, bylaws, etc.

-The online medical library is a SCMS membership benefit.

• CME information -Topic and dates for upcoming CME courses

July SCMS The Message 17

2011 Spokane Medical Student Essay The technology of medicine can be overwhelming. The Spokane Medical Student Essay was conceived to remind students that reflection is also an important aspect of a physician's learning, and what you learn about yourself as you care for the ill and dying.

In his own words...” The practice of medicine, as I caught a glimpse of it in this instant, is many things: a profession, a science, an art and even a lifestyle. Yet in that moment, the practice of medicine, to me became a vocation."

The 2011 winner and recipient of the 500-dollar prize was first year medical student Derek Weyhrauch. This annual competition is supported by the Shikany Endowment and its purpose is to encourage medical students to reflect on the human aspect of medicine and their experiences as they began their journey to become a physician. All first year medical students at the Spokane WWAMI Riverpoint campus and all Spokane track 3rd and 4th year medical students are eligible to enter.

Submitted By Judy Swanson, MD

On Becoming a Physician

By Derek Weyhrauch The man was clearly anxious. As I sat with the last patient at our last clinic in a remote northern corner of the Dominican Republic, my mind, inexperienced as it was, could still detect that something was stirring below the surface. It was the second time that he anxiously asked if he could receive anti-parasite medication that incited me to action. Leading him to the makeshift pharmacy, I collected the Vermox tablets and a cup of cool water. He took them eagerly. Lowering the cup from his lips, I saw the man flooded with relief as a smile brightened his face. The practice of medicine, as I caught a glimpse of it in this instant, is many things: a profession, a science, an art and even a lifestyle. Yet in that moment, the practice of medicine, to me, became a vocation.

As I applied to medical school, I was surprised to learn that, for as many times as I had said the word, I did not know the true meaning of the term “physician.” Derived from the Middle English phisik, an archaic term denoting medical practice, it describes one who treats others, specifically, through curing an ailment by medication for the purpose of catharsis. I had certainly witnessed these elements in my interaction with that young man in our final clinic, seeing and feeling for myself how rewarding the ability to practice medicine would be. But what separated me then from being a physician is a decade long process of medical education and training that transforms the individual, providing one with a skill set and clarity of purpose that is at once beautiful and terrifying.

At Orientation, just before school was to begin, we discussed the concept of entering the profession with our physician faculty and advisors. At what point, we wondered, does the medical student join the ranks of his predecessors? Is it upon admission to medical school, or when one is practicing autonomously? Or, maybe, does the transition occur in tandem with a change in the length of the white coat? I don’t know how general consensus would answer this question, but in reflecting on my short breadth of experience, I can earnestly tell the reader that in my life this process has already begun. I have tried my hand at interpreting chest x-rays, lab results, and patient symptomology. I have spent late nights studying the nuances of G-protein coupled receptors and pleasant afternoons trying to interpret heart sounds. I have at one moment analyzed the trauma indicated by the CT scan of a young man only to shortly thereafter stumble over myself as I tried to comfort his family when they knew he may not make it. Becoming a physician is, as much as anything is, a life-altering process.

Plowing as I am with my head down through moments such as these, it can be easy to focus solely on the moment and lose sight of what brought me here and of what lies ahead. I often find myself viewing the title of physician as an end-point that I am striving towards, rather than the means to a new beginning that it truly is. As I become a physician, I will gain a capacity to positively impact the human condition and leave an indelible mark in the lives of others. I learned this lesson very early on at my first clinic overseas. I was serving as an English-Spanish interpreter for the team’s American physicians, and one of the doctors had just finished demonstrating the comparison between an arthritic knee and a healthy one. I was overjoyed to be gaining first hand medical experience, but was called away to address a man who was almost frantic to be seen. Later, when it was time for his examination, the physicians could not find a physical cause for his apparent suffering. In talking with the man, however, we learned that just days earlier his eight-year-old son had been killed when a concrete wall collapsed. Although we could not completely heal this man’s pain, that day I witnessed how a physician can practice the socio-emotional aspect of healing, and guide a patient to catharsis.

