International Emergency Medicine

Here's a career focus that has tremendously expanded over the past decade for Emergency Medicine physicians:  International Emergency Medicine.

Not too long ago if you were an Emergency Physician and you wanted to do international work, you simply picked a geographic location and went.  There was no formal training and most practitioners learned by doing. 

While much of the international work done by these hardy individuals was well intentioned, many reported that it was difficult adjusting to a foreign assignment, especially in a remote region.  Few of these physicians had any training in tropical medicine and even fewer had exposure to public health.

In the 1990's a group of Emergency Physicians with extensive experience in international and remote medical care came together to attempt to codify the training needs of physicians who were going to similar locations.  Out of these discussions, a formal curriculum was recommended and fellowship programs in International Emergency Medicine began to spring up around the country.

I was fortunate enough to have been one of these International Emergency Medicine fellows from 2002 to 2004.  Our program included training in public health, clinical shifts at our academic institution, and extensive field work overseas.  It was a great experience and opened the door to a thousand opportunities for me that completely altered the trajectory of my career.

In 2004, towards the end of my fellowship, we published a review article in Prehospital and Disaster Medicine that reported on the International Emergency Medicine fellowships offered around the country to EM trained residents. You can read that article here . When the article was published, there were eight programs available. I find 23 on the website of the Society for Academic Emergency Medicine now.

Of course, there are detractors. When I told people I was going to extend my training for two years to do a fellowship in International Emergency Medicine, a number of my colleagues questioned whether this would be a good investment of time. Why not just sign up with an international organization and go?  Why lose two years being a fellow when you could be overseas gaining experience, or working in an emergency department somewhere paying off school loans?

I wasn't sure how to answer these questions when I decided to do the fellowship.  At the time, I just thought it was the right thing for me and I was really excited about the opportunity.

In retrospect, it has turned out to have been a pivotal moment in my career and an excellent investment of time. The fellowship in International Emergency Medicine  exposed me to leaders in international medicine. It trained me in public health. It offered me incredible opportunities to perform field work in remote locations all over the globe and it taught me how to think like an academic physician-- how to research, how to teach, how to write.

So the question is, if you're an Emergency Medicine doc and you're interested in international work, should you do a fellowship in International Emergency Medicine? 

My answer: it depends. 

It depends on a lot of factors including where you see yourself in five years and what your long-term goals are for your career. Not everyone has to do a fellowship to do international work. I know plenty of physicians who are not fellowship trained who do short-term international work and absolutely love it.

However, if international medicine is something you think you would like to do full-time as a career focus, then a fellowship might be the right move for you. The longer you spend overseas in remote areas the more important training in public health becomes. Also, the connections you make through a fellowship can open up job opportunities that you never would have found otherwise.

For those who are EM trained, fellowships in International Emergency Medicine are a good place to start a career in international health.

Ashley Wendel Joins Freelance MD

Freelance MD today announced the addition of Ashley Wendel from High Agility Healthcare as a contributing writer covering change management and organization for doctors.

"Ashley's expertise can make career change accessable and much less threatening for physicians." said Jeff Barson, Freelance MDs Founder. "Her meticulous approch to change managment  can make a world of difference for doctors contemplating a career outside of clinical medicine."

Through her business at High Agility Healtchare, Ashley works with Physician Leaders who are experiencing a feeling of being "stuck" in their professional lives, and who want to take that extra step to build their ability to manage and direct change in themselves and their organizations. She helps individuals in leadership roles to expertly address the challenges they face and to develop and implement concrete strategies to achieve their goals and exceed even their own peformance expectations.

As an organizational consultant, Ashley works with Physician Executives who need to find new and innovative ways to drive change within their complex health organizations. She works together with both executive and clinical staff to develop new strategies that build buy-in, accountability and sustainability for critical organizational initiatives. She helps heallth organizations build their "agility" competency, and become more responsive, flexible and adaptive in their response to rapid change.

About Ashley Wendel

Ashley has a Master’s Degree in Clinical Psychology, with a specialization in Behavioral Medicine, from San Diego State University / University of California, San Diego (Joint Program). Ashley spent 7 years studying and doing freelance work in the area of clinical diagnostics, neuropsychological testing, quantitative/qualitative research, teaching, and behavioral interventions in medical settings.

About Freelance MD
Freelance MD is an active community that gives physicians around the world intelligent information to gain greater control of their medical practice, income, and lifestyle.

