med-midwest medical edition-june 2012

Primary CareThe Fate of

South Dakota and the Upper Midwest’s Magazine for Physicians and Healthcare Professionals

June2012

Vol. 3 Issue 4

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A declining pool of doctors to serve a growing population is creating a perfect storm that could result in “critical primary care shortages” by 2020. What is to blame for the shortage? And can anything be done to stop it? We talk with some of the people in our area closest to primary care – including practitioners, students, and educators – to find out in part one of a two-part series.

Part 1 of a Two-parT SerieS

the Fate of Primary Care

ContentsJUNE 2012

Midwest Medical edition

RegulaR FeatuRes

2 | From Us to You

4 | Meet a MED Advisor –John Berdahl, MD

20 | The Nurses' Station

24 | Medicine & the Arts: er Doctor & artful Knitter

26 | Complementary Therapies: integrative Medicine for Cancer

29 | Grape Expectations: a Midsummer Night’s wine

31 | News & Notes: News from around the region

33 | Learning Opportunities: Upcoming Symposiums, conferences, CMe Courses

In thIs Issue 4 | american Cancer Society offers free Support

6 | is the Cost Curve Gending? By Dave Hewett

8 | Beating the odds: Sf Cardiac arrest Stats Beat National average

9 | Local paramedics Test Heart attack Treatment for JaMa Study

10 | Sanford Closer to Bismark Merger

10 | SD in Top 5 for eHr Growth

11 | Update Your Crisis Communication plan By Tana Tipton

18 | Midwest family Care

21 | Sf Doctor receives Med School award

22 | New Director Says Genome Sequencing Next for Breast Cancer

23 | avera: aDHD Breakthrough?

23 | New regional Breast Cancer Network and registry

30 | Children’s Care Names interim Ceo Cover Feature

page 12

Sponsored Feature

Note: a MeD “Sponsored feature”

is a commissioned and sponsored

promotional article.

About the cover: This month’s MeD original cover

artwork, “The waiting room” was created for MeD by Sioux

City artist erin Taylor. The original and prints are available.

Contact MeD for more information.

Midwest Medical edition 2

CoNTaCT iNforMaTioN

Steffanie Liston-Holtrop, VP Sales & Marketing

605-366-1479 [email protected]

Alex Strauss, Editor in Chief 605-759-3295 [email protected]

Fax 605-271-5486

MAiLiNG ADDrESS po Box 90646 Sioux falls, SD 57109

WEbSiTE MidwestMedicaledition.com

Jan/Feb Issue December 5

March Issue February 5

April/May Issue March 5

June Issue May 5

July/August Issue June 5

Sep/Oct Issue August 5

November Issue October 5

December Issue November 5

2012 Advertising / Editorial Deadlines

reproduction or use of the contents of this magazine is prohibited.

©2011 Midwest Medical edition, LLC

Midwest Medical Edition (MeD Magazine) is committed

to bringing our readership of 3500 South Dakota area

physicians and healthcare professionals the very latest in

regional medical news and information to enhance their

lives and practices. MeD is published 8 times a year by MeD

Magazine, LLC and strives to publish only accurate informa-

tion, however Midwest Medical edition, LLC cannot be held

responsible for consequences resulting from errors or omis-

sions. all material in this magazine is the property of MeD

Magazine, LLC and cannot be reproduced without permis-

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submissions for publication. please send your thoughts,

ideas and submissions to [email protected].

Magazine feedback and advertising and marketing inquiries,

subscription requests and address changes can be sent to

[email protected].

MeD is produced eight times a year by MeD Magazine, LLC which owns the rights to all content.

pUBLiSHer MED Magazine, LLC Sioux Falls, South Dakota

Vp SaLeS & MarKeTiNG Steffanie Liston-Holtrop eDiTor iN CHief Alex Strauss DeSiGN/arT DireCTioN Corbo Design CoVer pHoTo & DeSiGN Darrel Fickbohm pHoToGrapHer Kristi Shanks weB DeSiGN 5j Design CoNTriBUTiNG eDiTor Darrel Fickbohm

CoNTriBUTiNG wriTerS Heather boysen Dave Hewett Tana Tipton

STaff wriTerS Liz boyd Caroline Chenault John Knies

from Us to YouStaying in Touch with MeD

Write

to us!we accept

reader

submission

a letter from the vP & editor

alex Strauss

Steffanie Liston-Holtrop

IT’S SaiD THaT we rareLY appreCiaTe wHaT we HaVe

UNTiL we LoSe iT. if that is true, we may all start appre-

ciating primary care providers more in the coming decades.

as the number of medical students choosing primary care

dwindles nationally and the population grows, we bring you

insights from local providers, students and educators in the first

of a two-part feature.

