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By Brad Pope, MD SCMS President

Healthcare Reform, Integrated Practices and Physician Assistants:

What are the Opportunities? Models of Physician-PA Teams

April SCMS 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: Keith Kadel, 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


Physician Assistants - Our Versatile, Vital Colleagues . . . . . . . . . . . . . . . . . . . . . . .

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Healthcare Reform, Integrated Practices and Physician Assistants . . . . . . . . . . . . . . . . . . 2 Models of Physician - PA Teams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 MEDEX Northwest Program Continues to Excel in Physician Assistant Training . . . . . . . . . . . 6 Getting a Handle on Chronic Opioid Therapy, New Rules to Come in June . . . . . . . . . . . . . 7 In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Guideline for Prescribing Opioids for Chronic Non-cancer Pain . . . . . . . . . . . . . . . . . . .


Resources for Physician Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


The Future of Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 10 Healthcare Reform Market Changes Affecting Physicians . . . . . . . . . . . . . . . . . . . . 11 Karry Home a Kindle Kontest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 "On Becoming A Doctor" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


A Physician Perspective on the Beacon Community Project . . . . . . . . . . . . . . . . . . . . . 17 Project Access Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 The Physician Pipeline Really Works! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


FYI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 CME Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Spokane County Medical Society Message Terry 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). Advertising Correspondence Quisenberry Marketing & Design Attn: Jeff Akiyama 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889


Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Other Meetings and Conferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

“The best way to cheer yourself up is to try to cheer somebody else up." Mark Twain

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.

April SCMS Message Open3

Physician Assistants – Our Versatile, Vital Colleagues

Project Access: We have been introducing the new director, Lee Taylor, to our community. Lee recently participated in a statewide meeting with other Project Access directors and visited King County to learn about operational best practices and approaches for long-term success. Watch for updates from Lee.

By Brad Pope, MD

Spokane Prescription Opioid Task Force: Our Executive A few weeks ago my colleague Dave Blomgren, PA-C, retired from a Veradale medical center. I had worked with Dave for many years when he and I were part of a practice that included four family medicine doctors. Dave had also worked in internal medicine and pediatrics, and then received specialized education in orthopedics and sports medicine.

Committee continues to support the task force to educate the community about the issue and promote best practices in physician prescriptive behavior. The most recent meeting occurred on March 16. Thanks to all who attended the WSMA CPIN “Strategies for Chronic Pain Management in Primary Care” CME program after the March Board of Trustees’ meeting.

Working with Dave allowed for tremendous synergy in our practice. For one thing we recognized our limitations, and Dave was our in-house, go-to person for orthopedic patients. In our absence, he covered our patients and we knew they were taken care of well. When we had patients who required frequent follow-up, Dave was there to tag-team in the care. There’s no question—working with Dave helped us provide the best care to our patients.

Legislative Advocacy: Dr. Anne Oakley, vice president, and

This month’s the Message explores the vital contributions of physician assistants (PA) in our healthcare system. We are pleased that many PAs are part of SCMS’s membership and we welcome even more. Physician assistants are critical to having a high functioning care system, and they will become increasingly important as their talents and training are used in new ways. In addition to their traditional services, some PAs are being tapped as health coaches, specialists in ambulatory procedures and case management roles in chronic disease management. In some systems they already play a role in managing populations with patient care registries and reaching out to patients for prevention and chronic disease management. In my organization physician assistants now perform varicose vein procedures as primary proceduralists in the surgery clinic and practice in interventional radiology. Clinic leaders are exploring how to leverage PA skills to support obstetrical care. PAs contribute to better outcomes in chronic illness by doing patient teaching, leading support groups, and creating interactive care plans for depression, asthma and hypertension. They also bring another benefit that’s priceless: that is, the PA can sometimes cement a therapeutic relationship with a patient when a physician can’t. Sometimes it’s because the patient feels more comfortable opening up to the PA or the PA can give more time. Whatever the reason, for care to be patient-centered we need all kinds of providers to serve an increasingly diverse community. The PA role will continue to evolve and be defined by the patient population’s unique needs and the strengths of every practitioner on the healthcare team. We all face this exciting future and I personally look forward to working with physician assistants even more in the future.

On other fronts Now here’s a quick update of our activity last month.

Dr. Terri Oskin, president elect, have just returned from a trip to Washington D.C. as part of our delegation to advocate for physician issues with our federal legislators. Each year SCMS attends the AMA National Advocacy Conference and ensures that a contingent of Spokane physicians is visible and heard on Capitol Hill. Locally, Dr. Gary Knox and SCMS CEO Keith Baldwin met with Spokane County representatives, as have many other community stakeholders, to talk about implementing a regional approach to health reform by creating a multi-county healthcare authority. They discussed what a regional health authority is and how it differs from an accountable care organization, as well as what the role would be for payer and provider communities. The objective is to better meet the needs of low-income residents in our area with mental health, substance abuse, developmental disability, housing and other services. Our SCMS treasurer and secretary, David Bare, MD, represented our group with Keith Baldwin at the citywide meeting. We’ll keep you informed as the initiative progresses.

Medical School: Dr. Knox and Keith Baldwin were also invited to provide input as members of the Medical School Steering Committee’s to the strategic plan. The plan was developed with the assistance of Tripp-Umbach, a consulting firm hired by Greater Spokane Incorporated, to assess the economic impact of having a four-year school in Spokane. We look forward to reporting the results of the strategic planning process.

SCMS Informatics Committee: Dr. Jeffrey Collins, chief medical officer, and Frank Otto, CIO, for Providence Sacred Heart Medical Center, spoke to the Informatics Committee in March about making electronic medical record/ HIE (Health Information Exchange) decisions. The group discussed lessons that can be passed along to other physicians in the community. This continues to be a hot topic.

PET-CT Use: SCMS acted as the convener for a meeting with Jeffery Thompson, M.D., medical director for DSHS, Medicaid and physicians (Radiologists, Oncologists and others) who use PET-CT to support their treatment regimen primarily for cancer patients. It is hoped that convening this type of meeting supports our members in their pursuit of quality care for their patients. I hope that spring finds you well. As always I enjoy hearing from you if you have a comment or idea to express. You can reach me at or 509-241-7370.

April SCMS Message 1

Healthcare Reform, Integrated Practices and Physician Assistants: What are the Opportunities?  By Steven Meltzer, PA-C Director of MEDEX Outreach and Eastern Washington Education Programs and Theresa Schimmels, PA-C Dermatology, Rockwood Clinic Washington state, and the Spokane region in particular, is moving ahead with many elements of the Patient Protection and Affordable Health Care Act of 2010. In fact, our region may be very well positioned to take advantage of several aspects of the health care reform act because of our experience in team-based care and patient-centered care. For Physician Assistants and their employers, the following are some of the elements of the reform act that are relevant: • Increases funding for PA education programs and faculty loan repayment options through re-authorization of USPHS Title VII Health Professions Programs • Fully integrates PAs into new programs such as the medical home model and independence at home program, allowing for PAs to participate in home-based primary care teams • Provides a 5 year, 10% bonus for select primary care codes furnished by PAs, providing at least 60% of all services are qualified as primary care as determined by the Secretary of Health • Allows PAs to order skilled nursing facility care for Medicare beneficiaries (effective 1/1/2011) 1 The physician-PA team, by its original design, is perfect for the new models of health care. In the many communities with small solo or group family medicine practices, the team approach provides for greater flexibility in scheduling, appropriately sharing the patient load depending on the education and skills of the PA. The implementation of electronic medical records helps to simplify communication between providers. The recent joint policy statement of the AAFP and AAPA (Feb 2011), notes that “the physician-PA team is effective because of the similarities in physician and PA education, the PA profession’s commitment to supervised practice, and the efficiencies created by utilizing the strengths of each professional in the clinical setting.” 2 The next hurdle is numbers: every federal or professional association study completed in the past decade has reported a significant projected shortage of health care professionals. This includes nurses at every level, allied health providers such as pharmacists, physical therapists and more, as well as physicians

