Trianglephy may

M AY 2 0 1 6

Skin Wellness

Dermatology Associates

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 Cosmetic Vs. Medicinal Corporate Compliance

From the Editor

Healthy Balance Meet dermatologist Brooke Jackson, founder of Skin Wellness Dermatology Associates, a new practice in Durham and this month’s Triangle Physician cover story.

Dr. Jackson offers a personal overview of her practice and personal passions. Professionally she brings her patients extensive training and expertise, which encompasses Mohs micrographic surgery. She reports achieving international recognition as an expert in laser treatment of those with increased skin pigmentation. She also describes herself as an educator.

Dr. Jackson shares her interest in balancing career, self and family. She has had an accomplished career; she has run 10 marathons – all while raising a family. Here’s wishing Dr. Jackson continued success.

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

Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Margaret B. Boyse, M.D. Ted Gilbert Marni Jameson Andrea Lukes, M.D., M.H.Sc., F.A.C.O.G. Margie Satinsky, M.B.A. Michael J. Thomas, M.D., Ph.D.

This month we offer a nice balance of contributors. Women’s health specialist Andrea Lukes discusses a new approach to treating vaginal issues that plague many women as they age. Dermatologist Margaret Boyse addresses the line between cosmetic surgery, which is superficial, and medical treatment that addresses underlying causes. Endocrinologist Michael Thomas explores the key considerations for patients with multinodular goiter.

Creative Director Joseph Dally jdally@newdallydesign.com

This month we welcome Ted Gilbert, a new contributor to The Triangle Physician. He gives an overview of top digital marketing strategies.

Practice marketing consultant Margie Satinsky returns to share corporate compliance tips. Physician advocate Marni Jameson completes her two-part series on physicians uniting to protect their independence.

The Triangle Physician is published by: New Dally Design

According to Oxford Dictionary, equilibrium is “a state in which opposing forces or influences are balanced.” Within The Triangle Physician magazine we strive for a healthy balance of medical news and information that is contributed at no cost and advertising and cover story editorial that is, available at competitive rates. So the more than 9,000 readers within the medical Triangle, who receive each issue, can stay informed. This benefits all.

We welcome your practice news and medical insight. Please send your submissions to info@trianglephysician.com.

With gratitude for all you do,

Heidi Ketler Editor

2

The Triangle Physician

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

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.

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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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4

The Triangle Physician

Table of Contents

4

COVER STORY

Skin Wellness Dermatology Associates m ay 2 0 1 6

Vol. 7, Issue 5

FEATURES

8

O P F

Practice Management

Part II: Tips for Successful EHR Implementation Margie Satinsky’s chronological steps for a smooth transition maximize the roles of staff members and vendors.

12

DEPARTMENTS

Physician Advocacy

Fed Up With Excessive Oversight, Doctors Get Organized – Part I

Marni Jameson discusses the great frustration that is causing independent physicians to join forces across the country.

10 ENDOCRINOLOGY

Differentiated Thyroid Cancer

13 DUKE RESEARCH NEWS Prostate Cancer Metastasis Site Has Direct Impact on Survival Time

14 DUKE RESEARCH NEWS Thyroidectomy Recommendation: Choose Surgeons With 25-plus Cases a Year

16 WAKEMED RESEARCH NEWS Supersaturated Oxygen Therapy Has Potential to Improve STEMI Outcomes

17 NEWS

Welcome to the Area

On the Cover: Matthew G. Kanaan, D.O., founder of Wake Sports Medicine, specializes in helping patients delay, and in some cases avoid, surgery, using traditional and cutting-edge treatment options.

May 2016

5

Cover Story

Skin Wellness

Dermatology Associates Brooke Jackson, M.D., strides with purpose

Skin Wellness Dermatology Associates “is

Dr. Jackson applies this wholesome

through the Southpoint space that is Skin

a thrilling opportunity,” Dr. Jackson says of

runner’s philosophy to her practice, too.

Wellness Dermatology Associates, her

the practice that opened just last month.

“If I need to take extra time to explain a

innovative, new dermatology practice.

“I am able to pursue all of my passions:

procedure or educate a patient about

the medical, surgical and aesthetic aspects

her skin condition, I absolutely will,” Dr.

A 10-time marathoner, Dr. Jackson knows

of dermatology, as well as some exciting

Jackson says. “My goal is quality, above all

the importance of keeping a good pace.

advances and innovations in aesthetic

else. Quality care means quality medicine,

Armed with her favorite vente Starbucks,

dermatology while staying true to the

and that takes time.”

she walks briskly but stops to appreciate

name of the practice – Skin Wellness.”

the reception area, noting the calm,

Dr. Jackson moved in 2013 from Chicago to

welcoming atmosphere and the glass wall

Like many runners, she knows when to

the Triangle area with her husband, three

that runs along a stand of green and leafy

pick up the pace and when to take her

children and goldendoodle in pursuit of a

trees and bathes the space in natural light.

time. It’s not just a racing strategy. It’s also

healthy balance of work and life. She was

She points with pride to the state-of-the-art

about staying healthy, says the board-

attracted to the area for its quality lifestyle:

laser machines in the area designed for

certified dermatologist who studied at

excellent educational opportunities and

medical-grade aesthetic treatments. Jazz

Wellesley College, Georgetown University

weather and landscape that are ideal for

music plays softly in the background.

School of Medicine, University of Chicago

outdoor activities. She loves the easy-going

and Harvard University.

pace and the diversity of her neighbors. She loves that her children can walk to school.

Although she and her children miss the snow, Dr. Jackson appreciates the warmer winters. She also is well aware that with yearround outdoor activity come sun damage and its associated risks of skin cancer.

Skin wellness is Dr. Jackson’s practice goal, and she says she aims to accomplish it with every patient by teaching how to manage skin conditions in the welcome, but damaging North Carolina sun. “I am primarily an educator,” says Dr. Jackson.

“One of my career ‘a-ha’ moments came with the realization that, as dermatologists, we don’t cure much. Because many of the disease processes in dermatology are chronic, we spend most of our time controlling the disease. So it is important to educate patients about the nature of their conditions and exacerbating factors

Dr. Jackson has specialized expertise in laser treatment that is sensitive to the range of skin colors, including those with increased skin pigmentation.

6

The Triangle Physician

for a more successful treatment outcome.”

Dr. Jackson and her staff believe patients should leave their practice looking and feeling good.

As an African American, Dr. Jackson

also am able treat the diaper rash in the

The massive machines in her procedure

recognizes that many African Americans

next generation.”

rooms are lasers used for treating vascular and pigmented lesions, scars, unwanted

and other people of color believe they are protected from the sun’s harmful rays

That generational aspect is important to

hair,

discoloration,

benign

growths,

by their melanin. “Sun exposure is just

Dr. Jackson, whose late father headed

excess fat and photodamage, among other

a piece of the skin cancer puzzle, and

the pathology department at Howard

procedures. Dr. Jackson is considered an

unfortunately patients with darker skin

University in Washington, D.C. She says he

international expert in the use of lasers on

may underestimate their risk. Everyone

was an “enormous influence” on her and

skin of color, and she is very excited about

needs to practice sun-protective measures

encouraged her interest in medicine and

the advances the field.

on a daily basis, including the use of

lifelong learning.

