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january 2016

MacPhee Plastic & Reconstructive Surgery Transgender Patients Find Expertise, Compassion in N.C. Plastic Surgeon

T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S

Also in This Issue “Little Pink Pill” AID Makes Strides in 2015


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From the Editor

Brave New Directions T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S

In this issue’s cover story, we learn about plastic and reconstructive surgeon Keelee MacPhee’s mission to provide gender-confirming reconstruction in addition to her more conventional practice. Dr. MacPhee’s groundbreaking work serves to transform transgender patients emotionally and improve their quality of life as well. Her determined quest to advance surgery in this emerging field has led to national recognition. This month The Triangle Physician also features physician advocate Marni Jameson, who talks about the successes of Association of Independent Doctors in just one year. Obstetric gynecologist Andrea Lukes is dedicated to increasing awareness of the many facets of women’s health, and this month she discusses the benefits of flibanserin to treat low sexual desire.

Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Wendy Coulter Marni Jameson Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Margie Satinsky, M.B.A. Creative Director Joseph Dally jdally@newdallydesign.com

Advertising Sales info@trianglephysiciancom News and Columns Please send to info@trianglephysician.com

Practice management consultant Margie Satinsky provides a comprehensive overview of the considerations needed to determine if hiring a professional administrator makes sesne. Practice marketing consultant Wendy Coulter continues her four-part series with five more benefits of branding.

The Triangle Physician is published by: New Dally Design Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401

These are exciting times in health care and medical research, and we look forward to sharing your discoveries, breakthroughs and insights in 2016. Our readers represent the more than 9,000 within the Raleigh-Durham medical community. There is no cost to run your medical news and professional commentary. Advertising rates are competitive. Please send inquiries to: info@trianglephysician.com. Here’s wishing you and yours a happy, healthy and prosperous New Year!

Heidi Ketler Editor

Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.

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The Triangle Physician


Table of Contents Category

4

COVER STORY

Keelee MacPhee, M.D., Plastic Surgery Transgender Patients Find Expertise, Compassion in N.C. Plastic Surgeon january 2016

V o l . 7 , I ss u e 1

FEATURES

9

Endocrinology

20 Powerful Reasons to Brand Your Practice: Part 3 of 4 Wendy Coulter provides professional perspective on branding and gives five more reasons why practices need to do it.

12

10 Physician Advocacy

AID: What a Difference a Year Makes

14 Practice Management

Is a Professional Practice Administrator Right for You?

16 Duke Research News

Women Cardiologists Do Different Work, Make Less Money than Men

17 Duke Research News

Finding Solves Circadian “Mystery”

18 UNC Research News Women’s Health

“Little Pink Pill” Can Improve Women’s Sexual Experiences Dr. Andrea Lukes addresses the importance of sexual health and the benefit to some of new medication to improve desire.

DEPARTMENTS

- New SARS-like Virus Can Jump Directly from Bats to Humans - Technique to Jumpstart Bone Cell Formation Discovered Unexpectedly

19 UNC Research News

UNC and NCCU Awarded $7.5 Million for Alcohol Health Disparities Study

20 News

Bullies at Risk of Eating Disorders

21 Welcome to the Area

january 2016

3


Cover Story

Transgender Patients Find Expertise, Compassion in N.C. Plastic Surgeon Plastic and reconstructive

surgeon

Keelee

J. MacPhee, M.D., of Renaissance Plastic & Reconstructive Surgery, met her first transgenKeelee J. MacPhee, M.D.

der patient in 2005. He was a transman who

she never would have guessed was trans-

“While surgery doesn’t address every problem, it can go a long way in helping people feel more like themselves and live happy, productive lives.” – Keelee MacPhee, M.D.

gender. He was masculine, sounded like a man and worked on a farm. “He looked like

researched together to decide on the de-

that were not consistent with who he felt

any other farm guy, with huge muscles and

tails of shape and nipple positioning.

like on the inside were finally gone.”

The surgery was a success, and the man

With the gender-confirming surgery, the

But this man had been born female. In his

was ecstatic with the results. He was so

patient also was able to have the gender

early 30s at the time, he had been living as

much more comfortable without the bind-

marker changed on his legal identification.

male since adolescence.

ing and was better able to perform his job.

He went on to legally marry his girlfriend,

a full beard,” Dr. MacPhee remembers.

and Dr. MacPhee was invited to the wedding.

The man arrived at Dr. MacPhee’s office

“It was a dramatic change for my patient

with his very pretty, petite girlfriend and

physically, but also emotionally and psy-

their infant daughter. Dr. MacPhee would

chologically,” said Dr. MacPhee. “The anxi-

“The courage of this man to be true to him-

later learn that a friend had donated

ety and depression of having body parts

self in such a conservative environment, where he was risking his safety every day,

sperm, so they could start a family.

was profound for me to witness,” said Dr. The physical examination revealed that the

MacPhee. “It was through this experience

man had massive breasts – G cup size – and

that I realized just how great an impact my

he had tried all sorts of uncomfortable and

work could have on people’s lives. Plastic

even painful ways to bind and hide them.

surgery isn’t just about a physical change; it

He had struggled to find physicians who

often affects people on a deeper emotional

were willing to help him, and at some point

level. In my experience, that’s always the

along the way, he had resorted to buying

case for transgender patients.”

testosterone off the street and the Internet. The Numbers Tell the Story Studies and statistics support this premise.

Dr. MacPhee performed a bilateral mastectomy with free nipple grafting based on her best judgment of how his chest should

Social norms encourage transgender indi-

look. There was not a great deal of infor-

viduals to suppress their gender identity (the gender one feels oneself to be). Yet

mation available about transgender chest surgery at the time, so doctor and patient

4

The Triangle Physician

Female-to-male chest surgery after results.

many transgender people feel a fundamen-


tal unease and dissatisfaction with their biological sex. Being forced into traditional stereotypes often results in anxiety and depression. Furthermore, transgender people experience discrimination at a significantly higher rate than the general population. According to the National Transgender Discrimination Survey, 26 percent of trans people lost a job due to bias, 50 percent were harassed on the job, 20 percent were evicted or denied housing and 78 percent of trans students were harassed or assaulted. For a trans person of color, discrimination is exacerbated. It is not surprising then that the suicide rate is higher for the transgender population. But the extent of the disparity is staggering: In a survey conducted by the National Center for Transgender Equality, 41 percent of transgender and gender non-conforming respondents reported attempting suicide, compared to 1.6 percent of the general population.

Male-to-female facial feminization involving multiple procedures: Brow lift with frontal bone reduction, upper blepharoplasty (eyelid lift), and chin implant.

Pioneering a Field of Medicine

“I’ve had patients tell me their families re-

With this realization as her driver, Dr.