Reflecting on experiences like these that have led me to this point in my life, I realize how excited I am for what the future holds. As I become a physician, I may be quite surprised to learn that the maintenance of the title is in fact more difficult than its acquisition. The transition to life in medical school was a difficult one, with innumerable hours spent studying the nuances of the human body; the beauty of its function and the tragedy of its dysfunction. The immersion was and is rigorous, but I cannot imagine a greater reward for such efforts than that which lies at the end. The lifelong education undertaken by the physician is a challenge and an exciting endeavor. Becoming a physician is a journey that I am honored to have started, and I cannot wait to see where it takes me.

July SCMS The Message 18

Turning Doctors into Leaders A presentation and article by Thomas H. Lee, MD to the WSMA Leadership Development Conference, “Leading Change” May 14, 2011 A reflection on Dr. Thomas Lee’s presentation and article.

By Keith Baldwin, CEO, SCMS I was immediately struck by two things as Dr. Lee readied himself for his presentation to the WSMA Leadership Conference. First were his objectives: • Identify trends that are making change in healthcare inevitable • Describe why physician leadership is essential to manage change • Recognize the cultural forces that make change management challenging for physicians, and • Describe how improvement in value can serve as an overarching goal for all stakeholders.

They are all somewhat controversial. Many people, including some physicians, don’t always agree that change is a good thing!

The SCMS actually has a goal regarding encouraging Physician leadership in the midst of all this change, and the notion of creating value rather than volume just isn’t rewarded at all in our current system. So, he already had me interested.

Secondly, before he had gotten very far at all in his presentation, he boldly, yet with some slight embarrassment, noted that he had written a number of articles in the past and “Oh, by the way,” a small number of his quotes turned out not to be true or didn’t turn out the way he had expected. He aptly pointed out that change is messy, which is anathema to the fact that physicians are expected to be perfect in our culture, and that if physicians are going to be leaders, they have to act like leaders by admitting they make mistakes and learning from them. This isn’t just change management theory. This is cultural change in the deepest sense.

He then went on to discuss, “a path forward based upon teachings from three colleagues; Porter Strategy, Gawande Tactics, and Bohmer Operations.” The Porter bottom line is “Our shared goal should be improvement of value as defined by the outcomes that matter to patients and costs over meaningful episodes of care.”

The use of value dashboards then logically leads you to a care redesign plan. Taking from Gawande, “you need to measure these dashboard recommendations OR have a checklist of items to guide the redesign.” When you find out that you have reduced the readmission rate for a specific condition from 9% to 2%, you know you are creating value.

Finally, Dr. Lee wrapped up with Bohmer’s schematic of the “Shifting role and mission of delivery organizations.” It outlines the differences in Service Delivery versus Outcomes Generation.

For example, the management focus in Service Delivery is business process, supply chain and resource utilization versus clinical processes and system-wide performance in Outcomes Generation. Likewise, the Locus of Knowledge in Service Delivery is the individual clinician versus the organization in Outcomes Generation. So, you have to apply medical science to each individual patient through teams while measuring outcomes.

My take was that this is challenging work within a culture that incentivizes reimbursement for transactions or volumes of procedures done and patients seen. At the same time, the cost of care continues to increase with hopes of going back to the “good old days”, e.g. less regulation and medaling in the practice of medicine. I think we are entering the “New Normal,” if you have heard that term before, and we are not quite sure what that means.

I would like to finish with this - the Idea in Brief, a synopsis of Dr. Lee’s article from the Harvard Business Review, April 2010: Health care delivery is fragmented and chaotic, principally because of an explosion of knowledge and technological advances. Taming this chaos requires a new breed of leaders at every level.

Health care’s new leaders must organize doctors into teams; measure their performance not by how much they do but by how their patients fare; deftly apply financial and behavioral incentives; improve processes; and dismantle dysfunctional cultures.

By organizing care delivery around patients’ needs – an idea more radical than it sounds – the leaders of cutting-edge health care organizations are raising the quality, efficiency and value of the services they provide.