A perpetual student, she decided to pursue

sunscreen,” says Dr. Jackson, who has written several book chapters on skin

Dr. Jackson was the first African American

a second fellowship in Mohs micrographic

cancer in skin of color. “And everyone

at Harvard University to complete a

surgery and went on to establish the Mohs

should check in regularly with a board-

fellowship in cutaneous laser surgery,

surgery unit at the University of Texas MD

certified dermatologist.”

after which she taught on faculty. During

Anderson Cancer Center in Houston.

her fellowship she learned that available Dr. Jackson’s practice on Chicago’s

technology was more damaging to those

Dr. Jackson writes and speaks regularly

famous “Magnificent Mile” was diverse

with increased skin pigment and resulted

about skin health and has authored

in every way. There, she saw people of

in their exclusion from research trials she

book chapters and peer-reviewed articles

various backgrounds and ages. It’s one

was involved in. Her frustration of not

about skin cancer and laser and aesthetic

of the aspects of dermatology that she

being able to offer these patients certain

procedures, particularly in skin of color.

loves. Because of her expertise in lasers

treatment options fueled her career-long

This year she is an invited lecturer at

in skin of color, she saw patients from

interest with lasers in skin of color. “The first

several conferences and a session director

around the world. Her practice wasn’t

aesthetic lasers caused significant tissue

at a national meeting of dermatologists.

just about the acute visits but developing

damage in patients with darker skin tones,

long-term relationships too. She often saw

but now with advances in technology we

While she has excelled in these aspects

patients throughout their lives. “It is such

can treat patients of all skin colors safely.”

of her career, the work Dr. Jackson loves

an honor to have the privilege of helping

Dr. Jackson is proud to have been involved

most involves reaching out to a broader

a daughter and mother prepare for the

in clinical studies refining the parameters

audience. Her recent educational forums

daughter’s wedding, and if I am lucky, I

that now allow that to happen.

include: O, the Oprah magazine; the

May 2016

7

nationally syndicated Tom Joyner Morning

at several universities and worked in

Dr. Jackson and her husband are the

Show; and numerous appearances on

multispecialty

practice.

proud parents of eight-year-old twin girls

local television and radio shows. You can

With all the changes in medicine, she

and a six-year-old son, not to mention, that

catch her on YouTube discussing the best

is choosing once again to be in private

10 year-old goldendoodle.

foods for healthy skin or teaching men

practice, because she believes this is the

how to shave so they avoid bumps and

best fit for her and the way she wants to

“My life is very full,” Dr. Jackson laughs. “I

irritation. Whether it is skin health during

interact with her patients.

wouldn’t have it any other way.”

unwavering goal is to make sure everyone

“Each and every patient is really important

Even with a new practice and young

knows how to keep his or her skin as

to me,” she says. “I listen to them and enjoy

children, Dr. Jackson plans to train for

healthy as possible.

getting to know them, which allows me to

more races and has started to practice

tailor the treatment plan to fit their lifestyle,

yoga. She knows that running a marathon,

and that can take time.”

like running a medical practice, requires

and

private

the winter or for outdoor athletes, her

She also wants her patients to leave her

grit, planning and patience. She is ready

office looking and feeling good. “My aesthetic is a natural look,” she says.

In keeping with her closely held educa-

for the challenge, as this is “not my first trip

“When people compliment you, they

tional values and importance of overall

to the rodeo.”

should say, ‘You look great.’ They should

wellness , Dr Jackson started ChicagoFit,

not say, ‘You’ve had a procedure.’”

an organization that brought marathon

“I’m not a fast runner. I am persistent,” she

training to the South Side of Chicago. The

says. “But, you know, slow and steady gets

This is increasingly important, Dr. Jackson

first year, the program attracted 75 partici-

you to your goal too.”

says, as people stay in the workforce

pants, and within four years she had grown

longer or re-enter the workforce after some

participation to 450 new and experienced

Skin Wellness Dermatology Associates

time off. “Looking your best is always

runners. She also served on the Chicago

is located at 245 East NC Highway 54,

a confidence booster,” she says. “Who

board of Girls on the Run, a group that

Suite 202, Durham, N.C. 27713. Learn

doesn’t want that?”

teaches young girls life lessons through

more at www.skinwellnessdermatology.

sports. She is also an active member of the

com and visit the practice on Facebook:

Dr. Jackson brings experience from her

local chapter of Jack and Jill of America

skin wellness dermatology associates. Dr.

practice in a variety of clinical scenarios.

Inc., a national service organization.

Jackson can be reached at (919) 294-9440.

She has held academic appointments

Patient care is supported by a well-trained, compassionate medical team.

8

The Triangle Physician

Cosmetic Vs. Medicinal

Dermatology

Treating the Causes Rather Than the Symptoms

By Margaret B. Boyse, M.D.

There are now many options for cosmetic

explain to them that we need to start

treatments outside of the traditional der-

by treating the precancerous lesions

matology clinic. Med spas and aesthetic

on their skin, which will reverse the

centers offer laser treatments to minimize

aging process and increase collagen

hair, moles, age spots, acne, wrinkles, etc.

production. As a result, the patients look younger and healthier before we

These generally are satellite campuses

even start with Botox.

owned or overseen by a single doctor who probably is not onsite. The benefit to

2. W e often have patients who approach

this sort of system is it allows the company

us wanting to get rid of their acne

to offer treatments at a slightly lower cost,

“scars” before they have recovered

but not without sacrifices.

from acne. Much of what they are seeing as red or brown marks are

Physicians should realize that cosmetic

temporary and can resolve on their

concerns are often linked to the actual

own once the acne is controlled.

health and vitality of the skin and body.

For textural changes, in other words

Aestheticians can easily overlook under-

a true scar, we can begin to treat

lying disease and treat symptoms instead

with cosmetic approaches, such as

of causes. A dermatologist, on the other

fractionated laser resurfacing.

Dr. Margaret Boyse of Southern Dermatology takes a conservative, affordable, holistic approach to determine if the simple solution is best or if she needs to apply more advanced technologies to treatment. She enjoys educating patients about prevention, building long-term relationships through excellent customer care and being a part of their lives through her medical practice. Specialties include: cosmetic dermatology, general adult and pediatric dermatology, dermatologic surgery and skin cancer.

