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Wake Radiology

Independent and Unwavering in Commitment to Excellence

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

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COVER STORY

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Wake Radiology Independent and Unwavering in Commitment to Excellence

m ay 2 0 15

Vol. 6, Issue 4

DEPARTMENTS

FEATURES

14

Womenâ&#x20AC;&#x2122;s Wellness

7 Reasons Hospital-Physician Mergers Hurt Health Care Marni Jameson Counts the ways, includ-

9 Practice Spotlight

18 UNC News

Mastectomy Is Still Choice Even

Cary Gastroenterology

Revisiting HIPAA Compliance

ing decreased competition, quality and

12 Gastroenterology

choice and increased cost.

How the Internet Can Hinder the

16

Doctor-Patient Relationship

Gastroenterology

Paradigm Shift: Replacing Lost Volume Is Key to Taking Years Off Aging Skin Dr. Margaret Boyse says dermal fillers are more effective than facelifts in restoring youthful facial qualities.

13 Womenâ&#x20AC;&#x2122;s Health Understanding Options for Fibroids

17 Autism Society of North Carolina Accessing Services Guide Is Free and Part of Online Empowerment Series

COVER PHOTO: From Left, Lyndon K. Jordan III, M.D., and Richard J. Max, M.D., review images.

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The Triangle Physician

When Breast-Conservation

10 Practice Management

Surgery Is Option

19 DUKE NEWS - Changes in the Adolescent Brain on Alcohol Last Into Adulthood

- 2015 Editorial Calendar

20 NEWS Schaaf Awarded Highest Governor Honor

21 News

Welcome to the Area


From the Editor

Unwavering Commitment Wake Radiology arrived as a pioneer in 1953 and through the years has sustained

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

its commitment to serve patients as an integral part of the health care team. Now, 20 offices and nearly 50 radiologists strong, it continues its mission to provide specialized medical imaging as a local, independent, physician-owned practice. In this month’s cover story, you’ll gain insight into the strides Wake Radiology has made. From the first catheter angiography in the 1960s to one of the first to introduce three-dimensional mammography, it is “constantly leveraging new technologies to better serve the patients and physicians….” This month’s contributing editors demonstrate their unwavering commitment to patient care by taking the time to share specialized insight. Dermatologist Margaret Boyse enlightens readers on a safer and more effective medical process for preserving one’s youthful appearance, a characteristic that is highly valued. Also in this issue of The Triangle Physician, there are cautionary notes.

Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Margaret Boyse, M.D. Douglas Drossman, M.D. Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Marni Jameson 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

Gastroenterologist Douglas Drossman addresses how information from the Internet might impact the doctor-patient relationship, as well as care. Marni Jameson, who advocates for independent physicians, talks about the ways mergers can hurt health care. Practice management consultant Margie Satinsky discusses the challenges of HIPAA compliance. The Triangle Physician represents an unwavering commitment to the more than 9,000 within the Triangle medical community. The magazine serves this select audience by providing a cost-effective medium for sharing medical news, information and insight, which we welcome at no cost. Advertising rates are competitive. Please send information and inquiries by e-mail to info@ trianglephysician.com. Many thanks to all those who support the monthly production of The Triangle Physician, which includes you. Thanks for reading. With gratitude for all you do,

Heidi Ketler Editor

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The Triangle Physician

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

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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Cover Story

Wake Radiology

Independent and Unwavering in Commitment to Excellence Lyndon K. Jordan III, M.D., leans forward

The advances in medical imaging – which

another costly procedure, so it’s important

as the monitor comes to life. The Wake

allow physicians to see inside the body with

we get it right – and get it right the first time.”

Radiology physician closely examines the

greater clarity than ever before – have given

black-and-white images, looking for signs of

radiologists an increasingly important role

Dr. Jordan is one of nearly 50 radiologists at

injury to the ligaments and tendons around

in the care of the patient. Physicians now

Wake Radiology who collectively perform

the knee of his patient, a local high school

rely on images to identify and diagnose

nearly 600,000 procedures a year. Each one

basketball coach.

medical issues more often and at an earlier

is a specialist. Not just in the field of radiol-

stage.

ogy, but in a very specific type of radiology.

stark medical images in a small, darkened

“There’s a renewed emphasis on medical

“Our level of specialization is unique in

room that is purposefully tucked away in a

imaging today. We’re often involved early in

private practice, and it allows us to better

quiet corner of the Wake Radiology office.

the care of the patient and may offer the first

serve patients,” Dr. Jordan says. “Identify-

The specially designed reading room allows

insight to diagnose the problem,” says Dr.

ing subtle abnormalities requires a carefully

physicians like Dr. Jordan to focus on ana-

Jordan, president and managing director of

trained eye. A physician who spends his or

lyzing and interpreting medical images in a

Wake Radiology, the Triangle’s largest out-

her entire career studying specific kinds of

space free from distraction. The task at hand

patient provider of medical imaging. “We

images knows precisely what to look for

is too important.

realize that our interpretations often deter-

and is better equipped to accurately diag-

mine whether a patient needs surgery or

nose a problem.”

A radiologist, Dr. Jordan is surrounded by

He says the same is true for all radiology subspecialties, whether it’s breast imaging, neuroradiology or orthopedic/sports imaging. To leverage that expertise, Wake Radiology is structured around small teams of subspecialists that allow each physician to work in the field they know best and, when necessary, collaborate with others who have subspecialty experience. Wake Radiology physicians are members of the American College of Radiology and use imaging protocols to improve patient outcomes and better control health care spending. Dr. Jordan, a musculoskeletal radiologist who specializes in sports imaging, reviews computed tomography scans, magnetic resonance imaging scans, ultrasounds and Xrays. Like a pilot running through a pre-flight checklist, he carefully scans the images for All Wake Radiology computed tomography scanners are equipped with dose-reduction software.

6

The Triangle Physician

dozens of potential medical conditions that


may only be seen through sophisticated

in the past 20 years, two years ago and has

share them to consult with fellow radiolo-

medical imaging.

upgraded equipment in 80 exam rooms to

gists and collaborate with referring physi-

provide patients with more modern imaging

cians.

But as Dr. Jordan studies the images of

technology. A Spirit of Collaboration

knees, hips, shoulders and elbows, he sees beyond the bones and joints on the screen

“When I trained, images were still being spit

The physicians at Wake Radiology are ex-

before him – he always sees a patient. It

out on film and viewed on a light box,” Dr.

perts in reading medical images, but they

might be a neighbor who tweaked a previ-

Jordan says. “The advances we’ve seen in

are also an integral part of a patient’s larger

ous injury, a college athlete who took a nas-

the field of radiology in the past 20 years

health care team. The radiologists collabo-

ty spill during practice or an elderly patient

are astounding, and Wake Radiology is con-

rate with a patient’s primary physician to de-

suffering from joint pain.

stantly leveraging new technologies to bet-

termine the most appropriate imaging tests,

ter serve the patients and physicians who

discuss the results and help determine the

place their trust in us.”

best course of treatment.