Value for Patients = Health Outcomes ______________________ Cost of Delivering Outcomes Dr. Lee noted that patient outcomes are about patients, not physician reliability, they are condition specific and costs should be measured for a single patient’s condition of care. Also, the patient experience plays a key role in determining the value of the clinical outcomes that requires collaboration across silos of care teamwork.

July SCMS The Message 19

Meetings, Conferences and Events

In Memoriam

James Archibald McCallum II, MD

Institutional Review Board (IRB) – Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at (509) 358-7631.

Caduceus Al Anon Family Group – Meets every Thursday evening from 6:15 pm until 7:15 pm at 626 N. Mullan Road, Spokane, WA. Non-smoking meeting for spouses and significant others of Healthcare Providers who are in recovery or who may need help seeking recovery. Facilitated 12 Step Al Anon Format.

No dues or fees. Contact 509-928-4102 for more information.

Physician Family Support Group — Physicians, physician spouses or significant others, and their adult family members share their experience, strength, and hope concerning difficult physician family issues which may include medical illness, mental illness, addictions, work-related stress, life transitions, and relationship difficulties. The meetings are on Tuesdays from 6:30 pm – 8 pm at Sacred Heart. Format: 12 Step principles for everyone, confidential and anonymous personal sharing; no dues or fees.

Contact Bob or Carol at 509-624-7320 for more information.

WSMA and UW Physician Leadership Course for physicians who want to know more about healthcare leadership. This is a 10week course involving online and in-person learning in partnership with the University of Washington Graduate Programs in Health Administration and the UW Professional and Continuing Education.

Dates for the next course start September 23 and go to November 18, 2011. If you are interested in the course or have a physician(s) in your organization you would like to nominate, please email Jennifer Hanscom. Applicants are asked to submit a cover letter outlining their interest in the course and the goals they hope to accomplish, a CV and a letter of reference from a supervising or mentor physician. Please send the documents to Jennifer before August 1, 2011. The course is limited to 30 individuals, and the tuition is $2,000. If you have any questions about the WSMA/UW Physician Leadership Course, please contact Jennifer Hanscom at the WSMA Seattle office (206) 441-9762 or 1 (800) 552-0612 or jen@wsma.org.

James McCallum passed away May 19, 2011 at his home in Clayton, WA. He was preceded in death by his wife and soul mate of 36 years, Catherine McCallum. Jim was born in Camden, NJ, April 28, 1933. He attended Fort Union Military Academy, the University of North Carolina and Jefferson Medical School, from which he earned his doctorate in Medicine. He practiced medicine in Anacortes and Deer Park as a General Practitioner.

He served as a Captain in the National Guard. He was also a member of the Elks and United Methodist Church.

Jim enjoyed a variety of activities including scuba diving, camping, sports, cards, board games, and played "Hadley, the butler,” in the premiere season of Anacortes Community Theatre.

He loved music and had a beautiful bass voice. He was an avid golfer and enjoyed traveling, watching the "ponies" and visiting the local Casinos. He was a friend to animals. He also liked to create jewelry and "fix it yourself" projects. He was very outgoing and loved to tell jokes and tease.

Jim was a beloved father and physician. He is survived by his five children: Kristen Comeau, Karen McCallum, Blair McCallum, Brian McCallum and Beau McCallum, 10 grandchildren and 4 greatgrandchildren. He will be deeply missed by his family and friends.

Legal Issues Update: Protecting Your Practice WSMA 90-minute webinar: Wednesday, July 27, 2011 - 12:00–1:30 pm We've identified the most commonly occurring and potentially serious legal issues that you may encounter and will train you on what actions to take to protect yourself and your practice. New and existing laws and regulations you need to know: Health care assistants and medical assistants—learn what's required of your practice, and the proposed changes that could affect your staffing.

Interpreter services and Medicaid patients. Washington's new False Claim Act—changes that pose new risks. POLST forms; Death with Dignity: meeting your patients' needs. Forthcoming rules on pain medication prescribing and CME; medical marijuana.