4. P atients dealing with hair loss who are seeking transplantation might miss the

hand, understands the pathophysiology

underlying cause of the problem. The

of skin. This makes them uniquely able to

3. O ther patients approach aesthetic

hair loss could be caused by alopecia

understand and address root causes rath-

centers asking for laser treatments to

areata, lichen planopilaris, lupus or

er than endlessly hacking off branches.

minimize brown spots. Several things

any number of medical conditions,

can go wrong if we just start lasering

each requiring a different sort of

Here are four examples of skin treatments

these lesions away. Sometimes the le-

treatment.

that are addressed very differently by a

sion is a lentigo maligna melanoma.

dermatologist than an aesthetician:

Treating it like a mole or freckle can

This last example fits particularly well into

delay diagnosis for months to years.

my extended metaphor of addressing the

1. P erhaps one of the most common

Dermatologists are uniquely equipped

roots of the problems rather than cutting

concerns patients have is irregular

to recognize these often-subtle can-

down branches. Southern Dermatology

tone and texture of their aging skin.

cers and perform the needed biopsy,

understands the need for comprehensive

They normally present this problem

so treatment can begin. Often the pig-

care – care that treats causes and not

as a cosmetic concern, but the root of

mentation is the result of an inflamma-

just symptoms. The simple truth is that

their problem is often medical. Rather

tory condition that actually can’t be

cosmetic problems often have underlying

than starting with Botox or fillers, I

treated with lasers.

medical issues.

May 2016

9

Endocrinology

Multinodular Goiter

By Michael J. Thomas, M.D., Ph.D.

Multinodular goiter is a common finding in

Infrequently a multinodular goiter can

patients with advancing age. As the name

become so massive that it begins to extend

implies, the features of this condition

substernally and surgical intervention is

include multiple nodules (usually benign)

advised to avoid impinging cardiac output,

in the setting of a large thyroid (i.e., goiter).

if the goiter abuts the great vessels of the heart or compromises lung volume.

The etiology of this condition is complex but may include genetic factors, nutri-

Thyrotoxicosis

tional/dietary factors (namely iodine) and

Patients usually initially develop sup-

gender.

pressed TSH, and over time this may become more pronounced, leading to frank

Histologically, chronic low-grade hyperpla-

elevations in free T4 and/or free T3. Mild

sia is thought to precede the development

hyperthyroidism is often subclinical, and

of benign colloid nodules. Thyroid func-

may persist in a borderline state for many

tion is typically normal at the outset but

months or years but usually eventually

may gradually become thyrotoxic (hyper-

become progressive. Sometimes iodinat-

thyroid) if these nodules develop autono-

ed contrast dye, such as that given for a

my. When this occurs it is termed “toxic

computed tomography scan or cardiac

multinodular goiter” and may eventually

catheterization, can trigger iodine-induced

require treatment.

hyperthyroidism in these patients.

At least three key issues need to be

American Thyroid Association guidelines

considered in patients with multinodular

recommend treating nearly all individuals

goiter.

who have frank elevations in free T4/free

Dr. Michael Thomas graduated from the School of Medicine at West Virginia University in Morgantown, with medical and doctorate degrees in pharmacology and toxicology. He completed post-graduate medical training at Barnes Hospital at Washington University in St. Louis, including his internship, residency and fellowship in endocrinology.

Dr. Thomas established Carolina Endocrine, P.A., in the summer of 2005. He was previously a faculty member in endocrinology/medicine at Washington University, the University of Iowa and the University of North Carolina at Chapel Hill.

Dr. Thomas is board certified in internal medicine and endocrinology and is licensed to perform endocrine nuclear medicine procedures and therapies at Carolina Endocrine. He is a fellow of the American College of Endocrinology and has completed Endocrine Certification in Neck Ultrasound.

T3 and any patient over the age of 65 with a

sometimes makes it challenging to distin-

Compressive Symptoms

TSH greater than 0.1. Also, any individuals

guish benign nodules from malignant nod-

These symptoms include neck fullness, dys-

with a history of cardiac disease or those

ules. There is a slightly higher risk of iden-

phagia, dysphonia or infrequently, stridor,

suspected of having other potential com-

tifying thyroid malignancy in this setting,

facial edema or tracheal deviation causing a

plications of hyperthyroidism (e.g. osteo-

though at least some of this may be due

restrictive lung disease pattern. Pemberton’s

porosis, psychiatric disorders) should be

to selection or observer bias. Thyroid ul-

sign is the development of facial edema af-

considered for treatment.

trasound may not accurately predict which nodule(s) is malignant or benign, although

ter holding the arms above the head for 30 seconds and suggests thyroid impingement

Radioiodine therapy or surgical therapy

certain sonographic features can heighten

on the great vessels in the neck.

is usually the preferred treatments. Anti-

or lessen the suspicion for malignancy.

thyroid drugs, such as methimazole, Massive goiter is best managed surgically

can also be used on a short-term basis,

Thyroid nodule size, long thought to be a

with a subtotal or total thyroidectomy.

but because the underlying nodules/

risk factor for malignancy, actually carries

Non-surgical candidates can sometimes be

hyperthyroidism never goes into remission

little impact on whether a particular

treated with radioiodine ablation, although

(unlike some cases of Graves’ disease) this

nodule is likely to be malignant or benign.

the results on goiter shrinkage are variable

is usually viewed as a temporary measure

If in doubt, thyroid fine needle aspiration

depending on iodine uptake and dose of

to a more definitive treatment.

(FNA) biopsy can accurately determine whether a nodule is likely to be malignant

I-131. Sometimes, cosmetic concerns are also a consideration in the decision to

Neoplasia

proceed with surgical intervention.

The presence of widespread nodular hyperplasia throughout the thyroid gland

10

The Triangle Physician

or benign.

If a patient has thyrotoxicosis, a thyroid

Endocrinology

BE WELL.

nuclear medicine scan can identify hyperfunctioning (autonomous) nodules, which are termed “hot” nodules on thyroid scan. Nearly all “hot” nodules are benign hyperfunctioning

thyroid

adenoma,

whereas “cold” thyroid nodules carry ~20% risk of malignancy.

Usually thyroid nuclear scans are of

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limited value in the setting of normal thyroid function tests, often confirming the findings on ultrasound; and if there is a question about whether a nodule is malignant in this setting, an ultrasoundguided FNA biopsy is more cost-effective, specific and sensitive to perform, than it is

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11

Practice Management

Eight Corporate Compliance Tips Margie Satinsky, M.B.A.

Corporate compliance with federal and

programs under a corporate compliance

state laws is a must, not an option, in a

officer. In other practice settings, there is

well-managed medical practice. Here are

no such position and responsibility and ac-

eight practical suggestions for developing

countability are vague. We think it makes

a compliance program that meets industry

sense to start by centralizing responsibil-

standards.

ity for corporate compliance, then delegating responsibilities appropriately. For

1. Be Proactive, not Reactive

example, in many practices, the practice

The purpose of a corporate compliance

manager is the corporate compliance of-

program is to prevent violation of federal

ficer. He/she may retain responsibility for

and state laws. A comprehensive program

HIPAA Privacy and Security and delegate

is both a good strategy for avoiding prob-

responsibilities for OSHA, CLIA and cod-

lems and a good defense against com-

ing/billing compliance to members of the

plaints and possible external investigation.

clinical and billing staffs.

Make sure your compliance program positions you well and is not something you

3. Obtain Commitment and

address in a hurry when a problem arises.

Support from Very Top

Margie Satinsky is president of Satinsky Consulting L.L.C., a Durham consulting firm that specializes in medical practice management. She has helped many physicians start new practices, assess the wisdom of affiliating with a larger health care system and improve their current practices. Ms. Satinsky is the author of numerous books and articles, including Medical Practice Management in the 21st Century.