Dr. Setu Mazumdar Joins Freelance MD

Freelance MD today announced the addition of Dr. Setu Mazumdar as a contributing physician writer covering physician investing and wealth management.

Dr. Mazumdar is an affiliate of the National Association of Personal Financial Advisors (NAPFA) and a member of the Financial Planning Association (FPA>, the National Association of Tax Professionals (NATP, and the American College of Emergency Physicians (ACEP).

"Setu is a great resource for our physican members." said Jeff Barson, Freelance MDs Founder. "Dr. Mazumdar is a passionate proponant for physicians and offers level-headed advice and fantastic insight that set him apart. We're excited to have him on board as a contributing writer."

As a Freelance MD physician contributor, Dr. Mazumdar will be writing on both wealth creation and wealth management for doctors.

About Dr. Setu Mazumdar
Setu Mazumdar MD graduated as the valedictorian of Woodward Academy, the largest independent day school in the US. He then attended Johns Hopkins University and was admitted to the Phi Beta Kappa honor society for ranking among the top 1% in his class. After earning his MD degree from Johns Hopkins School of Medicine, he practiced emergency medicine in Atlanta, GA. As his passion for financial planning and investment portfolio management grew, he completed the CFP Board registered professional education program and passed the rigorous 10-hour CFP Certification Examination. He then worked for a finacial planning firm in Atlanta before launching his own wealth management firm, Lotus Wealth Solutions.

About Freelance MD
Freelance MD is an active community that gives physicians around the world intelligent information to gain greater control of their medical practice, income, and lifestyle.

Why Physicians Need Financial Planning

You don't need a finacial plan? Yes you do.

Imagine that you have a brand new patient in your office. What’s the first thing you want to find out? It’s the problem that the patient wants you to understand and solve.

So after doing a history and physical, and perhaps ordering a few tests, you come up with a differential diagnosis. Once you decide on your most likely diagnosis, you take what is perhaps the most important step in the process:

Implement an action plan.

The action plan is your custom tailored path to achieving what’s important to the patient: going from where they are now to where they want to go.

What’s incredible about this is that as physicians we plan for patients all the time, but we don’t plan our financial lives very well for ourselves.

If you’re like me you’ve got places you want to go as well--whether it’s retiring at age 55, or leaving a legacy for your children, or working part time so you can enjoy your family more.

And that’s exactly why you need a financial plan.

So where do you start when you create your financial plan and what areas should a financial plan cover?

First and most importantly is to define exactly what your goals are.  Don’t be vague about this.  “Investing in my 401k” is NOT a goal--it’s simply a tool you can use to get to your goals. “Investing in my 401k so I can retire at age 55 and travel all over the world and maintain my current lifestyle”--now that’s a goal.

But while goals form the foundation and destinations of your financial plan, what should the plan itself encompass?

I believe the plan itself should focus on 3 broad areas: wealth protection, wealth enhancement, and wealth transfer.

Wealth protection involves minimizing the chance of suffering a catastrophic financial loss--whether a lawsuit, your house burning down, or a bear stock market that wipes out your investment portfolio.

Wealth enhancement involves increasing the value of your assets and specifically investment assets while at the same time minimizing the impact of taxes.

Finally wealth transfer addresses the efficient transfer of your assets during lifetime and after death to your loved ones and others who are important to you.

Now let me emphasize that while a financial plan is important, it’s far less important than the PLANNING.

Going back to your patient, when you chart out a treatment plan you’ll have to modify that plan as you implement it.  Perhaps the patient is actually allergic to the medicines you prescribed or doesn’t respond to your initial therapy.

The same goes with your financial plan.  What if you don’t get the investment returns you thought you were going to get? What if you become disabled and your income drops by 50%?

The implementation of your financial plan should be a dynamic process that evolves over time as your life circumstances change. That’s why financial planning is so critical to achieving your financials goals as a physician.

Influencing Your Online Reputation

Here's some very good advice from one of our Select Partners, Medical Justice.  

The observation that social media is experiencing explosive growth is hardly novel. Moreover, social media is significantly influencing the medical profession.  CNN Money.com reported that Facebook passed the milestone of half a billion signed on users half a year into 2010.  The professional and legal ramifications from the rapid growth of social media touch almost every aspect of physicians practicing today.  One of the most challenging of these ramifications is a physician’s online reputation.