Tuition WSMA and WSMGMA members can attend for $89 per person. One registration fee per phone line lets your entire staff listen in. Non-members: Call for pricing.Questions? Contact Jenelle Dalit by phone at 1(800) 552-0612 or jcd@wsma.org.

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The following physicians/physician assistants have applied for membership, and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIANS Agress, Richard L., MD Obstetrics and Gynecology Med School: U of North Carolina, Chapel Hill (1978) Internship/Residency: U of Washington Medical Center (1982) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011 DiCarlo, Jason M., MD Diagnostic Radiology Med School: Eastern Virginia Medical School (2005) Internship: Carilion Roanoke Memorial (2006) Residency: Medial College of Georgia (2010) Fellowship: St. Francis Medical Center (2011) Practicing with Radia, Inc., PS beginning 8/2011

Morrison, David S., MD Obstetrics and Gynecology Med School: Tulane U (1992) Internship/ Residency: University Hospital (1996) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011 Ormazabal, Amaya, MD Diagnostic Radiology/Pediatric Radiology Med School: U of Texas Southwestern (2000) Internship: Swedish Medical Center (2001) Residency: U of Washington (2005) Fellowship: Children’s Hospital & Regional Medical Center (2006) Practicing with Radia, Inc., PS beginning 7/2011 O’Neil, Nancy A., MD Obstetrics and Gynecology Med School: Northwester U-Feinberg (1978) Internship/Residency: U of California, San Diego Medical Center (1982) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011 Reichard, Alexander K., MD Orthopaedic Surgery Med School: U of Louisville (2005) Internship/Residency: Indiana U (2010) Fellowship: The Anderson Clinic (2011) Practicing with Northwest Orthopaedic Specialists, PS beginning 8/2011

Fahmy, Jana L., MD Diagnostic Radiology/Pediatric Radiology Med School: Loma Linda U (1987) Internship Loma Linda U Medical Center (1992) Fellowship: Children’s Hospital of Los Angeles (1993) Practicing with Radia, Inc., PS beginning 7/2011 Iverson, Julie M., MD Obstetrics and Gynecology Med School: Mayo Medical School: (1991) Internship/Residency: Oregon Health Sciences U Hospital (1995) Practicing with Obstetrix Medical Group of WA, Inc., PS since 1/2009 Kelley, Michael B., MD Internal Medicine/Cardiovascular Disease Med School: U of Vermont (2004) Internship/Residency (2008) Fellowship: Vanderbilt U Medical Center (2011) Practicing with Inland Cardiology Associates beginning 8/2011 Lamuth, Delacy L, MD Diagnostic Radiology/Body Imaging Med School: New York Medical College (2004) Internship/Residency: Sound Shore Medical Center (2006) Residencies: Harlem Hospital Center (2008), St. Vincent’s Hospital (2010) Fellowship: U of Washington (2011) Practicing with Inland Imaging Associates, PS beginning 7/2011 Loos, Mary E., MD Internal Medicine Med School: U of Missouri, Kansas City (1981) Internship/Residency: University of Kentucky Hospital (1984) Practicing with Apogee Physicians since 10/2006

Reisner, Dale P., MD Obstetrics and Gynecology/Maternal-Fetal Medicine Med School: U of Washington (1982) Internship/Residency U of Texas, San Antonio (1986) Fellowship: Tufts U (1990) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011 Starley, James W., MD Obstetrics and Gynecology Med School: Creighton U (1972) Internship: Creighton U (1973) Residency: U of Utah (1976) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011 Upegui-Gomez, Jaime, MD Internal Medicine Med School: Univerisdad Pontificia Bolivariana (2003) Internship/Residency: St. Luke’s Roosevelt Hospital (2009) Practicing with Apogee Physicians since 9/2010 Whitehead, George F., MD Ophthalmology/Pediatric Ophthalmology Med School: Ohio State U College (2006) Internship: Riverside Methodist Hospital (2007) Residency: The Ohio State U (2010) Fellowship: Indiana U (2011) Practicing with Northwest Pediatric Ophthalmology beginning 7/2011 Continued on page 22