Many trans individuals want to make their

ject them, and it’s hard for them to find a

MacPhee conducted a bit of her own re-

bodies as congruent as possible with their

welcoming community,” said Dr. MacPhee.

search. She learned there were a very

gender identity, and in this way, sex reas-

“Many are loners, and they don’t feel safe.

limited number of skilled transgender sur-

signment improves their quality of life. To

While surgery doesn’t address every prob-

geons in the United States, making sex re-

live and be accepted as the man or woman

lem, it can go a long way in helping people

assignment surgery difficult for patients to

one sees oneself to be can bring enormous

feel more like themselves and live happy,

obtain. She decided this was the direction

relief and contentment.

productive lives.”

she wanted to take her practice. With a degree in plastic and reconstructive surgery from the University of North Carolina School of Medicine, residencies at UNC and the University of Florida, and private practice experience, Dr. MacPhee had the conventional training to perform many procedures that a trans patient might need. But she wanted to augment her traditional plastic surgery capabilities with specialized training in transgender reconstruction. This turned out to be more difficult than one might think. Since transgender surgery is not a surgical specialization offered

january 2016

5


at any medical school in the United States, Dr. MacPhee had to be a pioneer in the field. She researched and self trained, and she sought out several renowned transgender surgeons from around the country with whom she could exchange techniques and best practices. Her perseverance gave her new skills to take back to her practice in North Carolina. Nationally Recognized Transgender Surgeon Today Dr. MacPhee offers procedures for both trans women (MTF) and trans men (FTM) – including FTM top surgery, as well as MTF breast augmentation, vaginoplasty, tracheal shave, forehead bossing reduction

exam and, of course, for the surgery, but

dominoplasty and rhinoplasty, as well as

and other facial feminization treatments.

initial consultations, family meetings and

other facial plastic surgeries.

Following the standards of care set forth

some post-surgery follow-up appointments

by the World Professional Association for

can often be handled remotely.

She admits that she had some hesitation early on in opening up about the transgen-

Transgender Health (WPATH), she continues to train and develop her transgender

“Having patients go home and still be able

der side of her practice, not knowing what

practice, staying abreast of new proce-

to communicate with me directly saves

her traditional plastic surgery patients

dures and surgical advancements as they

the patients extensive travel time and ex-

would think.

unfold.

pense,” said Dr. MacPhee.

Her focus and dedication to this area of

A smart-phone application uses telemedi-

read on our patients’ feeling about trans-

practice are what draw transgender pa-

cine to communicate with other providers

gender surgery,” Dr. MacPhee said. “I was

tients from across the country to the Trian-

who have a role in the patient’s care, such

pleased to learn that a large majority of our

gle. She performs surgeries at North Caro-

as therapists, primary care providers and

cisgender patients support this area of our

lina Specialty Hospital and Duke Regional

endocrinologists. Patients can feel confi-

practice.”

Hospital. Board certified in plastic surgery,

dent that their personal information is safe,

Dr. MacPhee has built a reputation for her

since it uses three levels of encryption.

“We actually did phone interviews to get a

Changing Lives for the Better Whether she is performing traditional plas-

skill, compassion and understanding. “These tools are also helpful for patients

tic surgery or transgender reconstruction,

Technology Brings Patients Closer

who want to have an out-of-town family

Dr. MacPhee is focused on helping people

The need to travel to North Carolina from

member involved in their care without hav-

make positive changes.

far and wide creates certain challenges for

ing them physically travel to North Carolina

patients in their recovery and follow-up.

for appointments,” she said. “This is a real

“I’m so honored and feel so lucky to be

Therefore, Dr. MacPhee’s practice deploys

advantage in the level of care and personal

able to do this work,” she said. “If I can

several technologies to bridge the distance

connection we can provide our patients.”

help make people’s lives happier, safer, healthier and authentic, then that is what

once patients return home. Reactions from

I want to do.”

Telemedicine and HIPPA (Health Insur-

“Mainstream” Patients

ance Portability and Accountability Act)-

While transgender procedures tend to get

For more information about Dr. Keelee

compliant online chatting are enabling

the most attention, Dr. MacPhee also has a

MacPhee and her plastic and reconstruc-

communication without the need for trav-

large cisgender (non-transgender) patient

tive surgery practice, visit her website at

el, helping patients manage costs. Patients

population. She routinely performs breast

www.keeleemacpheemd.com.

must be seen in person for the physical

augmentations and breast reductions, ab-

6

The Triangle Physician


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The Triangle Physician


Practice Marketing

20 Powerful Reasons to Brand Your Practice Part 3 of 4 As we explored earlier in this series, your

By Wendy Coulter

recognize and remember it!

practice must differentiate its product or service from others and help build a col-

Be Recognized

lection of perceptions that will resonate

Recognition and memory of a brand is

with your patients in order to thrive and

key. Even with many dollars spent in ad-

grow. I continue with five more reasons to

vertising, sales conversion is not nearly as

brand your practice.

high without brand recall. A unique and creative brand story helps increase brand

Motivate Employees

recognition!

A brand strategy can help employees better understand their responsibility in rep-

Probably some of the most recognizable

resenting the practice and contributing to

branding in history has been done by Mc-

its success. It helps them know how to act

Donald’s through the golden arches and

and how to meet goals.

Ronald McDonald, not to mention this memorable jingle: “two all-beef patties,

Apple’s brand strategy includes a state-

special sauce, lettuce, cheese…”

ment that, “People don’t come here to play it safe. They come here to swim in the

Communicate What Your Practice

deep end. They want their work to add up

Stands for

to something. Something big. Something

An effective brand story goes beyond

that couldn’t happen anywhere else.” This

features and benefits and communicates

brand statement helps the company at-

style and character, including values and

tract people who are motivated and who

business principles. Many take this a step

will, in turn, be loyal to the company.

further by committing to local charities or even global causes.

Create Consistency
 Practices with clear and consistent brand-

For example, TOM’s was founded with a

ing help patients know what to expect

mission to donate a pair of shoes to a per-

when they visit, which puts them at ease.

son in need for every pair it sells.

Wendy Coulter is president of Hummingbird Creative Group Inc. She is a graduate of the School of Design at North Carolina State University with degrees in architecture and industrial design and a minor in communications. She founded Hummingbird Creative Group in 1995, with a desire to put her ideas to work, creatively solving problems for small businesses. Hummingbird Creative Group is an award-winning, full-service branding agency that helps companies define brand strategy, develop sustainable brand messaging and implement marketing tactics through advertising, graphic design, sales enablement, public relations and online marketing services. Awards include “Pinnacle Business Award” from the Raleigh Chamber of Commerce, as well as “Business of the Year,” “Employer of the Year” and “Successful Achievement” awards from the Cary Chamber of Commerce. Ms. Coulter was named a “Top 50 Entrepreneur,” “Woman Extraordinaire,” “Mover and Shaker” and “40 Under 40,” to name a few. She is active in a variety of community and civic endeavors and frequently presents on such topics as branding, marketing, advertising and design.