Beyond primary care doctors, there is a great deal to appre-

ciate in the South Dakota medical community this month. our

cardiac arrest rates are lower than the national average

(page 8), more of our doctors are adopting eHr’s (page 10),

local ophthalmologists are among the first to offer a major

advance in cataract surgery (page 4), and local scientists are

pioneering world-class research (throughout). our hope is that

seeing these accomplishments compiled in MeD makes you

proud to be part of this medical community.

we want to thank everyone who stopped by our booth at

april’s SDMGMa conference at the Holiday inn in Sioux falls.

it is always a pleasure to see so many familiar faces and learn

what is new in your offices. if we are not able to meet you in

person, rest assured that we do want to meet you and share

what you are working on, thinking about, learning, trying and

reading. MeD columns like Then & Now, off Hours, Medicine

& the arts, News & Notes and in review are your chance to

speak directly to 5,000 local colleagues who receive MeD, just

like you do.

Need a refresher on the kinds of things your colleagues have

shared in these pages? every issue of MeD is available on our

website at www.MidwestMedicaledition.com. our door, as they

say, is always open.

—Steff and Alex

MED Quotes

Each patient ought to feel somewhat the better after the physician's visit, irrespective of the nature of the illness. ~Warfield Theobald Longcope

pUBLiSHer MED Magazine, LLC Sioux Falls, South Dakota

Vp SaLeS & MarKeTiNG Steffanie Liston-Holtrop eDiTor iN CHief Alex Strauss DeSiGN/arT DireCTioN Corbo Design CoVer pHoTo & DeSiGN Darrel Fickbohm pHoToGrapHer Kristi Shanks weB DeSiGN 5j Design CoNTriBUTiNG eDiTor Darrel Fickbohm

CoNTriBUTiNG wriTerS Heather boysen Dave Hewett Tana Tipton

STaff wriTerS Liz boyd Caroline Chenault John Knies

One number accesses our pediatric surgical specialists, any problem, anytime.

Physicians’ Priority Line 1.888.592.7955

www.ChildrensOmaha.org

When a newborn is critically ill, a single call gives you instant access to our neonatal intensive care specialists and a full range of pediatric and surgical subspecialists, all supported by state-of-the-art technology and equipment. It can also link you to our neonatal transport service team, who will arrange for transport to Children’s Hospital & Medical Center based on the child’s needs. Twenty-four hours a day, seven days a week, one call links you to physician-to-physician consults, referrals and admissions. There’s no problem too large, no child too small.

Med Mag Ad, May, 2012.indd 1 5/1/12 9:55 AM

american Cancer Society offers

Free SuPPortphysicians encouraged to refer their cancer patients

the american Cancer Society is reminding physicians to help

patients take advantage of their free local

resources, including:the aCS webSIte – Patients who are uncomfortable asking questions or simply want more detailed information about their disease can be directed to ACS’ comprehen-sive website at www.cancer.org, for timely, reliable information

PatIent LodgIng Program – Patients who live too far away to commute for their cancer treatment may benefit from the ACS Patient Lodging Program. In cooperation with area hotels, ACS provide complimen-tary rooms on a space available basis.

road to reCovery – Patients who do not live far from their medical facility but

do not drive can take advantage of ACS’s free transportation service, thanks to local volunteer drivers.

Look good . . . FeeL better – This longstanding program helps patients cope with and counteract the way in which cancer changes their bodies. Women in the program can attend tutorials on makeup use to learn how to cover cosmetic-related side-effects of cancer treatment. ACS also provides wigs free of charge to patients who do not have insurance for head-coverings.

reaCh to reCovery – This program matches new breast cancer patients with breast cancer survivors with similar experi-ences or circumstances. For example, a patient with young children at home may be matched with a survivor who also had young children at home at the time of her treatment. ■Call 1-800-227-2345 to refer a patient for any of these services.

Nonprofit Spotlight


a talk with MED advisor

John berdahl, MD

Q: As a Harvard-recognized top cornea fellow, you could have practiced any-where. How did you end up at Vance Thompson Vision in Sioux Falls?

