The Eastern Physician Duke Cardiology Lumberton November 2012

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s e p t e m b e r / o c to b e r 2 012

Coastal Vein and Vascular Your Partners for Comprehensive Vascular Care

T H E M A G A Z I N E F OR H E A L T H C A RE PRO F ESS I O N A L S

Also in This Issue Rethinking HER Irritable Bowel Syndrome

september/october 2012

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Editor’s Note

Healthy Partnerships Coastal Vein and Vascular is the new name of a vascular group that has served the region for more than 40 years as Coastal Surgical Specialists. It is complemented by the introduction of Vascular Access Center, a stand-alone facility next door that is dedicated to minimally invasive diagnosis and treatment, with a vascular lab and procedure suites.

In our cover story on CVV, Dr. James Chalk says most vascular patients are treated today using minimally invasive procedures. Now for CVV patients, surgery at Vascular Access Center is likely to be as uncomplicated as a regular appointment. Then patients go back to their accustomed lives, ultimately healthier and happier.

T H E M A G A Z I N E F OR H E A L T H C A RE PRO F ESS I O N A L S

Also in this issue of The Eastern Physician, we welcome a number of contributing editors.

Gynecologist Andrea Lukes discusses irritable bowel syndrome in women. On the practice management front, WebChart Inc. owner Maryan Binkley writes about the electronic health record

Editor Heidi Ketler, APR

“revolution. Marketing specialist Amanda Kanaan discusses the benefits of a personal website in

Contributing Editors

combination with a practice website. Certified financial planner Paul Pittman gives pointers are

Maryan Binkley Amanda Kanaan Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Paul Pittman, C.F.P.

minimizing risk associated with retirement plans.

Your medical news and insight are welcome, too. Also consider the power of advertising in The Eastern Physician. Your news and advertising can be delivered to more than 6,000 throughout the region’s medical community, increasing the likelihood of more informed referrals that lead to happier partnerships with colleagues and patients.

Photography Bill Goode Photography Creative Director Joseph Dally

With respect and gratitude,

Heidi Ketler

Advertising Sales Paget@EasternPhysician.com Info@EasternPhysician.com

Editor

News and Columns Please send to info@easternphysician.com

Contents

4 Cover

oastal Vein C and Vascular Your Partners for Comprehensive Vascular Care

DEPARTMENTS 8 Practice Management

Rethinking the EHR Revolution

9 Physician News Duke Cardiologist Joins SRMC Medical Staff

10 Women’s Health Identifying Irritable Bowel Syndrome in Women with Abdominal Pain

Cover Image: From left, William H. Bell III, M.D., R.V.T., F.A.C.S., board certified in thoracic and general surgery; Mark A. Sinning, M.D., R.V.T., F.A.C.S., board certified in vascular and general surgery; and James E. Chalk, M.S., M.D., board certified in vascular surgery.

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The Eastern Physician can not be held responsible for the opinions expressed or facts supplied by its authors.

Opinion expressed or facts supplied by its authors are not the responsibility of The Eastern Physician. However, The Eastern Physician makes no warrant to the accuracy or reliability of this information.

11 Practice Management

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12 Your Financial Rx

Minimize Your Retirement Plan Risks

13 News

Welcome to the Area

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Cover Story

Coastal Vein and Vascular Your Partners for Comprehensive Vascular Care

By Amanda Kanaan

For more than 40 years Coastal Surgical

Although some may associate the field of

just like they would for a regular appoint-

Specialists has been partnering with neigh-

vascular surgery with predominantly com-

ment and undergo an array of minimally

boring primary care physicians to provide

plex and invasive procedures, Coastal Vein

invasive procedures.

superior vascular care to the New Bern

and Vascular challenges this misconcep-

and surrounding communities. Now with

tion by dedicating an entire outpatient facil-

Coastal Vein and Vascular’s state-

the addition of a third physician, a newly

ity (called the “Vascular Access Center”) to

of-the-art Vascular Access Center

renovated office, and an on-site Vascular

minimally invasive vascular care. “Patients

is equipped for all interventional

Access Center, Coastal Surgical Specialists

sometimes think that because they were

endovascular procedures including:

is changing their name to Coastal Vein and

referred to a vascular surgeon that they

•A rteriograms and Venograms with

Vascular to better reflect their reputation as

will be scheduled for open surgery. The

one of the most comprehensive and state-

truth is that most of our patients are treated

• Endovenous Ablation

of-the-art vascular groups in the state.

through minimally invasive techniques per-

• Mini Stab Phlebectomy

formed right in our office,“ says Dr. James

• Sclerotherapy for Varicose Veins

Offering the full range of Vascular Surgery

Chalk, board certified vascular surgeon

• Long Term Venous Access

treatments, the specialists at Coastal Vein

and CVV’s newest addition.

