Subscribe to an RSS web feed of new content posted on the locum tenens career blog from Interim Physicians. http://www.interimphysicians.com http://www.interimphysicians.com/blog/post.php?contentID=127 http://www.interimphysicians.com/blog/post.php?contentID=127 Mon, 21 Oct 2013 00:00:00 +0000

As short-term opportunities increase, so does the workforce, driven by medical students, residents and young professionals who seek to address global health disparities in access to health care resources. "Interest in global health ... has never been higher," says Dr. Brett Nelson, a member of the global health faculty at Harvard Medical School. Responding to this demand, "almost half [of U.S. medical schools] have established initiatives, institutes, centers, or offices for global health," according to John A. Crump of the Global Health Institute at Duke University. In addition, a growing number of residencies are now integrating global health training into their curricula. This often includes time blocks spent abroad working in resource-limited settings.


Once in practice, however, nurturing physicians' interest in global health can prove problematic. Most practice lifestyles have built-in constraints such as on-call obligations and other contractual commitments that leave little time for even short stints overseas. This is not a concern for the locum tenens physician. By combining locum tenens work with short-term volunteering abroad, they have the freedom and flexibility to chart a unique and rewarding career path while maintaining a reliable source of income.


(References: Journal of Graduate Medical Education, 2012 September, pp. 301-306. Health Volunteers Overseas website: www.hvousa.org)
]]> http://www.interimphysicians.com/blog/post.php?contentID=125 http://www.interimphysicians.com/blog/post.php?contentID=125 Fri, 27 Sep 2013 00:00:00 +0000

Six years ago, 16 percent of medical residents said they did not feel competent to take on the business of running an independent practice. Today that number is up to 48 percent. In 2001, only 3 percent of residents said they would rather work for a hospital than practice independently. Ten years later, that number had risen to 32 percent.


A few years ago, from 2003 to 2007, the University of Michigan surveyed 58,000 U.S. medical students and found "an overwhelming majority were confident about their clinical training. But when it came to understanding health economics, the health care system, managed care, managing a medical practice or medical record-keeping, 40 percent to 50 percent of students reported feeling inadequately prepared" (Academic Medicine, September 2009).


Despite these data, the total disappearance of independent medical practices in the foreseeable future is unlikely. A desire for preserving their autonomy will continue to motivate a significant number of physicians to set up practices outside hospital settings. Witness the growth of concierge medicine and the popularity of locum tenens careers, two ways in which the business side of practicing medicine can be effectively outsourced. In addition, like-minded physicians, practicing solo or in small groups, are likely to join forces to purchase managerial expertise. Regardless of how physicians choose to practice medicine in the future, they must never forget that the "business" of medicine is still about what's best for the patient.


(Reference: "Physician Hospital Employment: This Time It's Different." An issue brief by the Deloitte Center for Health Solutions, 2013).]]> http://www.interimphysicians.com/blog/post.php?contentID=126 http://www.interimphysicians.com/blog/post.php?contentID=126 Fri, 27 Sep 2013 00:00:00 +0000

Six years ago, 16 percent of medical residents said they did not feel competent to take on the business of running an independent practice. Today that number is up to 48 percent. In 2001, only 3 percent of residents said they would rather work for a hospital than practice independently. Ten years later, that number had risen to 32 percent.


A few years ago, from 2003 to 2007, the University of Michigan surveyed 58,000 U.S. medical students and found "an overwhelming majority were confident about their clinical training. But when it came to understanding health economics, the health care system, managed care, managing a medical practice or medical record-keeping, 40 percent to 50 percent of students reported feeling inadequately prepared" (Academic Medicine, September 2009).


Despite these data, the total disappearance of independent medical practices in the foreseeable future is unlikely. A desire for preserving their autonomy will continue to motivate a significant number of physicians to set up practices outside hospital settings. Witness the growth of concierge medicine and the popularity of locum tenens careers, two ways in which the business side of practicing medicine can be effectively outsourced. In addition, like-minded physicians, practicing solo or in small groups, are likely to join forces to purchase managerial expertise. Regardless of how physicians choose to practice medicine in the future, they must never forget that the "business" of medicine is still about what's best for the patient.


(Reference: "Physician Hospital Employment: This Time It's Different." An issue brief by the Deloitte Center for Health Solutions, 2013).]]> http://www.interimphysicians.com/blog/post.php?contentID=124 http://www.interimphysicians.com/blog/post.php?contentID=124 Wed, 04 Sep 2013 00:00:00 +0000
According to pain management specialist Dr. Arnold Feldman, most prescribing abuses are found in primary care and specialty practices where screening and oversight may not be as thorough as in pain management settings. "We're sitting in the middle of a minefield," he says. On the one hand, doctors are obligated from an ethical perspective to relieve pain and discomfort. On the other, they face increasing scrutiny from state medical boards and the DEA for overprescribing habit-forming drugs, especially opioids, to doctor-hopping patients.

Finding out which patients are abusing prescription drugs can be a challenge. California is making the job somewhat easier through a database called the California Prescription Drug Monitoring Program (PDMP) which can be queried by physicians when prescribing certain medications. In this database, doctors can see if patients are getting the same prescription from other sources.