Pew Internet and American Life Project recently released numbers that document just how important of the source of information regarding medicine and physicians the internet has become.  Sixty-one percent (61%) of American adults look on-line for health information. Forty-nine percent (49%) of Internet users report researching a specific disease or medical problem on the Internet.  Forty-seven percent (47%) report seeking information about their physician or other healthcare professionals from on-line sources.

Finally, five percent (5%) of “E-Patients” have posted a review online of a doctor. It is these very reviews from a small subset which form the basis of a physician’s reputation on-line.

Reputations are forged when people make judgments upon the mosaic of information available about us.”  Viewed in this light, ratings, blog postings, and web pages are the pieces of the reputation mosaic.  Unfortunately, all it takes is one or two bad pieces for the mosaic to be marred.  The implications of a damaged online reputation are extensive."

Most physicians equate a tainted online reputation with a direct loss of business.  The analysis is simple; the worse the online reputation, the fewer the patients.  There are certainly many examples to support this reasoning. 

Dr. Linda Morrison, a physician practicing in Indiana, experienced first hand the harm that arises from an online reputational attack.  In July of 2000, Dr. Morrison noticed that an anonymous individual was posting defamatory statements about her via the internet.  Dr. Morrison received e-mails from this individual under a pseudonym “Surfycity45” that, among other things, made threats against her medical license.  The attacks continued into the fall of 2000.  Dr. Morrison ultimately learned that “Surfycity45” had been circulating defamatory comments about her while simultaneously encouraging others to do the same.  “Surfycity45” worked hard to organize a cyber mob with Dr. Morrison as its target.  

Dr. Morrison, via counsel, attempted to enjoin Defendant American Online, Inc. from the continued posting of the defamatory statements about her by the anonymous subscriber.  For a variety of legal reasons, the United States Northern District Court of Indiana ruled against the injunction.  Although Dr. Morrison alleged that “Surfycity45” statements were false, defamatory, and had resulted in damage to her professional reputation as a physician, she was unable to have these remarks removed from the Internet in a timely fashion.  The damage was done.

The implications of a physician's online reputation now extends beyond patients.  At least twenty seven (27) states have a recognized cause of action for negligently credentialing a physician.  Given this liability, credentialing committees will likely perform detailed background checks using all available search tools, including social network sites.

Health institutions making credentialing or hiring decisions currently face a dilemma when it comes to information about physicians contained in social network profiles.  Although there may be some risks in searching against them (as discussed in the next section), the potential liability for making a panel decision in the absence of such information likely tips the balance."

It is not just patients and credentialing committees which are scrutinizing physicians’ online reputations.  In any  medical malpractice action, physicians should assume that the plaintiff’s attorney will checking the doctor’s online reputation.  Geoffrey Vance, a thirty eight (38) year old partner at McDermott, Will and Emry, makes use of social networking sites to gather facts about the opposing side for trials.  “I make it a practice to use as many sources as I can to come up with and to find information about the other side” Vance said.  “We used to run Lexus Nexus; we still do that.  We always look at cases, and now we use the internet – Google, and social networking sites.”

Mr. Vance is not alone.  Paul Kiesel, a lawyer in Los Angeles County, admits to using social media not only to investigate the opposing side, but also to help select jurors.  “Last month I had fifty (50) jurors, and as the Court Clerk read out the names, I had two (2) people in the courtroom and the third person back at the office, with all three (3) of them doing research.”

Lawyers are not the only actors in a courtroom who are using social media at trial.  Courts across the country are grappling with the serious problem of “Internet-tainted” jurors.  In case after case, judges and lawyers have discovered that jurors are doing independent research via cell phone during trials.  Last year in Arkansas, a state court judge allowed a 12.6 million dollar verdict to stand even though a juror sent eight (8) messages via Twitter from his cell phone.

 In another case, a juror decided to seek the wisdom of the masses by holding a Facebook online poll. “I don’t know which way to go, so I’m holding a poll, wrote the democratic juror.”  Upon learning of this misadventure, the juror was dismissed and the case proceeded.

Physicians’ online reputations are being examined with increasing frequency at crucial moments in their professional career.  It is no longer  prudent for a physician to fail to monitor his or her online reputation.  “Physicians should carefully monitor their online reputation.  I have seen examples of ex-spouses, past employees, and competitors all posing as disgruntled patients in an online effort to damage a physician’s reputation.  This is a real threat that is not going away,” says Rivera.

In the words of Benjamin Franklin “It takes many good deeds to build a good reputation, and only one bad one to lose it.”