Ask patients why they first visited, why

Your brand story should be consistent across all media from your corporate

Establish a Strong Reputation

they come back and why they chose you

identity and advertising, to your website

Reputation really is what branding is.

over competitors. The answers to these

and phone etiquette. And, you need to be

Looking for the right brand message for

questions can help you form a brand

committed to consistency for a long time…

your practice? Look straight to your repu-

promise, and as you continue to live up to

Turns out, just when you are tiring of your

tation and build on that.

that promise, your brand will establish a strong reputation.

brand story, patients are just beginning to

january 2016

9


Physician Advocacy

AID

What a Difference a Year Makes By Marni Jameson

T

he start of a new year is a great time to take stock and ask whether you’re on the

right course. For me, that includes reflecting on what has happened at the Association of Independent Doctors, since I joined as executive director a little more than a year ago. What a difference a year makes. The reason behind AID’s exponential

Marni Jameson is the executive director for the Association of Independent Doctors. You may reach her at (407) 865-4110 or marni@aid-us.org.

Frankly, worthy though I thought the cause,

growth is simple. It’s the result of commu-

I wasn’t sure the saving of America’s inde-

nicating a timely message tied to a solution.

pendent doctors was a fight we could win.

When doctors ask me, “Why should I join?”

Fortunately, I relied on the opinions of two

– and lately they ask every day – all I have to

smart, forward-thinking certified public ac-

do is look back at the past year’s highlights

countants.

and share them.

Tom Thomas and Carol Zurcher, partners

Here are 10 reasons:

AID-SAVE

at Thomas, Zurcher & White, an accounting

Fast Growth

Thanks to a partnership we have estab-

firm in Winter Park, Fla., saw a need for a

AID is the only national association dedi-

lished with medical supplier McKesson and

trade association dedicated to helping in-

cated to supporting independent doctors,

a national group purchasing organization,

dependent doctors survive. The worrisome

and we are growing fast. In the past year,

AID members save between 15 percent and

trend of hospitals buying up medical prac-

we have tripled our membership to nearly

35 percent on medical office supplies. The

tices was hurting the practice of medicine,

1,000 doctor members in 14 states, coast to

AID-SAVE program typically allows mem-

driving up costs astronomically and impact-

coast.

bers to recoup the cost of membership – $500 a year – in fewer than three months.

ing communities financially. State Chapters But no one was speaking up for the doctors.

We have three chapters in the United States,

Online Directory

So Thomas and Zurcher formed AID, and

and we are looking to form chapters in

If they choose, members may be part of

at the association’s charter meeting in April

every state. The existing chapters – Maine

AID’s online directory of independent doc-

2013, 100 doctors joined. Eighteen months

(260 members), California (61 members),

tors, which we promote to media. It is part

later, when I came on board, AID had just

and South Carolina (36 members) – were

of a campaign telling consumers why it’s

shy of 300 members and already a voice on

all groups of independent doctors that rec-

important to go to an independent doctor

the national stage.

ognized they were simply running in place

and providing a tool for them to find one.

and would be better off joining a national Today, we are nearing 1,000 doctor mem-

association and being part of a larger col-

United Front

bers in 14 states.

lective voice.

We give doctors the resources to champion their issues and answers to their questions,

10

The Triangle Physician


Practice Management such as what to consider when asked to

Focus

Chicago. The speaking calendar is filling for

join a clinically integrated network (CIN),

We stick to our goals: Stop hospital-doctor

2016.

and whom to call for help with insurance

consolidation, promote transparency in

contracting issues. We provide templates

health care pricing, push for parity in pro-

We are also a go-to source for national me-

for letters to send to lawmakers, and materi-

vider reimbursement by promoting site-neu-

dia and have been cited in media dozens of

als for media outreach. This is only a sam-

tral payments; help enforce anti-trust laws;

times in the past year. We give independent

pling of the support membership provides.

and stop nonprofit hospitals’ abuse of their

doctors a collective voice that’s long been

tax-exempt status.

missing from the discussion.

The fight for independence takes time,

Infrastructure

We are stronger together. We will do an

money and know-how. We have all three.

We were founded by business people, two

even better job as we grow. But to stop the

In December we hired our second full-time

CPAs and a health care attorney. We are a

trend of hospital consolidation, we need

person, a publicist with 18 years of public

501c6 nonprofit, have all the proper insur-

significant numbers, resources and you.

affairs and media experience. Together,

ances, dedicated office space and support

along with the occasional intern, we work

staff and are well capitalized.

Time and Expertise

Yes, we still have days where we feel like David up against 10 Goliaths, the personifi-

full-time getting the message out to consumers, media, businesses and lawmakers

Presence

cation of our nation’s giant hospital systems

about the importance of keeping doctors

In the past three months alone, AID has

and their lobby on steroids. But mostly days

independent. Although doctors harbor

presented at the national Medical Group

are marked by small steps toward progress

strong opinions, they are not inclined to

Management Association (MGMA) confer-

and the years marked by great strides.

organize, communicate strategically and ef-

ence in Nashville, at the National Physicians

fect change. We are.

Council on Healthcare Policy, on Capitol

For more information or to join AID, go to

Hill, and at Becker’s Healthcare Forum in

www.aid-us.org or call (407) 865-4110.

Spend Time c Your Patients, Not Battling IT. Get HIPAA Compliant Solutions

Let’s Talk Tech! Call (919) 296-1089 SAMIT-Medical.com

january 2016

11


Women’s Health

“Little Pink Pill” Can Improve Women’s Sexual Experiences By Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G.

There is a new “little pink pill” for women

chosocial approach. This emphasizes “the

called Addyi. Made by Sprout Pharmaceu-

importance of understanding human health

ticals, the medication is indicated for the

and illness in their fullest contexts by sys-

treatment of premenopausal women who

tematically considering biological, psycho-

have hypoactive sexual desire disorder.

logical and social factors and their complex

This is a problem characterized by low

interactions on health and illness.”

sexual desire that causes marked distress or interpersonal difficulty.