Although a physician is not required to continue treating prescription-abusing patients, certain steps must be taken prior to their dismissal. First, the patient must be alerted about the risk of not continuing medical treatment, and second, the patient must be given reasonable time to find another physician. These actions should be well-documented and in writing. A locum tenens physician, however, is not usually in a position to dismiss a patient from a client's practice. Any concerns the locum tenens doctor may have should be discussed with the client while maintaining patient confidentiality as may be appropriate to the situation.

(Reference: Health Leaders Media, August 15, 2013)]]> http://www.interimphysicians.com/blog/post.php?contentID=122 http://www.interimphysicians.com/blog/post.php?contentID=122 Tue, 25 Jun 2013 00:00:00 +0000
1. Don't use benzodiazepines or other sedative-hypnotics in older adults as the first choice for insomnia, agitation, or delireum. These medications more than double the risk of falls and hip fractures. Use them sparingly.

2. Don't use antibiotics to treat bacteruria in older adults if they have no symptoms. The prevalence of asymptomatic bacteruria is much higher in elderly women and men when compared to those under the age of 65. ASB is highest in women and increases with age. For women 90 years of age and older, ASB ranges from 22% to 43%, and up to 21% of men in this age group. In this population, studies have found no adverse outcomes for not using antimicrobials in patients who have bacteruria without symptoms. Plus, by not treating ASB in the elderly, potential antimicrobial side-effects are averted.

3. Avoid using diabetic medications to achieve hemoglobin A1c levels of less than 7.5% in most adults age 65 and older; moderate control is generally better. Evidence suggests that older patients are more likely to be harmed by intensive glycemic control. Studies show, for example, that hypoglycemic episodes resulting in hospitalization are more likely in the 'tightly controlled' elderly diabetic.

4. Don't recommend feeding tubes in patients with advanced dementia; offer oral assisted feeding instead. Aspiration pneumonia is the most common adverse event of tube feeding, along with agitation and the increased use of restraints and sedatives. Careful hand feeding has been shown to be superior to tube feeding, both in terms of overall patient comfort and lowering the risk of aspiration pneumonia. Studies show that nutritional benefits are not compromised when compared to patients who are tube-fed.

5. Don't use antipsychotics as the first choice to treat behavioral and psychological symptoms of dementia in the elderly. Based on randomized control trials and expert opinion, these medications offer limited benefits in this age group. In fact, the adverse effects of antipsychotic medication use in the elderly have been shown to offset any benefits when used to treat the psychotic, aggressive, or agitated patient.


(Reference: Journal of the American Geriatric Society, Volume 61, Issue 4, pages 622-631, April 2013.)

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=121 http://www.interimphysicians.com/blog/post.php?contentID=121 Tue, 28 May 2013 00:00:00 +0000
This is unfortunate, says Dr. Abraham Verghese of Stanford University's School of Medicine. In his keynote address at the recent Texas Medical Association meeting in San Antonio, Dr. Verghese told his colleagues to "pick the low-hanging fruit," to first do a thorough diagnostic exam at the bedside. Then decide what further studies are needed.

Although making an astute diagnosis is important, says Dr. Verghese, there's another reason for a thorough bedside exam -- "the power of the doctor's touch" -- what he refers to as a ritual and the "pinnacle" of the physician-patient relationship.

To make his point, Dr. Verghese has gone back to carrying a black bag on hospital rounds. In addition to its usual tools, he's added two more -- an iPad and a hand-held ultrasound. The iPad has proven to be a valuable teaching tool, not only for his medical students, but for patients as well. And, although the hand-held ultrasound does not take the place of additional imaging studies, it has added another dimension to the physician's capacity to make an accurate diagnosis at the bedside.

(To sharpen your bedside skills, I highly recommend The Stanford 25Website, "an initiative to revive the culture of bedside medicine,")

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=120 http://www.interimphysicians.com/blog/post.php?contentID=120 Thu, 25 Apr 2013 00:00:00 +0000
With input from a number of specialty organizations, the American Board of Internal Medicine Foundation has put together a list of 90 commonly used medical tests and treatments that it deems overused. Here are a few examples:

Don't perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer diseases.
American Board of Family Physicians

Don't indiscriminately prescribe antibiotics for uncomplicated acute sinusitis.
American Academy of Allergy, Asthma and Immunology

Don't perform EEGs for headaches.
American Academy of Neurology

Don't order antibiotics for conjunctivitis ("pink eye").
American Academy of Ophthalmology

Cough and cold medications should not be prescribed or recommended for respiratory illnesses in children under four years of age.
American Academy of Pediatrics

Don't perform annual stress cardiac imaging as part of routine follow-up in asymptomatic patients.
American College of Cardiology

Don't schedule elective, non-medically indicated induction of labor or Cesarean deliveries before 39 weeks 0 days gestational age.
American College of Obstetricians and Gynecologists

Don't obtain imaging studies in patients with non-specific low back pain.
American College of Physicians

Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.
American College of Radiology

Do not repeat colorectal cancer screening (by any method) for 10 years after a high quality colonoscopy is negative in average-risk individuals.
American Gastroenterological Association

Don't order coronary artery calcium scoring for screening purpose on low-risk asymptomatic individuals except for those with a family history of premature coronary artery disease.
Society of Cardiovascular Computed Tomography

To see the complete list and the reasons behind the recommendations, go to www.choosingwisely.org.