• Ports and Dialysis Access

Angioplasty, Atherectomy & Stenting

• Central Venous Lines

and Vascular (CVV) partner with primary care for patients’ overall vascular health.

State-of-the-Art, Onsite Vascular Access Center

The Vascular Access Center is the most

“Board certified vascular surgeons are the

Although many vascular surgery practices

advanced outpatient endovascular facility

most qualified physicians to diagnose and

perform minimally-invasive procedures in

of its kind in the area, and boasts two high-

treat vascular disease. They are also the

an outpatient setting, CVV’s Vascular Ac-

tech procedure suites and separate pre and

only specialists that can offer all treatment

cess Center provides patients with an extra

postoperative recovery areas. A private,

options available for vascular conditions,

level of convenience by offering such pro-

second waiting area next to the procedure

including medical management, minimally

cedures right from the comfort of their pri-

room is dedicated for friends and family to

invasive catheter-based procedures, and

vate office. No hospital fees, no scheduling

comfortably wait for their loved ones.

open bypass surgery,” says Dr. William

limitations of off-site outpatient facilities;

Bell, board certified in vascular and gen-

patients can walk right into their freestand-

Coastal Vein and Vascular’s stand-alone

eral surgery.

ing, single story office off Neuse Boulevard

Vascular Access Center allows the physi-

care physicians to provide comprehensive

cians to conveniently and promptly schedule and perform procedures at a lower cost and without causing interruption to a patient’s continuity of care. All progress notes and results are available for both patients and referring physicians within one day of completing a procedure. These exclusive benefits allow for a more comfortable and streamlined patient experience unlike any other clinic in the area.

In-Office Vascular Studies CVV also has an onsite, fully functional Vascular Lab which is performed by registered A patient undergoes a cartoid ultrasound by Coastal Vein and Vascular’s Registered Vascular Tech (RVT) in the practice’s minimally invasive vascular lab.

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The Eastern Physician

vascular technologists and supervised by physicians specifically credentialed to in-

current guidelines of antiplatelet therapy, smoking cessation, and cholesterol treatment with statins.

Should the patient develop life style limiting symptoms or limb threatening wounds or ischemia, most patients will undergo an arteriogram with intervention typically consisting of angioplasty, atherectomy or stenting in CVV’s office. The majority of patients are successfully treated on an outpatient basis in this manner. With recent improvement in technique and technology, many patients Coastal Vein and Vascular’s in-office angiography suite where the physicians perform arterial and venous angioplasty, stenting and athrectomies.

who were otherwise not a candidate for open bypass surgery can now undergo minimally invasive endovascular treatment. These patients who were previously only offered an amputation now have

terpret the studies. Patients no longer need to travel to a separate

better options, many of which can be performed on an outpatient

facility, wait for the results to be interpreted and delivered, and then

basis. A small number of patients may require surgery and if so,

visit their physician’s office at a later date. This process can be con-

would be admitted to the hospital for an open bypass performed

veniently accomplished in just one visit at CVV.

by the same physician.

It is not only more convenient for patients but the physician order-

Aortic disease including aneurysms and dissections

ing the study can personally review it or be present while it is being

Any artery 50 percent larger than its native size is considered an

performed. This can often eliminate duplicate or unnecessary stud-

aneurysm. Abdominal aortic aneurysms are usually repaired once

ies. Studies performed in CVV’s office include ABI (ankle brachial

they reach greater than 5cm. Since there are some exceptions to

index) at rest and exercise, ultrasounds of the carotid, aorta, abdo-

these recommendations, it is important that patients who present

men, upper and lower extremity for veins and arteries and dialysis

with an aneurysm of any size be evaluated by a vascular surgeon.

access scans.

Most aneurysms are treated with an endovascular stent graft which usually involves an overnight hospitalization. For a minority of pa-

Comprehensive Vascular Care

tients, a traditional open repair is recommended.

The specialty of vascular surgery has rapidly evolved over the past decade to include a growing number of minimally invasive

Carotid artery disease

alternatives to traditional hospital-based surgery. Coastal Vein and

Symptomatic stenosis of 60 percent and asymptomatic stenosis of

Vascular’s fellowship trained specialists have remained at the fore-

70 percent or greater are considered for open carotid endarterec-

front of this movement to offer patients the latest in diagnosis and

tomy or carotid stenting. Both usually require an overnight hospital-

treatment options for all forms of arterial, venous and lymphatic

ization and then close post-operative lifelong surveillance.

disease. “Other specialties may treat some variation of these conditions, but we are the only surgeons who do it all,” says Dr. Mark

Lower-extremity wound/ulcers

Sinning, board certified in general and thoracic surgery.

