making time to make a difference

Work/Life Balance: Three Ways to Keep Well

A New Beginning for OMA

11740 SW 68th PkwyPortland, OR 97223Return Service Requested

Volume 1, Number 1 • Spring 2008

Medicine in Oregon

A publication of the Oregon Medical Association Policy • Community • Practice

Differenceto Make a Making Time

Medicinein OregonPublished quarterly by

Oregon Medical Association 11740 SW 68th Pkwy, Ste 100Portland, OR 97223503-619-8000 • fax 503-619-0609www.theOMA.org • [email protected]

Magazine StaffExecutive Director | Jo BrysonManaging Editor | Betsy Boyd-Flynn

Editorial Advisory BoardCarla McKelvey, Physician EditorMonica WehbyPeter BernardoNancy BoutinEvelyn FordMike Crew (of counsel)

Advertising & Design byLLM Publications, Inc.8201 SE 17th Ave, Portland OR 97202503-656-8013 • 800-647-1511fax 503-655-0778www.llm.comPresident | Linda PopeGraphic Design | Heather ModraAdvertising Sales | John Garbett

On the CoverFor our premier issue, we highlight the splendor of the Oregon Coast.

© 2008 by the Oregon Medical Association All rights reserved. No part of this publication may be reproduced or transmitted in any form by any means, electronic or mechanical, including photocopy, recording, any information storage or retrieval system, without permission from the publisher.

“The Dancer” painting by Barbara Largent, MD

Postural Instability poem by Kathleen Fitzgerald, MD

Volume 1, Number 1 Spring 2008

Work/Life Balance 8 Feature

Making time to Make a Difference by earl Hines

PLUS Before you go...

13 tHinKing out LouD Choices by nancy S. Boutin, MD

14 Feature How three oregon Physicians Keep Well by Jennifer nordgaard

PLUS get out there

18 SPotLigHt on... Job Sharing Doctors are team Players by Lisa Senders, PhD, JD

21 PHySiCian aSSiStant SeCtion Balance in Practice: the Physician assistant Connection by Pat Kenney-Moore, Pa-C

31 in-HouSe CounSeL Fighting and Winning against Litigation Stress by Paul Frisch, JD, oMa general Counsel

Physicians seek to balance work and life by helping others around the globeDifferenceto Make a Making Time 8page

How Three Oregon Physicians

14page Keep WellMeet OMA members involved in unique activities that keep them active outside the practice of medicine

Also Inside 4 FroM tHe PreSiDent

in Challenging times, a Capacity for Change

6 FroM tHe DeSK oF Jo BrySon a new Beginning for oMa

7 uPCoMing eventS

7 neW & reinStateD MeMBerS

25 in tHe oFFiCe Mind the gap: underpayment Can add up to Big Losses by Marylin Happold-Lantham, MBa, FaCMPe

27 aDvoCaCy in FoCuS Strong Support for Medicare Payment Bill

BACk PAgE

Policy community Practice

In Challenging Times, a Capacity for Change

Monica Wehby, MD

Former US Senator Sam Ervin once said, “If men and women of capacity refuse to take part in politics and government, they condemn themselves, as well as the people, to the punishment of living under bad government.” A review of the challenges facing medicine shows us why it is time all of us take part.

Monica Wehby, MD, is president of the Oregon Medical Association. She is a pediatric neurosurgeon in private practice in Portland, and has been a member of OMA since 1997.

From the President

4 • Medicine in Oregon

This is an unprecedented era, which tests our profession’s ability

to continue the private practice of medicine at all. Medicare and Medicaid, two of the largest government health care programs, continue to reduce reimbursement levels below the cost of providing services. These programs are increasingly underfunded due to Congress’ inability to address long-standing systemic flaws and meet funding requirements necessary to put the programs on sound footing.

At the same time, many researchers believe that the country is not graduating a sufficient physician workforce to meet current or future demand. In Oregon, 45% of physicians are over the age of 50, and are likely to retire from or limit their clinical practice in the near future.

Most workforce experts believe that medical graduates must increase by 30% to meet future demands; we must also consider that many in the newest generation of physicians want a more balanced professional and personal life, and are not as inclined to work the extensive hours that past generations have worked.

As we move further into the 21st century, we continue to face unprecedented pressure to provide high quality care at the lowest possible cost, at the most convenient location in a culturally appropriate manner. Meanwhile, the definitions of those terms is still debated.

As medicine grapples with all of this, it seems nearly impossible to address the broad societal concerns regarding the sustainability of the American health care system and our desire to lead the country

toward universal access to health care coverage.

While it may appear that all is grim, organized medicine, including the American Medical Association, national and state specialty associations and not least the OMA, are working hard, together, to make things better. Physicians need to know that leaders of the OMA and AMA are engaged in much that reflects positively on the physician community.

We are focused on addressing the short term fiscal issues associated with Medicare and Medicaid, while working with the Oregon Health Fund Board and the process for state reform.

Liability reform remains a critical issue we must fight for. In Oregon, the Supreme Court’s recent overturning of the state Tort Claims Act presents an opportunity for us to once again champion reform for all physicians. We intend to seize that opportunity.

For example, after the 2007 OMA Interim House of Delegates endorsed Senator Ron Wyden’s Healthy Americans Act, the AMA House of Delegates adopted a resolution encouraging the AMA to work with the Senator to align his legislation with AMA policy. To that end, the AMA Council on Legislation met with Wyden and will recommend further action soon.

Here in Oregon, almost all of the committees of the Oregon Health Fund Board have physician representation, including the Board itself. The OMA has monitored the various committee meetings, and has presented testimony before several of them.

New Members 2008Farnoush abar, MDMatthew S. abrahams, MDBrian allen, Pa-CDaniel r. allen, Pa-CJoshi J. alumkal, MDPaula amato, MDtyler M. arkless, MDaaron ast, Pa-Ctan attila, MDMegan e. aylor, MDCharles F. Baker, MDScott a. Barbour, MDgina M. Bawden, Pa-Crichard K. Bell, MDCharles J. Bentz, MDvatche K. Bezdikian, MDJohn K. thomas Bischof, MDDebbie a. Boettner, PaBruce r. Bohman, MDKatrin i. Book, MDrichard J. Bower, MDMichael D. Brant, MDSally r. Byrd, MDWilliam J. Byrne, MDScott M. Chadderdon, MDMauricio r. Chavez, MDHsichao Chow, MDBrian J. Cobb, MDKenric Craver, Pa-CMichael Cunningham, Pa-Cgregory J. Davenport, Parobert F. Demayo, MDrichard a. Deyo, MDJay H. Donohoo, MDBrian W. Drake, Pa-CJames C. Dunn, MDtimo n. Dygert, MDBenjamin D. ehst, MDKai e. engstad, MDJonathan W. evans, DoPaula a. Folger, MDJonathan W. Force, MDantonio e. Frias, Jr, MDalice W. Fung, MDMadhavi gaddam, MDCarrie a. ganong, MDroger D. garvin, MDManuel gigena, MDMindy e. glivinski, PaMari M. goldner, MDMathew S greenberg, MDMichael L. Hall, MDvalerie J. Halpin, MDthomas e. Hansen, MDWei Hao, MDJoseph a. Hardman, MDMichael L. Hartmeyer, MDKeith a. Haugen, MDrobert D. Heros, MDDavid H. Hickam, MDraymond F. Higby, DoLaura a. Higgins, MDnatalie J. Hoshaw, MDirene S. Hsu-Dresden, MDKristin e. Hubert, MDShalini M. Jacob, MD