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=119 http://www.interimphysicians.com/blog/post.php?contentID=119 Wed, 27 Mar 2013 00:00:00 +0000
The increasing fragmentation of patient care is a big part of the problem. Not too long ago, the primary care physician would follow the patient from hospital admission to discharge. Today, the patient may be cared for by five or six physicians during one hospitalization: an emergency room doctor, three or four hospitalists, perhaps two or three consultants. Each exchange increases the risk that vital information will be overlooked.

An estimated 80% of serious medical errors are caused by miscommunication between caregivers during the patient handoff, according to the Joint Commission’s Center for Transforming Healthcare. ”There are 4000 handoffs a day in a typical teaching hospital,” says Joint Commission President Dr. Mark Chassin. ”If 90% go flawlessly, that’s still 400 failures per day.” When a lawsuit occurs, everyone whose name is in the chart will have to defend their actions, including how effectively they communicated with their peers at the time of handoff. “Almost all claims have multiple defendants and points of contact,” says Dr. Alan Lembitz of the liability carrier COPIC.

How can we make handoffs less prone to error? First, we have to acknowledge that this is a really serious problem. When our colleagues in the operating room started using checklists, their error rates went down significantly. Creating a standardized checklist to be used at the time of a handoff could help as well. For example, a handoff checklist might include this basic information:

~ differential diagnosis
~ medications and the patient’s reaction to these medications
~ pending laboratory and imaging studies
~ names and contact numbers of all caregivers
~ names of key family contacts
~ physician now assuming primary responsibility for the patient

Other suggestions: Make every effort to communicate with the next provider face to face, and make sure the next caregiver not only receives and reads your report but understands it. Remember: Information is not communication.

(Reference: Malpractice Threats in Well-Intended Patient Handoffs. Medscape, October 4, 2012).

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=118 http://www.interimphysicians.com/blog/post.php?contentID=118 Mon, 25 Feb 2013 00:00:00 +0000
An 80-hour weekly work limit, averaged over 4 weeks.
A minimum of one day off every week, averaged over 4 weeks.
A 16-hour limit on continuous duty for first-year residents.
A 24-hour limit on continuous duty for other residents.
In-house call no more than once every 3 nights, averaged over 4 weeks.

To keep their accreditation, residency training programs must report regularly to the Accreditation Council for Graduate Medical Education (ACGME) to show they they are following the rules. “I think we should challenge the whole idea of having a central committee dictate work limitations for all residency programs,” says Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons.

But, they don’t comply with the guidelines anyway, says Dr. Steven Lockley, sleep medicine specialist at Harvard Medical School. “A study by our research team [at Harvard] found 85% of residency programs were non-compliant with the work-hour rules.”

A survey done by the ACGME found only 5% non-compliance.

So what about patient safety? “When hours are reduced,” says Dr. Lockley, medical error rates fall enormously. No other simple solution comes as close as a way of cutting errors.” He adds that longer shifts affect physicians health and safety as well. “In surveys conducted by our group, residents working 24 or more hours in a row reported sticking themselves with needles 60% more often … as compared with [those working] shorter shifts.” “Yes,” says Dr. Orient, “people do tend to make more mistakes when tired. But the bigger reason for mistakes by physicians-in-training is lack of experience.” Dr. Orient believes that shorter shifts short-change the learning experience: “Many physicians, myself included, think new physicians are less well-trained. They have seen fewer patients and have done fewer procedures. [Consequently], future patients may pay the price when the less-experienced physician is working without close supervision.”

It’s almost impossible to take a neutral stance on this issue. As might be expected, older physicians are more likely to see the so-called “shift-work culture” as a threat to the traditional doctor-patient relationship in which doctors are customarily available outside “office hours.” Younger physicians are more likely to see patient care as “the collective responsibility of the team, rather than primarily the responsibility of ‘their doctor’.” Since this controversy is in part driven by differing attitudes between generations, it will take a while before it’s resolved.

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=117 http://www.interimphysicians.com/blog/post.php?contentID=117 Tue, 22 Jan 2013 00:00:00 +0000
"There is nothing we can do to protect ourselves except to provide good, high-quality patient-focused care," says Dr. Scott Manaker of the University of Pennsylvania Health System. Speaking recently at the annual meeting of the American College of Chest Physicians, Dr. Manaker noted that we need to recognize publicly reported data as part of today's medical landscape, "whether good or bad, accurate or biased." [Reference: Who Is Rating You Online and What Can You Do About It? Medscape.com. November 9, 2012.]
Dr. Ellimoottil's survey of online ratings of 500 urologists found that patients submitted comments that were extremely negative 3% of the time (e.g. "He needs to retire as he can barely walk"), 22% were negative, 39% were positive, and 14% were extremely positive (e.g. "One of the best checkups in a long time!!"). By the way, the top physician rating Web sites are Healthgrades.com and Vitals.com.