“We study a lot of images, but we never forget that each image belongs to a person. That image represents a woman worried about a new lump, a parent concerned about a child’s fractured wrist, a friend experiencing unexplained pain,” he says. “There’s a person behind every one of the images we review and we always remember that, even if we never meet the patient in person.” The Art of Imaging Medical imaging has come a long way since Albert M. Jenkins, M.D., founded Wake Radiology and opened the Triangle’s first outpatient imaging office in Raleigh’s Cameron Village in 1953. The tiny office featured one general purpose X-ray machine and had the ability to see up to 10 patients a day. Private radiology practices were rare at the time, but Wake Radiology was a pioneer.

Medical images are available immediately and can be accessed by referring providers on any mobile device via PACS (picture archiving and communications system).

Through the years, it has consistently raised the standard of radiology care in the Tri-

One advantage of Wake Radiology’s invest-

“We embrace that type of interaction,” Dr.

angle by introducing new imaging technolo-

ment in new software and equipment is the

Jordan says. “We want physicians to know

gies and techniques to the market – from

ability to capture high-resolution images us-

that they may contact us anytime to answer

the first catheter angiography in the 1960s

ing the lowest possible dose. All CT scan-

questions, review clinical information and

to the first cardiac MRI in the 1990s.

ners, for example, are equipped with dose-

discuss guidance on any additional testing

reduction software. In addition, the practice

that is necessary.”

As medical imaging has advanced from

follows rigorous CT dose compliance and

industrial X-rays to low-dose film to digital

quality control standards that go above and

Wake Radiology established telephone ho-

imaging, Wake Radiology has always led the

beyond the standards set by the American

tlines several years ago that connect physi-

way. That commitment to cutting-edge tech-

College of Radiology.

cians directly with radiologists in the reading rooms to discuss imaging results. And a

nology and high quality imaging continues The move to digital, computer-based imag-

new smartphone application will soon en-

ing forever changed the practice of radiol-

able referring physicians to connect with a

Wake Radiology introduced three-dimen-

ogy. Images are clearer, sharper and more

radiologist at the push of a button. The app

sional mammography, hailed as the biggest

detailed. And it’s possible to collect more

also will allow physicians to access patient

advancement in breast cancer screening

images, more quickly and immediately

images anywhere on a secure connection.

today.

may 2015

7


“It’s More Than A Job…

Hunter credits Wake Radiology with saving

While the practice has grown considerably

It’s A Calling”

her life. She didn’t have a family history of

in the past 62 years, it remains local, inde-

Susan Bradsher has been part of the Wake

breast cancer, but she knew the statistics:

pendent and physician owned.

Radiology team for nearly 30 years as one

One in eight women in America is diag-

of the Raleigh MRI front desk staff. But now

nosed with breast cancer and it kills nearly

With that independence comes an unwaver-

Ms. Bradsher brings a unique perspective

40,000 women a year.

ing commitment to serve the Triangle, Dr. Jordan says.

to her work. When the practice introduced 3-D mammography in 2013, Wake Radiology

She insisted on a 3-D mammogram and says

suggested that employees like her try the

it’s the best decision of her life. Her radiolo-

Wake Radiology demonstrates its commitment

new technology.

gist at Wake Radiology spotted a question-

by supporting local charities and health care

able shadow and later determined she had

causes. By investing in talented physicians and

She agreed, and her 3-D mammogram de-

breast cancer. Her primary physician was

caring support staff. By adopting cutting-edge

tected a tiny spot that raised concerns. A

astonished the cancer was detected, saying

technology that allows it to capture the perfect

diagnostic mammogram, breast MRI and

a traditional mammogram would have nev-

images. By doing whatever it takes to best

biopsy revealed the 49-year-old had an ag-

er caught it. The cancer would have likely

serve Triangle physicians and their patients.

gressive form of breast cancer. It’s likely the

continued to grow for another year and re-

cancer would not have been detected with

quired a much more aggressive treatment.

Wake Radiology. No one sees you like we do. www.wakerad.com • (919) 232-4700

a traditional mammogram. Serving the Triangle Since returning to work, Ms. Bradsher has a

Today, Wake Radiology sees thousands of

new outlook. “I believe we go through things

patients a day. It serves the Triangle from 20

•Body Imaging / MRI

like this for the people who come behind us.

offices that stretch from Raleigh, Cary and

•Breast Imaging / MRI

I have walked the road that some of our pa-

Chapel Hill to Fuquay-Varina, Garner, Mor-

•Interventional Radiology

tients are about to go down,” she says. “It’s

risville, Smithfield and Wake Forest. In addi-

•Neuro Imaging

more than a job now. It’s a calling.”

tion, it provides radiology services at region-

•Orthopaedic & Sports Imaging

Mary Leigh Hunter is one of those pa-

al hospital systems, including WakeMed

•Pediatric Imaging

tients who followed behind Ms. Bradsher.

Health & Hospitals, Maria Parham Medical

•PET-CT

A 69-year-old grandmother from Cary, Ms.

Center and Franklin Medical Center.

•Vein Therapy

Imaging Subspecialities

Three-dimensional mammography, the biggest breakthrough in breast cancer screening in the past 20 years, has been offered at Wake Radiology since 2013.

8

The Triangle Physician


practice

spotlight

Women’s Wellness

Cary Gastroenterology Opens Women’s Center for GI Health Doctors Juliana Miller and Shannon Scholl, along with an all female staff, provide care for women in the Women’s Center for GI Health, a Division of Cary Gastroenterology. Both physicians are Board Certified in Gastroenterology and have a special focus on women’s health issues and additionally, Dr. Scholl has special training in liver disease. The Center is centrally located, not far from Rex Hospital. The physicians of Cary Gastroenterology recognize that women’s GI issues are unique and that women express their symptoms differently than men, which prompted the opening of the Women’s Center. Many women experience digestive health issues that negatively impact their lives, but are embarrassed to discuss them with their physicians. The Women’s Center provides them an environment to discuss these intimate issues comfortably with their physician. Drs. Miller and Scholl are also cognizant of the need for special care in colon screening of women due to anatomical differences, often

from child bearing or other gynecological issues. They continually exceed national endoscopic quality measures for colonoscopy for women. Having served the Triangle community since 1986, Cary Gastroenterology’s physicians enjoy Tier 1 status with Blue Cross Blue Shield and more importantly rank substantially higher than the standard in their Adenoma Detection Rates (ADRs.). National benchmark standards show that 15% of women should have an adenoma discovered and removed during colonoscopy, Cary Gastroenterology’s physicians have an ADR rate of 34% in their female patients. Recent studies show that physicians with higher ADR’s prevent more colon cancers. Drs. Miller and Scholl provide endoscopy services in three state-of-the-art, fully accredited ambulatory surgery centers, utilizing IV sedation to ensure a comfortable experience. These endoscopy centers offer a relaxed environment, individualized care, and reduced costs compared to hospital-based procedures. They also perform procedures and see patients at WakeMed Cary.