A series of non-invasive vascular testing and an evaluation performed in our office suggest if a patient needs a revasculariza-

Some of the conditions primary care providers regularly

tion procedure to improve walking, leg pain or for the potential

refer patients include:

of wound healing. Some patients can benefit from an arteriogram

Peripheral arterial disease (PAD) This can affect up to 30% of the population over the age of 70.

(JAMA 2001; 286: 1317-1324) Most patients do not present with intermittent claudication; they have either atypical leg symptoms or no symptoms at all. These patients are at higher risk of death, myocardial infarction, stroke, and hospitalization rates of up to 21% per year. (JAMA 2007; 297: 1197-1206) Prevention and surveillance is the key to PAD management. Studies show the majority of patients will not need intervention but that these patients should be closely monitored with testing. Most are treated with medical management and a supervised exercise program. Their medication list should also be optimized to reflect the

State-of-the-art Vascular Access Center where the physicians at Coastal Vein and Vascular perform onsite dialysis access/PICC lines and central venous access procedures.

september/october 2012

5

A full spectrum of venous procedures are performed onsite. This begins with a comprehensive venous ultrasound. A specialized venous ultrasound is used to evaluate and develop a treatment plan for patients suffering from venous insufficiency. In appropriate candidates, laser or radio frequency ablation can be performed on the greater and lesser saphenous vein and perforator veins.

Larger, superficial varicosities are usually treated in the office with a micro stab phlebectomy or sclerotherapy after successful venous ablation. All procedures are followed up with an ultrasound which The caring and experienced staff at Coastal Vein and Vascular.

can be performed onsite as well. These procedures are very successful with up to 96 percent success rate at 3 years (J Vasc Surg

with intervention typically consisting of angioplasty, atherectomy

2011; 54:146-52) and can be performed during a morning or after-

or stenting or bypass to improve the blood flow to the wound.

noon office procedure. The patient experiences minimal disrup-

Renovascular hypertension If a patient presents with severe hypertension and remains uncontrolled on four blood pressure medications, a renal artery ultrasound and possibly an arteriogram can determine if the patient can benefit from revascularization of the renal arteries. These can be performed in our office with CO2 to minimize the risk of contrast to the kidneys.

Dialysis access Open AV fistulas and grafts are performed in the hospital usually on an outpatient basis. Venograms, fistulagrams with interventions such as angioplasty and stenting, and thrombectomizing a clotted access can be performed in our office.

tion to their schedule and most return to work the following day, all while avoiding an admission to the hospital.

A frequently unrecognized cause of venous insufficiency and varicose veins is a proximal obstruction, which can be diagnosed in the office with a venogram and intravascular ultrasound and treated with angioplasty and stenting

Your Partners in Vascular Health Coastal Vein and Vascular partners with primary care physicians in the comprehensive management of patients’ vascular health by providing the most convenient and leading edge treatments available. Specializing in minimally invasive endovascular procedures performed at their onsite Vascular Access Center, the board certified

Deep venous thrombosis

experts at Coastal Vein and Vascular continuously strive to provide

A comprehensive ultrasound is the first step to determine if a pa-

patients with the latest in alternatives to hospital-based surgeries.

tient will benefit from percutaneous intervention to treat and re-

The physicians at Coastal Vein and Vascular strive to maintain close

move the thrombus.

relationships with the referring community. If you would like to meet the physicians, please contact the practice at (252) 638-8118.To learn

Varicose veins and venous insufficiency

more about the group, including their location in New Bern across

Cosmetic and symptomatic venous problems can be treated in-

from Carolina East Medical Center, please visit www.cvVascular.com.

office. Only symptomatic patients who fail conservative therapy are considered for invasive treatments.

Minimally-Invasive Vein Treatments for Varicose Veins and Venous Insufficiency Nearly half of the adult population suffers from undesirable and sometimes painful vein disease according to the Society for Vascular Surgery (SVS). While many patients consider varicose and spider veins to be an unsightly cosmetic issue, if left untreated varicose veins can worsen and eventually cause pain, swelling and aching in the legs as well as skin changes such as rashes, redness and sores. Previously only symptomatic patients who failed conservative therapy were considered for invasive surgical therapy at the hospital. Now nearly all venous disease can be treated as an outpatient in the office from sclerotherapy to endovenous ablation to deep venous angioplasty and stenting.

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Coastal Vein and Vascular’s modern and well-designed patient reception and waiting area.

Practice Management

Rethinking the

EHR Revolution

By Maryan Binkley

For years, experts have pointed to electronic health records as a cure for many of the problems hindering our health care system, including the inability of physicians to quickly access a patient’s history.

Maryan Binkley is the owner and president of WebChart Inc. WebChart specializes in providing webbased, total medical data documentation solutions for physician practices, surgery centers and hospitals. Ms. Binkley graduated from nursing school in 1968 and began her career in a physician practice in the Washington, D.C., area. In 1974 she earned a bachelor’s degree in business administration.