It takes only one disgruntled patient to give you a negative online image. But, "it's not all beyond one's control," says Dr. Burt Lesnick of Atlanta. When interviewed for the Medscape article, Dr. Lesnick urged doctors to build their online presence on social networking sites, referring to them as "the mother of all physician ratings." He says that Facebook and Twitter are good ways to tell patients about yourself and your practice, plus "it's good marketing." When all is said and done, it's important to be proactive instead of trying to defend yourself against a few nasty comments.

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=115 http://www.interimphysicians.com/blog/post.php?contentID=115 Tue, 18 Dec 2012 00:00:00 +0000
The doctors' concerns didn't pan out after all. In fact, after the study ended, not one of the doctors elected to stop sharing their notes with their patients. From the patients' perspective, "we were thrilled by what we learned," said Dr. Tom Delbanco, one of the study's lead authors. "We had no clue that so many patients would read their notes, and that they would be as enthusiastic and report so many clinically important changes in their behavior" (Reuters Health).

This study isn't the first to open doctors' notes to patients. Dr. Thomas Feeley said it confirms what he and his colleagues have experienced over the past several years at M.D. Anderson Cancer Center in Houston. "There are no downsides to doing it -- patients don't get worried [or] anxious about it," Dr. Feeley told Reuters Health. He adds that this new evidence should reassure doctors who have been "on the fence" about opening up their notes to their patients.

In some practices, this may mean making notes available to patients online. In others, the policy might be to mail doctors' notes to patients after every visit or simply print them out as the patient goes out the door.

Ken Teufel, M.D.
Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=116 http://www.interimphysicians.com/blog/post.php?contentID=116 Tue, 18 Dec 2012 00:00:00 +0000
"Physicians are generally well-suited to almost anything they want," says Dr. Heather Fork, an Austin, Texas-based career coach. "If they've made it far enough to become a physician, it means they're intelligent, dedicated, hardworking, and able to work under stress and pressure. These are qualities that can be applied to any career."

Dr. Fork speaks from experience. After nine years as a dermatologist, she decided to sell her practice. "I wasn't enjoying dermatology as much as I thought I would." After some soul-searching, she completed an accredited coach-training program and then established her coaching practice called Doctor's Crossing. Dr. Fork was interviewed by Medscape for one of the "top ten" articles read by physicians in 2012: Tired of Being a Doctor? Choices for Opting Out of Medicine. February, 2012.

The Medscape article cites a 2010 survey of 2400 practicing physicians: 24% said they plan to quit clinical practice in one to three years. Of this group, half said they plan to leave healthcare entirely, and the other half plan a nonclinical but healthcare-connected career. No doubt, some will be taking on leadership roles in hospitals or other clinical settings. Over the past ten years, this career option has become increasingly popular as hospitals and health systems have expressed growing interest in hiring physicians for these jobs (American College of Physician Executives).

"A lot of doctors come to me confused and unhappy, and they aren't sure what they could or should do," says Dr. Fork. Although they often shortchange themselves, "the door is wide open," she adds. [A personal note: I'm concerned that some physicians wanting to opt out of clinical practice will act impulsively, "jumping ship" without a life preserver. KT]

Dr. Fork's advice in the Medscape article: "People need to have a firm grasp of bread-and-butter issues: How long can I afford not to work? Do my spouse and family support my decision? How much do I need to earn? But they also need to have a firm grasp of their skills and interest."

Dr. Ken Teufel
Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=112 http://www.interimphysicians.com/blog/post.php?contentID=112 Tue, 09 Oct 2012 00:00:00 +0000
Finances certainly play a role. U.S. primary care physicians earn $140,000 to $150,000 a year, but specialist can double or triple that amount. Add medical school debt to the equation and primary care becomes less attractive.

But, it's not just about money. "There's a culture of discouragement that exists in most medical schools around primary care," says Dr. Andrew Morris-Singer of Primary Care Progress. "A lot of medical schools disparage primary care." Quoted in the same New York Times article is Dr. Marjorie A. Bowman, the Chair of the Department of Family Medicine and Community Health at the University of Pennsylvania: "It is absolutely clear that [practicing primary care] is a lower prestige thing to do; if you're looking for prestige, family medicine is not where you go." Dr. Bowman adds that medical school deans and leaders need to show more respect for family medicine.

By 2020, the U.S. will have a shortage of 45,000 primary care doctors; by 2025, the projected shortage is 65,000 (Association of American Medical Colleges). To address this shortfall, our medical schools must become part of the solution. Right now, they're part of the problem.

Ken Teufel, M.D.
Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=111 http://www.interimphysicians.com/blog/post.php?contentID=111 Wed, 05 Sep 2012 00:00:00 +0000
Solo practitioners have read the obituary. And, just like Mark Twain, they have answered: “The reports of my death are greatly exaggerated.”

No one can deny that certain forces are threatening the future of solo practice. The hassle factor is at all-time high: more rules and regulations; rising malpractice premiums; bigger medical school debts; challenging information technology demands; flat or declining reimbursement. It’s hard to resist the attractive salaries and signing bonuses now being offered by hospitals and physician-directed groups. For many physicians, it’s a seductive alternative to building a practice “from scratch.” For other physicians, it represents a loss of autonomy, the underlying motivation for physicians seeking a more entrepreneurial lifestyle.