There can be unresolved physical or sexual trauma, abuse, medications and more that

Approximately 43 percent of women in the

may contribute to low sexual desire. It takes

1

United States report a “sexual problem.”

time to consider the causes of low sexual

The National Health and Social Life Survey

desire, but it is important to consider for

(NHSLS) has shown that sexual problems/

both the health care provider and the wom-

complaints were associated with low physi-

an experiencing low sexual desire.

cal and emotional satisfaction with sexual partners and low general happiness.2 Given

Given that only about one-third of women

the impact sexual problems can have for

with distressing sexual problems seek help,

women and their partners, this is a problem

health care providers must improve their

that health care providers should consider.

own screening of sexual concerns. This

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 cofounded and served as the director of gynecology for the Women’s Hemostasis and Thrombosis Clinic. She left her academic position (2007) to begin Carolina Women’s Research and Wellness Center. She and partner Amy Stanfield, M.D., F.A.C.O.G., head the Women’s Wellness Clinic, the private practice associated with Carolina Women’s Research and Wellness Clinic. Women’s Wellness Clinic welcomes referrals. Call (919) 251-9223 or visit www.cwrwc.com.

dress sexual health. Is this a medication that will work for your patient? This medication (flibanserin) is a 5-HT1A receptor agonist and a 5-HT2 receptor antagonist that has been studied in 11,000 women.3 The approved dose is 100 milligrams once at night. This has been shown to improve sexual desire, decrease distress and increase the number of satisfying sexual events. The contraindications include alcohol, moderate or strong cytochrome P450 3A4 inhibitors and hepatic impairment (addyi.com). The most common side The cause of low sexual desire is com-

isn’t easy to discuss for many women – and

effects of Addyi include dizziness, somno-

plex. Recently there has been an increase

unfortunately it isn’t easy to discuss for

lence, nausea, fatigue, insomnia and dry

in our understanding of low sexual desire.

many health care providers.

mouth.

and Woodard3, the pathophysiology should

The recent approval of Addyi gives women

In addition to considering treatment for low

be considered in the context of the biopsy-

and their providers an opportunity to ad-

sexual desire, it is important to provide sex

According to a recent review by Kingsberg

12

The Triangle Physician


Women’s Health education to women (and men). Do patients understand the normal sexual func-

Family Physician Needed

tion and models of the sexual response? The theories explaining this for women are many, but one of the most recent is by Rosemary Basson, M.B., F.R.C.P., of the University of British Columbia, who introduced an intimacy-based circular model to help explain the multifactorial nature of women’s sexual response.4 It emphasizes that women may not be motivated by spontaneous desire but that desire can result from arousal in the context of a loving relationship, illustrating that there is an intricate interplay of emotional intimacy, sexual stimulation, psychological factors and satisfaction within a relationship. This is something the providers at the Women’s Wellness Clinic review with each woman. Could a little pink pill help? “Yes!” Treatments for a problem help create the opportunity for patients and providers to learn. Sexual health is a complex issue, but when a woman has a healthy one –

Family Physician Needed at Avance Primary Care, Raleigh, NC Avance Care, P.A. is seeking a Board Certified Family Physician at our new Oberlin Rd practice opening in late 2015. Avance Care’s model was created to benefit our patients AND our physicians. • Work/life balance – our providers work 40 hours per week or less • Average patient load of less than 3 patients per hour • Proprietary operating and provider support systems – paperless facilities • Highly trained support staff • State of the art facility with onsite Pharmacy, X-Ray, Nutritionist, Behavioral Health Services, Allergy Testing and Immunotherapy • Operation that has consistently met or exceeded NCQA PCMH level 3, BQPP level 3, United Bridges to Excellence, Meaningful Use, NCQA DRP • Market leading private practice compensation package

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The providers at the Women’s Wellness

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“She wanted to move on with her life.”

cated time to understanding this complex

I REFERRED HER TO SOUTHERN DERMATOLOGY

Clinic are focused on providing the most comprehensive care to our patients, and

issue and the treatment options that may work for individual women. References 1. Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women. Obstet Gynecol. 2008;112(5):970-978. 2. Laumann E, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;28(6):537-544. 3. Kingsberg and Woodward. Female

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1 DER131_AD_Triangle Physican I Want 4.indd

january 20163:49 PM 13 8/27/15


Practice Management

Is a Professional Practice Administrator Right for You? By Margie Satinsky, M.B.A.

Is a Professional Practice Administrator Right for You?

update regularly? • Do we know the demographic trends,

Managing a medical practice requires

community dynamics, new laws and

both vision and operational skills. In some

regulations and competition, so we

practices where the physician(s) owner(s)

can respond appropriately to ongoing

has both managerial skill and an interest in administration, the physician runs the practice, providing direction to an office

changes in the environment? • Do we have a marketing plan that supports our strategic business plan?

manager and other staff. An alternative

• Have we identified the external

is for the physician(s) owner(s) to hire

individuals, organizations and

an experienced professional practice

agencies, with whom we need to

administrator.

develop relationships?

How do you know if a professional practice administrator (PPA) is right for

Financial Management • Do we have a revenue-cycle

you, and if it is, how do you find the right

management system that enables us

person? The best way to approach this

to meet our financial goals?

question is to start with your needs. Ask

• Are we satisfied with the way we

yourself the following questions about the

prepare and monitor our operating

current management of your practice.

and capital budgets?

Margie Satinsky, MBA, is President of Satinsky Consulting, LLC, a Durham, NC consulting firm that specializes in medical practice management. She’s provided strategic planning and operational guidance to more than 100 practices in North Carolina. Margie is the author of numerous books and articles, including Medical Practice Management in the 21st Century. For additional information, go to www.satinskyconsulting.com. Facilities •D  oes our current facility meet our current and projected needs?

• Do we have a managed care strategy Daily Practice Operations • Do our current methods for overseeing daily practice operations

that helps us maximize the revenue we receive and monitor actual vs. expected payments?

• Do we work well as a team to identify operational problems, determine potential solutions and implement changes on a timely basis? • Do we develop and clearly communicate practice plans and policies to physicians, staff and patients on a timely basis?

Human Resources

• Do we have a strategic business plan that guides our thinking and that we

14

The Triangle Physician

to support the administration of our patient care?

• Are all responsibilities and accountabilities clear? • Do we have standardized job descriptions and a job classification system? • Do we have and use a formal performance review system? • Do we have systems for physician recruitment, hiring, orientation and

Planning and Marketing

•D  o we use information technology practice and the direct provision of

meet the needs of physicians, managers, staff and patients?

Information Technology

performance?

Quality and Quality Improvement • Do we systematically respond on a timely basis to patient complaints and questions about claims? • Do we use satisfaction surveys for patients and for referring physicians? • Can we document the care that we provide to individuals and to groups of patients? • Do we benchmark our practice against acceptable standards and take


Practice Management measures to improve the care that we

appropriate issues?

Medical

• Are we comfortable having a PPA

provide? Legal and Regulatory Compliance • Do we have and use a compliance plan?

Managers

(NCMM)

and/or

Triangle Medical Managers. Some of our

work with us to develop a vision for

clients have had good luck with Craig’s

the practice and assume responsibility

List or indeed.com.

for assuring that our operations

support that vision?