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Sukut, Chadd J., MD Dermatology/Mohs Micrographic Surgery Med School: U of Washington (2006) Practicing with Advanced Dermatology and Skin Surgery, PLLC beginning 8/2011

Continued from page 21

PHYSICIANS PRESENTED A SECOND TIME Craigg, Gerald B. R., MD Internal Medicine Loma Linda U (1996) Practicing with Sound Physicians since 5/2011 Florez, Claudia, MD Pediatrics/ Neonatal – Perinatal Medicine Med School: Escuela Colombiana De Medicina (2001) Practicing with Pediatrix Medical Group beginning 8/2011 Gaur, Shobhana, MD Internal Medicine Med School: Gandhi Medical College, India (2002) Practicing with Rockwood Clinic, PS beginning 8/2011

Sunidja, Aditya P., MD, MPH Diagnostic Radiology Med School: Boston U (2003) Practicing with Radia Inc., PS beginning 7/2011 Wood, Benjamin T., DO Obstetrics and Gynecology Med School: Michigan State U College of Osteo Med (2007) Practicing with Rockwood OB/GYN Center beginning 8/2011

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME

Khan, Shireen E., MD Diagnostic Radiology/Pediatric Radiology Med School: Washington U, St. Louis (1993) Practicing with Radia Inc., PS beginning 7/2011

Quella, Alicia K., PhD, PA-C School: U of Iowa (1999) Practicing with Valley Hospital Emergency Department (Hospital Physician Partners) since 5/2011

LoCascio, Elizabeth S., MD Internal Medicine/Pediatrics Med School: Brody School of Medicine (2003) Practicing with Rockwood Clinic, PS beginning 10/2011 Mitchell, Bryan S., MD Orthopaedic Surgery/Orthopaedic Sports Medicine Med School: Dartmouth (2005) Practicing with Orthopaedic Specialty Clinic of Spokane, PLLC beginning 9/2011

SPOKANE COUNTY MEDICAL SOCIETY CONTINUING MEDICAL EDUCATION 2011 Program Schedule SEPTEMBER

Owen, Deborah H., MD Obstetrics and Gynecology Med School: Duke U (1986) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011

Moderate (Conscious) Sedation and Analgesia Monday, September 19, 5:30 – 9:15 pm Deaconess Health and Education Center

Parekh, Shyam D., MD Anesthesiology/Cardiothoracic Anesthesiology Med School: U of Michigan (2000) Practicing with Anesthesiology Associates of Spokane beginning 9/2011 Parekh, Susanne G., MD Anesthesiology Med School: U of Michigan (2000) Practicing with Anesthesiology Associates of Spokane beginning 9/2011

(SCMS’ annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety.)

Ro, Susie I., MD Neurology/Clinical Neurophysiology Med School: McGill U, Canada (1999) Practicing with Northwest Neurological, PLLC since 5/2011 Sanchez, Sean I., MD Internal Medicine/Nephrology Med School: U of Michigan (2004) Practicing with Rockwood Kidney & Hypertension Center beginning 8/2011

OCTOBER Endocrinology Update 2011 Thursday, October 06, 5:30 – 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented)

NOVEMBER Orthopaedic Update 2011 Date TBD, 5:30 – 9:15 pm Deaconess Health and Education Center

Singh, Satinder, MD Internal Medicine/Nephrology Med School: U College of Medical Sciences, India (2001) Practicing with Rockwood Kidney & Hypertension Center beginning 10/2011 July SCMS The Message 22

(Three one-hour topics will be presented)

REAL ESTATE

Luxury Condos for Rent/Purchase near Hospitals.

Two Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, very secure and quiet. Newly Remodeled. Full appliances, including full-sized washer and dryer. Wired for cable and phone. For Rent $ 850/ month. For Sale: Seller Financing Available. Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@inreach.com.