Having been a solo practitioner, I would argue that solo practice is not dead, just different from its traditional image. As hospitalists take over the inpatient responsibilities, today’s solo practitioner is more likely to have an “office-only” practice. Many solo practitioners are devoting more time and effort to patient wellness programs. Many have taken on the role of patient advocate, helping their patients navigate their way through an increasingly complex healthcare system. The growing interest in “concierge medicine” also falls into the domain of the solo private practitioner.

Another viable option for those with a solo practice mindset is locum tenens medicine. It offers the appeal of autonomy, flexibility, good income, and paid malpractice insurance, backed by the support of a caring team of experienced professionals.

Is solo practice dead? Not really.

Ken Teufel, M.D.
Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=110 http://www.interimphysicians.com/blog/post.php?contentID=110 Wed, 01 Aug 2012 00:00:00 +0000
How depressing is that? It was written in 1939 by Dr. Joseph A. Jerger. Today, we might say that he and his physician colleagues succumbed to a bad case of "burnout," characterized by a loss of motivation, ideals, and hope. Untreated, it can lead to disengagement and even depression.

"Burnout is a gradual process that occurs over an extended period of time," says Dr. Jeanne Segal. "It doesn't happen overnight, but it can creep up on you if you're not paying attention to the warning signals."

Some signs and symptoms of impending burnout:

~ feeling of being trapped
~ sense of failure and self-doubt
~ decreased sense of accomplishment
~ withdrawal from responsibilities
~ taking out your frustrations on others
~ increasingly cynical and negative in outlook
~ use of alcohol and/or drugs to cope with daily living

Insidious as it may be, burnout can almost always be prevented or "cured." Here are three tips from Dr. Segal:

1. Set boundaries. Don't overextend yourself. Learn how to say "no" to requests on your time.

2. Take a daily break from technology. Set a time each day when you completely disconnect. Put away your iPad and stop checking email.

3. Nourish your creative side. Creativity is a powerful antidote to burnout. Try something new. Start a fun project, or resume a favorite hobby. Choose activities that have nothing to with work.

"As I learned through hard experience, the practice of medicine is a black hole that can absorb every moment you will give." (M. Foster, M.D., Medical Economics, October 23, 1995).

The practice of medicine may be your calling and your very identity, but it doesn't have to be your downfall.

Ken Teufel, M.D.
Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=108 http://www.interimphysicians.com/blog/post.php?contentID=108 Wed, 18 Jul 2012 00:00:00 +0000
• 90% of our clients were pleased with the provider and would have them return for additional coverage
• 77% of the clients stated they received their expected return on investment from the locums provider
• 95% indicated they received excellent customer service from Interim Physicians
• 97.5% stated they would recommend Interim Physicians to other facilities

These results speak highly of our organization and reinforce our core values of Quality, Quantity and Excellence in customer service. While we are enthusiastic about the results, we remain constantly focused on our Advanced PeopleCare initiative of providing quality healthcare for our clients through our pursuit of committed physicians.]]> http://www.interimphysicians.com/blog/post.php?contentID=107 http://www.interimphysicians.com/blog/post.php?contentID=107 Mon, 02 Jul 2012 00:00:00 +0000
Interim Physicians’ Team Leader, Melanie Loehr recently underwent an involved process to become a Certified Physician Credentialing Specialist (CPCS) through the National Association of Medical Staff Services (NAMSS). Melanie had to pass an examination designed to test knowledge and the broad scope of areas including credentialing, privileging and primary source verification. She spent approximately 40 hours studying and endured the 4 hour long examination to gain her certification.

Melanie decided to pursue the CPCS certification because she truly wanted to better understand the rules and regulations clients were working under. She said it would help make the process at Interim Physicians more thorough and enable us to offer more assistance in the credentialing area.

While the certification is a huge individual accomplishment for Melanie, it also helps reinforce Interim Physicians’ mission of providing Advanced PeopleCare – or healthcare staffing with heart aimed at changing people’s lives.

Interim Physicians is proud to have an experienced and now officially credentialed member on the sales support staff. Melanie and the Quality Assurance team work hand-in-hand with the medical staff office to ensure verification of physician credentials, supply supporting documentation and coordinate between the physician and facility. We see it as a way to offer even more assistance to our clients in the credentialing area by taking the pressure off our client’s staff members and ultimately provide quality physicians at facilities.
]]> http://www.interimphysicians.com/blog/post.php?contentID=106 http://www.interimphysicians.com/blog/post.php?contentID=106 Wed, 27 Jun 2012 00:00:00 +0000
This issue of non-compliance is probably more prevalent than ever. More diagnostic and treatment options for more illnesses have made decision-making for doctors, as well as their patients, increasingly complex. Patient access to medical advice on the internet sometimes creates confusion and conflicting alternatives.

When a patient refuses a procedure or recommended treatment, is it ethical or appropriate
for a physician to drop the patient? It's my personal opinion that dismissing a patient should be a last resort. Every effort needs to be made to understand the patient's perspective and tactfully explain our own position.

If all else fails, and the decision is made to terminate the relationship, it's important to document that the patient has been informed of the possible consequences of failing to follow medical advice. To avoid being sued for abandonment, it's critically important to carefully follow our medical society's protocol for discharging a patient from our practice.