Ms. Binkley has worked in health care since 1968 in both clinical and administrative positions, providing her working knowledge of the challenges facing physicians and staff in today’s rapidly changing environment.

Contact Maryan at maryan@webchart.biz, office: 336-463-4198, cell: 336-408-4209 or at her website at www.webchart.biz.

In terms of making information more readily

of checkboxes for each patient they see.

available, new federal incentives to subsidize

The required computer interaction limits

the upfront costs of electronic health records

their mobility, and if the computer is in

(EHRs) are a welcome development. A

the exam room, their interaction with the

recent report projects a robust 12 percent

patient, causing dissatisfaction from both

growth rate for such systems over the next

parties. Physicians who use front-end voice

few years. After a notoriously slow start for

recognition fare only marginally better, as

the technology, four of every 10 physicians

they’re required to immediately correct

now utilize EHRs at their hospital or office.

anything the software misinterpreted.

Of course, adopting electronic records is only

The quality of the document can also suffer.

When the transcriptionist types the note

step one. The real key to improving patient

The physician becomes the only set of

into the system, the software automatically

outcomes and gaining efficiencies lies in how

eyes looking at information going into the

parses the document for discrete data,

EHRs are implemented. Clearly, the industry

record, making it harder to detect crucial

which is automatically uploaded to the

is still finding its way in this regard. Last year,

mistakes. When it comes to reviewing patient

appropriate field of the EHR. The provider

a study of more than 2,700 family physicians

information, because the information was

receives all of the structured data needed

found that only 49 percent were satisfied in

entered into a one-size-fits-all template,

to meet Meaningful Use requirements, but

whole with their system.

practitioners no longer have a narrative note

also retains access to the note in narrative

they can look to for a clear understanding of

form. Further enhancing the documentation

what previous medical personnel observed.

process, mobile applications are becoming

While there’s no silver bullet to improving

increasingly robust and look to be a viable

the EHR experience, providers often benefit

means to simplifying a clinician’s workflow.

from taking a clear-eyed look at what these

EHR users do well by playing to the

systems can deliver. Many facilities discover,

technology’s strengths. For a number

only after an expensive rollout, that electron-

of forward-thinking facilities around the

Efforts to improve interoperability within the

ic charts aren’t actually a panacea for their re-

country, this has meant integrating their EHR

industry continue to advance, suggesting

cord-keeping challenges. For instance, while

with other software programs and building

a bright future for such interfacing. What’s

physicians appreciate the ability to call up

synergies between them. One promising

becoming more apparent is that EHRs are not

patient data instantaneously, many are unen-

trend involves hospitals and clinics linking

the solution to inefficiencies in health care,

thused about not only how that information is

transcription management software with their

but rather part of the solution. The sooner

initially captured, but also how it’s presented.

EHR system, creating a “hybrid” solution.

providers realize this, the quicker we’ll see

Doctors who were previously able to quickly

With the help of a software technology known

dictate their exam notes into a phone system

as “discrete reportable transcription,” doctors

or digital recorder now have to log into a

can realize the benefits of EHRs without

For more information call (866) 953-2828 or

computer and scroll through extensive lists

giving up their ability to dictate patient notes.

visit online at webchart.biz.

the real information revolution we’ve been

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waiting for.

Physician News

Duke cardiologist Joins SRMC Medical Staff “Working with SRMC and Duke together will allow me to accomplish a longstanding ambition to improve the health status of the people of Robeson County, and provide advanced cardiovascular care to our community.” – Mathew S. Cummings, M.D.

and cardiovascular diseases and is board eligible in interventional cardiology, all by the American Board of Internal Medicine.

His

areas

of

special

interest

within

cardiology include the treatment of coronary artery disease and coronary artery stent implantation, as well as the treatment of complex

peripheral

vascular

disease,

including carotid artery stenosis, upper- and lower-extremity disease, and renal artery

L

umberton native Matthew S. Cummings,

Dr. Cummings completed a fellowship in

stenosis.

He also specializes in invasive

cardiovascular diseases at the University of

management of venous thromboembolism

Center,

Kentucky in Lexington, Ky., in 2011 and in

and acute pulmonary embolism.

providing care through the Southeastern

advanced interventional cardiology at Ohio

Heart Center managed by Duke Medicine.

State University in Columbus, Ohio, in 2012.