Dawn Jennings-Peterson, MDShae H. Johnson, Doann o. Jurani-Suarez, MDKatalin Kelemen, MDyasir Khatib, MDPeter Sung-Duk Kim, MDines P. Koerner, MDSaramati J. Krishna, MDCharlotte D. Kubicky, MDStephen M. Langley, MDChee y. Lee, MDannie M. Legard, Pa-Crachel Lemke, Pa-CJack B. Lewis, MDKai Li, MDvicky Li, MDteresa H. Liao, MDMichael J. Lloyd, MDPhilip e. Lund, MDoscar J. Ma, MDMartin Majer, MDStephen P. Malkoski, MDaubyn Marath, MDKieren a. Marr, MDMylynda B. Massart, MDMaureen e. Mays, MDMiranda C. McCormack, MDHall thomas Mcgee, MDnathanael J. McKeown, DoBrandi a. Mendonca, MDKent J. Mercer, PaMark J. Merkens, MDHelen C. Miller, MDJessica W. Miller, MDadam J. Mirarchi, MDBrandon W. Mitchell, MDnoelle e. Montano, MDLiberato v. Mukul, MDHitomi nakai, MDScott e. naugler, MDandrea Bishop navarre, Pa-CJennifer S. needle, MDHanh n. nguyen, MDStephanie a. nonas, MDKaren y.P. oh, MDJustin P. ortiz, MDPatricia S. otis, MDCharlotte C. ott, MDrachael M. Pakunpanya, MDSuvarna reddy Palla, MDCharles S. Parker, MDSirichai Pasadhika, MDtheodore D. Pawlik, MDvaishali v. Phalke, MDJorge a. Pineda, MDJoseph D. Pinter, MDJohn L. Powell, MDJuha P. rasanen, MDWilliam J. raum, MDMichael recht, MDJanette K. remling, PaMark D. reploeg, MDLeah g. reznick, MDoleg i. reznik, MDHubert a. rodriguez, Jr, MDDaniel M. rusu, MDMichael a. Sandquist, MD

OMA thanks those members who have paid their 2008 dues, and welcomes the following new members and those who have reinstated their membership with the OMA.

We recently helped to ensure that the full provisions of SB 337 were carried out. The law, passed in 2007, clarified what information could be collected in the Oregon Medical Board’s public database. The OMB has agreed to update their database retroactively, to remove any information relating to cases which did not result in settlement or verdict.

In the OMA’s ongoing effort to collaborate with various medical interests, we continue to host meetings with the Oregon Association of Hospitals and Health Systems, and with state specialty societies, to better coordinate our efforts in Salem.

Through the effort of Oregon physicians and the OMA, the

US House passed legislation recognizing that efficient states like Oregon should receive “bonus” payments for providing high quality, cost-efficient care. While this provision did not make it into the final legislation in 2007, our Congressional Delegation recognizes that payment disparities in Oregon and other states must be remedied.

Though things are not easy, we should be encouraged. Our work with federal and state leaders affirms that when organized medicine works in concert, with a unified vision and with a common goal, we can make a difference for our patients, and enact rational fiscal policies that reward good medical care. We must all choose to take part.

Magazine Submission guidelines

We welcome submissions from our members, including opinion pieces, essays about your practice, or visual art. We do not offer payment for published work, but can provide additional copies of the magazine in which your work appears.

if you are interested in writing but do not have a clear idea or a specific topic in mind, you may wish to contact a member of the editorial advisory board or the staff editor. they may be able to assign you a topic or make suggestions for content we are seeking for a particular issue.

get a sense of what is planned by viewing the editorial calendar for the year, which is kept up to date on the oMa website at www.theoMa.org/Mio.

Submission deadlines for each issue are as follows:May 31: Summer issue, Health Care reformSept. 30: Fall issue, Workforce Challenges Dec. 15: Winter 2009 issue, technology at Work

Send your submissions electronically to [email protected].

Written submissions should be sent in rich text format or MS Word 2003. any accompanying photos or illustrations can be sent either on CD or via e-mail. Please note these must be high-resolution files, 300 dpi or higher. We also have a 6MB size limitation on e-mail we can receive. include a brief (25 words or fewer) biographical note, including your specialty, where you practice and (optionally) how long you have been a member of oMa.

Submissions of visual art can be submitted either via mailed CD or e-mail, or contact Betsy Boyd-Flynn at (503) 619-8000 to arrange an in-person meeting.

Spring 2008 • 5

A New Beginning for OMA

Though launching this

magazine is a big step,

it’s really only a beginning. . .

Joanne K. Bryson, CAE

From the Desk of Jo Bryson


2008 OMA Executive Committee—Provisional

Nine months ago, our new director of communications was given the task with assessing how we currently

communicate with our members, and developing a comprehensive plan which would not only improve how we communicate but also broaden and increase the scope and depth of the information we provide to our members and other stakeholders.

After several months of extensive planning, ‘hard labor’ and anticipation, Medicine in Oregon is finally born—and we couldn’t be more proud! OMA’s flagship publication will reflect the integrity and dedication of the physicians in our state and let us more effectively communicate to and with our members about:

What we are doing on their behalf•What our volunteer members are doing•Industry trends in Oregon and how they will impact the •practice of medicineWhat is changing in the medical industry•The history of the organization and what it can become•What our medical societies and IPAs are doing•

When thinking about how we can ensure a strong, effective future for the OMA, we envision creating an atmosphere in which our members are able to communicate and connect with each other. This magazine is meant to be one way to do that.

We hope readers will find value through day-in-the-life stories of practicing physicians, or maybe an insight that will help them in their own practice. Perhaps more important, in these pages we expect to share discussions about the larger, key issues that concern our members. We hope to feature debates over the issues we might disagree on among ourselves, and encourage a deeper exploration of the common values that unite us.

We hope you’ll find this magazine a way to connect with each other, as we all seek to ‘raise’ the profession. It will take a village, so to speak, and I hope you’ll join us and contribute.

President | Monica Wehby, MDPresident-Elect | Peter Bernardo, MD Immediate Past President | Klaus Martin, MDVice President | James Hicks, MDSecretary-Treasurer | John Evans, III, MDSpeaker of the House | Carla McKelvey, MD

Vice Speaker | Mary McCarthy, MD

Member-at-Large | William Pierce, MD

Member-at-Large | Carlos Sanchez, MD

OMA Alliance President | Eva Germaine-Shimotakahara

uPCOMINg eventsnathan B. Sautter, MDLaura J. Schaben, MDandrew M. Schreiner, MDPeter M. Schulman, MDtara ann Schwab, MDrobert C. Sears, MDSubramaniam

Seetharaman, MDJennifer S. Semmelroth, PaMichael D. Shapiro, DoMichelle r. Shaw, MDDawn H. Siegel, MDKyle e. Smoot, MDroland Solensky, MDrachel Solotaroff, MDJianming Song, MDDonn H. Spight, MDthomas P. Stites, MDMatthew t. Sugalski, MDJames g. Suiter, PaDennis C. tan, MDJohn tyler thiesing, MDalyssa W. thompson, Dorebecca n. thompson, MDZoryana n. thompson, PaStephanie a. trautman, MDCharles g. turner, PaLisa S. turner, Pa-CPetra L. vajtai, MDronald u. vallejo, MDJennifer L. Wallace, MDrong Wang, MDyujen Wang, MDCharles W. Webb, DoBeau C Weill, MDChristopher M. Weinman, PaSarah K. West, MDCatherine a. White, MDMandy M. Wiesman, Pa-Camy L. Wiser, MDeric M. Wiser, MDScott r. Witherspoon, MDFawn M. Wolf, MDneal H. young, MDinski H.e.Q. yu, MDelizabeth u. yutan, MDWayne D. Zebelman, MDMichael a. Zimmerman, MDrichard L. Zobell, MD