Every doctor has made a commitment to care for their patients as best as we know how. In the end, however, it's still the patient's decision whether or not to follow our advice.

Ken Teufel, M.D.

Ken Teufel is the Medical Director for Interim Physicians

]]> http://www.interimphysicians.com/blog/post.php?contentID=105 http://www.interimphysicians.com/blog/post.php?contentID=105 Wed, 20 Jun 2012 00:00:00 +0000 Demand for locum tenens physicians has slowed” In fact, my answers to the reporter’s questions focused on how much later facilities are requesting coverage, preferring instead to get their current staff to pick up additional shifts, if they are able to.

The article by the AMA cites a survey by one of our competitor’s temporary physician placement division and how their own client facilities actually booked more locum tenens physician days in 2011 than they did in 2010. Another article surfaced in Forbes magazine, which picked up the same survey information and interpreted the data quite differently. Their headline read Demand for temporary doctors rises amid worsening physician shortage, Obamacare looking”. The article referenced the fact that Staffing Industry Analysts organization is projecting 7% growth in the locum tenens industry for 2012.

Temporary staffing firms – ours included – are subject to fluctuations in the marketplace. It's part of doing business. That said, the industry is growing and we remain optimistic about the future of locum tenens, in part based on the fact that the Affordable Care Act (aka, Obamacare) will ensure that individuals in huge numbers who do not currently have health insurance coverage will soon enjoy that benefit.

Read the full article]]> http://www.interimphysicians.com/blog/post.php?contentID=104 http://www.interimphysicians.com/blog/post.php?contentID=104 Thu, 07 Jun 2012 00:00:00 +0000 announced its official launch earlier this week. As the industry's first online blog, the site is targeted at industry professionals including physicians, midlevel providers, healthcare facilities and healthcare staffing firms.

With a mission of offering "news and perspectives for locum tenens professionals," the blog publishes original news and commentary about the locum tenens industry as well as curated news and resources from the best healthcare publications around the internet on a daily basis. The site also provides editorial coverage, focusing on the rapidly shifting landscape of healthcare.

Among the contributors to the site is Interim Physicians' own Vice President of Quality Assurance, Frank Phillips. Frank has published various articles on the site since its creation, ranging from criminal background checks on physicians to the delay in implementation of the new ICD-10 coding system. The site also features the first exclusive interview with Phillips as he prepares to take the helm of NALTO in 2013.

Interim Physicians is proud to be a sponsor of this valuable resource for locum tenens physicians. For the latest locum tenens news and trends, visit Locum Tenens Daily.]]> http://www.interimphysicians.com/blog/post.php?contentID=103 http://www.interimphysicians.com/blog/post.php?contentID=103 Thu, 17 May 2012 00:00:00 +0000
The physician workforce is America is not getting any younger; in fact, it's getting older. A recent survey in Virginia found that at age 65 more than one-third of physicians still in practice were working at least part-time.

Dr. Peter Carmel, president of the American Medical Association, is a pediatric neurosurgeon still operating at the age of 75. "America's patient population needs us," says Dr. Carmel (amednews.com, April 30, 2012). "This country is facing a shortage of doctors to meet the needs of our growing and aging population." Filling this gap, however, cannot be a trade-off for making certain that all patients have access to quality care.

The consensus in the medical profession is that clinical performance, not age, should determine whether or not a physician should be asked to step aside. Yet, physicians themselves are probably not the best judge of their competency. If that's the case, how does one "take away the keys" when an older physician wants to keep practicing? Should there be an annual recertification at some point, perhaps age 70? Or, should there be mandatory peer evaluations for all physicians over a certain age?

Facing the "R-word" is not easy, especially when one's personal identity is so tied to their profession.

Ken Teufel, M.D.

Ken Teufel is the Medical Director for Interim Physicians

]]> http://www.interimphysicians.com/blog/post.php?contentID=102 http://www.interimphysicians.com/blog/post.php?contentID=102 Mon, 09 Apr 2012 00:00:00 +0000
Among the recommendations: Don't take a "routine" pre-op chest x-ray if the patient has an "unremarkable" history and physical exam. Don't do a cardiac stress test or treadmill on a patient who has no cardiac symptoms or other significant risk factors for coronary artery disease. Don't routinely prescribe antibiotics for mild-to-moderate sinus infections unless symptoms last for seven or more days. Most sinusitis is viral and will resolve on its own.

Do these recommendations reset the standard of care? Will they allow physicians to practice medicine less defensively when ordering tests from their diagnostic toolbox?
Rather than limiting choices, the "45 dubious practices" open the door to new discussions with our patients. After all, even with the most challenging of patients, practicing good medicine is still a matter of shared decision-making between doctor and patient.

Ken Teufel, M.D.

Ken Teufel is the Medical Director for Interim Physicians

American Medical News

Chicago Tribune]]> http://www.interimphysicians.com/blog/post.php?contentID=100 http://www.interimphysicians.com/blog/post.php?contentID=100 Thu, 01 Mar 2012 00:00:00 +0000
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•team-oriented;
•trained in evidence-based medicine;
•skilled in panel and population management;
•technologically facile

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With a looming shortage of family doctors, medical students like Sade Olowudeadeyi are in high demand.