Dr. Cummings and his wife, Angela Guinn,

He is board certified in internal medicine

reside in Lumberton. He is the son of Physician

M.D., has joined the medical staff of

Southeastern

Regional

Medical

He is affiliated with Duke

Assistant Earl Cummings, and

Cardiology

Amelia Hunt, a registered nurse,

of

Lumberton,

both of Lumberton.

located at 2936 N. Elm Street, Suite 102 on the campus of Biggs Park Mall. Later this year,

“Above all, I feel very fortunate to

he will also treat cardiology

be home in the company of my

patients two days each week in

loving family and many friends,”

Pembroke at an office located

said Dr. Cummings. “Working

within Southeastern Urgent Care

with SRMC and Duke together

Pembroke, which is located at

will allow me to accomplish

812 Candy Park Lane.

a longstanding ambition to improve the health status of the a

people of Robeson County, and

bachelor’s degree from UNC

provide advanced cardiovascular

Pembroke in 1998 and his

care to our community. I am

medical degree from the Brody

humbled by this opportunity,

School of Medicine at East

and look forward to rekindling

Carolina University in Greenville,

old friendships and fostering

N.C., in 2004.

He completed

new ones. After being away for

his internal medicine residency

many years, it’s great to finally be

at East Carolina University/

home!”

Dr.

Cummings

earned

Pitt County Memorial Hospital in Greenville, N.C., in 2007,

For more information or to

serving as chief resident in the

schedule an appointment

department of medicine there

with Dr. Cummings,

from 2007-2008.

call (910) 671-6619.

september/october 2012

9

Women’s Health

Identifying

Irritable Bowel Syndrome in Women with Abdominal Pain

By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.

Abdominal pain is often multifactorial in

There are four types of IBS characterized

women, and health care providers should

by bowel habits: chronic or recurrent diar-

also consider a bowel etiology.

rhea (IBS-d), constipation (IBS-c), mixed (IBS-m) or unspecified (IBS-u). All types

Irritable bowel syndrome (IBS) affects as

have associated abdominal pain or dis-

many as 15 percent to 20 percent of ado-

comfort.

lescents and adults, presenting most commonly in young women. In fact, IBS affects

To diagnose IBS, a complete medical his-

about twice as many women as men.

tory and physical is needed. Symptoms must have started at least six months prior

IBS is a term encompassing abdominal pain

and must have occurred at least three days

and changes in bowel function that have no

per month for the previous three months.

diagnosed causes. It is not a disease, but a group of symptoms that occurs together (di-

IBS can have a significant impact on the

gestive.niddk.nih.gov/ddiseases/pubs/ibs).

patient’s quality of life, particularly when a patient presents with overlapping GI dis-

The changes in bowel function with IBS

orders that may exacerbate IBS symptoms,

include diarrhea, constipation or both. In

such as malabsorption of dietary sugars.

addition, there may be cramping, passing

However, IBS is not life-threatening, does

of mucous, rectal bleeding, bloating, back

not worsen if untreated, and does not pre-

pain, insomnia not related to other symp-

cipitate more serious diseases or disorders.

After earning her bachelor’s degree in religion from Duke University (1988), Dr. Andrea Lukes pursued a combined medical degree and master’s degree in statistics from Duke (1994). Then, she completed her ob/gyn residency at the University of North Carolina (1998). During her 10 years on faculty at Duke University, she co-founded and served as the director of gynecology for the Women’s Hemostasis and Thrombosis Clinic. She left her academic position in 2007 to begin Carolina Women’s Research and Wellness Center, and to become founder and chair of the Ob/Gyn Alliance. She and partner Amy Stanfield, M.D., F.A.C.O.G., head Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals for management of heavy menstrual bleeding. Call (919) 251-9223 or visit www. cwrwc.com.

toms, heart palpitations or urinary problems. Some patients report suffering ex-

More dangerous conditions must be ruled

of IBS. Stress reduction, particularly during

treme urgency with their bowel movements,

out in any diagnosis of IBS. A colonoscopy

meals, is encouraged, and changes in diet

while others report having up to 20 bowel

can rule out colon cancer, particularly if the

appropriate to the symptoms (such as add-

movements a day. Symptoms are often re-

patient has a family history of the disease,

ing more fiber to a constipated patient’s

ported as being worse after eating, during

and inflammatory bowel disease (Crohn’s

diet) are recommended. Large meals can

stressful times or during menstruation.

disease), which also may present similar

exacerbate symptoms, so smaller meals

symptoms as IBS. A pelvic ultrasound can

are recommended. A low-fat/ high carbo-

The causes of IBS are not well understood,

help identify ovarian cysts, and blood tests

hydrate (pasta, rice, whole-grain) diet may

but may be caused by brain-gut signal

can rule out Celiac disease and food aller-

help.

problems, gastrointestinal (GI) motor prob-

gies. Other tests for diagnosis of IBS are

lems, hypersensitivity, mental health prob-

not needed. However, a stool test, lower

Pharmacologic options for IBS include fib-

lems, bacterial gastroenteritis, genetics and

GI series and sigmoidoscopy or colonos-

er supplements, laxatives, antidiarrheals,

food sensitivity. The discomfort associated

copy may be indicated for symptoms that

antispasmodics, antidepressants and lubi-

with IBS is believed to result from abnor-

include fecal bleeding, rectal bleeding,

prostone (Amitiza). Further, providers

malities of muscular contractions or of the

weight loss, anemia and a family history of

should consider the benefits of probiotics.

sensory or motor nerves within the bowel,

colon cancer or IBS.