3100 Duraleigh Road, Suite 309, Raleigh 27612

The Women’s Center for GI Health is the first separate all female GI office to treat women in the Triangle, setting itself apart not only by focusing solely on women; but by incorporating advanced treatment modalities and diagnostic testing with such services as nonsurgical hemorrhoid banding, capsule endoscopy and on site anorectal manometry. As a full service outpatient practice, the Women’s Center treats disease and disorder such as IBS, celiac disease, gluten intolerance, Crohn’s disease and Ulcerative Colitis, while ensuring comprehensive treatment options resulting in best outcomes. Patients referred to the Women’s Center for GI Health receive the most up-to-date care available and referring physicians always receive comprehensive information back regarding their patient. Immediate appointments are available for patients being referred for an emergent issue. Providing exceptional GI care for women by women is the goal of the Women’s Center for GI Health.

919-787-1644 • carygastro.com/womenscenter

may 2015

9


Practice Management

Revisiting

HIPAA Compliance By Margie Satinsky, M.B.A.

The Health Insurance and Portability Act has

pliance with the original Privacy and Secu-

required Covered Entities to comply with the

rity requirements doesn’t guarantee compli-

requirements of the Privacy and Security

ance with more current requirements.

Rules since 2001 and 2005, respectively. We’ll point out two of the major changes in Our experience includes training more than

HIPAA requirements. One is the definition

100 medical practices and business associ-

of a “breach,” i.e. the unauthorized use or

ates on both rules. We’re repeatedly struck

disclosure of protected health information

by the inconsistencies that we see. Some

(PHI). The Omnibus Final Rule spells out

organizations approach Health Insurance

four questions to ask to determine breach

and Portability Act (HIPAA) compliance

occurrence and sets forth the specific steps

thoughtfully, carefully and correctly; others

to be taken in the event of a breach.

Margie Satinsky, MBA, is President of Satinsky Consulting, LLC, a Durham, NC consulting firm that specializes in medical practice management. She’s provided HIPAA compliance consultation to more than 100 Covered Entities and Business Associates. 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.

take the easiest and least expensive way out. A second change, issued in 2009 and clari-

uses PHI in order to carry out the services

Let’s start with three erroneous assumptions

fied in 2013, has to do with patients’ rights.

that it performs on behalf of a Covered En-

that we encounter most frequently:

Patients now have the right to pay in full for

tity. Examples are your information technol-

a service and ask that PHI not be disclosed

ogy software vendor or billing company.

1) Having a Notice of Privacy Practices (NPP) and Business Associate Agree-

to an insurer. They also have the right to re-

ments (BAA) constitutes HIPAA com-

quest that a Covered Entity provide their PHI

Business Associates have much greater li-

pliance.

in electronic format.

ability than they had when HIPAA went into

2) Completing risk analyses for both the

effect, and they’re now liable for most of the

Privacy and Security Rules is all that

Notice of Privacy Practices

same civil and criminal penalties that apply

needs to be done.

The Notice of Privacy Practices (NBPP) that

to Covered Entities. Moreover, in 2013, CMS

Covered Entities must make available to pa-

introduced a new concept, called “Agent”

tients is a good place to start. If you created

(i.e. subcontractor).

3) Compliance audits don’t target small practices.

an NPP in 2001 and never updated it, you’re HIPAA compliance may be much more

non-compliant. If you have a new NPP and

Depending on how work is done, some

complex than what you have incorrectly as-

didn’t inform patients about the changes,

Business Associates outsource aspects of

sumed!

you’re non-compliant.

the work they do for Covered Entities to

Changes in HIPAA Privacy

There are efficient ways to notify patients

able. If you put Business Association Agree-

and Security

about changes. You can send a letter by

ments (BAAs) into effect in 2001 and never

HIPAA has evolved since the passage of

mail and/or by email. You can and should

updated the language, you’re non-compli-

the initial Privacy and Security Rules. One

inform patients when they come to the of-

ant. If BAAs don’t have agreements in place

change occurred in 2009 with the passage

fice, giving them the opportunity to review

with agents, you’re non-compliant.

of the HITECH Act, part of the Affordable

the revised document.

third parties, i.e. agents. Agents, too, are li-

Care Act (ACA). The most recent change oc-

Use of Risk Analyses to Determine

curred in 2013, with the passage of the Om-

Business Associate Agreement

Current Compliance Status

nibus Final Rule. The Centers for Medicare

The concept of the Business Associate has

Both the Privacy and Security Rules require

and Medicaid Services (CMS) issued the

been part of HIPAA since the outset, but

using a Risk Analysis (also called “gap”

rule in March 2013, requiring compliance by

there have been major changes. A Business

analysis) to determine what compliance re-

Sept. 23, 2014 (with some exceptions). Com-

Associate is an organization that routinely

quirements have been addressed and what

10

The Triangle Physician


compliance requirements should be ad-

Next Steps for

its attestation to HIPAA compliance wasn’t

dressed going forward. We repeatedly see

Enhancing Compliance

valid.

that Covered Entities and Business Associ-

Here are suggestions for enhancing HIPAA

ates assume that answering the questions

Privacy and Security Rule compliance in

Next, use your assessment to determine

constitutes compliance; it doesn’t.

your practice. Start with an honest assess-

what needs to be done. Finally, get the job

ment of what you have in place and where

done in a way that recognizes your staff’s

The questions are just a starting point. You

you’d like to be. Although compliance with

competence and availability.

need to keep going, listing what needs to be

the requirements of Meaningful Use (MU)

done, the responsible party and the time-

are by no means the only reason to be

We have a strong opinion on what works

frame. Most important, use the lists to take

HIPAA compliant, the connection between

best – i.e. collaboration between an individ-

action steps.

HIPAA and the MU requirements is real

ual within the practice designated with the

and important. More than one practice that

responsibility for HIPAA compliance and an

HIPAA Privacy and

thought it met the MU requirements found

external expert.

Security Policies and Procedures

its financial incentive taken back because

Both the Privacy and Security Rules require Covered Entities and Business Associates to have policies and procedures (P&Ps). Realistically, busy medical practices find it hard to devote time to the creation of P&Ps. We think it’s not necessary to reinvent the wheel. A more reasonable approach is to customize a sample P&P to your particular situation. Privacy and Security Rule Similarities and Differences The Privacy and Security Rules have both similarities and differences. Both require a designated individual to take responsibility. In some organizations, the Privacy Official and the Security Official are different individuals; in other cases one person handles both Rules. Both Rules require a Risk Analysis, written P&Ps and annual workforce training. Let’s talk about differences. The Privacy Rule is administrative, and the requirements are straightforward. The Security Rule contains administrative, technical and physical components. There’s a distinction between requirements that you must meet and items that you must “address.” The address approach gives you options, with the expectation that you will use good judgment. Here’s an example. The Security Rule speaks to the security of your physical facility, but it doesn’t require installation of a particular alarm system. The choice is up to you. Womens Wellness half vertical.indd 1

12/21/2009 4:29:23 PM

may 2015

11


Gastroenterology

How the Internet Can Hinder the

Doctor-Patient Relationship By Douglas Drossman, M.D.