and PAs/NPs. Although some would argue there is more a distribution problem versus a number problem, it’s clear that the growing bubble of aging “Boomers” and the overall increase of population nationally will drive the need for greater numbers of providers. The Association of American Medical Colleges report on physician supply and demand released in June 2008 noted that even with projected increases in medical school graduates over the next two decades, the U.S. would still be short adequate physicians, particularly in primary care. This report was one of the first to recognize PAs and NPs in their calculations noting there are currently approximately 75,000 practicing PAs and 140,000 NPs. Projecting almost 46% growth in those numbers by 2025, some scenarios suggest PAs and NPs could play a vital role in maintaining or increasing access to primary care services. 3 Although the number of physicians and surgeons is expected to increase by 14 percent in the next decade, registered nurses and physician assistants, for example, are projected to grow by 23 percent and 27 percent, respectively. 4 This becomes an important point since academic medical centers will not be able to bring many additional medical schools, residencies and necessary teaching facilities on line quickly enough. Even with the relative expansion of medical school admissions over the past few years, the numbers are still too small to make a significant difference in meeting future needs. What does make sense, then, is utilizing PAs within the physicianPA team in the most effective manner. Recent data from the 2009 Medical Group Management Association annual survey, shows that for every dollar collected for services provided by a PA, the practice paid only $.36 for PA compensation. 5 That’s a significant increase of revenue for any practice! And yes, although it does mean a little more time and effort to appropriately supervise the PA, over time this becomes a smaller part of the relationship as the physician becomes more comfortable with the Physician Assistant’s knowledge, skills and ability to appropriately manage patients within the practice.

Where is the Physician Assistant profession headed? There are currently 154 accredited programs nationally, five within the WWAMI-0 region. The MEDEX program at the University of Washington (UW) is the second oldest program in the nation and has campuses in Seattle, Yakima, Spokane and Anchorage, AK. In Spokane, we are fortunate in that the UW anticipated a primary care and healthcare provider shortage in eastern Washington and opened the MEDEX Spokane satellite in 1997. The Spokane program now awards a Master’s Degree, graduating an average of 24 students per year. Approximately 110 students are admitted each year to the combined Seattle program and satellites. MEDEX Spokane joined the Riverpoint campus in 2008 and is proud is be part of the expanding “Academic Health Sciences Center”. Over the past fifteen years, the PA profession has shifted to the Master’s Degree, putting it at parity with most of the other allied

April SCMS Message 2

health professions. Although there has been some discussion at the national level about the entry-level doctoral degree, there has been less than enthusiastic support. PAs who are interested in advanced degrees often pursue such degrees in leadership, business or education with the idea of teaching, research, advocacy or administration. The only doctoral program currently operational is the U.S. Army program in Texas, which partners with Baylor University. Students do their clinical program at multiple military bases including Madigan Army Medical Center in Tacoma. Started in 2008, the Army now has programs in both emergency medicine and orthopedics which it hopes will encourage greater retention. Physician Assistants practice in virtually every area of medicine, with 35-40% in primary care. The largest cohort is in Family Medicine with 25%, followed by general internal medicine (17%), emergency medicine (10%), orthopedics (10%), pediatrics (4%), general surgery (3%), and all other surgical specialties (13%). 6 Hot areas for growth include hospitalist services, dermatology, gastroenterology and various surgical subspecialties. PAs have been highly visible in orthopedics for some time and continue to be a significant benefit to those practices. Because PAs are linked directly to physicians, we see the same skewing toward specialty practice over the past three decades. Overall, the MEDEX program has one of the highest rates of all PA schools graduates choosing primary care (54%), but with declining numbers of family medicine physicians, that may change over time. The lesson, therefore, is that both MD and PA professions need to enhance applicant pools and direct training toward primary care thus reinforcing the benefits of primary care practice.

Such approaches are being used successfully across the country to expand the reach of primary care practices and improve the health of the community. With emphasis on the Physician-PA team approach to patient-centered care, the opportunities continue to expand.

Join the Physician-PA Team!! 1. AAPA Overview of New Health Insurance Reform Law, April 2010 Accessed March 7, 2011 2. Family Physicians and Physician Assistants: Team-Based Family Medicine, February 2011. Accessed March 8, 2011 3. Dill MJ, Salsberg ES The Complexities of Physician Supply and Demand: Projections Through 2025. Center for Workforce Studies, November 2008, AAMC, pp65-67 4. United States Bureau of Labor Statistics (BLS). www. Accessed March 7, 2011. 5. Medical Group Management Association. Physician Compensation and Production Survey: 2010 Report Based on 2009 Data. July 2010 6. American Academy of Physician Assistants. National Physician Assistant Census Report: Results from AAPA’s 2009 Census. Accessed March 9,2011

In addition, interdisciplinary education and clinical training will provide new opportunities for learning effective communication, utilization and practice development. Several new federal funding streams are being directed toward such interdisciplinary models and the WWAMI region is very well positioned with multiple residency programs and WWAMI sites available to support students.

So what have we learned? No one has been able to quantify just what impact health reform will have on the profession. But with an estimated 32 million more Americans acquiring health insurance within a few years, the recently passed federal health reform law means the demand for health care providers in general is likely to grow. With the current medical home model pilot projects in Washington state, and projected new projects to include more rural practices and communities, Physician Assistants can play a vital role. Helping to implement medical home models by assuming a greater role in managing chronic disease patients to improve outcomes, opening additional schedule slots to increase access, extending care via home visits and/or extended clinic hours and participating in physician-PA “pods” within a practice are just some examples.

April SCMS Message 3

April SCMS Message 4

Models of Physician-PA Teams Family Medicine Spokane Residency Program By Gary Newkirk, MD, Dale Petersen, PA-C and Barry Linehan, PA-C Dale Petersen PA-C and Barry Linehan PA-C are an integral part of the faculty at Family Medicine Spokane (FMS), a community-based Family Practice Residency Training Program in eastern Washington. The mission of FMS is to “educate and train quality, compassionate and competent family physicians to practice in the underserved rural and urban regions of the Pacific and Intermountain West.”


Dr. Gary Newkirk, FMS Program Director, remains a strong proponent for the role of PAs in providing direct provider services as well as being an integral part of the educational experience of our residents. Both of the FMS PAs are residency faculty with clinical appointments through the University of Washington Department of Family Medicine. The overwhelming majority of our graduates will leave the program and work alongside PAs. Training together is a compelling advantage.

Rockwood Clinic – Urology By Louis Koncz, PA-C

Dale Petersen, PA,C, Gary Newkirk, MD and Barry Linehan, PA-C Barry and Dale manage the day-to-day patient flow in the clinic, ensuring that residents have every opportunity to practice their trade by serving a vulnerable urban patient population that is medically undeserved. The PAs also provide patient care, working directly with the residents as an important part of an integrated healthcare team. They deliver formal training programs for the residents on topics such as ambulatory care.

Dale brings with her considerable experience as a PA focusing on women’s health care and OB/GYN, training residents on prenatal care. She also oversees and coordinates our followup management of surgical cancer screening. Barry brings an MBA to the table and has helped implement an Open Access system that meets the unique and diverse needs of a residency training program. The results include decreased waiting time to see a provider, increased patient-provider continuity and a 50% decrease in the appointment no-show rate. All provide valuable educational opportunities for our family medicine residents.

Lou Koncz, PA-C has worked as a Physician Assistant in Urology for 19 years at the Rockwood Clinic. In thinking about the relationships between physicians and PAs in Rockwood, he notes: We have 46 full and part-time Physician Assistants at the clinic. They are working in several areas within the clinic including Family Practice, Pediatrics, Internal Medicine, Dermatology, Endocrinology, Nephrology, Orthopedics, Otolaryngology, Urology, Urgent Care and Anticoagulation. PAs provide quicker access to care, the ability to see work-ins and are able to help a practice grow. Working with PAs allows physicians, especially in the surgical subspecialties, to see the more complex patients as PAs see less complex cases and follow-ups. Assisting physicians in surgery frees up another surgeon who can be seeing patients or be in surgery on another case. PAs also provide increased income to the practice with less overhead, including salary. Continued on page 6

April SCMS Message 5

Continued from page 5 At the Clinic, PAs are an integrated part of the health provider team. Recently a PA was placed on the Board of Directors as a full voting member. The Clinic recognizes the valuable services that PAs provide and seeks their input for positive changes to improve patient care. It has been shown in numerous studies that PAs are accepted by patients and provide excellent care. The benefits of a PA as part of the medical provider team are becoming more recognized as the need for providers continues to increase especially in the new medical models which are being implemented.