Reinstated Members 2008Hasan akhtar, MDinger g. aliason, MDM. Patrick allender, MDDaniel P. Barrett, MDJames M. Bartruff, MDChristopher a. Bombeck, MDJuliene B. Bottom, Pa-Canne Marie Breitinger, MDDavid i. Buckley, Jr, MDBruce P. Byram, MDMaureen L. Carney, MDMichael C. Chen, MDSusan S. Cho, MDBryce L. Cleary, MDMinot Cleveland, MDCharlotte a. Clock, MDJustin D. Clutter, MDBrian M. Curtis, MD

Michelle J. Curtis, MDDavid H. Cutsforth, Jr, MDDarryl B. Denison, Pa-Crobert a. Dodds, DoHonora L. englander, MDJulie M. Falardeau, MDCarol S. Federiuk, MDWilliam r. Ferguson, MDShawn J. Foley, MDMarilyn J. Fraser, MDteresa F. gipson, MDDavid r. grube, MDulrike M. guempel, MDamy S. Hackett, MDJames o. Hancey, MDMichael C. Heinrich, MDLorri L. Hendon, DoWilliam r. Hersh, MDLawrence Hipshman, MDDavid t. Huang, MDPeter C. Hudson, MDCecilia a. Keller, MDKathleen a. Kemmer, MDWallace H. Knapp, Jr, MDJames r. Koski, MDJohn r. Ladd, MDJanel M. Lawrence, MDamey y. Lee, MDDavid M. Lewinsohn, MDJames r. McDonald, MDeunju r. Metzler, MDJill a. Miller, MDamer J. Mirza, MDJames r. naibert, MDJames t. nolan, MDJames M. nusrala, MDMelissa r. nyendak, MDJenny L. olsen, MDMolly L. osborne, MDgary L. oxman, MDSydney S. Piercey, MDnatasha Polensek, MDronald W. Powell, DoChristina g. rehm, MDJeffrey e. robinson, MDJustin B. rufener, MDLaura S. rung, MDedward J. Schmitt, MDvandy L. Sherbin, MDJennifer e. Slickers, MDChristopher r. Smart, MDWarren B. Sparks, MDrobert D. Steiner, MDCornelia C. taylor, MDPamela e. turner, MDChaim vanek, MDDavid Wagar, MDJennifer M. Watters, MDgregory S. Willis, MDrobert B. Wirth, MDCherisa Wolf, Doedward C. Wolf, MDMichael L. Wong, MD

Membership information is available through Beth Cherry at (503) 619-8000 or [email protected].

Oregon Health Fund Board Public Forumswww.healthforum.org/events/meetings.html

tuesday, June 3, 7–9 pmSouthwestern oregon Community College1988 newmark ave, Coos Bay

Wednesday, June 4, 7–9 pmLane Community College Center for Meeting and Learning 4000 e 30th ave, Bldg 19, eugene

thursday, June 5, 7–9 pmBend armory875 SW Simpson ave, Bend

tuesday, June 10, 7–9 pmainsworth united Church of Christ2941 ne ainsworth St, Portland

Wednesday, June 11, 7–9 pmFirst Congregational united Church of Christ700 Marion St ne, Salem

OMA Board of TrusteesSaturday, June 7, 9 am–noonoMa Headquarters11740 SW 68th Pkwy, Ste 100, Portland

OMA Roster Inquiries DueMonday, June 16Make sure your information is updated for 2008. Contact Beth Cherry at (503) 619-8000 if you have questions about the roster.

Oregon Environmental Council: Healthy Environment Forum Series Eventwww.oeconline.org/kidshealth/healthprofessionals/healthforum/#drugs

Drugs in the Water: How our Medicine Cabinets are Contaminating Naturethursday, June 19, 6–8 pm Doubletree Hotel—Lloyd Center 1000 ne Multnomah, Portland

Oregon Medical Board Meeting July 10–11Crown Plaza1500 SW First ave, Ste 620, Portland (971) 673-2700

OMA Executive Committee Meetingthursday, July 10, 4–7 pmoMa Headquarters11740 SW 68th Pkwy, Ste 100, Portland

Northwest Cancer Summit 2008www.cancercareresources.orgJuly 28–29, 8 am–5 pm oregon Convention Center777 ne MLK Jr. Blvd, Portland

Coding Book Order Forms Available on Aug. 1e-mail [email protected] for more details.

Spring 2008 • 7

by Earl Hines

Physicians seek to

balance work and

life by helping others

around the globe

Differenceto Make a

Spring 2008 • 9

IT wAS IN 2001, wHIlE ASCENDINg MT. kIlIMANjARO, that Dr. James Lace of Salem first met the director of the Yatima Group Trust Fund. Yatima was a fledgling

orphanage in Tanzania created to take care of just a few of the country’s nearly 2 million children orphaned by HIV/AIDS. “These people were living hand to mouth, day to day,” says Lace. With over ninety children, food, clothing and basic necessities were scarce. “They didn’t know where the next meal was coming from.” Dr. Lace, now age 60, was so moved by his experience in Tanzania that he took up the cause by donating his own money to buy land, supplies, and food. The next six years were filled with fundraising, planning and many more trips to Tanzania.

What does he have to show for his efforts? Well, quite a lot.

Yatima is now a thriving centre serving the needs of over 130 children. There are three new dormitories and electricity. A new 180-foot well provides the children clean drinking water and new gardens are being planted that will provide much needed food.

“Once you talk to the children, it makes all the time and monetary sacrifice worthwhile,” said Lace. “We cannot save all the children orphaned by HIV/AIDS, but we can help a few children in a big way.”

MEDICAl PHIlANTHROPy IS A FAMIly AFFAIR for Portland’s Dr. Tom Hoggard and his wife, Dr. Mary Burry. They began their careers in 1974, Hoggard practicing family medicine and Burry, radiology. “We both had long careers, and then in 2001, went to the London School of Hygiene and Tropical Medicine,” said Hoggard. “We had been going overseas with Northwest Medical Teams (now Medical Teams International), and wanted to educate ourselves so we could do more.” And more they did. Since then, Drs. Hoggard and Burry have responded to war and natural

disasters on 14 separate missions —that’s about two per year—including trips to Kenya, Albania, and Turkey. “After the floods in Mozambique in 2000, we were the only two doctors in a camp with 90,000 refugees,” Hoggard said. “People were dying every day from cholera and dehydration.” Though most people might find these circumstances unbearable, Dr. Hoggard sees them differently. “Every day, I’d step outside our little tent and be faced by this sea of humanity. I realized we were giving people something that they’d never get otherwise. That we were literally saving lives.”

Fitting philanthropy and time away from the office into a busy medical practice isn’t easy. When asked how he does it, Dr. Lace simply says: “By having really understanding partners.” Indeed, it would be nearly impossible for a solo practitioner to abandon practice for three or four weeks at a time. Dr. Hoggard faced similar challenges. “Not only was I not billing for a month at a time, my overhead

Children play outside a Liberian health clinic where Medical teams international oversees a Child Health Survival federal grant.

More and more physicians are seeking to

enhance their lives and careers by giving back

to underserved communities, and some are

doing it in surprising ways all over the world.