For more information, visit www. satinskyconsulting.com.

Compliance with external legal require2. Understand Scope and Organize

ments only works if the entire practice is

information. They refused to require the

Program Appropriately

on the same page. Make sure the owners

use of secure user names and passwords

Corporate compliance means different

understand the importance and scope of

to view a computer screen. Everyone who

things to different practices. Some practic-

corporate compliance.

walked down a major corridor could eas-

es limit corporate compliance to the risk

ily see protected health information (PHI)

areas identified by the Office of Inspector

Not long ago the practice administrator

by looking to the right. In addition, one

General (OIG). We prefer a broader defini-

of a large practice in North Carolina re-

particularly resistant owner prided himself

tion. Our list includes: coding and billing,

quested our help with HIPAA compliance.

on the huge piles of paper medical re-

the provision of reasonable and necessary

An out-of-state management company

cords he kept on a desk in a room that was

services, appropriate documentation of

had responsibility for HIPAA but had not

visible and accessible to all. The practice

care in the medical record, completion of

provided adequate support. The admin-

administrator could only do so much be-

the CMS-1500 form, attention to improper

istrator knew that her practice was plac-

cause everyone wasn’t on the same page.

inducements/kickbacks/self referrals, re-

ing itself at great risk. Having previously

tention of medical and business records,

worked for a large health care system that

4. Know the Relevant Federal and

Health Insurance Portability and Account-

had compliance and risk management de-

State Laws

ability Act of 1996 (HIPAA) Privacy and

partments, she herself had never directed

One of the most important aspects of cor-

Security, Occupational Safety and Health

a compliance effort. During the course of

porate compliance is the understanding of

Administration (OSHA) and Clinical Labo-

the project, the practice accomplished a

federal and state laws that impact the run-

ratory Improvement (CLIA), if relevant.

great deal, but the administrator hit the

ning of a medical practice. At the federal

proverbial stonewall.

level, the most important statutes are the

Depending on a practice’s definition of

False Claims Act (FCA), the Civil Monetary

corporate compliance, both organiza-

The practice owners refused to take the

Penalties Act, the Stark Self-Referral Pro-

tion and delegation of responsibility vary.

steps necessary to protect the visibility

hibitions, the Anti-Kickback Act of 1986,

Some practices centralize all compliance

of computer screens with patient-specific

HIPAA, OSHA, and CLIA. Depending on

12

The Triangle Physician

quirements and internal operations.

7. Train the Workforce Once the Corporate Compliance Program is in place, make sure every workforce member understands the components.

Create a structured training program and repeat it annually. Incorporate compliance into the orientation for all workforce members, including clinicians. In between formal training sessions, encourage workforce members to collaboratively discuss issues and concerns without fear of penalty. Make compliance an ongoing process, not a once-a-year event. the location of the practice different state

6. Develop Written Policies and

8. Marry Corporate Compliance

statutes apply.

Procedures

with Human Resources

Documentation is critical. For each aspect

Make corporate compliance an integral

It’s critical not only to know which laws

of corporate compliance, develop written

part of the practice’s human resources

apply, but also to remain up-to-date on

policies and procedures. Specify the pur-

program. Include corporate compliance

changes. HIPAA is a good example. The

pose, responsibility, accountability, proce-

requirements in job descriptions and dis-

law was passed in 1996. Although many

dures, monitoring and enforcement. Date

ciplinary procedures, reminding each

of the provisions of the original Privacy

the creation/revision of the policy and

workforce member of the obligation to

and Security Rules have remained intact,

procedures and review it regularly to make

support a culture of compliance as well as

both the 2009 Affordable Care Act and the

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Physician Advocacy

Critical Condition:

Doctors Link Arms to Save Profession – Part 2

By Marni Jameson

All across America a movement is afoot that

the hospital, has opted out of Medicare and

is unlike any other. Doctors, who are fed up

out of contracts with “payors who give me

with the intrusion of government overreach

nothing but administrative headaches and

and corporate acquisitions, are speaking out

low reimbursements,” she said. “I got tired

and joining forces to protect their profession.

of playing ‘how low can you go.’ When you cut out the middleman, it’s much more

To survive, they are creating membership

affordable for patients.”

groups to fight the regulations crippling

Marni Jameson is the executive director for the Association of Independent Doctors.

You may reach her at (407) 571-9316 or marni@aid-us.org. Visit www.aid-us.org for more information.

them and the pressure to succumb to

American College of Private Physicians

hospital employment.

While AAPS helps liberate doctors from

by overreaching government and corporate

the tyranny of third-party payers, the new

entities,” said Dr. Strickland. “Let My Doctor

The Association of Independent Doctors

American College of Private Physicians

Practice is a movement to restore the voice

(AID), a trade association that started in Flor-

(ACPP) helps them navigate the waters of

of the doctor to the practice of medicine.”

ida three years ago to enlighten consumers,

direct practice or concierge medicine.

businesses and lawmakers about the impor-

That means working to stop the intrusion

tance of supporting independent doctors,

Two years ago, AID executive board member

into the doctor-patient relationship by third

has grown like wildfire, spreading coast to

Thomas W. LaGrelius, M.D., a concierge phy-

parties, “fighting ‘Meaningful Use,’ which is

coast. It is working together with these other

sician practicing in Torrance, Calif., formed

a degradation of the medical record, and not

groups that are fighting for the same cause:

ACPP. “This group picks up where the AAPS

letting health insurers dictate care options

leaves off, helping members navigate the

over doctors’ recommendations,” Dr. Strick-

Association of American Physicians

day-to-day running of a concierge practice,”

land said.

and Surgeons

said Dr. LaGrelius, who estimates that 10,000

Although the Association of American Physi-

United States doctors are working this way in

Remarkably, while associations in the same

cians and Surgeons (AAPS) has been around

some fashion.

industry often compete for members, the op-

since 1943, lately it has taken a new tack.

posite here is true. Rather than elbow each

When I attended the AAPS annual meeting in

“We want to help doctors take back control,”

January in Orlando, the day focused entirely

he said.

on the topic of opting out of Medicare and

other out, we link arms.

I’ve been a guest on Dr. George’s radio show,

Medicaid and even from some insurance

Let My Doctor Practice

Medicine on Call. I will deliver the opening

plans, so patients pay directly for services.

Last year, Let My Doctor Practice formed

address at the ACPP annual meeting in Las

under the direction of Michael Strickland,

Vegas this September. And I sit on the advi-

Elaina F. George, M.D., an Atlanta pediatric

M.D., an Ohio internist. The group conducted

sory committee of Let My Doctor Practice.

otolaryngologist, AAPS leader and AID

a summit in Keystone, Colo., where

member, spoke at the meeting and shared

practitioners gathered to discuss strategies to

“It’s simple,” said Dr. Strickland. “We all want

her partial direct-pay model. Direct pay, she

oppose the constraints tying doctors’ hands.

to return the practice of medicine to those

says, “is the future.”

who actually practice medicine. We are sick “We believe in the sanctity of the doctor-

Tired of the red tape, Dr. George, who has

patient relationship and the autonomy to

her own surgical center so she can bypass

practice medicine without restraint imposed

14

The Triangle Physician

of being told how to practice.”