Resource: Physicians + Facebook Marketing - How to do it correctly!

Guest post by Joy Tu of Medical Justice.

Submit a guest post and be heard.

Dr. Gary Taff Joins Freelance MD

Freelance MD today announced the addition of Dr. Gary Taff as a contributing physician writer.

Dr. Gary Taff brings a unique perspective to Freelance MD with broad experience in both occupational medicine and real estate investing.

"Dr. Taff is well-know as a principled physician who teaches other doctors how to get started as real-estate investors." said Jeff Barson, one of Freelance MDs Founders, "but Dr. Taff's expertise also extends to occupational medicine. We're excited to have him on board."

As a Freelance MD physician contributor, Dr. Taff will be writing on both real-estate investments for physicians as well as occupational medicine.

Despite previously negative experiences of "buying high and selling low", he started with $20,000 capital, and used equity sharing, intensive market research and an eye for buying the best deal in emerging small to medium- sized markets. This plan allowed Gary to purchase 190 properties in 13 states over a five year period. The portfolio spanned a wide range of residential properties from single family homes to condos, duplex to fourplexes, rehab projects, condo conversions and multi-unit apartment complexes. Gary is most proud of the fact that his portfolio has achieved a 39% per annum appreciation rate, mainly based on buying below market value.

Over the past two years, Gary has turned his attention to wholesaling, in which he buys multiple properties at significant discounts and then sells or assigns the properties to investors at prices below current market values. He has served as the Northern California Area Manager for a nation-wide clearing-house type of real estate network, as well as other real estate networks. He has given several seminars on value investing, use ofleverage, understanding and taking advantage of the five stages of a real estate cycle, and working with wholesalers.

About Dr. Gary Taff
Born in New Jersey, and schooled in New York City, Gary followed a well-worn family tradition by becoming a physician. As a foreshadow of a life- lon~ tendency towards ''getting there first", he started college at the age of 16 and became a doctor after just turning 23.

Gary attained Board-Certification in Emergency Medicine in the first year of that field of medicine's recognition as a specialty. He went on to direct several hospital emergency departments in Southern California. In 1983, Gary opened one of the nations' first urgent care centers. He grew that first site into a seven medical center, 70 employee, 60,000 patient visits-per-year medical group. This achievement earned Gary several awards, including the California Inland Empire Crescendo Award, Small Business Person of the Year and finally, Ernst and Young's Entrepreneur of the Year in 1993.

Gary sold his medical group in 1998 at the peak of the health-care market cycle, and moved to Northern California. After creating a hospital-based occupational medicine program and directing an ambulance company, Gary turned his attention to real estate investing.

About Freelance MD
Freelance MD is an active community that gives physicians around the world intelligent information to gain greater control of their medical practice, income, and lifestyle.

Dr. Steven Knope Joins Freelance MDs Physician Writers

The physician community Freelance MD today announced the addition of Dr. Steven Knope to its growing team of contributing physician writers.

"We're excited to have Dr. Knope on board" said Dr. Gregroy Bledsoe, one of Freelance MDs Founders. "Dr. knope's expertise and depth of knowledge around Concierge Medicine and direct pay patient care gives use a point of view that we know our physician readers will find valuable."

Dr. Knope has received local and national media attention for his work as an uncompromising patient advocate and opponent of the HMO industry. He has been covered in the New York Times, Forbes Magazine, Arizona Daily Star, Money magazine and The Wall Street Journal. In his fight against a local HMO, Nobel Peace Prize Laureate and inventor of the cardiac defibrillator, Dr. Bernard Lown, praised Knope as “courageous” and “deeply principled.”

About Dr. Steven Knope
Dr. Knope is a board-certified internist and sports medicine expert. He completed his premedical studies at Columbia University and graduated with honors in internal medicine from Cornell University Medical College in 1988. He completed his residency training at UCLA, where he was awarded the first Sherman Melinkoff Teacher of the Year Award. He has served as Chief of Medicine, Chairman of the Department of Medicine, and Director of the ICU in the Carondelet system in Tucson, Arizona. He is a pioneer in the field of concierge medicine, opening one of the first concierge practices in America in December 2000. He authored the first book on concierge medicine entitled, Concierge Medicine; A New System to Get the Best Healthcare (Praeger, 2008).

About Freelance MD
Freelance MD is an active community that gives physicians around the world intelligent information to gain greater control of their medical practice, income, and lifestyle.