Before you go…Medicine in oregon spoke with two experts on medical missions to develop a list of some very practical questions to consider for physicians interested in doing medical mission work overseas.

what’s your comfort with chaos? are you excited by the opportunity to mobilize quickly in response to a breaking disaster? or are you more interested in development work, helping with basic patient care and training other health

care providers to help the underserved? the type of experience you seek should match your disposition and tolerance for the uncertain. as Barbara agnew, a spokesperson for Medical teams international tells us, “those who like disaster trips are a different breed of cat—the trips are unpredictable, and you need a sense of adventure and flexibility.”

other opportunities offer a fixed schedule and plan. the Center for Personal restoration programs involve time spent in clinic, and house calls for every provider on the trip. according to Dr. David Krier, president of the oregon-based organization, “the benefit [of the house calls] is that you can see the impact of your work quite clearly.” the corollary is that you need to be prepared to handle extreme poverty, which is easier for some than for others.

what’s your ideal weather? if you have a strong aversion to heat or damp, make sure you know the typical forecasts for your destination before you get going. Heating in some mountain communities is limited, and air conditioning in hot climates is even more scarce. you may find that you don’t notice the weather once you get busy, but if you know in advance, you can prepare yourself mentally.

Can you handle real culture shock? Language barriers can be tough to work with. Consider whether you will be most comfortable working in a situation where english is spoken, or whether you are willing to work with interpreters. While in a disaster response situation this might not be a choice, you can usually at least expect to have interpreters on site before you arrive. Beyond language, Ms. agnew encourages participants to consider how comfortable they are with different cultures—especially when those cultural differences might impact the health of the people in need. For example, in some areas, physicians must only treat patients of the same gender—if that will bother you, choose your mission accordingly.

Do you prefer treating or training? are you more interested in working with local providers, or treating patients yourself? Development programs are placing increasing emphasis on equipping local providers with new materials, protocols or procedures they might not have learned otherwise. Dr. Krier recalled a story of local physicians performing orthopedic surgery with assistance from the visiting physician—without power equipment. the learning that day was mutual.

Should you bring your family? according to Dr. Krier, some physicians report that taking their older children with them is an incredibly powerful experience that helps to shape a passion for giving in their children and themselves. not every mission is compatible with that, however, so bear that in mind as you choose your program.

there’s a lot to consider, and there is a lot of work based here in oregon. to get started, visit www.medicalteams.org to learn more about Medical teams international, or www.cprestoration.org for the Center for Personal restoration.

was killing me, too.” About eight years ago, Dr. Hoggard and Dr. Burry completely restructured their lives to solve this problem. They abandoned their traditional practices and became independent contractors, relying on part-time assignments and locum tenens positions to earn their living. They rented out a room in their home to a trusted friend who manages things while they’re away, set up auto-payments for their bills, and entrusted the checkbook to a family member. All of this provides them the flexibility to hop on a plane when a disaster happens. They flew to New Orleans after Hurricane Katrina and to Sri Lanka after the tsunami.

yOu DON’T HAvE TO BE A SEASONED PHySICIAN TO HElP. Medical student Evelyn Ford isn’t waiting until she’s a doctor to save the world. Even though she is in her second year at Oregon Health & Sciences University, Ford made time for not one, but two missions to Zimbabwe last year to volunteer for Africa AIDS Response. Her next trip—this time to Ethiopia—is already in the works. “Global health is very important to me,” Ford said. “I have a strong desire to help under-served populations.” But Ford recognizes that once she’s out of school she’ll have to balance her desire to be philanthropic with her need to make financial ends meet. In fact, her charitable interests are a significant factor in how she evaluates future career options. “I want to work for an organization that gives me flexibility and more control of my schedule,” Ford said, “which is why I’m leaning towards academics instead of private practice.”

oMa member Dr. randy Jacobs of Bend, volunteers with Medical teams international. Here, he performs medical tests during a health clinic visit in uganda.

Tips from the TrenchesIf you’re interested in joining the ranks of these medical philanthropists, they point out a few things you should consider:

Go Slow.1. Seek out a group that has a mission you care about and then see how you can help (see sidebar for some things to consider). Dr. Hoggard is anxious to point out that you don’t have to leave Oregon to find good causes. If you are drawn to an international location, don’t be concerned if you can’t afford to take time away initially. “Early on, I just helped other doctors from here,” Hoggard said, “with small donations or by helping them gather medicines.” You also don’t have to start off with big donations. “$50 or $100 can make a huge difference in a developing country,” said Dr. Lace. “One individual can’t save the whole world, but a bunch of us together can help many people.”

Take a Field Trip.2. Consider taking your next international vacation in a place where you’re interested in volunteering and use that time to do some research. Or take a day off from work and visit a charity in your own backyard. Whether your cause takes you out of the country or not, meeting the people doing the work will show you if the organization is right for you. “It all comes down to trusting the people involved,” said Dr. Lace. “You have to feel you can hold them accountable.”

SimpliFy your liFe.3. If you discover a real passion, you’ll find you need to make room in your life to pursue philanthropy. If you are leaving the country for an extended time, consider having someone you trust live in your house while you’re away. Set up internet-based bill-pay for your checking accounts, and auto-payments for recurring expenses. If you will be out of touch for a long period, hire a reputable, licensed Financial Advisor who can keep an eye on your investments while you’re away.

Whether you’ve been practicing for years or are just starting out, there are a variety of ways you can make a difference. Though everyone comes to their particular cause in their own way, most agree that regardless of your age, experience, how much money or time you have, you can make a tremendous difference in the lives of people in underserved communities. And if you really need a push to get out your door, let Dr. Lace help you schedule a safari tour to Tanzania. You and your friends will have a great time, and ten percent of your tour cost will go to support his orphanage.

Earl Hines is co-founder and managing principal of Hines & Warner Wealth Management. As a Certified Estate Advisor® and Financial Planner, he helps clients marshal and protect their wealth so they can live full lives today while still planning for tomorrow. Contact him at [email protected] or (503) 292-2775.

(top) a Honduran woman and her child wait in a small health clinic sponsored by Medical teams international. Many patients must travel by foot or bicycle for up to 8 hours to reach the health facility.

(middle) Dr. Jon Bird, a Missouri volunteer with Medical teams international, prepares to weigh a child during a health clinic visit in Darfur, Sudan.

(bottom) oMa member Dr. thomas Hoggard of Portland cares for a patient at the new orleans Convention Center immediately following Hurricane Katrina, while volunteering for Medical teams international.

Spring 2008 • 11

Spring 2008 • 13

A professor from western Oregon university sent a letter to my office a

couple of weeks ago, looking for women doctors “of a certain age.” She wanted interview opportunities for her students about “the changing face of medicine” in a class called Health, Medicine and Gender in Historical Perspective. Of course, the implied issues have been percolating through the back of my consciousness ever since.

I am a member of the sandwich generation, at work as well as at home. I’m too young to have been a feminist pioneer, but too old to be able to really embrace the healthier balance of work and life so naturally embodied by many Gen X doctors of both sexes. Recently, an e-mail came across my desk from a male physician who very much wanted to attend an important meeting. The message ended with the statement, “But if it has to be on Wednesday morning, I’ll need to get someone else to represent me. I have child care responsibilities then.”

Never in my career would I have admitted such a thing. I felt like a failure during my first pregnancy when impending pre-eclampsia forced me to miss the last two weeks of my VA medicine rotation. Four hours after the birth of my second child, I stopped

by my department to sign charts. We were back at work five days later, my newborn sleeping in a padded bankers’ box while I did the radiation physics portion of my residency. Although I don’t recall ever feeling any overt sex discrimination, I knew better than to give anyone any ammunition. And despite my current comfortable, senior position and wonderful partners, the ingrained ethic of practice over family persists. A few months ago, I kissed my dying father goodbye and told him, “I have to go to work now. I’ll see you later.” I never got a chance to say anything else.