Atlas is shrugging.

Practice Marketing

Top Three Digital Marketing Strategies

By Ted Gilbert

Probably the last thing you thought you’d

So the first goal of search engine optimization

be when you graduated medical school was

(SEO) is to make your site as search engine-

a digital marketer. But attracting patients in

friendly as possible. Doing so involves

today’s competitive health care markets

strategic selection of keywords and phrases

means making digital marketing an integral

that prospective clients/patients likely use

part of a practice’s marketing mix.

to search for your type of business online.

For example: the words “eye” or “eyes” and

Getting started on Internet marketing leaves

“doctor” in addition to “ophthalmologist.”

many feeling lost in a virtual alphabet soup of acronyms and strategies. Here are

The next goal of SEO is to push your

the top three strategies that doctors and

business’s site to the top of search results.

practice administrators must understand to

This involves appropriate – not just liberal –

effectively apply digital marketing.

use of keywords within your online content, so is easily understood by prospective and

1. Pay Per Click

existing patients and search engines, which

Pay per click (PPC) may be the most

index online sites.

familiar digital marketing strategy to most

A veteran of the life sciences industry, Ted Gilbert honed his marketing skills starting in commercial medical product launches and later was introduced to digital marketing as the operations manager of a contract testing laboratory as a way to level the playing field with bigger companies competing solely on commodity-priced testing services. After finding his niche as a successful digital marketer capable of bringing immediate and lasting change to marketing initiatives, Mr. Gilbert joined Sam IT Solutions, where he specializes in the digital marketing of medical practices of all sizes and enjoys working closely with his clients to achieve sustainable return on investment (ROI).

people. Much like the old Yellow Pages, you

3. Content Marketing

put an ad (or “banner,” in the virtual world)

For most businesses and certainly health

in a directory and hope that it attracts the

care businesses, an educated consumer is

articles. Hubspot reports that marketers

attention of people looking in your section

your best customer. That’s why 50 percent

who prioritize blogging are 13 times more

of the phone book. People notice a large

of business-to-consumer companies intend

likely to achieve a positive return on

flashy ad for your medical practice over the

to increase their content marketing budget

investment.

plain listings of your competitors.

in 2016, according to the Content Marketing Institute.

So, what’s the best content marketing

There are two things that make PPC

approach for your health care business? A

advertising better than the print ads in the

Content

strategic

mix of all three should be used to build a

Yellow Pages. You don’t pay a flat fee and

placement of valuable, relevant content that

balanced, steady lead-generation stream for

hope patients notice your ad. You pay per

will keep Internet users on, and returning

your medical practice.

click, meaning you are only required to

to, your practice’s digital site. It requires an

pay for the service when a prospective

understanding of the type of information

For quick results, PPC ads will bring

customer actually clicks on your ad. The

prospective clients/patients are seeking.

consumers to your site. Relevant and

marketing

is

the

feature also gives you the added control of

valuable content marketing, such as a

reviewing and updating your listings at any

If you have effectively selected keywords

blog or social media feed, will keep them

time.

and clients navigate to your site based

there. For long-term, sustainable returns,

on the content provided, then you are

effective SEO will ensure customers find

2. Search Engine Optimization

increasing SEO and turning curious Internet

your website.

If search engines (Google, Yahoo, Bing,

searchers into patients “organically,” or as a

etc.) can’t find your practice’s online site,

natural result.

To learn more about how these marketing

your prospective patients won’t find it either.

strategies work or how Sam IT Solutions can Content marketing could be in the form

help you attract and retain patients, send an

of e-mails, Facebook posts or blogging/

e-mail to Ted@SamITSolutions.com.

May 2016

15

Women’s Health

Solution for Improved Feminine Life

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

The Women’s Wellness Clinic is one of the

How Does FemiLift Work?

first in North Carolina to offer FemiLift, a

FemiLift uses the thermal heating and

minimally invasive, outpatient laser solu-

micro-ablation of the carbon dioxide

tion for vaginal health issues.

fractional laser, the gold standard in skin resurfacing. The energy waves applied to

Aging, childbirth, weight fluctuations and

layers of vaginal tissue stimulate collagen

hormonal changes are among the causes

regeneration, contracture of elastin fibers,

of damage to vaginal tissue and the pelvic

neovascularization and improved vaginal

floor, which can alter the mucosal tone

lubrication.

of the vaginal wall. These physiological changes can lead to such conditions as

FemiLift is performed in our office. There

stress urinary incontinence, vaginal atro-

is no anesthesia and little-to-no downtime.

phy, dryness and recurring infections, all

The laser is precisely delivered, so sur-

of which can affect sexual functioning and

rounding tissue is not impacted, speeding

routine activities, causing pain, discomfort

up recovery time.

and embarrassment.

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.

disappearance of small lesions associated with low estrogen and an increase in vaginal secretions.

Safety and Treatment Strategy When I counsel women on this new, elective procedure, I emphasize how safe it Many women believe these conditions are

Patient Satisfaction

is. Safety is enhanced by proper training,

normal and simply accept them. Others

Recently, a woman in her mid 50s com-

thorough understanding of the technology

seek out treatment options that have in-

plained of vaginal dryness and discomfort

and procedural expertise.

cluded vaginal lubricants, such as Replens

with intercourse. She was using low-dose

and Lubrin, and hormonal replacement

HRT. There are reasons why she did not

There are almost no side effects and the

therapy (HRT).

want to increase her dose. She also didn’t

benefits can be life changing.

want to use vaginal estrogen.

We recommend three treatments, with ap-

FemiLift is an alternative that enables med-

proximately four to five weeks in-between.

ical practitioners to treat various feminine

She underwent FemiLift with little-to-no

indications, restoring vaginal tissue to a

pain. On follow up she expressed subjec-

more youthful state. Women report an al-

tive improvement in function and overall

More Information

most immediate return to normal activity,

satisfaction. On physical examination, she

More information can be found at www.femi-

including sexual intercourse.

had objective improvement in the color of

lift.com. Our clinic is offering free, 15-minute

the vagina, mucosal appearance with the

consultations regarding the procedure.

16

The Triangle Physician

Duke Research News

Anti-Cancer Approach Seems to Attack Cancer Cells and Not Other Cells

Edward F. Patz, Jr., M.D.

A research team from

One of the features that separated these

Once the antibody for CFH was identi-

Duke Health has devel-

patients from those who had more lethal

fied, Dr. Patz and colleagues sought to ex-

oped an antibody from

tumors was the presence of antibodies

plore how this immune response could

the body’s own immune

against a protein called complement fac-

be optimized as a cancer therapy. Critical

system that preferential-

tor H, or CFH, which protects cells from

to that effort, according to the press ad-

ly attacks cancer cells.

an immune system attack, according to a

visory, was finding a way to produce an-

Duke Health press advisory,

tibodies that recognized the exact-same part of CFH as the autoantibodies made

The antibody works by targeting a natural defense mechanism that cancer tumors

CFH works by preventing activation of an

by the early-stage cancer patients. This

exploit.

important immune response. It inhibits the

assured the antibodies would have a par-

deposit of a complement C3b protein on

ticular affinity for cancer cells.