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"I do definitely try to be very sweet about it," she said. Her methods have proven successful as colleagues generally have welcomed the advice -- just as she welcomes their unsolicited advice on ways to be a better internist.

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General surgeon Dr. Atul Gawande says practicing physicians need coaches, too (New Yorker magazine, October 3, 2011). He got a coach when he felt his career had reached its peak. After eight years in practice, he felt that his surgical skills were no longer improving. That's when he asked a highly respected, retired surgeon to look over his shoulder in the operating room, then give him advice on what he might do to improve his performance. Dr. Gawande is convinced that having a "coach" has made him a better doctor.

In medicine, the presumption is that, after a certain point, you no longer need instruction. You finished your residency. You're done. The coaching model holds that "no matter how well-prepared people are in their formative years, few can achieve and maintain their best performance on their own," says Dr. Gawande.

Coaching is not limited to the operating room. Perhaps a coach could help us improve our communication skills. How to give bad news to patients. How to communicate more effectively with our peers. How to handle the "difficult" patient.

The possible benefits? Fewer malpractice suits. Better patient compliance. Maybe even more satisfaction from doing what we do for a living.

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=96 http://www.interimphysicians.com/blog/post.php?contentID=96 Mon, 27 Feb 2012 00:00:00 +0000
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The policy establishes a window of no fewer than three years and no more than
seven years between training and certification. Within that timeframe, the maximum time allowed will depend on the specialty.

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The National Health Services Corps will disperse the money to students in 30 states and in Washington, D.C., according to an HHS news release. It's part of the National Health Service Corps' Student to Service Loan Repayment Program, which lawmakers established with the Patient Protection and Affordable Care Act.

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Dr. Joseph Kvedar is a staunch advocate for using email to communicate with patients:
"...making myself available via email gives my patients a sense of direct access to me. It sends a message that I care and that I'm available to answer questions in a timely manner. It builds a bond between us that has tangible benefits for my patients' health."

Dr. Sam Bierstock takes the opposite view:
"The doctor's office is where medicine should be practiced." He argues that "email raises privacy issues," and it's "a treasure chest for malpractice attorneys." Although Dr. Bierstock says email "can be useful for appointment scheduling and prescription refills...it is no way to practice medicine."

I appreciate the viewpoints on both sides of this issue. But, one of my concerns (not addressed in the Wall Street Journal article) is that many patients are either not able to communicate effectively by email or prefer direct, face-to-face contact. Then there's the concern about the importance of nonverbal communication that cannot be appreciated in an email message. Even if we support email communication with patients, we must also recognize that not all of our patients have computer skills or English proficiency.

Where do you stand on the use of email in communicating with patients?
]]> http://www.interimphysicians.com/blog/post.php?contentID=77 http://www.interimphysicians.com/blog/post.php?contentID=77 Mon, 16 Jan 2012 00:00:00 +0000
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The natural tendency may be to either blow it off as a one-time anomaly caused by a particularly challenging patient or family, or assume that it's something that happens to only "bad" doctors and is something to be ashamed about. But hospitalists and health care experts focused on improving quality say that physicians should not suffer alone.

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Growth in locum demand is expected because, with more money tied to various quality measures, health systems will be under more pressure to maintain full staff coverage.

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But those physician specialists haven't been available for at least three years at St. Vincent Healthcare, with no relief in sight, says Dyk, service line director for women's and children's services at the 286-bed nonprofit hospital in Billings, Mont. The nearest pediatric surgeon, and, in fact the only one serving the sprawling state, practices 350 miles away in Missoula, she says

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But to make it less likely that this dream will turn into a nightmare, physicians need not only read the contract but also be wary of potential land mines hidden within.

Read the full article]]> http://www.interimphysicians.com/blog/post.php?contentID=65 http://www.interimphysicians.com/blog/post.php?contentID=65 Tue, 13 Dec 2011 00:00:00 +0000 Among nocturnists who provided cross coverage, almost half (42.9%) were responsible for 50 or more patients. And close to one in five nocturnists (23.8%) reported having more than 21 patient encounters per shift.

Read the full article from Today's Hospitalist]]> http://www.interimphysicians.com/blog/post.php?contentID=63 http://www.interimphysicians.com/blog/post.php?contentID=63 Thu, 08 Dec 2011 00:00:00 +0000
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"Vitamin supplements associated with increased risk of death." Published in October, this study followed 38,000 women over 22 years (hardly a small study). The bottom line conclusion is that there are very few if any benefits from vitamin and mineral supplements.

A study in the British Medical Journal in April 2011 showed a 20% increased risk of heart attack and stroke in people taking both calcium and vitamin D. A report in the October 12 issue of JAMA reports that men taking 400 IU of vitamin E per day increase their risk of prostate cancer by 17%.

In other words, more is not necessarily better. Making matters worse, Americans spend over 20 billion dollars annually on dietary supplements.

Happy new year!

Ken Teufel

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=62 http://www.interimphysicians.com/blog/post.php?contentID=62 Wed, 07 Dec 2011 00:00:00 +0000
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Read the full article here
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Not much has changed over the years when it comes to disgruntled patients’ dissatisfaction over the service they receive from providers, facilities and other healthcare staff. The difference now is that reimbursement will be partially tied to the patients’ satisfaction of the care they receive.