If you already have a practice manager who has some but not all of the skills that

Finding the Right PPA

you want in a PPA, invite him or her to ap-

• Do we use consultants to help us with

If your responses to this second list of

ply for the position. Use your structured

Obtaining Outside Help When We Need It tasks we cannot perform internally?

questions indicate that your practice is

job description to objectively match skills

• Do we manage the consultants that

receptive to hiring a PPA, make sure you

against requirements and minimize any

we have identified as appropriate

find the right person for you. Begin with

discomfort that arises if your current per-

resources for our practice?

a job description and an employment

son isn’t qualified for the job. You may find

agreement that covers salary, benefits,

that with education and coaching, your

profit

current employee can actually do the job.

Will a Professional Practice Administrator WorkRADAR: for Us?

BAY15001

sharing,

bonus,

leadership

development and professional education.

If the responses to theAd: questions Versionabove 1

Conclusion

identify aspects of your current Date: 6/15practice

With

job

By doing an honest assessment of your

that need improvement, keep going.

opportunity, decide if your recruitment

practice, determining your practice’s

respect

to

posting

the

efforts will be national, regional or local

readiness for a PPA, and using an objective

Honestly assess your potential for accepting

and contact the professional organization

process for recruitment and hiring, you

a new management arrangement. Here are

to which most practice administrators

can make sure that the management of

belong – i.e. Medical Group Management

your practice meets the highest standards

Association (MGMA), North Carolina

of excellence.

good questions to ask: • Are we satisfied with the role that physicians now play in managing our practice? • Does the current office manager have the vision and skill to make the practice flourish? • Are our physician leaders intellectually receptive to sharing power with a PPA? • Given our personalities, what’s the likelihood that we can adjust to hiring a PPA? • Are we willing to support an appropriate compensation package? • If necessary, are we willing to revisit our governance structure and distribution of responsibilities? • Would a PPA give physicians more time for patient care, practice planning and professional education? • If we have multiple locations, can a PPA help us centralize functions that are not decentralized? • Are physicians receptive to working in partnership with a qualified and experienced non-physician PPA

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on practice finances and on other

january 2016

15

WI


Duke Research News

Women Cardiologists Do Different Work, Make Less Money than Men Despite efforts to in-

types of work performed and pay rates.

totals more than $1 million.

crease gender diversity in cardiology, major

The researchers found that:

differences

job

•W  omen constitute about 12 percent of

“This is the first study to show that although

and

cardiology ranks, which is dispropor-

men and women cardiologists share the

pay persist between

tionately low, given that half of medical

same specialty, they have markedly dif-

men and women who

school graduates are female.

ferent job descriptions,” Dr. Douglas said.

in

characteristics Pamela S. Douglas, M.D., M.A.C.C., F.A.S.E.

counterparts. Over a lifetime of work this

patients,

•W  omen are more likely to specialize in

“Thirty-nine percent of men are interven-

according to a Duke Medicine-led study

general/noninvasive cardiology, with 53

tionalists vs. 11 percent of women, and this

presented at the annual American Heart

percent pursuing this subspecialty com-

sets the stage for higher compensation.”

treat

heart

Association meeting.

pared to 28 percent of men. •A  lmost 91 percent of male cardiologists

The researchers found that the ranks of

stated they work full time, while about

women cardiologists remain disproportion-

80 percent of women said they work full

ally small compared to those in medicine

time.

overall; women who choose the field are

•M  en dominate in interventional sub-

much less likely to specialize in higher-pay-

specialties that perform higher-paying

ing interventional procedures; and women

catheter-based procedures. More than 39

earn less, even when adjusting for the dif-

percent of male cardiologists reported an

ferent types of work they do.

interventional subspecialty, compared to 11 percent of women.

“These results recapitulate the salary differ-

•M  en earn more money, even after ac-

ences that have been found among male

counting for all measured differences

and female physicians, lawyers, business

in job description, practice setting and

executives and others,” said cardiologist

productivity. Inherent in the measure of

Pamela S. Douglas, M.D., M.A.C.C., F.A.S.E.,

productivity are the known biases in the

Geller professor of research in cardiovascu-

billing system referred to as the relative

lar diseases at the Duke Clinical Research

value unit (RVU), in which procedures

Institute. Dr. Douglas is senior author of the

are reimbursed by the federal Centers for

research, which is also being published in

Medicare & Medicaid Services based on

the Journal of the American College of Car-

a score that accounts for the complexity,

diology.

time and value of a service. Interven-

Credit Mark Dubowski for Duke Medicine.

tional procedures generally have higher

“The differences in subspecialization and

“Cardiology needs to be welcoming to

RVU scores than cognitive services. As

practice were striking and merit note,” said

women,” Dr. Douglas said. ”One way to do

a result, male cardiologists generated a

radiation oncologists Reshma Jagsi, M.D.,

this is to acknowledge these differences

median 9,301 RVUs, while women gener-

associate professor at the University of

and work toward correcting them.”

ated 7,430.

Michigan and the study’s first author. “But

•T  he different procedures, working hours

it’s also important to note that the differ-

Dr. Douglas and colleagues analyzed data

and billing rates translate into higher

ence in compensation between men and

from 161 cardiology practices in United

earnings for men – a median of about

women couldn’t fully be explained by dif-

States communities surveyed in a 2013 re-

$100,000 a year more for men than for

ferences in subspecialty, procedures or the

women.

many other personal, job and practice char-

port from MedAxiom, a firm that gathers

acteristics that we evaluated.”

and distributes data and business informa-

•E  ven adjusting for differences in the

tion specifically for cardiologists. The sur-

amount and type of work performed,

vey is considered a non-biased look at busi-

women in cardiology make about

Dr. Douglas said the study did not address

ness practices, including hours worked,

$32,000 less per year than their male

the reasons why women steered to gen-

16

The Triangle Physician


Duke Research News optimizing patient care.”

eral cardiology rather than the interven-

“It’s important to be looking at this, be-

tional subspecialty nor did it explain the

cause we as a profession are not having

differences in the workload. But the study

full access to our ‘talent pool’ of qualified

In addition to Drs. Douglas and Jagsi, study

authors suggest that the differences could

internal medicine residents,” Dr. Douglas

authors include: Cathie Biga; Athena Pop-

stem from enduring gender inequities pro-

said. “That becomes a business and health

pas; George P. Rodgers; Mary N. Walsh;

fessionally and differences in choices in

care issue, as we increasingly recognize the

Patrick J. White; Colleen McKendry; Joseph

work/life balance.

importance of diversity among providers to

Sasson; and Phillip J. Schulte.