MEDEX Northwest Program Continues to Excel in Physician Assistant Training Paul G. Ramsey, M.D. CEO, UW Medicine Executive Vice President for Medical Affairs and Dean of the School of Medicine, University of Washington As health-care reform increases access to health services in the coming years, the demand for physicians, physician assistants and nurse practitioners will increase. Increased focus on interprofessional training and efficient teamwork also will be needed to improve the quality and safety of health care.   Interprofessional training has long been a focus at UW Medicine, as evidenced by the MEDEX Northwest Program, located within the School of Medicine, that trains physician assistants (PAs). The west coast version of the PA role was first developed in Seattle through the MEDEX Program. Ruth Ballweg, division director and program director and a graduate of the MEDEX program, has done a superb job leading the program since 1985. MEDEX began in 1969 as a joint project of the UW School of Medicine and the Washington State Medical Association. The first eight MEDEX classes were exclusively military corpsmen. The program still requires significant medical experience as a requirement for admission, although student backgrounds now include emergency medicine, nursing, allied health, and other categories of medical personnel. Forty-two years later, the program has graduated 1,800 PAs, almost all of whom are working in the WWAMI region. The MEDEX Program originally was designed to support rural physicians and to increase health-care access in the region. Currently, about 50 percent of the program’s graduates work in primary care and the remainder work in specialties. Within the UW Medicine Health System, PAs are employed in all of our clinical sites and virtually all specialties. Continued on page 14 April SCMS Message 6

Getting a Handle on Chronic Opioid Therapy, New Rules to Come in June

patient specific goals for their therapy as well as standard

By Tom Schaaf, MD

patients. In our system, the patient gets the same message

information about the risks of the narcotic, given the condition. The plan clarifies the number of refills, where they will be filled and the actions needed to stay safe. We’ve lowered the temperature on tense discussions with everywhere they go—in primary and urgent care, pharmacy, etc.

In most of our practices, we see patients who need medication to manage chronic noncancer pain.

Each patient is also assigned a risk level based on morphine equivalent dose and behavior issues, which clarifies how often

Yet for many doctors, prescribing opioid drugs to patients

we’ll see the patient and how often they will get a urine drug

poses a dilemma. We know the inherent risks to prescribing

screening. We explain that even behaviorally low-risk patients

narcotics—that patients become tolerant and may require more,

may be taking high doses, so we screen consistently for everyone.

which can lead to overdose. Washington State has one of the highest rates of overdose death in the country. From 2003 to 2008 the state death rate from prescription pain medication increased 90 percent. Poisoning is now the state’s leading cause of unintentional injury—more than vehicle accidents. Perhaps we’ve seen a patient who was manipulative about their medication because of a chemical dependency. It’s hard not to be conflicted after a few of these experiences.

In six months, our primary care teams have updated problemlist fields and created new care plans for high-risk patients. We’ll adjust the program to conform with the new rules. In 2009, the Group Health Research Institute completed a study of nearly 10,000 patients who received multiple opioid prescriptions for common chronic pain conditions like back pain and osteoarthritis. Patients who received higher opioid doses were nine times more likely to overdose than were those receiving

We, the medical community, want to give our patients the best

low doses. Still, most of the overdoses occurred among patients

treatment safely, but we are not consistent in how we handle

receiving low to medium doses, because prescriptions at those

the issue. Some of us prescribe without reservation, never

levels were much more common.

challenging the patient. Others won’t prescribe at all.

This is an issue that requires everyone’s attention. To learn more

Beginning in June 2011, Washington’s Department of Health will

about our COT Program, please contact me at (509) 241-7669 or

require five professional boards to uniformly apply new rules to

manage non-cancer chronic pain. Washington’s Medical Quality Assurance Commission represents physicians; the others boards represent nursing, osteopathic medicine, podiatry, and dentistry. See MQAC proposed rules at Professions/PainManagement/files/pmrule.pdf.

Health Cooperative’s Eastern Washington/North Idaho District. Board-certified in Family Medicine, Dr. Schaaf has practiced at program in 1997.

Six months ago Group Health deployed a Chronic Opioid Therapy (COT) process that’s intended to be compassionate while maintaining barriers to abuse. Our doctors use it throughout our medical centers. Our first step was to remove judgmental and paternalistic language from our care—from “drug-seeking” to “pain contracts.” It’s easy to label a patient—and hard to remove one once it’s there. We now flag patients in our electronic medical record’s problem list as being on COT. It’s a neutral, non-judgmental term.  We also include a brief description in the problem list of why the patient is on the medication and its limits, so a doctor can view at a glance

Developing the treatment plan with the patient is key. Our

Tom Schaaf, MD, is the assistant medical director for Group

Group Health in Spokane since 1992, and founded its hospitalist

Our approach

whether the patient is being managed.


In the News Louis Koncz, PA-C was recently elected the 2011 – 2012 President Elect of the Washington Association of Physician Assistants. Louis is the PA representative on the SCMS Board of Trustees. He graduated from the University of Utah in 1992 and works at the Rockwood Urology Center.

Jan Martinez was awarded the 18th annual Sister Peter Claver Award by Providence Sacred Heart Medical Center and Children’s Hospital. Martinez created Christ Kitchen, which helps women gain skills and work experience. Christ Kitchen is a ministry of Christ Clinic, a non-profit medical clinic serving the needs of Spokane's working poor.

doctors use a template for the treatment plan that includes April SCMS Message 7

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

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 . April SCMS Message 8

Guideline for Prescribing Opioids for Chronic Non-cancer Pain

your browser’s address window: As always, we welcome your additions to this ever-growing list of authoritative information. – Please contact George McAlister at 509-325-5010,, for more information.

Prescription opioid abuse is a growing problem in our community. During the last decade, opiate-related poisonings in Spokane County increased 102% for Emergency Department visits, 213% for hospitalizations and 25% for deaths. Researchers from the University of Washington are surveying healthcare providers in our community to evaluate the diffusion and acceptance of the Washington State’s Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain. The Spokane County Medical Society and the Spokane Regional Health District support this effort and encourage your participation. Participating in this evaluation will help strengthen knowledge about how to prevent accidental overdoses from opioid prescriptions. It is important to have as many providers participate as possible to accurately reflect provider practice. The Spokane Regional Health District and community partners can use this information to guide prevention efforts, working in partnership with the medical community. The survey typically takes less than 20 minutes to complete and is located at Participation is voluntary and responses are anonymous. There will be no benefit to the respondent for participating in this research, but it will help efforts to improve Washington State’s Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain. If you have questions about this survey please contact Kathleen Egan at (206) 685-7194 or email her at

Resources for Physician Assistants

“The Future of Health Care” By Keith Baldwin, CEO, SCMS Greater Spokane Incorporated in partnership with the Journal of Business invited the community to peer into the future on a snowy Thursday morning, February 24, 2011. They invited a diverse panel of individuals to discuss two general topics The Business of Health and Factors Driving Change and Innovation and Solutions to Deliver Quality Health Care and Reduce Costs.  The panelists included Dr. Maxine Hayes, WA State Health Office, DOH; Heidi Alessi, Attorney, K&L Gates, LLP; Jan Wigen, Employee Benefits Principal, Mercer Health & Benefits; George Iranon, CEO, Career Path Services; Brian Kingsbury, District Manager, Safeway, Inc.; Dr. Tom Schaaf, Assistant Medical Director for E. WA and N. ID, Group Health Cooperative; Dr. Ronald Inge, VP & Dental Director, WA Dental Service; Jac Davies, Director of Beacon Community of the Inland Northwest (BCIN); Dr. Lisa Shaffer, President, Signature Genomics from PerkinElmer and Dr. Ken Roberts, Director, WWAMI/WSU Spokane. Each panelist gave insightful information about their particular area of expertise and several themes seemed to consistently surface from the presentations and questions which followed. • The management of chronic disease must be a priority in

By George McAlister Health Information Resources Director

order to improve quality and reduce the cost of health care, especially diabetes care, which uses about 40% of our health

Physician assistants provide physician-directed patient care in all medical and surgical settings. To help support your clinical practice, areas of interest, and special expertise, we have created an ongoing resource category within Medicor ( for physician assistants. Over 40 resources have recently been added, including selected PAcentric websites, academic and professional associations, state boards, directories, scope of practice competencies and other specialized resources. The new “Physician Assistants” collection of resources can be found within the Medicor library information portal under the following menu headings: Find Resource>Category>Physician Assistants. Or enter this URL in

care dollar. • The PPACA (health reform law) has brought some needed improvements to the health system but it will be years before all the rules are written and we actually have “health” reform rather than insurance reform. • People (individuals) and employers must take more responsibility for preventative health behaviors and employer sponsored programs to reduce the need for expensive health services and treatments so we will all live healthier lives.