Do I think I made the right decision? Absolutely not. If I’d called in and told my staff and my patients to carry on without me, would they have given it a second thought? Not a chance in the world. But it didn’t occur to me that I had that option until some weeks later.

Many years ago, my pre-med Bio TA told me, “If you want to be a doctor, you’d better get an A in this class. It doesn’t matter if your mother dies mid-semester, you still have to perform.”

I absorbed a similar message in medical school, during my surgical internship, and even in my family-friendly radiation oncology residency. True, I arranged my life so I could be a mom and a doc. I chose a specialty

with regular hours and light call responsibilities, and I joined a practice whose partners had already created a schedule padded with days off and frequent vacations. I also had the luxury of involved parents who lived just a few blocks away and adored their granddaughters. But when I was on the schedule, by gum, I was on the schedule. No early outs for a school program or days off because the teachers had booked conferences. We took our kids out of class for family trips rather than asking for more than my share of Spring Break weeks or Christmas vacations. But now that my younger daughter is graduating from college, I wish I’d seen more of her track meets and lacrosse games.

Please don’t think I’m complaining. I made my choices. No one forced me to do anything I didn’t choose to do. And, I do have a life outside of medicine. I quilt, I write, I have friends, and I have a terrific husband who has been there beside me every day since before I got my first medical school acceptance letter. But when I hear older colleagues say that today’s young doctors are lazy or don’t have a good work ethic, I just have to believe they’re making better choices than I did.

Nancy Boutin is a radiation oncologist in private practice in Salem.

ChoicesThinking Out Loud

By Nancy S. Boutin, MD

ChoicesChoices

How Three Oregon Physicians Keep Well

Keeping active and maintaining a balanced life can be a challenge for any busy practicing physician.Meet OMA members involved in unique Oregon activities that help them do it.


Dr. Ronald Fraback hadn’t biked much since grade school. When a good friend invited him to participate in Cycle Oregon twelve years ago, he was bit by the cycling bug and has been biking ever since. Starting with his first Cycle Oregon in 1995, Dr. Fraback has ridden in it a total of ten times, having only missed a couple of years.

He starts biking and training for the event in early spring. “I’m pretty much a fair-weather cyclist,” says Dr. Fraback, a rheumatologist with NW Rheumatology Associates in Portland. Typically, he rides once or twice during the week and on weekends, averaging around 15 miles per ride. He also plays squash about two to three times per week at the MAC Club. “Cycling is a great sport, if you like it. It keeps you refreshed, physically fit and helps reduce stress,” says Dr. Fraback.

The first Cycle Oregon took place in September 1988, and attracted 1,006 cyclists from 20 states. In 2007, there were

more than 2,000 participants from almost 40 states and several foreign countries. “Cycle Oregon is a great ride,” states Dr. Fraback. “It’s fun, social, good exercise and a great outlet for taking your mind off stressful things.”

The route of the 300+ mile tour changes each year. So far, his favorite Cycle Oregon was the one that took place in 2005, during the Lewis and Clark Bicentennial celebration, which basically followed the same route that Lewis and Clark had traveled. The ride began in Boardman, on the banks of the Columbia, continued through the Gorge and ended in Astoria.

“I’ve lived in Oregon most of my life, and Cycle Oregon is a great way to see parts of the state you’ve never seen or been to before,” says Dr. Fraback. “The best part is traveling from town to town, seeing beautiful parts of the state and spending time in these small towns, meeting the people.”

Seeing the state while cycling

by Jennifer Nordgaard

Spring 2008 • 15

Act Alive—A decathlon for a causeIt began with a casual conversation over Guinness. After a full day of windsurfing, while relaxing in the hot tub, Dr. Tim Hindmarsh’s wife asked him how he wanted to celebrate his upcoming 40th birthday. He decided he wanted to spend it doing the activities he loves the most—sports ranging from windsurfing to snow and waterskiing to running and biking.

While talking about his plans with Larry Mullins, President/CEO of Samaritan Health Services, the idea of doing these activities while raising awareness for a cause was suggested, and the Act Alive Decathlon was born. “There’s a need in our community for diabetes education scholarships for patients who fall through the cracks,” says Dr. Hindmarsh, a Sweet Home family physician. “This became the mission of the Act Alive Decathlon—to raise money for scholarships and awareness about diabetes and the importance of getting enough exercise and nutritious foods every day to stay healthy.”

Dr. Hindmarsh completed the first decathlon in 2005 on his 40th birthday. This year, the Act Alive Decathlon is set for Friday and Saturday, June 27–28. Over the course of 24 hours, Dr. Hindmarsh will take part in 10 athletic events, starting with windsurfing in the Columbia Gorge, followed by skiing and snowboarding early the next morning at Timberline Lodge, then on to three water sports—wakeboarding, barefooting and waterskiing. He’ll follow that with motocross, then hop on his bike and ride 14 miles from his family practice clinic in Sweet Home to Lebanon. After a short break, he plans to skydive and land in time for the last event, a 5-K run/walk. All who are interested are invited to participate with him on the bike ride and 5-K.

Making time for the activities he loves is an important part of how he maintains balance.

“Geography makes a huge difference in my being able to have the practice I want and still have time for

my family and the sports I love,” says Dr. Hindmarsh. He lives six miles from Sweet Home Family Practice, where he’s one of four

family physicians. “I can come home from work and within minutes be doing an activity I love,” he continues. His family even has a motocross

course in their yard.

“I retired from my obstetrics practice last year to have more free time,” says Dr. Hindmarsh. “There are also systems now in place at work, like the use of hospitalists at Lebanon Community Hospital, that make it easier to leave my work there at the end of the day.”

Dr. Hindmarsh isn’t the only physician in his family. His wife, Dr. May Hindmarsh, is a family physician as well, and works two days a week in urgent care at the Sweet Home clinic. “One of the things I’m most proud of is my marriage. We’ve worked out our shared responsibilities, yet support each other when we need to take some time for ourselves.”

His advice on how to stay active and maintain balance? “Like I tell my patients, if you have time to watch TV, you have time to be active. I make sure to schedule recreation time for myself each week,” concludes Dr. Hindmarsh.

Get out thereLearn more about the activities featured in this article.

Fitness, friendship and dragon boatsWhile practicing as a pathologist at Woodland Park Hospital in the late 1980s, Dr. Joel Shilling had never heard of the ancient Chinese sport of dragon boat racing. When a fellow physician, Dr. Eng Lock Khoo, who had been instrumental in founding the Portland–Kaohsiung Sister City Association, announced that the sister city association had selected dragon boat racing as an annual cultural event for anyone who was interested in participating, Dr. Shilling enthusiastically volunteered as a paddler on the Woodland Park Hospital team.

In June 1989, Portland’s first dragon boat races were held with 31 teams, representing Portland and Kaohsiung, competing with only four of the heavy, ornate wooden boats

that bear colorful dragon heads and tails in a Chinese motif. Since that time, the Portland Rose Festival dragon boat race has grown to include more than 90 local and international teams competing in 100 heats over two days.

Dr. Shilling’s involvement in dragon boat racing has grown exponentially as well. He became the Sister City Dragon Boat Race co-director in the early 1990s, and was involved in the process to develop the various men’s, women’s, and mixed divisions. He also helped found DragonSports USA in 1994, a non-profit dragon boat paddling club that promotes fitness and friendship through paddle sports.