Finding Solves Circadian “Mystery” A team of scientists

adapts to diverse conditions, such as tem-

The findings have several implications. The

from Duke-NUS Gradu-

perature and metabolic changes.

phosphoswitch gives researchers and scientists a potential drug target to influence

ate Medical School Singapore (Duke-NUS) and

The research team found that the stability

the behavior of the circadian clock. This

the University of Michi-

of PER2 is dependent on a process called

new target may make it possible to counter

gan at Ann Arbor have

phosphorylation, in which phosphates are

the effects of jet lag, shift work and perhaps

discovered a molecular

added at key sites to influence the function

seasonal affective disorder.

switch that regulates the body’s circadian

of PER2. Dr. Virshup and the team discov-

clock and allows it to keep time. This switch

ered that phosphorylation acts as a switch.

The study also provides a mathematical

could be a potential drug target to treat cir-

This “phosphoswitch” leads to two alterna-

model that accurately predicts the behavior

cadian rhythm disorders caused by jet lag,

tive fates for PER2: increased stability or in-

of the clock under different circumstances.

shift work or metabolic disorders.

creased degradation.

This model will be useful in determining

David Virshup, M.D.

when drugs should be administered to Normally, the circadian body clock (24-

The researchers report that this phospho-

modify circadian rhythms, so they are most

hour cycle) is synchronized with the ris-

switch is sensitive to changes in tempera-

effective.

ing and setting of the sun, ensuring that

ture and metabolic signals, and so it fine-

we sleep at night. One of the reasons this

tunes clock speed as needed. Usually, the

The next step for the team is to test their

is possible is because the body clock is

rate of a biochemical reaction increases as

predictions in an animal model. They plan

relatively insensitive to small changes in

the temperature rises, so in this case the

to explore more about how phosphatases,

temperature. This is important, because

speed of the body clock should increase

an enzyme found in the body, and other

otherwise the body clock could run too

if the temperature rises. However, the team

kinases may be important in regulating the

fast when it is hot or too slow when it is

showed that at higher temperatures, the

circadian clock. Their current hypothesis is

cold. A long-standing scientific mystery is

phosphoswitch ensures that degradation

that the interplay of these systems will regu-

how the human body clock compensates

of PER2 is slower, therefore maintaining the

late the sleep and wake cycle.

for changes in temperature and maintains

speed of the body clock. In addition to Dr. Virshup and Dr. Forger,

its speed. “This study sheds light on one of the biggest

study authors include first author Duke-

Over the past few decades, research has

mysteries of the circadian clock in the last

NUS research fellow Min Zhou and KAIST

advanced the understanding of the circa-

60 years and has helped to explain some

(Korean Advanced Institute of Science

dian clock. One of the proteins critical for

of the basic mechanisms that govern the

and Technology) mathematician assistant

determining the timing of the clock, as well

timing of the clock,” explained Dr. Virshup,

professor Jae Kyoung Kim. This research

as the timing of sleep, is Period2 (PER2).

director of the Cancer and Stem Cell Biol-

is supported by the Singapore Ministry of

ogy Programme at Duke-NUS and professor

Health’s National Medical Research Coun-

In the current study, published Oct. 1 in

of pediatrics at the Duke University School

cil under its Investigator Research Grant.

the journal Molecular Cell and led by David

of Medicine. “By using both biochemical

Virshup, M.D., from Duke-NUS and Daniel

analysis and mathematical modeling we

For more information, please visit www.

Forger, Ph.D., from Michigan, the findings

demonstrated how the core circadian clock

duke-nus.edu.sg.

shed light on how PER2 regulates our cir-

keeps to a 24-hour cycle despite tempera-

cadian clock. It also clarifies how the clock

ture changes and metabolic changes.”

january 2016

17


UNC Research News

New SARS-like Virus Can Jump Directly from Bats to Humans

Ralph Baric, Ph.D.

Researchers from the

“Studies have predicted the existence of

was thought to have been extinct since

University of North Car-

nearly 5,000 coronaviruses in bat popula-

2004.

olina at Chapel Hill have

tions, and some of these have the potential

discovered a new SARS-

to emerge as human pathogens,” said se-

Dr. Baric and his team demonstrated that

like virus that can jump

nior author Ralph Baric, Ph.D., a professor

the newly-identified SARS-like virus, la-

directly from its bat

of epidemiology at the UNC Gillings School

beled SHC014-CoV and found in the Chi-

hosts to humans with-

of Global Public Health and professor of

nese horseshoe bats, can jump between

out mutation. However, researchers point

microbiology and immunology the UNC

bats and humans. They showed that the

out that if the SARS-like virus did jump, it

School of Medicine and world-renowned

virus can latch onto and use the same hu-

is unclear whether it could spread from hu-

expert in coronaviruses. “So this is not a

man and bat cellular receptor for entry. The

man to human.

situation of ‘if’ there will be an outbreak of

virus also replicates in primary human lung

one of these coronaviruses but rather when

cells, the preferred target for infection.

The discovery, reported in the Nov. 9 is-

and how prepared we’ll be to address it.” “This virus is highly pathogenic, and treat-

sue of Nature Medicine, is notable not only because there is no treatment for this

SARS first jumped from animals to humans

ments developed against the original SARS

newly discovered virus, but also because

in 2002-2003 and caused a worldwide out-

virus in 2002 and the ZMapp drugs used to

it highlights an ongoing debate over the

break, resulting in 8,000 cases, including

fight Ebola fail to neutralize and control this

government’s decision to suspend all gain

one case in Chapel Hill. With nearly 800

particular virus,” Dr. Baric said. “So build-

of function experiments on a variety of se-

deaths during that outbreak, SARS-CoV

ing resources, rather than limiting them, to

lect agents earlier this year. The move has

presents much like flu symptoms but then

both examine animal populations for new

substantially limited the development of

can accelerate, compromise breathing and

threats and develop therapeutics are key

vaccines or treatments for these pathogens

bring on a deadly form of pneumonia. The

for limiting future outbreaks.”

should there be an outbreak, according to

outbreak was controlled through public

a UNC press advisory.

health interventions and the original virus

Technique to Jumpstart Bone Cell Formation Discovered Unexpectedly Photo Credit: Max Englund, UNC Health Care

Janet Rubin, M.D.