April SCMS Message 9

Continued on page 11

A Multidisciplinary Approach to Improving Quality of Life. Physical Medicine & Rehabilitation Psychology Interventional Spine Pain Medicine EMG/NCS Jamie Lewis, MD Phone: 509.464.6208

Patricia Fernandez, PsyD

Fax: 888.316.1928 April SCMS Message 10

Spokane, Washington

Continued from page 9 • The delivery of medical care must take advantage of technology and be patient centered in order to increase care coordination, be timely and improve patient and provider

10 Healthcare Reform Market Changes Affecting Physicians By Laura P. Jacobs, MPH

satisfaction. • Oral health must be considered an integral part of a healthy lifestyle. • An adequate supply of primary care physicians, who direct the team process of care with other health professionals, is critical to a new model of health care delivery which emphasizes prevention and care coordination of chronic disease. • A four-year medical school in Spokane, complemented by numerous other health professional education offerings, is critical to the economic success of this region and significant improvement in health status.

The panelists reinforced the need for creating an environment which incentivizes healthy behaviors by individuals and for the payment system reforms which will incentivize providers to improve the quality of care provided (value versus quantity). In a special report on “The Future of Health Care” in the Journal of Business (Feb 24, 2011), Dr. Brad Pope, SCMS President, noted the serious effects rising medical costs are having on patients, businesses and all sectors of the medical community. Reversing this trend will require a transformation that will include consolidation of healthcare systems, a shift to outcomebased reimbursement and more transparency when it comes to costs, quality and service for patients. “If the transformation is successful,” Dr. Pope noted, “our society will enjoy healthier people and a healthier economy.”

While the specific regulations from the Patient Protection and Affordable Care Act (“ACA”) are still evolving, the “barometer reading” for change is clear. Market place trends and healthcare reform have clear implications for physicians. The pace of change will depend on specific market dynamics, private payer initiatives, and the degree of physician organization and physician-hospital integration, not to mention government action.  Physicians in private practice have been faced with a series of challenges and opportunities in recent years, and some assume that “this too shall pass.” The risk, though, of ignoring market trends is to face the downside of evolution – extinction. Here are the top ten ways in which these market forces, dominated by healthcare reform, affect physicians. They may not all affect you now, but your radar should be scanning for “blips” of change in your market. 1.      Traditional payment will decline. Since the ACA did not “fix” the Medicare formula driven by the sustainable growth rate (“SGR”), there will be threats of decreases in the traditional Medicare fee schedule – this year close to 30 percent. While it likely that these decreases will be periodically “patched” by Congressional action, it is unlikely that Medicare fees will increase in the near future. Since many private payers link their fee schedules to Medicare rates, this means no increases for the foreseeable future. For some specialties, it will mean decreases, since Medicare and some other payers are shifting dollars from primary care to specialty services – but not adding any new money to the “pot.” The only hope of “upside” will come through new payment models such as bundled payment, shared savings, and pay-for-performance. Continued on page 12

Karry Home A Kindle Kontest! Tell us about this interesting piece of medical history and enter to win an Amazon Kindle! (Hint: this is an early piece of lab equipment originally patented in 1927). Winning a Kindle 6” 3G Wireless Reader is easy and fun! (a $189.00 value) Simply go to our website at , find this picture on one of our web pages and follow the simple instructions to enter our contest. Are we being too obvious? Of course! We’re holding this contest to increase interest among our members in both our monthly newsletter, “The Message” and our newly redesigned website. April SCMS Message 11

Continued from page 11 2.      EMR and connectivity are “table stakes.” With the passage of the American Recovery and Reinvestment Act of 2009 (“ARRA”), physicians have the opportunity to earn incentives up to $44,000 from Medicare for implementation of electronic medical records (“EMR”) that meet “meaningful use” criteria. But after 2015, penalties are imposed if practices fail to meet these criteria. Additionally, the need to be clinically integrated with other physicians and hospitals is growing due to various new payment methodologies, not to mention patient expectations. Within the next few years, it will not be a “benefit” to have an EMR AND connectivity with other providers, it will be a requirement to stay in the game. 3.      Expect to be measured – no more “invisible man (or woman).” The Physician Quality Reporting Initiative (“PQRI”) program was expanded in ACA, so that there are increasing incentives to participate through 2014, then the penalties for non-participation begin (sense a theme here?). Results will be posted publicly on the to-be developed “Physician Compare” website sponsored by CMS. This is in addition to the data gathered by payers and other private rating websites such as HealthGrades. Whether or not the measures are “right,” they will be published and available to consumers. The forward-thinking physician organizations are collecting and sharing this information among physicians now to provide timely feedback and improve organization-wide performance and outcomes. 4.      Are you now or have you ever been an ACO? ACOs will be selected by CMS beginning in 2012. Some private payers and self-insured employers are evaluating this model as a way to reduce healthcare cost inflation and improve population health. It is widely accepted that ACOs must be physician-led in order to achieve these objectives. Since the infrastructure required to function successfully as an ACO is substantial, many smaller physician groups will be participate in ACOs; others will be large enough to potentially qualify as an ACO. The key question for physicians to consider is: what role should/can we play in an ACO model, and what resources, leadership skills and partners will we need to successfully fulfill that role? 5.      Would you like to be a pilot? The ACA calls for the funding of $10 billion to the CMS Center for Medicare/Medicaid Innovation to provide grants and lead demonstration projects to identify new delivery models and/or payment models. The hope is that through incentivizing discovery, new care delivery models such as the patient-centered medical home (“PCMH”) or payment models such as bundled payment will evolve to “reduce program expenditures while preserving or enhancing quality of care.” Alert physician organizations, large and small, can participate in these demonstration projects to be at the leading edge of innovation and seize opportunities to lead the market. 6.      Access (when and how) matters. Providing the estimated 32 million or more currently uninsured individuals with access to health insurance will likely create or exacerbate access issues

for medical care. Patients already have difficulty obtaining physician appointments within a desired timeframe in some communities. Given the current shortage of primary care physicians in many markets, access to primary care is likely to be the first to be affected. Only through redesigning care delivery models, implementing electronic visits (e-visits) and other electronic tools such as telemedicine, effectively utilizing a broad array of healthcare practitioners and support staff, and empowering patients to play an active role in their health will an access “meltdown” be avoided. Even today, patients are increasingly expecting ready access (defined by the patient) to their healthcare providers through e-mail, portals, and, when necessary, the face-to–face visit at home. Physicians who cling to the traditional office visit as the only venue for care will risk declining patient preference and limited – hence declining – patient revenue. 7.      Patient expectations will continue to rise. A combination of factors will result in an increase in patient expectations for healthcare services: • The newly insured will expect to have access like anyone else. • Those with insurance may face increased cost-sharing, so will now “shop” for the best service and quality. • The Baby Boomer generation wants to avoid looking or feeling older, and will expect their healthcare provider to provide the solution(s). • There will be an increasing demand for the ability to communicate via text, social networking, or web portal with healthcare providers. • Disruptive innovators and innovations can change the competitive landscape (e.g. Google, Walmart). • Exploding wealth of data and health information will appear online for the worried well, chronically ill, or recently diagnosed patient. These factors will result in an increasingly savvy healthcare consumer who expects that their physician is responsive to their expectations. Language in the ACA speaks of rewarding providers who embrace “patient-centric” processes; physicians must take stock of their practice and processes to evaluate how well they are prepared for these expectations.  8.      Reframing the clinical workforce. The ACA includes funds to increase training positions for primary care and general surgery, add training in preventive medicine and public health, and support training for medical homes and team management of chronic disease, among other initiatives. But these will likely fall short of filling the gap of demand/capacity in many key specialties – particularly primary care. In addition, the generational shift in expectations among young physicians – for employment models that provide greater security, balanced work life, and part-time options that many small private practices cannot offer – creates a dynamic in many markets where the big groups