Cells in the body essentially use a home

the cell surface. Complement C3b initiates

security system that relies on certain pro-

the degradation of the cell membrane,

Dr. Patz and colleagues pooled the white

teins to protect the cell surface and keep

which eventually leads to cell death.

blood cells from CFH antibody-producing

it safe. These proteins help the cell avoid injury and even death from unwanted activation of the immune system.

In a paper published online May 5 in Cell Reports, the Duke team describes the workings of a cancer-fighting antibody they discovered, developed and tested in cell lines and animal models. The

A new angle on battle against cancer A protein in the body called complement factor H, or CFH, helps protect the body’s cells against an immune system attack.

rived antibody developed as an anti-cancer therapy, which is very different from other immunotherapy approaches,” said

CFH protein

...taken away...

More people whose cancer had not spread, had a specific antibody that works against the CFH protein. Since CFH protects cells, having an antibody that disables this layer of protection, can allow cancer cells to be destroyed.

People whose cancer spread.

People whose cancer did not advance beyond stage 1.

Scientists cloned the antibody from the patients

senior author Edward F. Patz, Jr., M.D., the James and Alice Chen professor of ra-

CFH does this by blocking another protein (C3b) from penetrating the cell surface and instigating cell destruction.

Cancer cells exploit this cell protection.

cell surface

cancer cell’s defense system and then

“This is the first completely human-de-

C3b

A layer of protection...

antibody dismantles a specific part of a employs several mechanisms of attack.

C3b

Anti-CFH using a process that would ensure the antibody antibodies only affect cancer cells.

CFH protein

diology and professor in the Department of Pharmacology and Cancer Biology at Duke.

The antibody disabled CFH, allowing the protein (C3b) to initiate cell destruction.

...may lead to the body’s ability to effectively destroy cancer cells.

C3b

The cloned antibodies were tested on human cell tumor lines and in mice. The antibodies caused tumor death and inhibited tumor growth.

Since only cancer cells are attacked, this represents a promising new treatment approach.

Dr. Patz and colleagues include principals from the Duke Human Vaccine Institute, who have been advancing the development of antibodies for an HIV vaccine.

C3b cancer cell surface

They started their cancer-fighting pursuit with the observation that some lung can-

The damage to the cell also triggered a cascade of other cells that created a beneficial immune system response.

inflammatory cells

cer patients have early-stage tumors that never progress to advanced disease.

Alisa Weigandt for Duke Health

May 2016

17

Duke Research News cancer patients and then isolated and

effects. The antibodies also appeared to

side effects to achieve tumor control,” Dr.

cloned the antibody genes from single

trigger an additional adaptive immune

Patz said. “We believe we can modulate

immune cells that make the specific an-

response when the damaged cells sent

the immune response and let the body’s

tibodies.

signals to recruit an army of lympho-

own immune system take over to either

cytes, creating a potentially more lethal

kill the tumor or keep it from growing.”

According to Duke Health, this was an

systemic attack.

In addition to Dr. Patz, study authors

efficient process that enabled the researchers to produce mature antibodies

“We believe it might be this additional

include Ryan T. Bushey; M. Anthony

that recognized the same region of CFH

cellular response that could potentially

Moody; Nathan Nicely; Barton F. Haynes;

targeted by the original patient’s immune

have the most profound impact on can-

S. Munir Alam; Stephen T. Keir; Rex C.

systems – therefore leading to the attack

cer outcomes long term,” Dr. Patz said,

Bentley; Kingshuk Roy Choudhury; Eliza-

of cancer cells, not healthy cells.

noting that further tests would be re-

beth B. Gottlin; Michael J. Campa; and

quired to understand the full potential of

Hua-Xin Liao.

The researchers then tested the antibod-

the approach.

The study received funding from the LUN-

ies in multiple cancer cell lines, including lung, gastric and breast cancers, in

“This could represent a whole-new ap-

Gevity Foundation, the Department of De-

lab dishes and in tumors in living mice.

proach to treating cancer, and it’s excit-

fense (W81XWH-13-1-0189), the National

They found that the antibodies caused tu-

ing because the antibody selectively kills

Institutes of Health (UL1TR001117) and

mor cell death without any obvious side

tumor cells, so we don’t have significant

the Duke Translational Research Institute.

Breast Cancer Expert Named to TIME’s 100 Most Influential People Shelley Hwang, M.D.,

treated, according to a Duke Health press

chief of breast surgery

advisory.

conservative approach to DCIS. “Shelley is an exceptional surgeon-

at the Duke Cancer been

Dr. Hwang’s research and advocacy

scientist, who is, through elegant and

named one of TIME’s

for a more informed approach to

focused investigation, redefining our

100

DCIS

could

understanding of breast cancer,” said

include lumpectomy and/or ongoing

Allan D. Kirk, M.D., Ph.D., chairman

surveillance

aggressive

of the department of surgery at the

One of the world’s foremost experts in

radiation or mastectomy – has helped

Duke University School of Medicine

early-stage breast cancers, Dr. Hwang

spur

and surgeon-in-chief at Duke Health.

has become an international leader

has been a voice for women who are

“However,

calling for research to guide treatment

diagnosed with DCIS to receive the best

the

for ductal carcinoma in situ (DCIS), in

treatment available while sparing them

understanding she brings to each of her

which abnormal cells are detected in the

unnecessary procedures that don’t help

patients. She sets the standard for other

lining of a milk duct, but haven’t spread

or may even cause harm.

surgeons to follow.”

Dr. Hwang and fellow breast cancer

Dr. Hwang’s work in the operating

DCIS is the most common form of

surgeon Laura J. Esserman, M.D., MBA,

room and in the lab has focused on

noninvasive breast cancer in the United

of the University of California, San

the evolutionary basis for how breast

States, and accounts for about 20 percent

Francisco, share the honor in TIME.

cancer progresses. Her lab also is

of all new breast cancer cases diagnosed

Musician Melissa Etheridge, who is

working to identify common biomarkers

from

Institute, Shelly Hwang, M.D.

most

has

influential

people for 2016 as a pioneer in her field.

treatments

–

which

instead

international

of

discussion.

She

her

genuine

strongest empathy,

trait care

is and

to other tissues.

But

a breast cancer survivor and activist,

of cancer progression that in the future

doctors are divided on how some

provides comments for TIME about

could lead to clues in preventing the

patients with low-risk DCIS should be

these two top-100 winners and their

disease. In addition, Dr. Hwang serves

18

mammogram

The Triangle Physician

screenings.

NEWSOURCE-JUN10:Heidi

8/5/10

Page Research 1 Duke News

12:57 PM

on committees for the National Cancer Institute and National Comprehensive Cancer Network and is an advocate for cooperative group clinical trials in

Do They Like What They See?

breast cancer.