Researchers at the Uni-

By treating stem cells – which can be-

versity of North Caro-

come fat or bone cells - with cytochalasin

Dr. Rubin added, “This was not what we ex-

lina School of Medicine

D – the result was clear: The stem cells

pected. This was not what we were trying to

may have found a way

became bone cells. Further, injecting a

do in the lab. But what we’ve found could

to tip the scale in favor

small amount of cytochalasin D into the

become an amazing way to jump-start lo-

of bone formation that

bone marrow space of mice caused bone

cal bone formation. However, this will not

could help those who

to form.

address osteoporosis, which involves bone loss throughout the skeleton.”

heal slowly, particularly the elderly. “And the bone forms quickly,” said Janet They used cytochalasin D, a naturally oc-

Rubin, MD, senior author of the paper and

The research published in the journal Stem

curring substance found in mold, as a

professor of medicine at the UNC School

Cells details how the scientists altered the

proxy to alter gene expression in the nuclei

of Medicine. “The data and images are so

stem cells and triggered bone growth.

of mesenchymal stem cells to force them to

clear; you don’t have to be a bone biolo-

become osteoblasts (bone cells).

gist to see what cytochalasin D does in one

At the center of the discovery is a protein

week in a mouse.”

called actin, which forms fibers that span

18

The Triangle Physician


UNC Research News cytoskeleton but do not allow the actin to enter the nucleus, the little bits of actin just sit in the cytoplasm, and the stem cells do not become bone cells.” Dr. Rubin’s team then turned to a mouse model. Using live mice, they showed that cytochalasin D induced bone formation in mice. At left, green actin fibers create architecture of the cell. (Right) With cytochalasin D added, actin fibers disband and reform in the nuclei.

Bone formation in mice isn’t very different from that in humans, so this research might

the cytoplasm of cells to create the cell’s

“My first reaction was, ‘No way, Buer,’” Dr.

be translatable, according to a UNC press

cytoskeleton. Osteoblasts have more cyto-

Rubin said. “‘This must be wrong. It goes

advisory. And while cytochalasin D might

skeleton than do adipocytes (fat cells).

against everything in the literature.’ But he

not be the actual agent scientists use to trig-

said, ‘I’ve rerun the experiments. This is

ger bone formation in the clinic, Dr. Rubin’s

what happens.’”

study shows that triggering actin transport

Buer Sen, M.D., first author of the stem cells paper and research associate in Dr. Ru-

into the nuclei of cells may be a good way

bin’s lab, used cytochalasin D to break up

Dr. Rubin’s team expanded the experi-

to force mesenchymal stem cells to be-

the actin cytoskeleton. In theory – and ac-

ments while exploring the role of actin.

come bone cells.

cording to the literature – this should have

They found that when actin enters and

destroyed the cell’s ability to become bone

stays in the nucleus, it enhances gene ex-

Dr. Rubin, the vice chair for research at the

cells. The cells, in turn, should have been

pression in a way that causes the cell to

UNC School of Medicine, holds joint ap-

more likely to turn into adipocytes. Instead,

become an osteoblast.

pointments in pediatrics and pharmacol-

Dr. Sen found that actin was trafficked into

ogy, and is an adjunct professor of bioen-

the nuclei of the stem cells, where it had

“Amazingly, we found that the actin forms

the surprising effect of inducing the cells to

an architecture inside the nucleus and

become osteoblasts.

turns on the bone-making genetic pro-

This work was funded by the National Insti-

gram,” Dr. Rubin said. “If we destroy the

tutes of Health.

gineering.

UNC and NCCU Awarded $7.5 Million for Alcohol Health Disparities Study Researchers at University of North Carolina

pathology, alcoholic liver disease, alcohol-

thology creating an ac-

School of Medicine and North Carolina

related cancers, including breast cancer,

tive NCCU program that

Central University have been awarded $7.5

and the effects of alcohol and marijuana on

will involve students

million to continue an ongoing collabora-

brain stem cells and neurotoxicity.

and prepare them to become leading scientists

tion aimed at understanding and reducing alcohol-related pathologies among African-

Gregory Cole, Ph.D., chair of biological and

Americans.

biomedical sciences at NCCU, and Fulton

Fulton Crews, Ph.D.

in the future,” Crews said.

Crews, Ph.D., director of UNC Bowles CenThe award from the National Institute on

ter for Alcohol Studies,

This partnership opens UNC research

Alcohol Abuse and Alcoholism (NIAAA) of

are lead investigators of

laboratories, core facilities and libraries to

the National Institutes of Health (NIH) is for

the project.

NCCU faculty, improving opportunities for

$6 million to NCCU and $1.5 million to UNC

“The UNC-NCCU part-

developing productive research laborato-

over a five-year period. This funding will

nership will promote,

ries at NCCU and providing NCCU students

continue a research program investigating

support, and mentor

with opportunities to work with some of the

research on alcohol pa-

world’s leading alcohol researchers.

the molecular mechanisms of fetal alcohol

Gregory Cole, Ph.D.

january 2016

19


News

Bullies at Risk of Eating Disorders Being bullied in childhood has been associated with increased risk for anxiety, depression and even eating disorders. But according to new research, it’s not only the victims who could be at risk psychologically, but also the bullies themselves. Researchers at Duke Medicine and the University of North Carolina at Chapel Hill were surprised to find that in a study of 1,420 children, those who bullied others were twice as likely to display symptoms of bulimia, such as bingeing and purging, when compared to children who are not involved in bullying. The findings are published in the December issue of International Journal of Eating Disorders. “For a long time, there’s been this story

Illustration by Mark Dubowski for Duke Medicine.

could be affected.

about bullies that they’re a little more hale

Children who were both bullies and victims had the highest prevalence of anorexia

and hearty,” said lead author William Cope-

Participants were divided into four catego-

symptoms (22.8 percent compared to 5.6

land, Ph.D., associate professor of psychia-

ries – children who were not at all involved

percent of the children not involved in

try and behavioral sciences at Duke Uni-

in bullying; victims of bullying; children

bullying) and also the highest prevalence

versity School of Medicine. “Maybe they’re

who sometimes were victims and some-

of binge eating (4.8 percent of children as

good at manipulating social situations or

times were instigators; and children who

compared to less than 1 percent of uninvolved children) and vomiting as a way to

All of these behaviors can have devastating effects on the long-term health of children

maintain their weight. But the impact of bullying behavior on those who were bullies was also significant, with 30.8 percent of bullies having symp-

getting out of trouble, but in this one area

were solely bullies, repeatedly abusing oth-

toms of bulimia compared to 17.6 percent of

it seems that’s not the case at all. Maybe

er children verbally and physically, socially

children not involved in bullying.

teasing others may sensitize them to their

excluding others and rumor mongering

own body image issues, or afterward they

without ever becoming a victim themselves.

have regret for their actions that results in

All of these behaviors can have devastating effects on the long-term health of children,

these symptoms like binge eating followed

The researchers were not surprised to find

said Cynthia M. Bulik, Ph.D., a distinguished

by purging or excess exercise.”

that victims of peer abuse were generally at

professor of eating disorders at UNC-Chapel

increased risk for eating disorders.