April SCMS Message 12

Continued on page 13

Continued from page 12

hand, hospitals are the employer of physicians at an increasing

(or hospital-owned) get bigger, and the small practices disappear as physicians retire. All this requires physicians to evaluate how their group or practice is structured for recruitment of a clinical workforce to facilitate growth and/or succession planning to meet community need. This may require looking to advanced practice nurses or physician assistants as well as a re-evaluation of compensation plans, benefits, and even medical group structure.

rate; on the other, there are many physicians who never set foot in the hospital and are unaware where the medical staff dining room is or cannot recognize key specialists other than by name. Further, many of the hopes for healthcare reform are riding on better chronic care management, which is not a skill most hospitals possess. What the new payment models (e.g., shared savings, bundled payment, PCMH) and the “triple aim” espoused by Dr. Don Berwick of CMS (i.e., “better care, improved health,

9.      No relief in operating costs. Despite the fact as previously noted that traditional sources of revenue are likely to be constrained in the future, there is nothing in the ACA or in economic trends that give practices any relief in day-to-day practice expenses. The ACA does little to mitigate increases in malpractice costs, the taxes on biotech and pharmaceutical companies are likely to increase these supply costs, and implementing EMR requires annual maintenance fees. So the recent trends of increasing overhead costs will not likely go away – unless practices evaluate new models of care or ways to achieve economies. This means evaluating how support staff are being

and lower costs”) require, though, is a care delivery system that is based on collaboration between physicians, hospitals, and other healthcare providers. To achieve optimal performance under any of the proposed payment models, whether you are a small practice or large multispecialty practice, requires collaborative physician-hospital relationships. This will require both hospitals and physicians to put aside old frameworks that assume one entity “controls” the other; how these partnerships evolve will depend on who leads innovation and demonstrates a commitment to healthcare improvement and operates effectively

utilized (i.e., are they working at the top of their qualifications in a

to remain financially strong.

way that maximizes provider productivity and effectiveness)?

HealthLeaders Media , March 10, 2011

10.     Hospital relationships matter. In recent years the “centricity” of the hospital as the focal point of the healthcare community has been affected by conflicting trends: on the one Riverpoint Rx.pdf


10:55:21 AM

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April SCMS Message 13

Continued from page 6 A two-year program, MEDEX operates four training sites — Seattle (40 students), Yakima (20 students), Spokane (20 students) and Anchorage (20 students). The Seattle and Spokane sites offer a master’s degree and the Yakima and Anchorage sites offer a bachelor’s degree.   This year, MEDEX received two new federal training grants. An equipment grant is designated for purchase of additional teaching technology for the decentralized program. A nearly $2 million expansion grant will support new training slots for an additional 50 students over the next five years. These students will receive annual stipends to support their primary care career plans.   In addition to contributing to the U.S. health workforce, MEDEX has begun working on the development and expansion of training for PA (or PA-like) programs globally. The program has hosted medical leaders from Australia, the UK, New Zealand, Ghana, Mozambique, China, South Africa and Canada to discuss the potential for PA training and practice. 2011 will bring significant leadership changes to the MEDEX Program. In June, Ruth Ballweg (left) will pass the program director responsibilities for the entry-level PA program to Terry Scott. This will allow Ruth — who will continue as division director — to focus on the broader functions of the MEDEX program, including research, innovations in medical education, post-graduate programs, global health projects, and the overall expansion of PA utilization in the region. Terry Scott is a highly respected PA leader at UW Medicine, where he has served on the MEDEX faculty and practiced at the Roosevelt Family Medicine Clinic since 1997. Terry is a past president of the Washington Academy of Physician Assistants and currently serves on the City Council for Shoreline. The MEDEX Program is a superb example of an educational program that has carefully expanded its breadth and depth as it remained focused on serving the region. I would like to thank Ruth Ballweg and her colleagues for developing and implementing one of the nation’s finest physician assistant training programs, and for remaining strongly focused on our mission of improving the health of the public.

Spokane County Medical Society 2010 PHYSICIAN/CITIZEN OF THE YEAR The DEADLINE for nominations has been extended to April 18, 2011. Any member of the Spokane County Medical Society is eligible for nomination.

For nomination forms and further information visit the SCMS website at

April SCMS Message 14

WE SPECIALIZE IN: ƒƒ ƒƒ ƒƒ ƒƒ ƒƒ ƒƒ

Angioplastyƒ(mechanicalƒwideningƒofƒtheƒbloodƒvessel) Atherectomyƒ(removingƒplaqueƒfromƒtheƒartery) Placingƒstentsƒorƒaƒballoonƒinflationƒinƒtheƒartery Implantingƒpacemakersƒtoƒimproveƒtheƒheartƒfunction Implantingƒdefibrillatorsƒtoƒnormalizeƒheartƒrhythms Electrophysiologyƒ(mapping,ƒablation,ƒpacers,ƒAICDƒdevices)

April SCMS Message 15

ƒƒ ƒƒ ƒƒ ƒƒ

Peripheralƒvascularƒissues Congestiveƒheartƒfailure Interventionalƒandƒnuclearƒcardiology Thrombolysis

Below is the winning essay of the 1st annual resident writing competition. The essay was written by Dorien McAbee, a second year resident with Internal Medicine Residency Spokane Program.


The last time I say her, and she was in a crisis – shaking, crying and telling me she no longer felt in control of her ability to

stop drinking alcohol. She felt hopeless about the future, did not care if she lived or died, and looked to me with pleading eyes. As I sat in clinic listening, I was at a loss. Do I reach for anti-depressants, Antabuse, refer to counseling? The tremendous amount of trust she placed in me, to come to me for help at one of the lowest points in her life, really weighed on me. Five hundred twenty five thousand six hundred minutes…/how do you measure, measure a year/in daylights, in sunsets/in midnights, in cups of coffee.../

This melody from a song crosses my mind when I sit down and think about the road I have been down to becoming a

doctor. How do you measure becoming a doctor? In years of training? In number of patients? In late nights studying or in tests? Memories swirl across my mind like flashes of light – running down the long fluorescent lighted hallway to a code, living out of a suitcase traveling to different rotation sites, excitement of seeing a baby born, holding a patient’s hand and telling them they were dying, the privilege I felt to be able to hold a spinal cord in my hand in anatomy lab. Also a series of “firsts” – my first week in medical school, getting my white coat, my first day of clinical rotations, my first day of residency, my first night on call, the first time someone called me “doctor”. The first time a family member was ill and everyone looked to me for answers. The first time I made a mistake. The first time I saw someone die. The first time I coded someone and they survived.

Four months later I saw my patient again in clinic. She had enrolled in an intensive outpatient counseling program and we

had gone through trails of different medication including Antabuse, Campral and Naltrexone. With tears in her eyes, and a smile on her face, she told me she had not had a drink of alcohol in ninety days, and felt like she had been given her life back. She no longer felt like she wanted to go to sleep and not wake up. As she left the clinic, she put her hand on my arm, and with a waver in her voice, told me how she did not think she was going to make it through that time. She told me sincerely how much it meant to have a doctor she trusted enough to admit she was at rock bottom and needed help.

I know that in reality, a relapse is a likely hurdle in her future. And I know there might be nothing medically I can offer.