These days patients increasingly take to the

On the positive side, with a good patient-

Internet for health information to find sup-

provider relationship, the relationship is a

port from other people who share similar

partnership not a confrontation. The patient

health conditions or experiences and to

can bring ideas from the Internet, and the

research health care providers via online

provider puts it in perspective.

review sites. Here are some examples of how a doctor While the Internet can empower patients to

might respond positively: “Yes you have

take a more active role in their health, it may

pain that seems like pancreatic cancer, but

also do more harm than good. The endless

a year ago the computed tomography scan

amount of information available makes it

was negative; if you had pain from cancer, it

difficult for patients to know which sources

would have been seen at that time. Let’s focus

are credible, whether the information is

on managing your functional gastrointestinal

scientific or even relevant and accurate for

pain.” Or if the physician is not sure, “Let’s

their particular health condition.

consider this and other possibilities further.”

Let’s consider scenarios where a patient’s

From the physician side there may also be

online hunt for information can challenge

problems.

both the patient and the provider. Clinicians are forced to spend more and

Dr. Douglas Drossman graduated from Albert Einstein College of Medicine and was a medical resident and gastroenterology fellow at the University of North Carolina. He was trained in psychosomatic (biopsychosocial) medicine at the University of Rochester and recently retired after 35 years as professor of medicine and psychiatry at UNC, where he currently holds an adjunct appointment. Dr. Drossman is president of the Rome Foundation (www.theromefoundation.org) and of the Drossman Center for the Education and Practice of Biopsychosocial Care (www. drossmancenter.com). His areas of research and teaching involve the functional GI disorders, psychosocial aspects of GI illness and enhancing communication skills to improve the patient-provider relationship. Drossman Gastroenterology P.L.L.C. (www. drossmancenter.com) specializes in patients with difficult-to-diagnose gastrointestinal disorders and in the management GI disorders, in particular severe functional GI disorders. The office is located at Chapel Hill Doctors, 55 Vilcom Center Drive, Suite 110 in Chapel Hill. Appointments can be made by calling (919) 929-7990.

Googling for Answers: When people

more time online with the electronic medi-

search using common symptoms (i.e., diar-

cal record (EMR), which, I believe, is more

rhea, constipation, nausea and abdominal

for billing purposes than to help the patient.

pain) the results will include a very large

Too much attention to the computer dur-

number of possibilities that takes medical

ing the office visit can take away from good

knowledge to sort out.

communication.

Self-diagnosis: With such information

Many doctors need to maintain their prac-

make a doctor look like an ogre. So one or

patients are vulnerable to “med student

tices through referrals. With specialties at

two bad reviews doesn’t necessarily mean

syndrome.” When a medical student has a

major medical centers it may come from

there is a problem.

symptom and they look it up, what do they

other specialists or primary care. But for

focus on? The worst possibility.

community doctors, they also need to rely

From the patient’s perspective they can

on their patients’ recommendations: “Dr.

judge the doctor’s interpersonal skills, but

Information overload: Some patients may

Jones… he’s the best! He really takes the

there is no good way to judge technical

run the risk of going to the doctor armed

time to listen.”

skills or the physician’s ability to diagnose

with their new Internet knowledge and may

and treat. For technical competence and

challenge the physician. “How do you know

Now there are patient evaluation sites, like

good knowledge, the patient must check

this isn’t pain from pancreatic cancer? I just

Health Grades, Vitals, etc., where patient

their training credentials and the hospitals

read about it and have those symptoms!”

evaluations of doctors are compiled. The

where they work.

good news is that if a provider consistently The physician may practice defensive medi-

gets glowing reviews, the patient can expect

Some doctors may try to encourage good

cine and order tests just to satisfy the patient

a good clinical interaction and in general

comments. There are doctors who might ac-

when it’s not really indicated or conversely

people like to give good reviews.

cede to requests to prescribe certain medi-

may stand ground and appear confrontational to the patient.

12

The Triangle Physician

cations e.g., opioids, when it might not be However, it only takes one angry patient to

medically indicated.


Gastroenterology Yes, the Internet is rapidly changing the doc-

health care providers need to be mindful of

of the physician in providing care.

the ways patients are using the Internet and

tor-patient relationship by giving patients the opportunity to assume much more responsi-

We need to urge patients to recognize the

learn how the vital role of effective communi-

bility for their own health care – and there is

ways in which the Internet can hinder their

cations can help foster a collaborative physi-

no doubt that this increased empowerment

relationship with physicians and potentially

cian-patient relationship that achieves quality

of patients is challenging the traditional role

impact the delivery of care. Additionally,

delivery of care with or without the Internet.

Women’s Wellness

Understanding Options for

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

Uterine leiomyomas, or fibroids, are ex-

Treatment of fibroids largely can be bro-

traordinarily common. Some studies es-

ken into medical management and surgi-

timate that 70-80 percent of women have

cal management. Medical therapy includes

fibroids by the fifth decade of life.

hormones (both combined oral contraception and progestin treatments) as well as

As women learn that they have fibroids, we

gonadotropin-releasing hormone agonists.

emphasize that not everyone needs treat-

Further, the levonorgestrel-releasing intra-

ment. For many women – realizing how

uterine system is an option. Surgical options

common fibroids are can allay their fears.

include resection of fibroids, embolization

Many women live with fibroids and do not

of blood vessels that feed fibroids, endome-

have treatment.

trial ablation, hysterectomy and more.

When women with fibroids have symp-

Currently we are involved in a number

toms – they are typically related to 1)

of clinical trials for the medical manage-

heavy or prolonged periods or 2) bulk

ment and surgical management of uter-

symptoms (pressure, urinary frequency,

ine fibroids. Participation in clinical trials

difficulty emptying bladder).

has many benefits. First, detailed imaging of fibroids is usually done, followed by a

When symptoms are present, there are

detailed review of the patient’s symptoms.

many options for management.

Further, an endometrial biopsy may be done to evaluate a woman for cancer or

Management of fibroids involves under-

precancerous lesions.

standing the type(s) of fibroid. This can be done with a pelvic ultrasound. When

Women participating in the clinical re-

our providers perform a pelvic ultrasound,

search studies are compensated for their

we also provide an education on the type

participation. Compensation ranges from

and number of a woman’s fibroids. Once

$800 to $1,500.

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.

The Women’s Wellness Clinic (www. cwrwc.com) welcomes referrals of women

diagnosed, we review the prevalence and reassure the patient that fibroids are com-

A clinical trial is not always the answer, but

mon. We then review treatment based on

we are excited to offer them as options. We

a woman’s symptoms, size of fibroid, loca-

also work with radiologists, oncologists and

tion of fibroid, her age and her plans for

reproductive endocrinologists who special-

family.

ize in management of uterine fibroids.

with heavy periods and uterine fibroids. Call (919) 251-9223 to make a referral or with questions you may have regarding options for women with uterine fibroids.

may 2015

13


Physician Advocacy

7 Reasons Hospital-Physician Mergers Hurt Health Care By Marni Jameson

Every day more physicians are giving up their independent practices to become hospital employees. And who can blame them? It’s tempting. Hospitals can offer doctors more money, since hospitals get paid more for the same procedures. Plus, hospitals will take over the administration of the practice and cover staffing, billing, overhead and marketing. They will drive patient referrals into the practice, cover the costs of electronic medical records and pick up the tab for the malpractice insurance. Why wouldn’t a doctor do this? Well, because hospital-physician consolidations have many repercussions that doctors may not realize. Studies show that such mergers can negatively impact patients, doctors, communities and the nation’s health care. According to Tommy Thomas, a certified public accountant based in Winter Park, Fl., and founder of the Association of Independent Doctors (AID), here are seven of those consequences, which physicians should consider before they trade independence for employment: 1. Competition Decreases: When hospitals buy physician practices, competition dries up. It’s simple economics: Fewer independent providers competing with each other means costs go up and quality goes down. According to America’s Health Insurance Plans (AHIP), “An acquisition that eliminates significant competition between providers increases the ability of providers to lower their quality of care, abandon innovation and demand and obtain higher prices for medical care.”