Hill and a co-author on the findings.

terviews from the Great Smoky Mountains

Children who were victims of bullying were

“Sadly, humans do tend to be most criti-

Study, a database with more than two de-

at nearly twice the risk of displaying symp-

cal about features in other people that

cades of health information on participants

toms of anorexia (11.2 percent prevalence

they dislike most in themselves,” Dr. Bulik

who enrolled at age nine. The data is con-

compared to 5.6 percent of children who

said. “The bullies’ own body dissatisfaction

sidered a community sample and not repre-

were not involved in bullying) and bulimia

could fuel their taunting of others. Our find-

sentative of the United States population but

(27.9 percent prevalence compared to 17.6

ings tell us to raise our vigilance for eating

offers clues to how children ages nine to 16

percent of children not involved in bullying).

disorders in anyone involved in bullying

The findings come from an analysis of in-

20

The Triangle Physician


News exchanges – regardless of whether they are

“We want to do a better job of understand-

In addition to Drs. Copeland and Bulik,

the aggressor, the victim, or both.”

ing why some people are able to experi-

study authors include Nancy Zucker, Dieter

ence the same things as others and be able

Wolke, Suzet Tanya Lereya and Elizabeth

Although many children experience life-

to get through them without the same con-

Jane Costello.

long effects, many appear to cope and suc-

sequences,” Dr. Copeland said. “We really

ceed after such experiences, Dr. Copeland

need to understand the resilience in those

The study was sponsored by the National

said. He and colleagues are examining

who have been bullied. That can help us

Institute of Mental Health (MH63970,

myriad factors, including looking at finan-

determine the children who are going to

MH63671, MH48085, MH080230); the Nation-

cial and educational outcomes and genetic

need the most attention and how we can

al Institute on Drug Abuse (DA/MH11301);

biomarkers associated with bullying or be-

promote those traits in others to increase

the William T. Grant Foundation; and the

ing victimized.

their resilience.”

Economic and Social Research Council in the United Kingdom (ES/K003593/1)

Welcome to the Area

Physicians

Laura Michelle Iafrati, MD

Nancy Pham, MD

Kayleigh Ann Gilmore, PA

Psychiatry

Radiology

Family Medicine

Duke University Hospitals Durham

Apex

University of North Carolina Hospitals Chapel Hill

Emergency Medicine/Sports Medicine; Orthopedic - Surgery of the Hand; Orthopedic Sports Medicine; Orthopedic Surgery of the Spine; Adult Reconstructive; Orthopedic Surgery

Sara Ahmadi, MD

Gary Wayne Jay, MD

Gynecology; Urological Surgery

Knightdale

Endocrinology, Internal Medicine; Metabolism

Cary

UNC-Ch Department of OB/GYN Urogyneoclogy Division Chapel Hill

Chelsea Blanche Hayman, PA

Leann Rae Simpson-Tarokh, DO

Neurology; Pain Medicine

Duke University Endocrine Division Durham

Robert Andrew Jones, MD

Megan Michelle Arvidson, MD

Benjamin Joseph Judd, MD

Psychiatry

UNC Hospitals Chapel Hill

Staci Erin Beamer, MD

Emergency Medicine

Pinehurst Anesthesiology

University of North Carolina Hospitals Chapel Hill

Cardiovascular Surgery

Sixto Manuel Leal Jr, MD

University of North Carolina Hospitals Chapel Hill

Pathology

UNC Hospitals Chapel Hill

Tina Yin Chang, MD

Winston Yunqing Li, MD

Family Medicine

Duke Primary Care-Brier Creek Raleigh

Tavia Denise Clark, MD Pediatrics

Durham

Matthew Melton Cole, MD Ophthalmology

Samantha Joy Pulliam, MD

Monica Baireddy Reddy, MD Diagnostic Radiology

UNC Hospitals Chapel Hill

Christopher John Severyn, MD Pediatrics

Duke University Hospitals Durham

Charles Gregory Smith, MD Environmental Medicine; Preventive Medicine/Occupational-Environmental Medicine; Public Health

Psychiatry

Efland

UNC Hospitals Chapel Hill

Eric Nicholas Stashko, MD

Angela Marie Lowenstern, MD

Wake Emergency Physicians, PA Cary

Cardiology; Internal Medicine

Duke University Hospitals Durham

Emergency Medicine

Christopher Michael Thompson, MD Family Medicine - Hospice and Palliative Medicine

Taylor Retina Center Raleigh

Andrew Pringle Peacock, MD Rocky Mount

Transitions LifeCare Raleigh

Gregory Deshaurn Crenshaw, MD

Jessica Alison Peak Vanleer, MD

Syeda Rabia Younus, MD

Vascular Surgery

Vascular Center Durham

Henry Dinh Do, MD Internal Medicine, Geriatric

Alignment Healthcare Garner

Christopher Lee Holley, MD Cardiovascular Disease, Internal Medicine

Duke University Medical Center Durham

Anatomic and Clinical Pathology; Blood Banking/Transfusion Medicine; Clinical Cytogenetics; Clinical Molecular Genetics; Cytopathology; Dermatopathology; Forensic Pathology;

UNC Hospitals Chapel Hill

Dolly Chanta’E Penn, MD Family Practice; General Practice; General Preventive Medicine; Public Health

University of North Carolina Hospitals Chapel Hill

Adolescent Medicine; Cardiac Electro physiology, Internal Medicine; Cardiovascular Disease; Clinical Pathology; Diabetes; Endocrinology

Carolina Internal Medicine & Pediatrics Goldsboro

Kaitlin Quinn Maher, PA Orthopedic - Surgery of the Hand; Orthopedic Sports Medicine; Orthopedic Surgery of the Spine; Orthopedic Surgery, Adult Reconstructive; Musculoskeletal Oncology; Orthopedic Surgery, Pediatric

Duke Orthopedics Durham

Tifi Otto Toilolo, PA Critical Care-Internal Medicine

Duke Dept of Advanced Clinical Practice Durham

Thanh Tran, PA Emergency Medicine; Family Medicine; Family Practice; General Practice; Internal Medicine; Pediatrics

Raleigh

Psychiatry

Eric Matthew Tupis, PA

120 Berrydowns Drive Morrisville

Cary

Orthopedic Surgery

Megan Elisabeth Vilcek, PA

Physician Assistants

Stacy Lynn Drew, PA Abdominal Surgery; Addiction Psychiatry; Adolescent Medicine; Allergy/Immunology, Diagnostic Lab; Anatomic and Clinical Pathology; Bariatric Medicine; Cardiology

Abdominal Surgery; Young Adult Medicine; Adolescent Medicine; Critical Care Pediatrics; Critical Care Surgery; Critical Care-Internal Medicine; General Surgery; Hospitalist; Internal Medicine - Nephrology

Duke University Medical Center Durham

204 Sandhurst Rd Raleigh

january 2016

21


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