Dr. Hwang is currently leading a

Make sure you connect with your key audiences using strategic, cost-effective advertising, marketing and public relations.

national study evaluating how an oral hormone blocker could treat women with low-risk DCIS that may be fueled by estrogen. She is also the principal investigator of the first large, national

Our services range from consultation, to design, to creation and implementation of strategic plans.

trial that will compare the benefits of surgery or monitoring for patients with low-risk DCIS. She and co-investigators hope the trial provides landmark data to

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“This an important study of more than 1,000 women that asks when it may be appropriate for women diagnosed with DCIS to omit surgery,” Dr. Hwang

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said. “We have assembled a dedicated multidisciplinary team of investigators and patients across the country to address a fundamental question about how we think of cancer and cancer treatment. I am proud that Duke and Duke Surgery provide an environment where we can address such questions.”

Dr. Hwang joins a prestigious roll on the TIME list, which this year honors the activism, innovation and achievement of

artists

and

leaders

including

Christine Lagarde, Priscilla Chan and Mark Zuckerberg, Ta-Nehisi Coates, Leonardo DiCaprio, Aung San Suu Kyi and Kendrick Lamar. Dr. Hwang is the second Duke Cancer Institute physician to be named to the TIME list. In 2013 medical oncologist Kimberly Blackwell, M.D., was an honoree.

A full list of this year’s TIME 100 most influential people appeared in the May 2 issue of the magazine. It is currently

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May 2016

19

WI

News Welcome to the Area

Physicians

Alexander Jefferson Craft, DO Diagnostic Radiology; Musculoskeletal Radiology; Radiology

Duke University Hospital Durham

Kendall Leonard, DO Anesthesiology

Pinehurst Anesthesia Associates Pinehurst

Benjamin Stevens Bryner, MD

Melissa Jean Fitzgerald, MD

Elizabeth Grace Jarvis, MD

Thoracic Surgery

Pediatrics

Obstetrics and Gynecology

Duke University Hospitals Durham

Eileen Tsai Chambers, MD Pediatric - Nephrology

Duke University Medical Center/ Children’s Health Center Durham

Don Clarence Chaplin, MD

Khoa Mai Nguyen, DO

Burlington

Orthopedic Surgery; Orthopedic Surgery, Adult Reconstructive

Jeffrey Cheng, MD

Triangle Orthopaedic Associates Durham

David Edgar Deleon Tolentino, DO Internal Medicine

Campbell University Lillington

Amir Aghajanian, MD Cardiology; Internal Medicine

Otorhinolaryngology; Pediatric Otolaryngology

Duke Children’s Hospital & Health Center Durham

Jason Yebin Cho, MD Child Psychiatry; Psychiatry

Duke University Hospitals Durham

University of North Carolina Hospitals Chapel Hill

UNC Hospital Chapel Hill

Kimberly Elizabeth Fryer, MD

Pediatrics

Obstetrics and Gynecology

UNC Healthcare Chapel Hill

Marame Khaled Gattan, MD Alcohol and Drug Abuse; Anesthesiology; Cardiovascular Disease, Internal Medicine; Critical Care Surgery; Critical Care-Internal Medicine; Emergency Medicine; Internal Medicine; Obstetrics; Obstetrics and Gynecology; Ophthalmology; Orthopedic Surgery

Duke University Hospitals Durham

Thaidra Ann Gaufin, MD Internal Medicine

UNC Hospitals Chapel Hill

University of North Carolina Hospitals Chapel Hill

Julien Mathieu Cobert, MD Chapel Hill

Christopher Jordan Hancock, MD

Laura Kathleen Altom, MD

Michael Kevin Dougherty, MD

Anesthesiology

Colon and Rectal Surgery; Surgery

Rex Surgical Specialists Raleigh

Arthur Wakefield Baker, MD Infectious Diseases, Internal Medicine

Anesthesiology; Internal Medicine

Gastroenterology, Internal Medicine; Hospitalist; Public Health

UNC Gastroenterology Chapel Hill

Eugenie Du, MD

Duke University Medical Center Durham

Head and Neck Surgery; Otolaryngology - Plastic Surgery Within the Head and Neck

Adam Zachary Banks, MD

UNC Dept of Otolaryngology Chapel Hill

Cardiovascular Disease, Internal Medicine

Duke University Hospitals Durham

Dane Michael Barrett, MD Otolaryngology - Plastic Surgery Within the Head; Neck

Duke Otolaryngology of Durham Durham

Megan Rebecca Barrett, MD Obstetrics and Gynecology

Duke Women’s Health Associates Durham

Ashley Nicole Battarbee, MD Obstetrics and Gynecology

UNC Maternal-Fetal Medicine Chapel Hill

Meghan Kay McPheeters Black, MD Hospitalist; Internal Medicine

University of North Carolina Hospitals Chapel Hill

Sonya Thomas Blizzard, MD Ophthalmology

Michael Sean Enslow, MD

Megan Dale Henley, MD Anesthesiology

Duke University Medical Center Durham

Aaron David Falchook, MD

Derrick John Hoover, MD

Radiation Oncology

University of North Carolina Hospitals Chapel Hill

Adolescent Medicine; Dermatology; Diabetes; Family Medicine; Family Practice; General Practice; General Preventive Medicine; Geriatrics; Urgent Care

Nicholas Craig Farber, MD

Advance Community Health Raleigh

Ophthalmology

UNC-CH Department of Ophthalmology Chapel Hill

Oluwadamilola Motunrayo Fayanju, MD

General Surgery; Surgical Oncology Duke University Hospital Durham

Duke University Eye Center Durham

The Triangle Physician

Duke University Medical Center Durham

Duke University Hospitals Durham

Gregory Daniel Brown, MD

20

Neurological Surgery; Neurological Surgery, Critical Care; Vascular and Interventional Radiology

UNC Hospitals Chapel Hill

Avni Patel Finn, MD

Duke University Hospital Durham

Erik Friedrich Hauck, MD

Diagnostic Roentgenology Radiology; Musculoskeletal Radiology; Neuroradiology; Nuclear Medicine; Nuclear Radiology; Pediatric Radiology; Vascular and Interventional Radiology

Duke Eye Center Durham Internal Medicine; Psychiatry

University of North Carolina Hospitals Chapel Hill

Ophthalmology

Julian Thornton Hertz, MD Emergency Medicine

Alicia Germaine Howard, MD Hospitalist; Internal Medicine

Catawba Valley Medical Center Hickory

Austin Archie Howard III, MD Internal Medicine

University of North Carolina Hospitals Chapel Hill

Abigail Elizabeth Huang, MD Ophthalmology

Duke Eye Center Durham

Jacob Keith Johnson, MD UNC Hospitals Chapel Hill

Andrew Robert Karenz, MD Anesthesiology

University of North Carolina Hospitals Chapel Hill

Cristine Nicole KlattCromwell, MD Head and Neck Surgery; Otolaryngic Allergy; Otolaryngology; Otolaryngology - Neurotology; Otolaryngology - Plastic Surgery Within the Head & Neck; Otolaryngology, Otology-Neurology; Otolaryngology/ Facial Plastic Surgery