Receiving your medical degree unfortunately does not result in waking up the next morning and having all the answers. Becoming a doctor is a journey that never ends – every patient can teach you something. I remember writing my medical school essay, about my motivation to enter this field. I talked about wanting that rewarding feeling of using my knowledge to truly change a person’s life for the better. Now, I know that despite my best efforts, some people do not improve, accept my advice, or stay compliant to therapies. But sometimes, a patient makes you stop in your tracks and reminds you to the core why you decided to do what you do.

Not everyone gets better. But some of them do. And that makes it worth it. In Memoriam

ten of those years were spent in Ethiopia helping to develop an Orthopedic training program at the Black Lion Hospital in Addis

Robert Paul Shanewise, MD

Ababa. He also served as the Director of Volunteers for Ethiopia in Orthopedic Overseas. After retiring from his practice, Bob and

Robert Shanewise passed away at home on February 26,

his wife, Helen, built and ran the assisted living facility, Moran

2011. He was born on October 13, 1921, in Akron, Ohio. Bob

Vista, located on the south hill. During his life he was very active

graduated from Mount Union College in Ohio in 1943 and in the

in the Spokane community. He was a member of Spokane Medical

fall enlisted in the Navy where he served three years. In 1950 Bob

Society and in 1983 was selected as Physician/Citizen of the Year.

graduated from the University of Rochester Medical School in

Bob enjoyed skiing, duck hunting, mountain climbing and white

New York and in 1955 he completed his residency at Washington

water canoeing. He ran in Bloomsday races from 1977 until 2004.

University in St. Louis, Missouri.

He is survived by his wife of 68 years, Helen, daughter

In 1955 Bob and his family moved to Spokane where he

Katherine (William) Hunt, sons Dr. Jack (Phillis Levin) Shanewise

began a practice as an orthopedic surgeon that lasted until 1998.

and Steven Shanewise, grandchildren Creedence (Rowena)

From 1975 until 1996 Bob volunteered for Orthopedic

Smith, Sarah and Charlotte Shanewise, nieces Sharon Smith, Christine Shanewise and nephew Craig Shanewise.

Overseas working in many third world countries. The last

April SCMS Message 16

A Physician Perspective on the Beacon Community Project By Colleen Carey, MD, Endocrinologist The Beacon Community of the Inland Northwest (BCIN) project is designed to provide support to physicians and other care providers for the management of Type 2 Diabetes Mellitus across a large, 25-county geographic area in eastern Washington and northern Idaho. The project’s overall goal is to achieve better outcomes for this growing population of patients that are typically very difficult to manage. Type 2 diabetics have multiple medical issues that must be addressed. These include blood glucose control, blood pressure and lipid management, and lifestyle intervention with nutritional and exercise counseling. They are at risk for coronary artery and peripheral vascular disease and diabetic nephropathy which may progress to dialysis or kidney transplant. Diabetic retinopathy can lead to loss of vision without timely intervention by an ophthalmologist. Managing all of these problems and coordinating subspecialty consultations create an enormous demand on the provider. There is abundant data supporting early aggressive interventions in diabetic risk factors to improve outcomes. However the care of this vulnerable population is burdensome and physicians traditionally have focused on their sicker diabetic patients, those who have progressed to severe hyperglycemia or developed serious complications. Although understandable, this focus results in a lost opportunity to prevent or delay complications by aggressively managing diabetics much earlier in the course of their disease. The BCIN project uses information technology to facilitate patient care. This includes filling information gaps so that caregivers have more complete medical records. Consultations by ophthalmologists, nephrologists, cardiologists and other medical specialists would be readily available to the provider. It is much more helpful to review what the ophthalmologist’s report found than to have only the patient’s report that he or she saw an eye doctor. Laboratory testing, such as a fasting lipid profile, would be available in the medical record so the information is known at the time of the visit and the possibility of duplicate testing could be avoided. Timely hospital in-patient and emergency department records will improve continuity of care. Standards of care have been developed through an understanding of the pathogenesis of diabetes mellitus and its complications. Those will evolve over time and health information exchange provides a way to give current guidelines in an interactive format.

Some clinics have full diabetic support with diabetic educators, nutritionists and diabetic nurse practitioners. Others have limited resources. BCIN can connect clinics with those support services depending upon their needs and help coordinate services. Participating providers can more readily track their patients’ outcomes, which will make it easier to focus on those areas where more intensive care is needed. For example, a patient may be checking blood glucose at home but unable to understand guidelines for adjusting insulin. A diabetic educator could help here. Often patients want to follow a healthier diet but lack of knowledge, limited financial resources or irregular work hours present barriers. A skilled nutritionist can help patients tackle those issues. The BCIN will help us achieve more consistent care for diabetic patients in our region. As primary care physicians participate in the BCIN project, I anticipate they will become more confident in managing their diabetic patients, and by utilizing care coordination services find that they can do so more efficiently. Dr. Colleen Carey is an Endocrinologist and the CHER Diabetes Education Center's Medical Director. She specializes in Endocrinology and Metabolism and has been in practice in Spokane, Washington since 1980. Dr. Carey obtained her degrees from Pomona College and the Medical College of Pennsylvania. She was a member of the clinical faculty of the University of Washington School of Medicine for a number of years and since January of 2010 has been an assistant clinical professor at the University, working with students and residents at the Internal Medicine Residency Clinic. She is especially interested in Diabetes Education.

Project Access Update By Lee Taylor The New Project Access Director I’m still the “new guy” for a little while. So far, so good! I am learning and gathering lots of information that will help us increase the value of Project Access in the community. A physician I know reached out to me after seeing the announcement of my position with Project Access. He said, “Welcome to our world – glad to have you on board!” And my thought was . . . yes . . . it is a different world . . . and yes . . . I feel welcome! I have already learned a great deal from many doctors and administrators who are very willing to share ideas and give me candid feedback about the value of Project Access to them and to their organizations. This is very good! It will keep us healthy, help us grow and provide the path to creating more value in the community. The baseline for this new chapter for Project Access is our performance in 2010. Last year we coordinated donated Continued on page 18

April SCMS Message 17

Continued from page 17 specialty medical services to 571 Project Access patients with acute conditions. The patients had no other way to access proper health care. They had no medical insurance and they were not eligible for any other public assistance programs to help pay for their healthcare, even though many are working. Without Project Access, they would have gone without treatment, or showed up in the emergency room when their condition went from acute to emergent. That is really good . . . but our goal in 2011 is to serve many more patients. Last year approximately 600 specialty physicians and providers volunteered their services to help Project Access patients. It is more than the previous three years, but our goal in 2011 is to build more partnerships and engage additional physicians who are willing to help more people in need. There is no question that the need for Project Access services is great, and growing. The Community Indicators Initiative of Spokane, under the leadership of Eastern Washington University, reported that 31.1% of Spokane County residents with incomes at or below the Federal poverty level are uninsured. And 20.8 % of the county’s residents with incomes between 100% and 199% of the Federal poverty level are uninsured. This research shows that the number of uninsured people in Spokane County has increased by 4.7% in the past two years. We know that negative health outcomes often correlate with low income, less educated, uninsured populations. This is a huge problem with no solution until health reform provides insurance for many more individuals . . . if it ever does. Even with successful health reform in 2014 and beyond, it is clear that ALL people will not have health insurance coverage. Project Access, and many physicians with a big heart, will continue to have an important role in helping people who have “fallen through the cracks”.

No matter how obvious the need for those services may be, I believe we need to know the quantitative value of Project Access’ services to our community at-large, and to the medical community. Reducing the use of the emergency room for non-emergency health care is one of the areas where Project Access can work to reduce the cost of medical care. We are working with area hospitals to refer patients with acute medical problems that are not a medical emergency to Project Access. Those patients can be seen by a primary care physician who has agreed to donate services. The referral provides the patient a medical home and helps make sure that they receive the proper diagnosis and a referral to a specialty physician if needed. If surgery or other hospital services are prescribed by the specialty physician or the primary physician, the patient can then access the needed care through regular hospital services, rather than being treated in the ER. And then there is opportunity to eliminate services that are not needed. That adds value to our community too. We provide case management and patient coordination services for Project Access patients. Case management services include medical screening by the Project Access nursing staff and with volunteer physicians through our Therapeutics Committee. One area where we know Project Access adds value is the screening of prescribed imaging services to insure that they are necessary and appropriate for each patient. The imaging screening alone saved over $55,000 in resources during 2010 that would have been expended unnecessarily without Project Access case management. I know there are many more ways that Project Access can collaborate with our partners to make smart and valuable decisions that will make a difference in the medical community and for Project Access patients. I am looking forward to learning more! If you have ideas that you would like to share please call me at (509) 220-2651 or email me at

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April SCMS Message 18

large. Second, our inaugural class of first-year students is now in their third year and they wanted to return to this community which gave them such support and a warm welcome.