14

The Triangle Physician

2. Quality goes down: Hospitals track how many patients their doctors admit and how many tests they order. Employed physicians’ employment contracts can depend on their numbers. This pressure results in employed physicians ordering more unnecessary tests and procedures, which not only drives up health care costs but also can put patients in harm’s way. “Consolidation of providers results in a welldocumented record of harm to consumers with price increases of 20 percent to 40 percent after consolidation,” according to AHIP. 3. Patients have less choice: Employed physicians are expected to refer to other doctors employed by that hospital and to order tests through hospital-owned facilities, regardless of whether those doctors or facilities are the best or most cost effective. Patients unwittingly get into the funnel, going only to hospital-owned entities, which costs them more. 4. Costs increase. In a large study, the Medicare Payment Advisory Commission (MedPac) confirmed that hospitals charge more than independent doctors for the same procedure – sometimes several times more. For instance, a heart catheterization in a freestanding center costs around $1,100, while the same procedure costs $4,000 in a hospital outpatient setting. “The disparities create incentives for hospitals to buy physician practices, which drives costs up for everyone: Medicare, private insurance companies, employers, employees and patients,” the 2013 MedPAC report concluded. A study published in the Journal of the American Medical Association (Oct. 22, 2014) further substantiated the higher costs. The California study, which included 4.5 mil-

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. lion patients seen between 2009 and 2012, found a significant difference in the mean inpatient costs when comparing patients of independent doctors, of doctors employed by a hospital and of doctors employed by a multi-hospital system: • Independent doctor: $3,066 • Hospital-owned doctor: $4,312 • Multi-hospital-system-owned doctor: $4,776 It adds up. “If hospital facilities charged the same as independent doctors for the same services for 66 groups of services, taxpayers would save $900 million a year in Medicare costs,” said MedPAC. Imagine if insurance providers also brought their contracted rates with hospitals in line with their reimbursement rates for private practitioners. 5. Communities lose jobs. Independent practices are small businesses. Small businesses create about 65 percent of our nation’s new jobs and are vital to the market dynamics of healthy communities. When independent doctors sell to hospital systems and become employees, the hospital assumes staffing and that often means loyal office workers lose their jobs. 6. Taxes go up: When a nonprofit health system acquires an independent physician’s practice, overnight that practice goes from


supporting the community through paying property, tangible and sales taxes to paying no taxes. We all pay for that. 7. Job satisfaction and security go down: Employed doctors often find the best year of employment is the first one. After that, contracts often get worse, if they get renewed at all. Remember, employed physicians’ jobs, salaries and benefits can depend on their numbers. Most physicians usually have to sign as a condition of employment a non-compete agreement if they leave, so some aren’t allowed to practice in the area again for a specified period of time. The risk of not signing the agreement is that their contracts won’t be renewed.

55 Vilcom Center Drive Boyd Hall, Suite 110 Chapel Hill, NC 27514

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919.929.7990

www.drossmangastroenterology.com

Drossman Gastroenterology

Most physicians don’t want to be part of the fallout that occurs when hospitals acquire them, but many also feel they don’t have a choice. We think they do. The Association of Independent Doctors is a fast-growing, national nonprofit organization designed to help independent doctors stay that way. Since it was established in April 2013, the association has grown to include members in eight states. “We fight a fight that doctors have neither the time, means nor clout to pursue,” said Mr. Thomas.

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By organizing physicians in the fight to stay independent, AID communicates to patients, insurance providers and government representatives the important reasons why our health care system needs physicians to remain independent. For more information, go to www. aid-us.org. Next month Ms. Jameson will look at a high court’s decision in an anti-trust case involving the purchase of a large medical practice by a major health care system. The verdict is being felt nationwide.

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Dermatology

Paradigm Shift

Replacing Lost Volume Is Key to Taking Years Off Aging Skin By Dr. Margaret Boyse, M.D.

Virtually everyone over 40 or 50 is losing fat in the facial fat pads of their cheek and under eye areas, making us look tired and old whether we feel that way or not. During the last 10 years there’s been a paradigm shift in the way anti-aging experts view aging. For a long time, the view was that gravity pulled everything down, and the answer was a facelift that cut that sagging skin and lifted it upwards. The new view is that gravity is secondary to the real issue – which is volume loss. A youthful face has an ample amount of volume, creating a surface that reflects light in a pleasing way. A youthful face reflects light at the

Dr. Margaret Boyse practices at Southern Dermatology. After earning her medical degree from the University of Texas, she completed her internship at Walter Reed Army Medical Center and residency at the University of Michigan. Special interests include: general adult and pediatric dermatology, dermatologic surgery, cosmetic dermatology and skin cancer. She is a member of the American Academy of Dermatology and North Carolina Medical Society. For more information, visit www.southernderm.com.

top of the brow, the middle of the nose, cheeks, upper lip, chin and ear lobes, giving the skin a soft, luminous quality. How the face reflects

Volume is lost in the face as we age: the skin, soft tissue and the

and shadows the light really is what gives us an idea of its age.

craniofacial skeleton, which is the supporting structure of the skin. To complicate matters even more, each layer loses volume at in-

Start looking at young faces, and you can see for yourself how they

dependent rates in each individual. So our skin does all the same

reflect light outwards.

things as we age, but there’s a very individual stamp on it. Replacing lost volume where each individual needs it is the key. My patients see wonderful results from dermal fillers, such as Juvéderm® Voluma, Restylane® and Perlane. Dermal fillers injected underneath the skin do a very effective job of lifting the skin back into place, softening wrinkles and filling creases by restoring the volume that’s lost due to aging. I am proud to be one of the few physicians in the area that uses

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very flexible. There are fewer entrance pokes than with needles. And most importantly the risk of a vascular catastrophe is almost eliminated. Taking years off aged skin obviously doesn’t require a facelift in today’s environment. These dermal fillers can replace volume to restore youthful skin with little downtime.

16

The Triangle Physician


Autism Society of North Carolina

Accessing Services Guide

Is Free and Part of Online Empowerment Series

The Autism Society of North Carolina re-

nosed with ASD in North Carolina, accord-

education and services to directly improve

cently released the “Accessing Services”

ing to a prevalence study of eight-year-old

the lives of individuals affected by autism.

toolkit, the sixth in a series designed to

schoolchildren conducted by the Centers

empower parents and caregivers of indi-

for Disease Control and Prevention.