We encourage providers to work with gastroenterologists to establish the best model

leading to pain or dysfunctional reflexes.

Imbalances of neurotransmitters, particu-

Treatment of IBS usually involves encour-

of care for women with IBS-related abdomi-

larly serotonin, may also contribute.

aging the patient to avoid the aggravators

nal pain.

10

The Eastern Physician

Practice Management

New Marketing Trend:

Personal Doctor Websites

By Amanda Kanaan

If you are part of a larger medical group, then

Nearly 85 percent of patients now turn to

your practice most likely has a website. How-

the internet for information on their ailments

ever, a growing number of physicians are

and their physicians. These “e-patients” are

now creating websites to market themselves

empowered, knowledgeable and expect and

individually. Although it’s important that the

demand a far higher level of service and

community be familiar with your practice

resources from their health care providers.

name, the most successful physicians I’ve

Physicians who are able to capitalize on this

worked with also understand the benefit of

new “e-patient” revolution stand to gain the

personal branding.

greatest benefit through a savvy online marketing strategy.

Medical practice websites often include a section called “meet the team” or something

Here are the top ways in which a personal

similar. Each team member’s page usually

website may be beneficial:

includes a name, bio and headshot.

1. T o establish a personal brand and

However, this isn’t enough information for

2. If your clinical interests are different

respected reputation patients to really connect with you or to establish a reputation within your field. By designing a personal website just for you (e.g. “www.drbrown.com”), this gives you the ability to include all the information necessary to establish your brand – that is, what differentiates you among your peers.

than your partners 3. If you have a new skill that you want to market 4. To offer your services for speaking engagements

Amanda Kanaan is the president and founder of WhiteCoat Designs, a North Carolinabased marketing agency catering specifically to physicians. WhiteCoat Designs offers doctors affordable marketing solutions to help them grow their practices. Services include website design, search engine optimization (SEO), social media management, online reputation monitoring, brochure and collateral design, branding makeovers and physician liaison services to build patient referrals. Ms. Kanaan can be reached at amanda@whitecoat-designs. com or (919) 714-9885. To learn more, visit www.whitecoat-designs.com.

Creating a personal website is an affordable

5. To submit yourself to the local media for interviews as an expert in your field

and effective way to build, maintain or grow your reputation in the community. Patients

6. If you are a new doctor who needs to

are researching their doctors online more

A good example of this would be an OB/

build a reputation within the vicinity

now than ever, and it’s important that your

GYN doctor who wants to establish himself

7. I f you are considering leaving your cur-

services be easy to find and provide as

as the leading robotic surgeon in the area.

rent practice at some point in the future

much information and transparency as pos-

If he solely relied on his practice website to

8. If you are trying to rank higher for cer-

sible when describing your offerings. Your

tell patients within his bio that he also offers

tain keywords in the search engines

website has seven seconds to make an im-

robotic surgery, it would take much longer to

pression on a patient. Make them count.

build his reputation. By having an individual website devoted to his robotic surgery, he can now talk more in depth about his training and qualifications, the number of cases he’s performed, photos of how the procedure works, patient outcomes, testimonials, a video introducing himself, etc. He can then use this website to promote himself in the search engine rankings, such as Google, to increase traffic to his site and attract more patients.

september/october 2012 September/October

11

Your Financial Rx

Minimize Your Retirement Plan Risks

By Paul J. Pittman, C.F.P.

One of the most difficult aspects of my job

How

is helping a client understand risk. Some

investments that you offer inside your

often

are

you

reviewing

the

risk is a necessary evil for most investors

retirement plan? Are you putting funds

and not a bad thing, if properly managed.

on a watch-list? Are you removing and

Unnecessary risk is the bane of a portfolio.

replacing funds that are not in line with your investment policy statement?

I preach every day that if you do not have to take on risk to accomplish your goals,

One way to limit the risk of your employee

then don’t do it! If all of your goals can be

retirement plan is to have a qualified

met by putting your money in certificates

adviser review and oversee the plan. This

of deposits, then by all means, do it.

is the person who should be counseling

Everyone does not need to be in the stock

you and your employees.

market, but when the markets are good, everyone wants to be in the stock market.

The broker-in-charge of every plan charges a fee every quarter of every year. Are you

Take a good, long look at your financial

getting what you are paying for? How often

picture and consider the risks. I have written

is your broker-of-record contacting you and

before about allocation, diversification,

meeting with the employees?