In Memoriam

George Yip Min Wang, DO George Yip Min Wang passed away February 11. George was born in Hong Kong, China the second sibling in a family of seven, to Shung Heung Li and Din Ying Wong. He attended Diocesan Boys School in Hong Kong and graduated in 1959. At age 17 he left home and came to the United States to follow his dream of becoming a physician. He attended the Iowa College of Osteopathic Medicine and Surgery in Des Moines, Iowa and graduated with his medical degree in 1966. He completed his internship at Cafaro Memorial Hospital, Youngstown, OH in 1966-1967. From 1971-1974 he completed his residency in Psychiatry at Western Missouri Mental Health Center, University of Missouri School of Medicine, Kansas City, MO. He became certified with the American Board of psychiatry and neurology in 1977. George was an instructor at the University of Missouri School of Medicine, Kansas City from 1972-1974, and was the Adjunct Clinical Assistant Professor of Psychiatry at the University of Kansas School of Medicine. He worked at the VA Hospital in Kansas City, MO as staff psychiatrist in charge of psychiatric consultation and liaison from 1974-1976. In 1967 George joined the Navy as Lieutenant CommanderGeneral medical officer and served until 1971. He then served in the Active Reserve Navy from 1971 to 1976 when he joined the Air Force until his retirement in 1992. He worked at Eastern State Hospital as a staff psychiatrist until his retirement. George loved long walks, Mahjong Games, dinner parties, fishing and travel. He leaves behind his wife Cean, of 40 years, one son Jason of Hilo, HI, sister Alice of Vancouver, BC, brother Joseph and wife Eliza of Hong Kong, brother Edward of Hong Kong, sister Grace and husband Anthony of Hong Kong, sister Emily and husband James of Vancouver, BC, brother Robert and wife Angela of Vancouver, BC and many nephews and nieces and great nephews and nieces.

The Physician Pipeline Really Works! By Deb Harper, MD UW School of Medicine Assistant Dean for Regional Affairs & WWAMI Clinical Coordinator for Eastern & Central Washington Five years ago I began working for the UW School of Medicine’s WWAMI Program as an Assistant Dean for Eastern Washington. That year we had two 3rd year Spokane Track students (students who spend at least five of their six required clerkships here). One of them stayed on to do his residency at Family Medicine Spokane and, in July 2010, Dr Eric Tubbs joined me as a colleague in practice at Group Health. How cool is that? This year we have thirteen 3rd year Spokane Track students and we have added a 4th year Track as well. The growth of our Tracks can be attributed to two factors. First, our clerkships are getting terrific reviews from the students who appreciate the great teaching, access to patients and attendings, and the support of the Spokane medical community and community at

But wait, there’s more! Next year we will have thirteen 4th year Track students. And not all of them are from our 3rd year Track cohort. Several students who did only one or two 3rd year clerkships here had such a good learning and living experience they have asked to spend their final medical school year here as well. This year we have 67 individual students coming to Spokane for their 3rd year clerkships. We also have 59 students who are coming to eastern and central Washington for clerkships in Omak, Yakima, Walla Walla, the Tri-Cities, Othello and Wenatchee. This is our opportunity to shine and be able to attract our future colleagues, and the high quality people who will be our personal physicians in the future. If you would like to begin teaching students or if you are already teaching students but want to improve your teaching skills, you are invited to the conference “Having Fun Teaching: The Joys of Teaching Medical Students, Residents and Physician Assistant Students” on the morning of May 21. Admission is free, there will be food, lectures and time to interact with students and residents as well. We have applied for Category 1 CME (3.5 hours). For additional information, please contact John McCarthy at or me at

FYI PAML Support Medical Education By Judy Benson, MD Family Medicine Spokane, Internal Medicine Residency Spokane Transitional Year Residency The PAML Foundation has donated four laptop computers for resident use. As electronic documentation has become increasingly common, computers are in huge demand.  Resident staff have been experiencing frustration when computers on the floors of the hospital are unavailable for their patient care needs.  The PAML Foundation graciously came forward to donate computers to graduate medical education which is very much appreciated by the Family Medicine Spokane, Internal Medicine Residency Spokane and Transitional residents and faculty.  They are truly remarkable partners in furthering medical education in our region. Valley Hospital and Medical Center - Pediatric Hospitalists: In mid-March a Pediatric Hospitalist Program was added to the clinical services at the Valley Hospital and Medical Center. The hospitalists will work with the pediatric nursing staff and provide care for non-critical children on the 12-bed Family Care Services Unit. The service will also be at Deaconess Medical Center. Pediatric hospitalists will be available to care for patients 24 hours a day, 7 days a week. By calling (509) 473-PEDS, community physicians can directly admit patients to the Valley or Deaconess Pediatric Units or request a hospitalist consult. 

April SCMS Message 19


APRIL Update in Pain Management Thursday, April 28, 5:30 - 9:15 pm Evening Seminar for the Primary Care Update Conference Red Lion Inn at the Park (Two one and one-half hour topics will be presented) JUNE Endocrinology Update 2011 Wednesday, June 8, 5:30 - 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented)

Register online at This activity has been approved for AMA PRA Category 1 Credit. AAFP Preferred CME credit has been applied for and determination is pending. If you have questions about registration call Jenelle Dalit at 1-800-5520612 or If you have questions about webinar content or CPIN in general: call Lance Heineccius at (206) 9563657 or

Other Meetings, Conferences and Events 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

OCTOBER Moderate (Conscious) Sedation and Analgesia Wednesday, October 5, 5:30 - 9:15 pm Deaconess health and Education Center (SCMS' annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety)

contact the IRB office at (509) 358-7631. Caduceus Recovery Group Meeting for Healthcare Professionals – Meets every Thursday evening, 6:15 p.m. – 7:15 p.m., at 626 N. Mullan Rd, Spokane. Contact (509) 928-4102 for more information. Non-smoking meeting for Healthcare Providers in recovery. Physician Family Fitness Meeting – Physician Family Fitness

NOVEMBER Topic TBD Tuesday, November 8, 5:30 - 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented)

is a recently created meeting for physicians, physician spouses, and their adult family members to share their common problems and solutions experienced in the course of a physician’s practice and family life. The meetings are on Tuesdays from 6:30 p.m. – 8

To sign up for a Continuing Medical Education class, please contact Jennifer Anderson, CME Coordinator (509) 325-5010 ext. 28 or

p.m. at the Sacred Heart Providence Center for Faith and Healing Building, due east of the traffic circle near the main entrance of SHMC. Enter, turn right, go down the stairs, Room 14 is on your right. Format: 12-Step principles, confidential and anonymous

Continuing Medical Education

personal sharing; No dues or fees. Guided by Drs. Bob and Carol

An Overview of Care Coordination Essentials – Noon – 1:00 p.m., April 28, 2011 This one-hour webinar will present an indepth overview of the essentials for effective care coordination, giving participants a practical, four-part framework for improving how care is coordinated among clinical partners. Focused on the patient-centered medical home model of care delivery, the framework begins with taking responsibility for the care your patients receive regardless of setting and includes identifying the best practice service partners, building relationships with these partners, providing patient logistical support, and developing formal agreements and connections to improve care coordination. The webinar will be presented by Ed Wagner, MD, MPH, FACP, a general internist/ epidemiologist and Director of the MacColl Institute for Healthcare Innovation at the Group Health Cooperative Center for Health Studies. This webinar is free of charge for medical groups, physicians or other health care providers. A fee of $75 will be charged for all others.

Health Care Team Challenge – Monday, April 11 from 4:30 to

Sexton. The contact phone number is (509) 624-7320.