To combat dissatisfaction, the provider must always be thinking about patient safety. Most providers work in a team environment, which calls for clear and explicit communication between the physician and the rest of the staff. As a locum tenens provider, the unfamiliar environment and staff may present this as a challenge. You may need to go the extra step and make certain a nurse understands your order, and if he or she seems puzzled, have the nurse repeat the order back to you. It is vital to take that extra step on the front-end rather than having an undesirable outcome with the patient on the back-end.

As a provider, patients really do expect excellent customer service from you. Embrace them as valuable, contributing partners in their healthcare. Learn to ask them about their concerns and listen to them carefully. Speak to them in laymen’s terms so they understand their condition as well as any treatment options available. Ask for patient feedback and encourage the patients’ families to proactively participate in the treatment plan.

Some of the obstacles that stand in the way of a patient’s satisfaction include: inconsistency in treatment team membership, insufficient information sharing, lack of coordination and follow ups, distractions, and workload. Do not assume your team is doing the right thing – take 30 seconds to ASSURE it! A few key phrases that mean, “stop and listen to me, we have a potential problem,” are included in the United Airlines CUUS program.

I’m Concerned
I’m Uncomfortable
This is Unsafe
I’m Scared

The teams that perform well all have clear roles and responsibilities, optimize resources, exemplify strong leadership, engage in regular discipline of feedback, develop a strong sense of collective trust and confidence, and optimize performance outcomes. As a locum tenens provider, all of these aspects can be more difficult given your unfamiliarity with the environment.

The patient’s satisfaction will encompass the dimensions of nurse and physician communication, hospital responsiveness, pain management, communication regarding medicine, facility cleanliness and quietness – just to name a few. As a locum tenens provider, you have the opportunity to make a difference every time come in contact with a patient. At Interim Physicians, we have adopted a new concept to go hand-in-hand with all of this – we call it Advanced PeopleCare. You will hear more and more about this in the coming months, but it all starts with you, the provider.

As you move forward in your locum tenens career, do your best to increase your professionalism and training around patient safety, quality and service. Understand the importance of teamwork and effective communication, demonstrate your compassion and provide a high quality servant attitude with every patient you see. ]]> http://www.interimphysicians.com/blog/post.php?contentID=45 http://www.interimphysicians.com/blog/post.php?contentID=45 Fri, 28 Oct 2011 00:00:00 +0000
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Access the information here]]> http://www.interimphysicians.com/blog/post.php?contentID=47 http://www.interimphysicians.com/blog/post.php?contentID=47 Fri, 28 Oct 2011 00:00:00 +0000
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No, Interim Physicians is not setting up a branch in Southeast Asia. I'm here to help establish a four to six-week study abroad course for U.S. medical students. You may be aware of the unprecedented growth of global health studies in many of our medical schools. My own alma mater, the University of Texas Medical Branch at Galveston, has a well-established global health track that includes required study in developing countries. Duke and the University of Washington (among others) have similar programs.

Of course, interest in spending some time in developing countries is not limited to medical students. Physicians just out of residency training as well as those in established practices are now working abroad for weeks or months, sometimes several times a year. A number of non-government organizations offer such opportunities in Asia, Africa, South and Central America.

Just complete your residency? Why not integrate short-term service abroad with assignments from Interim Physicians when you're here at home? Already in a practice commitment? Ask Interim Physicians to cover your practice until you get back.

"Making a difference" in the developing world has never been easier.

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=37 http://www.interimphysicians.com/blog/post.php?contentID=37 Fri, 07 Oct 2011 00:00:00 +0000
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Interim Physicians has placed you into an assignment at a university student health center. The first day there, you are asked to take care of an unmarried female patient, a 17-year-old freshman complaining of a persistent sore throat. What's the first thing you do?

a) Do a throat culture and wait for the results before deciding whether or not to treat with antibiotics.
b) Do a throat culture but start antibiotics while waiting for the results.
c) Find out if parental consent has been given to treat this young woman.

This a somewhat of a trick question. The best answer is "c." Given this scenario, you need to assume that the patient is a minor: someone under the age of 18 who has never been married and never been declared an adult by a court. (See Neavel and Tyson, Liability and Reporting Issues in Adolescent Medicine.)

Thanks to an Interim Physicians doctor on an assignment, a Texas university recently clarified its policy regarding treatment of minors at its health center. Specifically, the university now requires all students under the age of 18 have parental consent on file before being treated. This avoids the whole issue of having to determine whether or not a patient under the age of 18 can be called an "emancipated minor." (Note: This anecdote is provided as a commentary on the treatment of minors and is not intended to provide advice on any specific legal matter.)

The "take home" message is this: To properly care for adolescent patients, physicians should be aware of the consent and confidentiality laws specific to the state in which they are practicing.

Ken Teufel is the Medical Director for Interim Physicians]]> http://www.interimphysicians.com/blog/post.php?contentID=2 http://www.interimphysicians.com/blog/post.php?contentID=2 Mon, 12 Sep 2011 00:00:00 +0000
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