Currently, he coaches two teams—the Hampton Woods Paddling Club, a mixed team, and the Snapdragons, a women’s team—as well as officiates at races. This year, he will be officiating at the nationals in Long Beach, Calif. During the busy summer and fall race season, he travels most weekends to competitions up and down the West Coast and Canada. “One of the greatest rewards for me is seeing team members become ‘all that they can be,’” says Dr. Shilling. “At the start, they may be very sore and physically hurting, and then as they begin to get into shape, it turns into feelings of great accomplishment.”

Currently a medical director at Quest Diagnostics in Portland, Dr. Shilling also serves on OMA’s board of trustees, and was recently named to the board of the American Society for Clinical Pathology. How does he keep this active and involved in the sport, yet continue his professional practice? “The secret to success and fulfillment in life is maintaining the balance—balance between helping patients and others, and meeting your own fulfillment,” says Dr. Shilling. “I feel every professional is in a privileged position, and needs to give back to the community in some way. Giving back in this way helps meet my need for fulfillment.”

Although Dr. Shilling says he never plans to fully retire, his advice for physicians contemplating retirement is to maintain some structure in their life. “Dragon boating is very structured; it fosters teamwork, helps maintain fitness, and is something people can do their whole lives.”


Do you have a story to share?

We know our members

are finding creative

ways to balance their

professional and personal lives;

we’d love to hear your story.

Contact Betsy Boyd-Flynn,

OMA director of communications,

at [email protected].

DRAgON BOATINg The Portland–Kaohsiung Sister City Association website is located at www.pksca.com. You’ll find information about team building, training, registration, and the history of the PKSCA and of the sport of dragon boating.

CyClE OREgON The Cycle Oregon website is located at www.cycleoregon.com. Log on to find training information, routes and summaries of previous years’ races, and information about how to participate this September, or just get to see them ride by. (At press time, the full tour was sold out, though the weekend ride in August was still available).

ACT AlIvE DECATHlON Find more information about this event at www.actalive.com. You’ll learn more about the mission of the event, how to support the fight against diabetes in Linn county, and even catch video of the skydiving from the 2007 event.


STRIvINg FOR wORk/FAMIly balance, physicians are

successfully creating practices where job sharing is the rule rather than the exception. Almost twenty years ago, a young physician was asked to join The Children’s Clinic in Portland. Anticipating that she would want to start a family, she posed the idea of job sharing. The group had never done anything like that before, but they were willing to experiment. They recruited another like-minded, part-time physician, and today the pediatric group has grown from five doctors to twenty-three. Those who job share outnumber full-time doctors. One physician wanted to devote more time to his role as Dad, another was shifting gradually toward retirement, and still another simply wanted to job share as a lifestyle choice.

Teamwork and communication are key ingredients for physician job sharing. The group must regularly ask: “How do we do this better?” “What are the barriers?” Who is this working for?” One assumption the above practice made was that the best continuity of care for two part-time doctors was to have one full-time nurse. However, they were burning out their nurse. They responded to this by hiring two RNs, one working three days per week, the

job Sharing Doctors Are

TEAM PlAyERS

Spotlight On...

By Lisa Senders, PhD, JD

other working two. Continuity of care was preserved.

Job sharing is potentially more productive than full time practices because of greater coverage. A full time doctor is available to patients four days/week whereas a job share provides coverage five days/week. In the job share practice one can work a half a day each, split the week in two half-day segments, or divvy the work week up in any way that is amenable to the needs of the physicians. Patients can be encouraged to see both doctors in the job share so that they are familiar with all who may be involved in their care.

Sticking points for job sharing that have tripped up other groups are call schedules and finances. The question to ask is “What is fair?” If a doctor works part-time, then should s/he be taking full time call? Financially, how do you determine if you are a full or partial partner? It may be best to base decisions on principle rather than how it will affect oneself. Physicians’ income can be production driven and not seniority based. One advantage of production-based income is that such a structure allows the physician who wants to earn more the ability to do so. Another financial consideration is determining how a new partner buys into the entity. The stock price for a partner buying in need not be based on

the value of the corporation because it may be prohibitive for a young partner. When a doctor retires, the remaining partners purchase her/his share.

For two decades, this group of twenty- three physicians has had the dedication and desire to make job sharing work. These doctors serve as models for the evolving workforce of the 21st century. Clearly, teamwork and regular reassessment are the keystones that have made this group’s venture into the unknown territory of job sharing a viable and rewarding endeavor.

Lisa Senders, PhD, JD, is a psychologist who special-izes in coaching individuals on work/life issues, tran-sitions, and developing habits that enhance creativity. She can be contacted at 1133 NW 21st, Portland, OR 97209 or (503) 222-5010.

Other questions to consider:What is the patient’s perception of the level of care? �

is a job sharing partner’s level of commitment �the same as a full time partner’s?

How do my actions affect the group? �

What are models for sabbaticals, partnerships �and increased longevity of practice in medicine?

What are the financial ramifications? �

Can more than two doctors job share and �meet patient needs?

Do we sign forms for each other’s patients, �see the other’s patients in the hospital, and sign each other’s prescriptions?

The popular Practice Performance Group program, conducted by consultant Judy Bee, Treating Patients Right: Tact, courtesy and etiquette in the medical office, is now available in a convenient DVD format along with a complete course syllabus and self-test. This program is designed to provide clinic managers and staff with practical solutions for day-to-day management problems in easy, short chapters.

The DVD and workbook are ideal for use in staff meetings, at new staff orientations, or times when your staff can’t attend a Treating Patients Right program.

To order, call the OMA offices at (503) 619-8000.

Treating Patients RightDVD and Work Book

Available exclusively

through OMA for $189

Spring 2008 • 21

THE PHySICIAN ASSISTANT PROFESSION was developed by

physicians more than 40 years ago as a means of addressing a critical health care shortage. These new providers were trained in the medical model, practiced with physician supervision, and represented a new type of health professional who extended the effectiveness of their physician partners. The efficiency of the PA/MD team model resulted in the expansion of the PA profession across the United States and around the world, and PAs are currently utilized in all medical and surgical specialties.

The PA profession remains committed to the physician/PA team concept and values a physician-delegated scope of practice. This is unique among health professions and provides complementary services to the physician. Since the PA scope of practice is primarily determined by the supervising physician, the physician can plan for PA utilization in a manner that best supports the needs of the patients and the practice.

Because PAs are licensed to provide a broad range of diagnostic and

therapeutic services, they can ease physician workloads by handling routine office visits for health maintenance, chronic disease management as well as acute illnesses and injuries. In the inpatient setting, PAs routinely perform a variety of tasks including hospital rounds, call and surgical assisting. These duties can free up physician schedules allowing greater practice efficiency and the time to manage more complex cases.

In 1994, the American Medical Association’s Socioeconomic Monitoring System survey measured the benefits of employing “nonphysician providers,” including PAs, and found that physicians who employed nonphysician providers were able to work one week less per year on average while improving access and increasing net income by 18 percent.1 Of the four types of nonphysician providers studied (PAs, nurse practitioners, clinical nurse specialists and certified nurse-midwives), PAs were rated the highest for productivity and patient acceptance. Having a PA as part of the medical team can enhance continuity of care as well as patient

adherence to disease management and health promotion/disease prevention plans.