For more information, call (800) 442-2762 or visit www.autismsociety-nc.org.

viduals with autism spectrum disorder. For more than 45 years, the Autism Society The free guide helps inform parents and

of North Carolina has provided advocacy,

guardians of children and adults on the autism spectrum about the kinds of services and supports that may be available in North Carolina and how to obtain them. The “Accessing Services” toolkit covers such topics as individualized education programs (IEPs), bullying and advocacy and is available on the Autism Society of North Carolina (ASNC) website, www. autismsociety-nc.org. The toolkit series was researched and written by ASNC’s autism resource specialists. They include parents of those with autism who now work with families in need of support; licensed psychologists and certified analysts from the ASNC clinical team and leaders in ASNC’s advocacy and services departments, who are knowledgeable about North Carolina law and the services system. ASNC plans to introduce more toolkits on a variety of topics in coming months. Background Autism Spectrum Disorder (ASD) is a lifelong developmental disability that typically appears during the first three years of life. As many as one in 58 children may be diag

may 2015

17


UNC News

Mastectomy Is Still Choice Even When Breast-Conservation Surgery Is Option No approved targeted therapies exist to

tients and their surgeons made this choice.

growth of new blood vessels – to the stan-

treat triple-negative breast cancer, but new

Previous studies have found that for those

dard regimen of chemotherapy given to

chemotherapeutic treatment strategies are

who are eligible for breast-conserving sur-

patients with triple-negative breast cancer.

helping shrink tumors so less breast tissue

geries such as a lumpectomy, the rate of

The team found a trend suggesting that the

needs to be removed during surgery.

survival for patients who chose to have a

addition of one or both drugs increased

lumpectomy is the same as for those who

the number of patients eligible for breast-

New research led by Brigham and Wom-

chose to have a mastectomy. A study by

conserving therapy. Forty-two percent of

en’s Hospital in collaboration with the

von Minckwitz et al. found that in a popu-

185 women who were not initially candi-

University of North Carolina Lineberger

lation from Germany, nearly 75 percent of

dates for breast-conserving therapy were

Comprehensive Cancer Center finds that

patients underwent breast-conserving ther-

considered to be eligible after receiving

breast-conserving therapy – or the removal

apy for similar type tumors, much higher

drug treatment. And breast-conserving

of less breast tissue via a lumpectomy –

than the overall breast-conserving therapy

therapy was successful for 91 percent of

was successful in more than 90 percent of

rate of 47 percent reported in the current

the 53 women who chose it.

the women who became eligible for this

study. “In triple-negative breast cancer patients,

procedure after treatment with chemotherapy. Despite these findings, 31 percent who

“In general, if possible, we try to offer

we continue to increase the complete

were eligible for breast-conserving therapy

breast-conserving therapy as a preferred

pathologic response rate with our new

chose to have the entire breast removed

option for women with early stage breast

drug combinations,” Dr. Ollila said. “On

via mastectomy.

cancer,” said corresponding author Mehra

our trial, more patients were eligible for

Golshan, M.D., director of Breast Surgi-

breast preservation. Despite these advanc-

The complete manuscript of this study and

cal Services at Dana-Farber/Brigham and

es, more patients chose mastectomy as

its presentation at the American Surgical

Women’s Cancer Center. “One of the rea-

their surgical procedure. The reasons for

Association’s 135th annual meeting in April

sons we use chemo first is to potentially al-

this paradox need to be further explored.”

is anticipated to be published in the Annals

low women who originally needed to have

of Surgery pending editorial review.

the entire breast removed because of more

Dr. Golshan and his colleagues note that

advanced disease to now be eligible for

they did not study specific patient or sur-

“We’ve shown that

breast-conserving therapy. We see though

geon factors, such as fear of cancer re-

we can offer breast-

that a significant number of patients who

currence or whether a patient harbored

conserving

were eligible still ended up deciding to

mutations in genes such as BRCA. Future

have their breast removed.”

studies could shed light on how these vari-

therapy

to more women using

ables impact the choice between mastec-

these drug combina-

tomy and breast-conserving therapy.

tions, and if they con-

“We don’t have an answer for why this is

vert, we’re really suc-

the case, but we hope that this work en-

cessful,” said senior

courages more patients and clinicians to

Research reported in this publication was

author David Ollila, M.D., James and Jesse

think about why this is happening and

supported by the National Cancer Insti-

distinguished professor of surgery at UNC

what we can do to address this,” said Dr.

tute of the National Institutes of Health

School of Medicine, co-director of the UNC

Golshan, who is also director of Breast Sur-

under Award Numbers U10CA180821 and

Breast Program and a member of the UNC

gical Services at the Susan F. Smith Center

U10CA180882 (to the Alliance for Clinical

Lineberger Comprehensive Cancer Center.

for Women’s Cancers at Dana-Farber Can-

Trials in Oncology), CA180888 (SWOG),

“We have more and more women eligible

cer Institute. “It’s a work in progress.”

U10CA180791, and U10CA180867. This work

David Ollila, M.D.

was also supported in part by grants from

for breast preservation, and still we saw more than 30 percent of women choosing

The new study examined the impact of

the Breast Cancer Research Foundation

mastectomy.”

adding carboplatin – a platinum-based

and Genentech.

chemotherapeutic agent – and/or bevaThe new work does not explain why pa-

18

The Triangle Physician

cizumab – a drug designed to slow the


Duke News

Chances in the Adolescent Brain on Alcohol Last Into Adulthood Repeated alcohol exposure during adoles-

are much less adept at memory tasks than

Importantly, the LTP abnormality was ac-

cence results in long-lasting changes in the

normal animals – even with no further al-

companied by a structural change in indi-

region of the brain that controls learning

cohol exposure.

vidual nerve cells that Drs. Swartzwelder and Risher and colleagues identified.

and memory, according to a research team at Duke Medicine that used a rodent model

What has not been known is how these

The tiny protrusions from the branches of

as a surrogate for humans.

impairments manifest at the cellular level

the cells, called dendritic spines, had ap-

in the region of the brain known as the hip-

peared lanky and spindly, suggesting im-

The study, published April 27 in the jour-

pocampus, where memory and learning

maturity. Mature spines are shorter and

nal Alcoholism: Clinical & Experimental

are controlled.

look a bit like mushrooms, refining cell-tocell communication.