6:30 p.m. in the South Campus Facility Court located on the Riverpoint Campus organized by the Riverpoint Interprofessional Education and Research student group. For more information contact Barbara Richardson, RN, PhD at or (509) 358-7582. Save the Date: Saturday morning, May 21, 8:15 - 12:15. “How to have fun teaching, learning to enjoy working with medical students, residents and PA students!" The morning will include a chance to interact with medical students, information on teaching without impacting productivity and an introduction to the UW online library services.  CME Category 1 has been applied for. More information to come.

April SCMS Message 20

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.

Internship: Rochester General Hospital (2006) Residency New York U Medical Center (2009) Fellowship: New England Baptist Hospital (2010) Practicing with Inland Neurosurgery and Spine Associates since 3/2011


Chappell, John S., MD Pediatric Surgery Med School: U of Witwatersrand, South Africa (1960) Practicing with Pediatric Surgery Center since 2/2011

Barber, Anna A., MD Pediatrics Med School: U of Washington (2004) Internship/Residency: U of California, Davis (2007) Practicing with Providence Family Medicine North beginning 8/2011 Barber, Douglas R., MD Obstetrics & Gynecology Med School: U of Washington (2004) Internship/Residency: U of California, Davis (2008) Fellowship: U of California, Davis (2011) Practicing with Sacred Heart Center for Maternal Fetal Medicine beginning 8/2011 Brown, Anthony N., MD Orthopaedic Surgery Med School: U of Minnesota (1992) Internship: Hennepin County Medical Center (1993) Residency: U of California, Davis (2000) Fellowship: St John’s Health Center (2007) Practicing with Providence Orthopedic Specialties beginning 8/2011 Feliciano, Beejay A., MD Surgery/Vascular Surgery Med School: U of California, Davis (2004) Internship/Residency: Virginia Mason Medical Center (2009) Fellowship: Indiana U (2011) Practicing with Rockwood Heart & Vascular Center beginning 8/2011 Grosse, Scott E., MD Physical Medicine & Rehabilitation Med School: U of Washington (1992) Internship/Residency: U of Washington (1996) Practicing with Spine Team Spokane since 3/2011


Goswami, Sushanta K., MD Internal Medicine Med School: Sri Ramachandra U, India (1986) Practicing with Sound Physicians since 3/2011 Maixner, Andrew H., MD Anesthesiology Med School: U of Washington (2005) Practicing with Anesthesiology Associates, PS beginning 4/2011 Messick-Laeven, Petra M., MD Pediatrics Med School: U of Amsterdam, Netherlands (1995) Practicing with Pediatric Surgery Center since 1/2011 Nievera, Jr., Conrad C., MD Neurology Med School: U of the Philippines (1991) Practicing with Rockwood Clinic, PS beginning 8/2011 Pidgeon, John S., MD Neurology Med School: Upstate Medical U (2003) Practicing with Rockwood Clinic, PS since 3/2011 Saw, Eng C., MD Surgery/ Thoracic and Vascular Surgery Med School: Loma Linda U (1969) Practicing with Department of Veterans Affairs Medical Center since 7/2010 Webb, Joel D., MD Obstetrics & Gynecology/ Gynecologic Oncology Med School: U of New Mexico (1992) Practicing with Rockwood Clinic, PS beginning 6/2011

Henkel, Amy E., MD Diagnostic Radiology Med School: Creighton U (2005) Internship/Residency: Loyola U Medical Center (2010) Fellowship: The Methodist Hospital (2011) Practicing with Inland Imaging Associates, PS beginning 7/2011

Wyrick, Jared J., MD Internal Medicine Med School: Medical College of Wisconsin (2005) Practicing with Rockwood Clinic, PS beginning 8/11

Poulton, Thomas L., MD Urology Med School: Uniformed Services U of Health Sciences (1996) Internship/Residency: Madigan Army Medical Center (2003) Practicing with Rockwood Kidney and Hypertension Center beginning 5/2011

Quinlan, Linda A., PA-C Physician Assistant Med School: U of Washington, Medex Northwest (1999) Practicing with Inland Neurosurgery and Spine Associates, PS since 6/2000


Sandhu, Neelwant, MD Physical Medicine & Rehabilitation Med School: Oregon Health & Science U (2005) April SCMS Message 21

REAL ESTATE Luxury Condos for Rent/Purchase near Hospitals. 2 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 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 MEDICAL OFFICES/BUILDINGS

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. $24 NNN. Please call Geoff Julian for details (509) 939-1486 or email 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 fullservice medical building with lab and full radiology services. For more information, call (509) 981-9298. 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:

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. 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

April SCMS Message 22

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 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)325-0255 or Ed McCarron, Director of the House of Charity, at (509)624-7821. PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Pediatrician and BE/BC Family Practice Physicians. 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. Providence Physician Services (PPS) is our physician-led network of more than 100 primary and specialty care physicians in multiple clinic locations. Learn more at www. or contact Mark Rearrick or April Mayer april.mayer@ 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 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@ 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 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 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 1-800260-1515 x2226 or email or visit our website to learn more about our company. EMERGENCY ROOM PHYSICIAN POSITION OPENING NorthEast Washington Medical Group is currently recruiting for a full-time ER physician to join us in beautiful Colville, a rural northeast Washington community located 75 miles north of Spokane. NorthEast Washington Medical Group consists of 27 providers that serve a surrounding area of approximately 30,000 in the very rural tri-county area. We offer flexible hours for an ER physician or FP physician with Emergency Room experience. Our ER physicians enjoy working in the new emergency department at Mount Carmel Hospital, a 25-bed, full service critical access facility with 24/7 ER and ancillary service coverage. This is an outstanding practice community located in the middle of a wonderful recreation area with limitless opportunities for outdoor activities. Qualified individuals should contact Ed Johnson, MD, ER Medical Director, via phone at 509-685-7831 or e-mail at or Ron Rehn, DHA, Chief Executive Officer, via phone at 509-684-7723 or e-mail at rrehn@newmg. org. Mailing address is NorthEast Washington Medical Group, 1200 E Columbia, Colville, WA 99114. Visit our website at www. for more information. INTERNAL MEDICINE POSITION OPENING NorthEast Washington Medical Group is currently recruiting for a full-time (Monday through Thursday) Internal Medicine physician to join us in beautiful Colville, a rural northeast Washington community located 75 miles north of Spokane. NorthEast Washington Medical Group serves a surrounding area of approximately 30,000 in the very rural tri-county area. This is an outpatient based Internal Medicine position with call. There is supporting physician call in Family Practice, OB, surgery, and orthopedics. Our clinic physicians have privileges at Providence Mount Carmel Hospital, a 25-bed, full service critical access facility with 24/7 ER and ancillary service coverage. This is an outstanding practice community located in the middle of a wonderful recreation area with limitless opportunities for outdoor activities. Qualified individuals should contact Ramon Canto, MD, Internal Medicine Medical Director, by phone at 509-684-7706 or Ron Rehn, D.H.A., Chief Executive Officer at 509-684-7723 or e-mail at rrehn@ The mailing address is NorthEast Washington Medical Group, 1200 E Columbia, Colville WA 99114. Visit our website at for more information about Colville Medical Center P.S.

April SCMS Message 23

The design says “sophistication.” The hospitality says “Coeur d’Alene Casino.”

See what’s changing. See what isn’t.

1 800 523-2464 | CDACASINO.COM 25 miles south of Coeur d’Alene at the junction of US-95 and Hwy-58

April SCMS Message 24



U.S. Postage


Spokane, WA Permit No. 512


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

gonzaga mba in Healthcare Management

ATTEND AN INFORMATION MEETING We invite you to come learn more about Gonzaga’s new hybrid-model MBA in Healthcare Management program, with online and weekend classes for working professionals: Wednesday, June 1st, 5:30 - 7 PM at Gonzaga’s Jepson Center RSVP AT:


Questions? contact Colleen Mallon at RANKED #58 IN THE NATION BY US NEWS & WORLD REPORT

April SCMS Message 25

The Message April 2011  

Physician Assistants Our Versatile, Vital Colleagues

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