After a two-year study on the PA profession, the Pew Health Professions Commission supported the physician/PA model and stated:

The traditional relationship between PAs and physicians, the hallmarks of which are frequent consultation, re-ferral and review of PA practice by the supervising physician, is one of the strengths of the PA profession. The characteristics of this relationship are also considered to be the elements of professional relationships in any well-designed health system.2

The American Academy of Physician Assistants, the national professional society for physician assistants, views the role of the PA in this way:

Hiring a PA means gaining an extra set of skilled hands, eyes, and ears. PAs offer an array of benefits to prac-tices and physicians, including higher revenues, improvements in patient satisfaction via accessible care, and more flexibility in the schedules of their employers.3

Perhaps your work-life balance could be improved by employing a PA in your practice. Additional information about the PA profession, scope of practice and employment is available through the AAPA at www.aapa.org.

Pat Kenney-Moore, MS, PA-C is the OMA Physician Assistant Section Chair. She can be contacted at [email protected].

Balance in Practice

1 gonzalez, ML, ed. Socioeconomic Characteristics of Medical Practice 1995. Center for Health Policy research, american Medical association. Chicago, iL.

2 the Pew Health Professions Commission. Charting a Course for the twenty-First Century – Physician assistants and Managed Care. San Francisco. uCSF Center for the Health Professions. 1998.

3 american academy of Physician assistants, accessed april 11, 2008. www.aapa.org/gandp/issuebrief/hiring.pdf

Physician Assistant Section

The Physician Assistant Connection

By Pat Kenney-Moore MS, PA-C


Why is litigation so stressful? Quite simply, the charge that a physician has committed malpractice is an assault. And with any assault or traumatic life event common reactions occur: shock, disbelief, guilt, anger, fear, flight, depression and anxiety. To most physicians the world of the law and lawyers is the stuff of great mystery. The arcane vocabulary, the adversarial stances and posturing, the hyperbole of the pleadings, the archaic rules, the endless motions and memoranda, the robed judges perched on elevated benches in cavernous, dark paneled courtrooms each deliberately seek to evoke a sense of unassailable erudition and majesty. Somehow, when you are the defendant in a lawsuit charged with malpractice, the lawyer jokes that doctors love to tell just fall flat.

And the stakes can be very high if the physician loses. Lawsuits often seek damages in excess of a physician’s malpractice insurance coverage, raising the fear that all she or he has worked for could be lost. Articles can appear in newspapers making the complaint’s tabloid-style allegations of wrongdoing painfully public. Awards and settlements are reportable to the National Practitioner Data Bank and follow the physician throughout her or his career. And in perhaps the cruelest turn, litigation takes many months or even years to complete, giving the affected physician ample opportunity to repeatedly experience these difficult emotions as the process slowly runs its course. Physicians tell me that in order to carry on following an unexpected bad outcome they must “wall off” the

experience until a letter from their lawyer appears, or their deposition is scheduled or the trial notice arrives and each time all the anxiety and anger and tension floods back in until they are able to wall it off again.

Without a plan, litigation stress can exact a terrible toll on the physician, her or his family, colleagues and even friends. It can transform a magnificently performing professional into a withdrawn, dispirited, even desperate individual. But it does not have to be that way; there are viable alternate strategies.

The key to mastering any traumatic experience is to explore the emotions associated with it, organize the experience intellectually in a way that helps in understanding it, and eventually correct any distortions about it. In order to do this, defendants need to obtain the knowledge necessary for understanding and clarifying the event and by talking about their feelings with others. Individuals who have such support are less likely to respond with long-term symptoms. However, remember that this is litigation and physicians should not talk about the factual details of the case with anyone other than their legal counsel, claims professional, husband or wife, or other legally protected individual.

So what do we mean about gaining mastery over the event? Step 1: Become a good defendant. Learn about the legal process. Figure out what the legal jargon really means, and which steps in the process are

Fighting and winning Against litigation StressBy Paul Frisch, JD

A HEAvy SET MAN STRODE INTO A BuSy MEDICAl OFFICE filled with the afternoon’s patients. He wore shorts and a tee shirt emblazoned

with the words, “Wife Beater,” and loudly proclaimed he was there to serve a lawsuit summons and complaint on the doctor. Thus began one Oregon physician’s journey into the world of malpractice litigation. One thing is certain: most who have been through it say it is not for the faint of heart.

In-House Counsel

Paul Frisch, JD, is OMA general counsel and co-author of Adverse Events, Stress and Litigation: A Physician’s Guide.

Spring 2008 • 23

crucial. Prepare for your case by knowing the medical record better than anyone else. When your lawyer gives you the go ahead, become expert in the disease or condition which is the subject of the litigation. Help identify and secure expert witnesses to review the claim and perhaps give testimony at trial. Educate yourself about the strategies used by plaintiff lawyers in their deposition and trial questioning—their goals are different in each instance. Understand what jurors are looking for as they evaluate the credibility of witnesses. In preparation for trial, practice telling your story of what happened plainly and directly…doctors always start out with jurors giving them the benefit of the doubt.

Step 2: use the event as a means of taking stock. Are you doing what you like to do? Are there practice or life changes that appeal to you now as you attempt to gain some needed perspective? Would slowing down a bit help? Would volunteering some of your time give medicine more meaning? Is it time not just to plan that vacation with the family but to actually take it? Have you ever wanted to play the piano or learn a language or take a cooking class?

Step 3: Take care of yourself. Do you have a personal physician? If not, locate one and get a full health assessment. If indicated, seek counseling. Exercise to reduce stress and improve your stamina; being a defendant requires energy and effort. It also combats the roller coaster effect of the event reemerging in the course of the litigation process. If your needs are spiritual, take the time necessary to search for the inner peace you seek. Besides yourself, your family, patients, colleagues and friends will all be the better for your journey.

Step 4: Get your affairs in order. This is the time to consult with your financial advisor or accountant or

insurance professional. Explore the worst case scenarios; not because they are possible, but because you gain a sense of control over your destiny knowing that whatever happens there will be a roof over your family’s head and money to pay the bills.

Step 5: Visualize that time when you are no longer a defendant. See the end of this process and how you actively defended your integrity.

When the case closes, take a moment to reflect on the journey you have taken. Seven of every ten claims against Oregon physicians are abandoned by the plaintiff or thrown out of court. You may be relieved that yours was one of those seven but still have a bittersweet feeling because there was no public vindication. You may feel a let down for having to settle the case. If settlement was necessary, give yourself permission to put that fact into perspective. Over time we heal. I like to

tell the story of a physician in the first year following a settlement who wrote pages about the case on one of his credentialing documents. By the fifth year he was shocked to be reminded that he had forgotten to list it in his application for credentials at a different institution. Some physicians channel their emotions following a settlement or adverse award by helping other physicians who are going through the litigation process. Eventually they bow out, saying it is time to move on. For them the healing process is complete and along the way they have done a small thing to help others in crisis.

For further information about these and other matters related to being a malpractice defendant go to www.physicianlitigationstress.org. Remember that litigation is an intensely human experience but can, by active participation, be mastered.


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To learn more about the conference center, contact Ron Costa, OMA Executive Chef, at (503) 619-8000.

Spring 2008 • 25

FOR THE lAST 12–15 yEARS in the Portland area, physicians have signed contracts with health plans

to take discounts on their charges in return for having patients “directed” to their practices. Contracts and contractual adjustments on billed charges are a way of life.

The practice this author manages does 99.5 percent of its business with contracted health plans. Less than 1 percent of gross charges are billed to “indemnity” style plans—those that pay 100 percent of the doctor’s billed charges because they have no contract with the doctor. What most physician practices lack is an estimate of how frequently the health plan pays the doctor according to their contract or conversely, how frequently the doctor is underpaid.