All Costs Included--Upscale View Condo One of a kind, separate entrance condo built into an upscale home on the north side. (Owners rarely in residence) This home is located in a quiet, upscale-gated community, with panoramic views overlooking a small lake and golf course. It is totally turnkey furnished, dishes, linens, cleaning supplies etc. All new appliances, modern decor.

One bedroom (king size bed/rollway for guests) one bath, complete laundry room w/full size wash/dryer and one car garage with extra storage. ALL COSTS ARE INCLUDED! Heat/AC, Utilities/Water, Cable TV, Internet/Wi-Fi, Long Distance phone.

Golf and walking trails right out the door. Close to Holy Family Hospital and Whitworth College. Please call 954-8339 for details.

Also willing to rent "unfurnished.”

For Sale: 17718 E Linke Rd, Greenacres WA $649,900 Elegance redefined featuring a custom-built rancher and horse property situated on 5 breathtaking acres. For you over 3,800 sq feet, opulent master bedroom, formal dining, open floor plan & a gourmet kitchen. For your horses a 56’ x 48’ metal show barn, heated tack room, 12x12 wash area, 11 matted stalls, mechanical horse walker. Everything to accommodate you & your equestrian needs. Offered by John L Scott Real Estate – John Creighton at (509) 979-2535. For a virtual tour www.tourfactory.com/709316.

For Lease 3700 sq ft of second floor space in a new 18,900 sq ft building available. It is located just a few blocks from the Valley Hospital at 1424 N. McDonald (just South of Mission). First floor tenant is Spokane Valley Ear Nose Throat & Facial Plastics. $22 NNN. Please call Geoff Julian for details (509) 939-1486 or email gjulian@spokanevalleyent.com.

Sublease: Furnished Medical Office Space ~ Need immediate space for one or more north Spokane care providers?

This shared suite is ready for occupancy; all furniture and exam room equipment included. Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area. 963 sq ft total, original lease $23/sq ft; will negotiate lower rate. Excellent location in a full-service medical building with lab and full radiology services.

For more information, call (509)

South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting.

Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860.

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue.

The building has various spaces available for lease from 635 to 6,306 usable square feet available. The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include, pediatricians, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials can be emailed upon request. A Tenant Improvement Allowance is Available, subject to terms of lease. Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720. Email: psrourke@comcast.net.

OTHER

Closing OB/GYN practice – For sale 2 exam tables, 1 electric MEDICAL OFFICES/BUILDINGS

Good location and spacious suite available next to Valley Hospital on Vercler. 2,429 sq ft in building and less than 10 years old. Includes parking and maintenance of building. Please call Carolyn at Spokane Cardiology (509) 455-8820.

exam table (like new), colposcope, non-stress test machine, speculums, metal filing cabinets, office supplies, waiting room chairs and bookcases. Call 747-6600 for more information.

Northpointe Medical Center Located on the North side of Spokane, the Northpointe Medical Center offers modern, accessible space in the heart of a complete medical community.

If you are interested in locating your business here, please contact Tim Craig at (509) 688-6708. Basic info: $23 sq/ft annually. Full service lease. Starting lease length 5 years which includes an $8 sq/ft tenant improvement allowance. Available space: *Suite 210 - 2286 sq/ft *Suite 209 - 1650 sq/ft *Suite 205 1560 sq/ft *Suite 302 - 2190 sq/ft

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July SCMS The Message 24

POSITIONS AVAILABLE PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact Kelly McDonald at (509)444-8888 or kmcdonald@chas.org.

OUTREACH CLINIC AT HOUSE OF CHARITY – This is an opportunity to volunteer and bring to the underserved in our community first line medical care. We need one or two more doctors to help us. We see the homeless, predominantly, two afternoons each week. Join four Board MDs and twelve RNs to rotate once or twice monthly in an excellent, well-equipped clinic with pharmacy. If you are completely retired, the state will pay for your medical license and malpractice. For more information and to sign up, call Dr. Arch Logan, Medical Director, at (509)326-0255 or Ed McCarron, Director of the House of Charity, at (509)624-7821.

PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Pediatricians to join us in Spokane, the urban center of spectacular eastern Washington. Excellent opportunity to join a collegial, physician-led medical group affiliated with the region’s most comprehensive and caring hospitals. Providence offers generous hiring incentives, competitive compensation, comprehensive benefits and flexible work arrangements to fit individual needs.

Contact: Mark Rearrick, mark.rearrick@providence.org, (509) 4746605, www.providence.org/physicianopportunities.

PEDIATRIC HOSPITALISTS OPPORTUNITIES: If you would like the opportunity to participate in the growth of our pediatric services at Deaconess and Valley Medical Centers, please consider joining our multi-disciplinary team. We need four to five Pediatric Hospitalists at either facility. You will be working with nurses with many years of pediatric expertise. You will be part of a team of hospitalists providing 24-hour coverage/365 days per year. Please contact Evelyn Torkelson Director, Physician Recruitment, at torkele@empirehealth.org for more details.

EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty. Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, 509.565.4352, email maikeshi@ dshs.wa.gov. PO Box 800, Medical Lake, WA 99022-0800.

URGENT CARE POSITION – First Care Med Centers has four Urgent Care locations in Spokane, WA. We are seeking a Board Certified physician with comparable Urgent Care experience for a full-time position. Excellent salary and benefits package with flexible work schedule - 12-hour shifts and no call. Please contact Evelyn Torkelson at torkele@empirehealth.org or (509)473-7374.

SPOKANE REGIONAL OCCUPATIONAL MEDICINE (SROM) has an opportunity for a physician. Our treatment approach takes a comprehensive view that encompasses the medical, psychosocial and functional outcomes of the injured worker and follows best practices as defined by Washington State L&I’s Center of Occupational Health and Education (COHE). SROM is affiliated with Valley Hospital and Medical Center, Deaconess Medical Center and Rockwood Clinic. This affiliation provides exceptional administrative support, offers state of the art diagnostic services’

improving our ability to diagnose and treat, and a referral system that is unmatched. For more information contact Evelyn Torkleson, physician recruiter at (509)473-7374 or email at torkele@ empirehealth.org.

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family practice, Internal medicine and General medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy.

The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration.

Please contact Katrina Nudo at 1-800-260-1515 x2226 or email knudo@qtcm.com or visit our website www.qtcm.com to learn more about our company.

PRIMARY CARE INTERNIST WANTED (PULLMAN) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential. Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments.

We can't wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or email tkwate@palousemedical.com. Contact us today and discuss your future at Palouse Medical!

Membership Recognition for July 2011 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.

40 Years Robert N. Walker, MD

7/7/1971

George H. Rice, MD

7/26/1971

20 Years Sharon R. L. Genung, MD

7/17/1991

Keith A. Kadel, MD

7/17/1991

Daniel J. Murray, MD

7/17/1991

Joel K. Sears, MD

7/17/1991

Jon T. Stevenson, MD

7/17/1991

10 Years Scott B. Hoefer, MD

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7/9/2001

services: clinic consultations and follow-up Holter monitoring Heart rhythm monitoring echocardiography Transesophageal echocardiography stress echocardiography Nuclear stress testing Echocardiography and nuclear stress testing will be available on a full time basis to any and all practices in the Coeur d’Alene/ Spokane Valley corridor in the Valley Hospital Outpatient department supervised by Rockwood Cardiologists.

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PRSRT STD

SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

U.S. Postage

PAID

Spokane, WA Permit No. 512

ADDRESS SERVICE REQUESTED

Printed on GP Spectrum速 Paper: Certified by the Sustainable Forestry Initiative. Please recycle.

circling raven summer special

STAY AND PLAY

starting at $112 per person*

take a tour @ circlingraven.com/video

*Includes 18 holes of golf and one night stay Sun-Thurs.

Based on deluxe room double occupancy. Expires October 2nd, 2011

1 800 523-2464

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circlingraven.com

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Worley, Idaho

July SCMS The Message 27

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