University of North Carolina Hospitals Chapel Hill

Harajeshwar Singh Kohli, MD Emergency Medicine

Duke University Medical Center Durham

Matthew Kirk Langman, MD Diagnostic Radiology; Radiology; Vascular and Interventional Radiology

Duke University Hospitals Durham

Lindsay Roofe Lavin, MD Pediatric - Emergency Medicine; Pediatrics

Wake Emergency Physicians, PA Cary

Wonchon Lin, MD Ophthalmology

Duke University Eye Center Durham

Sheppard Allen McKenzie III, MD Gynecology

Raleigh

Megan Ann McNamara, MD Hematology and Oncology, Internal Medicine; Hematology, Internal Medicine; Internal Medicine; Medical Oncology

Duke University Medical Center Durham

Shriti Masrani Mehta, MD Cardiology; Cardiovascular Disease; Internal Medicine - Interventional Cardiology

UNC Hospitals Chapel Hill

Brian Edward Moore Jr, MD Psychiatry

UNC Hospitals Chapel Hill

News Welcome to the Area Haley Arden Moss, MD

Elizabeth Schweighofer

Gynecology/Oncology; Obstetrics & Gynecologic Surgery; Obstetrics & Gynecology - Gynecologic Oncology; Obstetrics and Gynecology

Sandberg, MD

Department of Gynecologic Oncology Durham

Liliana Nanez, MD General Surgery; Vascular Surgery

Rex Vascular Specialists Raleigh

Venu Nemani, MD Orthopedic Surgery; Orthopedic Surgery of the Spine

Raleigh Orthopaedic Clinic Raleigh

Hien Ngoc Nguyen, MD Addictionology or Addiction Medicine; Administrative Medicine

Western Wake Treatment Center Apex

Myles Stanley Nickolich, MD Hematology and Oncology, Internal Medicine; Internal Medicine

Duke University Hospitals Durham

Sarah Elizabeth Nickolich, MD Family Medicine

University of North Carolina Hospitals Chapel Hill

Latoya Cherry Patterson, MD Obstetrics and Gynecology

Duke University Hospitals Durham

Eric Davis Pauley, MD Cardiology; Hospitalist; Internal Medicine

University of North Carolina Hospitals Chapel Hill

Richard B Phinney, MD Ophthalmology

Pinehurst

Chad Edward Pletnick, MD

Pediatrics

University of North Carolina Hospitals Chapel Hill

Jill Annette Schaeffer, MD Internal Medicine

Duke Primary Care Raleigh

Joseph John Schreiber, MD Orthopedic - Surgery of the Hand; Orthopedic, Hand Surgery

Raleigh Orthopaedic Clinic Raleigh

Sounok Sen, MD Cardiovascular Disease, Internal Medicine; Internal Medicine

Duke University Hospital Durham

Evan Samuel Shelby, MD Internal Medicine

University of North Carolina Hospitals Chapel Hill

Pediatrics

Duke University Hospitals Durham

Kaitlin Marie Ryan, MD Administrative Medicine; NeonatalPerinatal Medicine; Pediatrics

Duke University Medical Center Durham

Duke University Hospitals Durham

Monica Casey Tang, MD Allergy and Immunology; Internal Medicine; Pediatrics

Duke University Hospital Durham

Genevieve Louise Taylor, MD Pediatrics

University of North Carolina Hospitals Chapel Hill

Sandra Leta Silberman, MD Hematology and Oncology, Internal Medicine; Hematology/Oncology; Internal Medicine

VA Medical Center Durham

Jessica Son, MD General Preventive Medicine; Gynecology; Obstetrics; Gynecologic Surgery

Associates in Women’s Healthcare Raleigh

Michael Landron Soo, MD Neurology; Sleep Medicine

Durham Ophthalmology

Hospitalist; Internal Medicine

Jonathan Doo Young Yun, MD Dermatology; Diabetes; Family Medicine; Family Medicine Adolescent Medicine; Family Practice; Public Health; General

UNC Family Medicine Clinic Chapel Hill

Wenlan Zhang, MD Ophthalmology; Pediatric Ophthalmology

Duke University Durham

Gaurav Telhan, MD Physical Medicine; Rehab - Pain Medicine; Physical Medicine and Rehabilitation

University of North Carolina Spine Center Chapel Hill

Rebecca Elizabeth Traub, MD Neurology; Neuromuscular Medicine

Christopher Lawrence Weller, MD

UNC Kittner Eye Center Chapel Hill

Candice Marlow Roberts, MD

Duke University Hospitals Durham

First Health Moore Regional Hospital Pinehurst

Department of Anesthesiology at Duke University Medical Center Durham

Cary

Internal Medicine; Pulmonary Disease and Critical Care, Internal Medicine

Hospitalist

Randall Noah Stein, MD

Emergency Medicine

Eric Michael Yoder, MD

Department of Neurology, University of North Carolina at Chapel Hill Chapel Hill

Moushumi Rahman Shumi, MD

Anesthesiology; Anesthesiology - Pain Medicine

Nicholas David Reid, MD

Aparna Chandra Swaminathan, MD

Ophthalmology

Duke Eye Center Durham

Benjamin Joseph White, MD Obstetrics and Gynecology

Physician Assistants

Jennifer Lynn Beard, PA Family Medicine; Family Medicine Adolescent Medicine; Family Medicine - Geriatric Medicine; Family Practice; Family Practice/Geriatric Medicine; General Practice; Sleep Medicine

Rural Health Group Henderson

Michelle Christine Johnson, PA Gastroenterology, Internal Medicine

Kernodle Clinic West Burlington

Betsy Clifton Joyner, PA Pediatrics

University of North Carolina Hospitals Chapel Hill

Cary

Michelle Joette White, MD

Central Dermatology Center Chapel Hill

Pediatrics

University of North Carolina and NC Children’s Hospital Chapel Hill

Benjamin Marshall WildmanTobriner, MD Diagnostic Radiology; Radiology

Duke University Hospitals Durham

Jessie Peyton Wilson, MD

Stephanie Marie Knutson, PA Dermatology

James Lance McGhee, PA Orthopedic Surgery

Kernodle Clinic Burlington

Dennis Charles Polley II, PA Dermatology

Polley Clinic of Dermatology Wilson

Pediatric Infectious Diseases; Pediatrics

Rebecca Stone Ramey, PA

University of North Carolina Hospitals Chapel Hill

Family Practice

Rural Health Group-Whitakers Whitakers

Duke University Medical Center Durham

Noah Bedford Wohlert, MD

Stephanie Marie Reese, PA

Stephanie Gauder Sussman, MD

University of North Carolina Hospitals Chapel Hill

Matthew Nicholas Suberlak, MD Diagnostic Radiology

Pediatrics

University Pediatrics at Chapel Hill North Chapel Hill

Family Medicine

Pediatrics

Mebane Pediatrics Mebane

John Patrick Yeatts, MD Hospitalist

Duke University Hospital Durham

May 2016

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