Finding the gapIt is hard for a practice to determine underpayment totals because many practices contract with between 15 and 20 different health plans. Although most contracts use a similar

methodology (an RBRVS Relative Value Unit multiplied by a dollar conversion factor), the variation between RVUs from year to year and different conversion factors results in a practice being paid 15 or more different amounts for a single CPT code. Even the most competent billing staff would have a difficult time remembering the amount a certain plan pays for a given CPT code. The only alternative a practice has is to audit payments received from the health plans.

Women’s Clinic, PC, an eight physician practice in Portland, began auditing payments from health plans in 2004 using specialized software called Premier DataPlus. The Clinic’s administrator and the physicians were surprised at what the software uncovered. Nearly three to four percent of the all filed claims were not paid according to the contract. Some claims were underpaid by only a few dollars, while others were underpaid by hundreds of dollars.

Billing department staff spent considerable time recovering the amounts that plans should have paid in the first place. Despite this frustration, the Clinic feels its efforts in recovering underpayments from health plans to be highly successful. Not only was the practice able to pay for the audit software with the recovered underpayments, but the knowledge and understanding of contracts and the contracting process has been an invaluable benefit.

The most frequent offenders of underpayment appear to be the Preferred Provider Organizations. Because PPOs often have 100 or even 200 different employees processing payments, it is easy to imagine the challenge of these payers correctly entering fee schedules for each practice into their claims processing systems. The amount the practice was underpaid varied greatly from payer

In the Office

underpayment Can Add up to Big losses

Mind the Gap

One practice was able to pay for the audit software with the recovered underpayments.

By Marylin Happold-Lantham, MBA, FACMPE


to payer and from code to code, and the size of the health plan had no effect on their ability to pay claims correctly. The payer that made the fewest errors over the four years was Medicare.

This distinction is important for specialties such as obstetrics and pediatrics that have less Medicare and more commercial business. These specialties are more likely to be chronically underpaid by the health plans. Networking with other physician practices in Central Oregon and SW Washington that also use payment audit software confirms that underpayment is not an isolated incident with a single practice, or within a particular region.

One might ask, “Why do these underpayments by the health plans occur?” No one in management of the health plans could provide an answer. The practice was initially led to believe the underpayments were just random

occurrences but the software proved otherwise. The same CPT codes were often repeatedly underpaid by the health plan by the same amount, yet the same plan was paying correctly on the same codes in other instances. One of the most frustrating aspects about auditing payments was the lack of apparent concern on the part of the health plans. Nearly four years after bringing underpayment to the attention of nearly all contracted plans, the underpayments continue. The PPOs do not audit their payers to ensure they are paying physicians correctly. Their opinion is that physicians are responsible for identifying underpayments by PPO payers.

As noted above, doing “spot checks” on a practice’s payments are not only very labor intensive, they provide only anecdotal evidence that underpayment is occurring. Even random samples that allow a practice to extrapolate a statistical estimate of the amount of underpayment can do very little to enable the practice to recover the underpayments. The health plans require specific dates of service, EOBs and reprinted claims in order to even consider whether or not the claim has been underpaid. Specialized software and skilled, knowledgeable staff are crucial in determining the extent the practice is being underpaid and are a great investment from which the practice will receive returns.

Marylin Happold-Lantham, MBA, FACMPE is the Administrator of the Women’s Clinic, PC, in Portland. She serves on OMA’s Health Care Finance Committee as the Group Management Representative.

In the Office, cont. The Health Care Finance Committee and OMA staff will continue to monitor underpayment issues with health plans.

If you are experiencing these problems with carriers, contact

Reina O’Beck at [email protected].

Spring 2008 • 27

THE AMERICAN MEDICAl ASSOCIATION and Oregon Medical Association are engaged in a grassroots

lobbying effort to urge Congress to replace steep cuts in Medicare payments to doctors with updates that better reflect increases in practice costs.

Under current law, Medicare will cut physician payments by 10.6 percent on July 1 and another 5 percent or more on Jan. 1, 2009. That’s $8,000 per Oregon doctor and $80 million to the states’ physicians as a whole over an 18-month period. With 60 percent of U.S. physicians saying the cuts will force them to limit the number of new Medicare patients they can treat, seniors will have a harder time finding a physician.

In addition to posing access problems for Oregon’s half million Medicare patients, the cuts are alarming for Oregon’s nearly 60,000 enrollees in the military’s Tricare program. Reductions in Medicare payments trigger cuts in Tricare payments. Military families already have problems finding enough doctors who can afford to accept this insurance plan. And in these challenging economic times, the cuts pose a threat to the 37,000 employees of medical practices in Oregon. More than half of physicians say they will not be able to meet their current payroll—and will have to reduce their staff—if Medicare payments are cut.

In Oregon, where 14 percent of patients are on Medicare (above the

national average), the cuts would hit especially hard. That’s in part because physicians outside of the Portland area face cuts of an additional 1.8 percent on top of the 10.6 percent cut across the country. Although the 2003 Medicare law provided a temporary increase in geographic payment adjustments for states such as Oregon, this increase will expire on June 30 unless Congress acts.

Scheduled reductions in Medicare physician payments have become an annual problem. AMA House of Delegates Speaker Dr. Jeremy A. Lazarus, 2007 OMA President Dr. Klaus Martin, and current OMA President Dr. Monica Wehby, drew news headlines about this issue last summer during an AMA National House Call visit to Oregon. Congress subsequently averted the cuts for six months, resulting in the current mid-year deadline to address the issue again.

The AMA and OMA are rallying around the Save Medicare Act of 2008 (S. 2785), which would avert the steep 10.6 percent cut slated for July 1, keeping payments level for the rest of 2008. It would also provide a positive update of 1.8 percent for 2009 and, important for Oregon, extend the geographic payment adjustment that is set to expire. Notably, the payment updates in S. 2785 are fully funded; they won’t require a steeper payment cut down the road, which has been the

case in the Medicare bills Congress has passed in recent years.

“The 18-month time frame will inject some stability into the system for seniors as well as physicians forced to make difficult practice decisions because of planned payment cuts,” said AMA President-elect Dr. Nancy H. Nielsen. “It will also give Congress time to begin working on a long-term solution to the broken payment system without having to take action to stop the cuts twice in one year.”

At the recent AMA National Advocacy Conference, hundreds of physicians and their families participated in a “white coat” rally on Capitol Hill to urge Congress to pass S. 2785. AMA and OMA leaders are also working closely with Oregon’s U.S. senators, Democrat Ron Wyden and Republican Gordon Smith, who are on the Senate Finance Committee.

But your voice is critical in getting the message to Congress about the importance of preserving access to care for Medicare beneficiaries. Call the AMA Grassroots Hot Line at (800) 833-6354 or visit www.ama-assn.org/go/medicarepaymentkit to get in touch with your members of Congress in support of S. 2785.

When you become an AMA member, you join physi-cians from every state and specialty in one strong, national voice. Visit www.ama-assn.org/go/join or call (800) 262-3211 to join the AMA or renew your membership today.

Advocacy in Focus

Strong Support for Medicare Payment Bill

Your voice is critical in getting the message to Congress

“The Dancer” is printed here with permission of the artist, Dr. Barbara Largent, a family physician from Bend. This piece recently won “Best in Show” in a national juried watercolor and pastel competition. Contact the artist at [email protected]

Postural Instabilityby Kathleen Fitzgerald, MD

I take a stepThe world spinsLiftoff

GravityThe astronaut returns

I kiss the earth

Dr. Kathleen Fitzgerald is a neurologist in private practice at Cascade Neurology in Springfield.

Send your “Creative Outlets” to Betsy Boyd-Flynn at [email protected].

See complete submission information on page 5.

the DancerBarbara Largent, MD

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