Paul Pittman is a Certified Financial Planner™ with The Preferred Client Group, a financial consulting firm for physicians in Cary, N.C. He has more than 25 years of experience in the financial industry and is passionate about investor education.

He is also a nationally sought-after speaker, humorist and writer. Mr. Pittman can be reached at (919) 4594171 and paul.pittman@pcgnc.com. Send an e-mail to receive Mr. Pittman’s Weekly Market Commentary.

If you already have a qualified retirement

redundancy, weightings, etc., etc. Just don’t employment-sponsored

Take a look at the name of the broker-in-

plan, such as a 401(k), you can also start

retirement plan, a huge risk factor every

charge of your plan. Are your employees

a cash balance plan. A cash balance plan

month.

familiar with this person? If not, then you

is a type of retirement plan that belongs to

are not getting the kind of service and

the same general class of plans known as

Fiduciary Advisors

guidance you deserve. If you and your

“qualified plans.” A 401(k) is a qualified

If you are the employer, you may have

employees aren’t 100 percent thrilled with

plan. These plans “qualify” for tax deferral

infinite and personal liability for your

this person, then you can easily replace

and creditor protection under ERISA.

retirement plan. It is important for you

him or her at any time.

to understand that compliance with

Cash Balance Plans

In a cash balance plan, each participant has

Employee Retirement Income Security

What about the risk of not putting away

an account. The account grows annually in

Act (ERISA) standards is not enough to

enough money for your own retirement?

two ways: first, a contribution and second,

overlook

your

an interest credit, which is guaranteed

protect you or properly take care of your employees.

With the economy the way it is, you have

rather than being dependent on the plan’s

no doubt asked yourself that question

investment performance.

Attorneys ask me on a regular basis to meet

when you look at your statements. Do not

with business-owner clients, who ask, “Do

let this stop you from putting money away.

For owners and partners seeking larger

I, as the business owner, have any personal

You may want to make some changes as to

tax deductions and accelerated retirement

liability with my employee retirement

where the money is placed, but definitely

savings, cash balance plans may be the

plan?” The short answer is this: yes!

make the deposit.

solution. 2006 legislation is encouraging

12

The Eastern Physician

News Welcome to the Area

Physicians

Edwin Houng, MD

Paul Edward Kelley II, PA

Nathan Gene Miller, DO

Family Medicine, Family Practice

Southern Regional AHEC Fayetteville

Cardiovascular Surgery, Emergency Medicine, Hospitalist, Internal Medicine, Thoracic Cardiovascular Surgery

120 Newcastle Dr Jacksonville

Robert James Allen Jr., MD Physical Medicine & Rehab - Pain Medicine

Cape Fear Pain Treatment Center Fayetteville

Lilian Andries, MD Internal Medicine, Hospitalist

New Hanover Regional Medical Center Wilmington

John Gerome Bertolino, MD Administrative Medicine, Family Medicine

Naval Hospital Camp Lejeune Camp Lejeune

Ajit Kumar Bisen, MD Internal Medicine

more and more professionals and successful business owners to adopt this type of plan.

Hope Mills

Miranda Elizabeth Blevins, MD Family Medicine

Davis Regional Hospital Statesville

Robert Christopher Brock, MD

A cash balance plan is a defined benefit

plan

that

specifies

both the contribution to be credited to each participant and the investment earnings

Emergency Medicine

Vidant Medical Center, GME Greenville

Ambrose John Joseph Chazhikattu, MD Internal Medicine

Wilmington

to be credited based on those

Joshua David Dobstaff, MD

contributions. Each participant

Wilmington Health, PLLC Wilmington

has an account that resembles those in a 401(k) or profit sharing plan. The plan actuary, who maintains the account, generates annual participant statements.

Cash

balance

contributions

are age-dependent. The older the participant, the higher the amount. The reason for this difference is that an older person has fewer years to save toward the approximate $2.5 million lump sum that is allowed in a cash balance plan.

As an example, if you were born in 1950, you can defer $150,261 into a cash balance plan plus $20,500 into your 401(k) for a total of $170,761 for that year!

Few advisers are aware of cash balance plans. Make sure the one who is overseeing your portfolio risk management is.