Research, provides new insights at the cellular level for how alcohol exposure

Using small electrical stimuli applied to the

during adolescence, before the brain is

hippocampus, the Duke team measured a

“Something happens during adolescent

fully developed, can result in cellular and

cellular mechanism called long-term po-

alcohol exposure that changes the way

synaptic abnormalities that have enduring,

tentiation, or LTP, which is the strengthen-

the hippocampus and other regions of

detrimental effects on behavior.

ing of brain synapses as they are used to

the brain function and how the cells actu-

learn new tasks or conjure memories.

ally look – both the LTP and the dendritic spines have an immature appearance in

“In the eyes of the law, once people reach

adulthood,” Dr. Swartzwelder said.

the age of 18, they are considered adult, but

Learning occurs best when this synaptic

the brain continues to mature and refine all

activity is vigorous enough to build strong

the way into the mid-20s,” said lead author

signal transmissions between neurons. LTP

Dr. Risher said this immature quality of

Mary-Louise Risher, Ph.D., a post-doctoral

is highest in the young, and effective learn-

the brain cells might be associated with

researcher in the Duke Department of

ing is crucial for adolescents to acquire

behavioral immaturity. In addition to spine

Psychiatry and Behavioral Sciences. “It’s

large amounts of new memory during the

changes in the hippocampus, which affects

important for young people to know that

transition to adulthood.

learning, colleagues of the Duke group have shown structural changes in other

when they drink heavily during this period of development, there could be changes

The researchers expected they would find

brain regions that control impulsiveness

occurring that have a lasting impact on

abnormally diminished LTP in the adult

and emotionality.

memory and other cognitive functions.”

rats that had been exposed to alcohol during their adolescence. Surprisingly,

“It’s quite possible that alcohol disrupts the

Dr. Risher and colleagues, including se-

however, LTP was actually hyperactive in

maturation process, which can affect these

nior author Scott Swartzwelder, Ph.D., a

these animals compared to the unexposed

cognitive functions later on,” she said.

professor of psychiatry and behavioral sci-

rodents.

“That’s something we are eager to explore in ongoing studies.”

ences at Duke and senior research career scientist at the Durham VA Medical Center,

“At first blush, you would think the animals

periodically exposed young rodents to a

would be smarter,” Dr. Swartzwelder said.

The researchers said additional studies

level of alcohol during adolescence that,

“But that’s the opposite of what we found.

would focus on the longer-term cognitive

in humans, would result in impairment,

And it actually does make sense, because if

effects of alcohol on brains, along with ad-

but not sedation. Afterward, these animals

you produce too much LTP in one of these

ditional cellular changes.

received no further exposure to alcohol

circuits, there is a period of time where you

and grew into adulthood – which in rats

can’t produce any more. The circuit is satu-

In addition to Drs. Risher and Swartzweld-

occurred within 24 to 29 days.

rated, and the animal stops learning. For

er, study authors include Rebekah Lyn

learning to be efficient, your brain needs

Fleming; W. Christopher Risher, Kelsey

Earlier studies by the Duke team and oth-

a delicate balance of excitation and inhibi-

Miller, Rebecca Klein, Tiffany Wills, Shawn

ers have shown that adolescent animals

tion – too much in either direction and the

K. Acheson, Scott D. Moore, Wilkie A. Wil-

exposed to alcohol grow into adults that

circuits do not work optimally.”

son and Cagla Eroglu.

may 2015

19


News The research team is part of the Neurobiolo-

The

Alcohol

ed States Department of Veterans Affairs

gy of Adolescent Drinking in Adulthood (NA-

Abuse and Alcoholism provided fund-

and the Institute for Medical Research. A

DIA) consortium, which studies the effects of

ing (U01AA019925; UO1AA020938; BX-

full list of funding sources is provided in

adolescent alcohol exposure https://www.

001271-02; DA031833; 2T32NS51156-6 and

the published study.

med.unc.edu/alcohol/nadiaconsortium).

1F32NS083283-01A1), along with the Unit-

National

Institute

of

Schaaf Awarded Highest Governor Honor Robert Schaaf, M.D., president and managing partner of Wake Radiology for 27 years, was presented with The Order of the Long Leaf Pine, one of the highest honors that the governor of North Carolina can bestow. Robert W. Seligson, executive vice president of the North Carolina Medical Society, presented the award to Dr. Schaaf on behalf of Gov. Pat McCrory during a special ceremony on April 13. Dr. Schaaf, who retires in June, was recognized for his outstanding service to the state’s medical community. A board-certified radiologist, Dr. Schaaf has served on the NC Medical Society’s board of directors since 2004 and currently serves as president of the organization. He has served on the board of directors of Medical Mutual Insurance Co., the largest insurer of physicians in North Carolina, since 1998 and was elected vice chairman in 2005. “It’s a great honor to present The Order of the Long Leaf Pine to one of our state’s most dedicated and accomplished physicians,” Mr. Seligson said. “His record of service and commitment to the state’s medical community over the past 35 years makes him well qualified to receive such an honor.” The Order of the Long Leaf Pine was established in 1963 by Gov. Terry Sanford to honor people who have demonstrated a lifetime of service to the state of North Carolina. It confirms upon the recipient “…the rank of

20

The Triangle Physician

ambassador extraordinary, privileged to enjoy fully all rights granted to members of this exalted order, among which is the special privilege to propose the following North Carolina toast in select company anywhere in the free world: “Here’s to the land of the long leaf pine, The summer land where the sun doth shine, Where the weak grow strong and the strong grow great, Here’s to “down home,” the Old North State!” Dr. Schaaf came to North Carolina in 1976 following graduation from Tufts University Medical School in Boston for a combined internship and residency in diagnostic radiology at Duke University Medical Center. He went on to serve as an assistant clinical professor of radiology at the Duke University Medical Center (1980-1990) and the University of North Carolina at Chapel Hill (1980-1992). He joined Wake Radiology in 1980 and was named president and managing partner in 1986. In addition, he served as chairman of WakeMed’s radiology department (19811984) and chairman of the radiology department at Franklin Regional Medical Center (1984-1996). In April 2004, North Carolina Gov. Mike Easley appointed Dr. Schaaf to serve on the NC Medical Care Commission, which oversees regulation of the state’s hospitals and health care facilities. He continues to serve on the commission today.

Dr. Schaaf is a fellow and member of the American College of Radiology, Radiological Society of North America, American Society of Neuroradiology, American Roentgen Ray Society, American Medical Association, North Carolina Medical Society and the Wake County Medical Society. He was appointed to the Wake Forest University Law School Board of Visitors in 2012 Business Leader Magazine named Dr. Schaaf “Medical Business Leader of the Year” in 2012.

2015 Editorial Calendar June Men’s Health, Pulmonary July New Imaging Technologies, Vein Diseases, Rheumatology August Gastroenterology, Nephrology, Sports Medicine September Bariatrics/Neonatology Advances in NICU, Obstetrics/Gynecology October Cancer in Women Wound Management, Dermatology November Urology, ADHD, Austism December Sports Medicine, Otorhinolaryngology Pain Management


News Welcome to the Area

Physicians

Reid Cameron Chamberlain, MD

David Wonil Lee, MD

Craig Conover Reed, MD

Amir Homayoun Barzin, DO

Pediatrics

Gastroenterology, Internal Medicine

Duke University Hospitals Durham

Cardiology; Internal Medicine

Family Medicine

UNC Family Medicine Chapel Hill

Lars Benjamin Gardner, DO Neurological Surgery, Critical Care

Raleigh Neurosurgical Clinic Raleigh

Matthew Justin Merritt, DO Emergency Medicine

Nash General Hospital Rocky Mt

Emily Christine Valenta, DO Family Medicine

Chapel Hill

University of North Carolina Hospitals Chapel Hill

Idan Cudykier, MD

Brice Nielsen Lefler, MD

Patrick David Retterbush, MD

Emergency Medicine

Internal Medicine

Duke University Hospitals Durham

Durham VA Medical Center Durham

Dermatology

Genevieve Guenther Ricart Embree, MD

John Strudwick Lewis Jr., MD

UNC Center for Heart & Vascular Care

Orthopedic Surgery

General Preventive Medicine; Internal Medicine; Occupational; Public Health

Duke University Hospitals Durham

UNC Hospitals Chapel Hill

Sandy Junjun Li, MD

Elizabeth Eve Falchook, MD

Gynecologic Surgery; Obstetrics Gynecology Endocrinology/Infertility; Reproductive