Internal Medicine

Janie Louise Jacobs, MD Pediatrics

Premier Pediatrics Southern Pines

Satya Naga Sai Sowjanya Mantripragada, MD Pediatrics

Hope Mills Pediatrics, PC Fayetteville

Noha Mataoui, MD Family Medicine

New Hanover Regional Medical Center Wilmington

Ogheneochuko John Oteri, MD Emergency Medicine

Cape Fear Valley, Fayetteville

Rajen Sudhir Patel, MD Family Medicine

Vidant Medical Center, GME Greenville

Ashwin Viren Patel, MD Obstetrics and Gynecology

Wilmington

Jeffrey Howard Perlman, MD Endocrinology, Internal Medicine

The Regional Diabetes and Endocrinology Fayetteville

Vidant, Greenville

Azeem Elahi, MD

Steven Roger Turley, MD

Internal Medicine - Endocrinology, Diabetes & Metabolism, Sleep Medicine, Geriatric, Pulmonary Disease, Rheumatology, Gastroenterology, General Preventive Medicine

Nephrology, Internal Medicine

Zelalem Atakilt Gebreananya, MD Hospitalist, Internal Medicine

Cape Fear Valley Health System Fayetteville

Solomon Tewolde Ghebregziabiher, MD

Brook Rene Wager, MD Emergency Medicine

The Outer Banks Hospital Nags Head

Sarah Wistran Young, MD Internal Medicine

West End

Physician Assistants Kimberli Anne Alcaino Dement, PA Family Medicine

Joel Health Clinic Fort Bragg

Internal Medicine

Lauren Elizabeth Finley, PA

Village Internal Medicine Fayetteville

Family Practice

Joel Health & Dental Clinic, Fort Bragg

Anna Blair Hatchett, MD

Dale Herd, PA

Surgery, General Surgery, Surgical Critical Care

Orthopedic - Surgery of the Hand, Sports Medicine, Surgery, Adult Reconstructive, Trauma, Emergency Medicine, Family Medicine, General Practice

Abdominal Surgery, Critical Care Vidant Medical Center, GME Greenville

Justin Arman Haynes, MD

Womack Army Medical Center Fort Bragg

Emergency Medicine

Robert Allan Hodge, PA

Vidant Medical Center, GME Greenville

Franklin

Aaron Michael Scheib, PA Emergency Medicine, Surgery (general)

Fayetteville

Michael Volk Stewart, PA Emergency Medicine, Psychiatry, Geriatric

Carolina Cardiology P.A., Fayetteville

Audrey Martin Thornberg, PA Emergency Medicine, Family Medicine, Urgent Care

Carolina East Medical Center New Bern

Valorie Anne Van Houten, PA Adolescent & Young Adult Medicine, Alcohol and Drug Abuse, Allergy/Immunology, Diagnostic Lab, Cardiology, Cardiovascular Disease, Internal Medicine, Clinical Neuropathology, Clinical Neurophysiology, Critical Care Pediatrics, Critical Care Sugery

Bradleigh Rose Zito, PA

Allison L. Scott, PA Certified Family Nurse Practitioner

Duke Cardiovascular Surgery of Lumberton and Southeastern Heart Center

Vidant Medical Center, GME Greenville

Internal Medicine

Vidant Internal Medicine Washington Washington

Emergency Medicine, Family Practice, Obstetrics and Gynecology, Surgery, Pediatrics

Eastern Radiologists, Inc., Greenville

Hospitalist, Internal Medicine

Urvi D Gandhi, MD

Linda Sax, PA

Radiology

Cary

Fayetteville

Rocky Mount

East Carolina Heart Institute, Greenville

Anesthesiology

Pediatrics

Family Practice

Cardiovascular Surgery, Critical Care Surgery, Thoracic Cardiovascular Surgery, Thoracic Surgery

Nash General Hospital, Rocky Mount

Ramya Thota, MD

Shanti Priya Eranti, MD

Claudine Polley Lamanna, PA

Zaneta Yeungjoo-Chung Strouch, MD

Amira Aly El Sherif, MD

Vidant Medical Center Greenville

Greenville

Cardiovascular Surgery, Critical Care Surgery

First Health of the Carolinas Pinehurst

Lumberton

Event Tues, October 2 Village Design Group will be hosting a special fundraiser Golf Tournament (open to all golfers) at Foxfire Resort and Golf Club benefitting the Cancer CARE Fund and the Clara McLean House at FirstHealth.

The format of the tournament will be Captain’s Choice The registration fee of $75 provides green fee, cart, oncourse beverages, lunch and door prizes.

Nationwide Insurance and Bill Smith Ford are sponsoring a Hole-in-One Par 3 Challenge to win a car. In addition, participants may purchase mulligans, T-shirts, and raffle tickets with all proceeds going to the Cancer CARE Fund and the Clara McLean House of FirstHealth.

Meadow Creek Tile and Kitchen & Bath Galleries of Southern Pines are also assisting with the event. Hole sponsors for businesses ($100 each) and memorials to cancer victims ($20 each).

Please help us promote this important event, benefitting local organizations and victims of cancer. Contact Village Design Group at 910-692-1000 to register or for more information. Players can register on facebook.com/villagedesigngroup using PayPal.

september/october 2012

13

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