Doctors Making House Calls Durham

Addiction Psychiatry; Child Psychiatry; Neurology/Psychiatry; Geriatric; Psychosomatic Medicine

Duke Fertility Center Durham

Christopher Michael Wozniak, DO

University of North Carolina Hospitals Chapel Hill

Eben Isaac Lichtman, MD

Family Medicine

Rex Family Practice of Wakefield Raleigh

Krista Ruth Alexander, MD

Deborah Faith Gelinas, MD Neurology/Psychiatry

Grifols Research Triangle Park

Psychiatry

Hematology and Oncology, Internal Medicine

Hematology/Oncology

Maria Emmeline Lim, MD Pediatric Ophthalmology

Duke Eye Center Durham

Duke University Medical Center Durham

Robert Thomas Harris, MD Administrative Medicine; Psychosomatic Medicine

Jose Antonio Lozano Jr., MD

Emma Longley Barber, MD

CSC, Inc. Raleigh

Duke University Hospitals Durham

Gynecology/Oncology, Surgery, Critical Care Medicine, Hospice; Palliative Medicine; Obstetrics and Gynecology

UNC Hospitals Chapel Hill

Meena Bhatia, MD

Kelly Lawson Hastings, MD

Rebecca Wertman Bialas, MD Dermatology

Duke University Medical Center Durham

Ryan Christopher Bialas, MD Anesthesiology

UNC Hospitals Chapel Hill

Edith Villette Bowers, MD Dermatology

UNC Dept of Dermatology Chapel Hill

Joseph Donald Brogan, MD Internal Medicine

Duke University Hospital Medicine Durham

Physical Medicine; Rehabilitation

UNC Hospitals Chapel Hill

Adnan Siddiqui, MD Anatomic Pathology; Clinical Pathology; Hematology Pathology

Morrisville

Mandeep Singh, MD Anesthesiology - Critical Care Medicine

Duke University Hospitals Durham

John Stephen Sullivan, MD Critical Care Pediatrics

WakeMed Health & Hospitals Raleigh Infectious Diseases, Internal Medicine

University of North Carolina Hospitals Chapel Hill

Duke University Hospitals Durham

Brittany Emma Howard, MD

Andrew Walker Mccrary, MD

Broncho-Esophagology; Facial Plastic Surgery; Head and Neck Surgery; Otolaryngology Pediatric Otolaryngology; Reconstructive Surgery

UNC-CH Department of Otolaryngology - Head and Neck Surgery Chapel Hill

Alison Kay Kalinowski, MD Obstetrics and Gynecology

Kamm McKenzie ObGyn Raleigh

Michael Raymond Kazior, MD Anesthesiology

UNC Dept. of Anesthesiology Hospitals Chapel Hill

Bryan Young Hoon Kim, MD Ophthalmology

Brian Richard Kincaid, MD

Kelly Amanda Bruno, MD Anesthesiology

Duke University Hospital Durham

Univ of North Carolina Hospitals Chapel Hill

Bradley Mark King, MD

Hospitalist; Internal Medicine; Psychiatry

Ophthalmology

Cardiology; Internal Medicine

University of North Carolina Hospitals Chapel Hill

University of North Carolina Hospitals Chapel Hill

Rajesh Kurpad, MD

Marie Masse Caldwell, MD Internal Medicine

University of North Carolina Hospitals Chapel Hill

University of North Carolina Hospitals Chapel Hill

Garjae Dayan Lavien, MD

Laura Mosby Carlson, MD

Duke Div of Urology Durham

University of North Carolina Hospitals Chapel Hill

Lee Thomas Shuping, MD

Joshua Thomas Thaden, MD

UNC Gastroenterology Chapel Hill

Maternal and Fetal Medicine; Gynecology

N.C. Childrenâ&#x20AC;&#x2122;s Heart Center Chapel Hill

Wake Med Health System - Pediatric Hospitalist Division Raleigh

Gastroenterology, Internal Medicine

Adam William Caldwell, MD

Pediatric Cardiology

Pediatrics

UNC-CH Department of Ophthalmology Chapel Hill

Philip John Brondon, MD

Pamela Sue Ro, MD

John Bryan Lykes, MD

Diagnostic Radiology; Neuradiology; Vascular and Interventional Radiology

Anesthesiology - Critical Care Medicine

University of North Carolina Chapel Hill

Hospitalist; Internal Medicine

UNC Hospitals Chapel Hill

Urological Surgery; Urology

Urological Surgery; Urology

Pediatric Cardiology; Pediatrics

Duke University Hospital Durham

Nisha Mukherjee, MD Ophthalmology

Duke University Hospitals Durham

Joseph Adam Yancey, MD Radiology: Diagnostic, Musculoskeletal, Nuclear, Pediatric, Vascular, Interventional; Neuroradiology

University of North Carolina Hospitals Chapel Hill

Carlos Armando Gonzalez, MD Diagnostic Radiology; Neuroradiology;

Univ of North Carolina at Chapel Hill Chapel Hill

Bhavini Patel Murthy, MD Preventive Medicine/Occupational; Public Health

UNC Hospitals Chapel Hill

Allison Lindsay Overmon, MD Anesthesiology; Critical Care Medicine, Hospice and Palliative Medicine, Pain Medicine

Duke University Medical Center Durham

Shelly Rae Harrell Pecorella, MD Anesthesiology

Physician Assistants Allison Kathleen Alexander, PA Emergency Medicine; Hospitalist; Internal Medicine; Urgent Care

Fuquay-Varina

Whitney Claire Andrew, PA Hematology and Oncology, Internal Medicine

Duke University Hospitals Durham

Hillsborough

Lamise Zouka Rajjoub, MD

Cardiology; Emergency Medicine/Sports Medicine; Family Medicine

Ophthalmology

University of North Carolina, Department of Ophthalmology Chapel Hill

Veena Shiva Rao, MD Ophthalmology

Duke Eye Center Durham

Reshmi Preethi Raveendran, MD Rheumatology, Internal Medicine

UNC Hospitals Chapel Hill

Thomas Vincent Recore, MD Psychiatry

Duke University Hospitals Durham

Daryl Carducci, PA Raleigh

Emily Caitlin Godfrey, PA Mebane

Reginia Everett Gurley, PA Dermatology; Family Medicine; Psychiatry

SHAE Partners Durham

Kelsey Hines, PA Dermatology; Family Medicine; Obstetrics and Gynecology; Otorhinolaryngology; Pediatrics

Durham

Clarissa Anne Urban, PA Medical Oncology

Waverley Hematology Oncology Cary

may 2015

21


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The Triangle Physician May 2015

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The Triangle Physician May 2015

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