A: i grew up in Hills, Minnesota and started thinking about moving back after we had a little kid. My grandma is one of my heroes and Dr. Thompson goes to her church. He took a picture of himself with my grandma with the message, “Your grandma wants you to come work for my practice.” So, that’s how he sealed the deal!

Q: Has it been the right decision?

A: absolutely. There is nothing like working in the community that helped raised you. also, ours is a very high-flying practice and we get our hands high-end technology earlier than other places. Companies seek us out to help maximize their new technology.

Q: What are some of the most exciting recent advances in eye care?

A: Cataract surgery is reaching an unprec-edented level of accuracy with a system called reLaCS – refractive Laser assisted Cataract Surgery. we had the fifth laser in the country. There is a new glaucoma stent that is the smallest device ever implanted – so small it will fit into a ridge in a finger print. also, new lenses that can be reshaped using ultraviolet light will improve cataract surgery results. They are also in fDa studies.

Q: Tell us about your work with NASA.

A: eye health is the number one health priority for astronauts. They are coming back from space with swelling of the optic nerve, which can impair vision in space. we have been consulting with NaSa on ways to minimize the risk.

Q: What was it like to do surgery on your 86-year-old grandma this year?

A: So gratifying. She told me that she had never seen the Sea of Tranquility on the moon so clearly. That is the kind of thing that really make me glad we came home.

OPHTHALMOLOGiST

aCS offers free transportation to non-driving cancer patients through the road to recovery program.

At Midwest Family Care, we’re focused on providing innovative and personalized care for every member of your family. And, when it comes to care, we want to make it convenient for you. That means you can call us and get same-day appointments — and we even have extended hours upon request.

Call (605) 444-8650 to make an appointment.

family care.

sfsh.com/primarycare716 E 19th StrEEt | S ioux FallS , SD 57105

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716 E 19th Street, Sioux Falls, SD 57105 www.OpenUprightMRI.com

SPecialty centerS


THE LEAD HEADLiNE iN A recent New York Times article read, “In Hopeful Sign, Health Spending Is Flattening Out”.

Between 2009 and 2010, the percentage of gross domestic product (GDP) attributable to medical care held steady at 17.9% which in effect means that medical inflation rose at the same rate as general inflation – some-thing that hasn’t happened in a long time.

In the end, the article doesn’t have a firm reason for the near-merging of the two infla-tionary lines, but it does offer some interesting observations:

“Much of the slowdown is because of the recession, and thus not unexpected, health experts say. But some of it seems to be attrib-utable to changing behavior by consumers and providers of health care – meaning that the lower rates of growth might persist even as the economy picks up.”

Certainly, the recession had something to do with the slow down as people lost their jobs and health insurance coverage, but there is another way to look at this factor. It was the experience in South Dakota that the health care sector was one of the few places that offered steady employment. Physician clinics and hospitals still had to be staffed and nursing home residents weren’t moving out–meaning that staffing levels remained essentially unchanged.

Health care was also one of the few areas of the economy that moved forward with capital improvement projects keeping at least some of the building trades employed during that time. Indeed one might have surmised that health care during this time would have increased the gap between medical and gen-eral inflation, which occurred in 2010.

That said, according to the article, the policy experts have been surprised about

the drop in Medicare spending for those beneficiaries being cared for in hospitals. They also noted that some of the states where health care spending slowed most rapidly were states that were not hit as hard by the recession (like South Dakota).

So what other explanations are there? Some point to coverage plans with higher deductibles making people more aware of what they are buying. Other reasons men-tioned in the article include:

✔ people are actually getting it and living

healthier lives. Stated another way,

keeping people out of hospitals and

emergency rooms.

✔ physicians and hospitals have taken to

heart the public reporting of “hospital

acquired conditions” and other quality

and patient safety measures. They have

responded positively to the incentive

payments and the threat of payment

penalties.

✔ Treating chronic conditions using best

practices and coordinating care among

provider experts.

✔ a lack of expensive, novel drugs

coming onto the market.

✔ “finally, and most important, health

economists point to a shift toward

accountable care, in which providers

are paid for the quality of care, not the

quantity.”

Yes, can you believe it? The New York Times said something that the South Dakota provider community has been saying for at least four years. Most experts are still unwilling to go out on a limb and say that this absolutely, positively happened for rea-sons beyond the recession. They seem to be in shock. Perhaps other parts of the country are actually starting to discover what we’ve known and been doing in South Dakota for several years. We’ve often said that we wouldn’t have a crisis in health care if other parts of the country would deliver care like we do. Maybe, just maybe, that message is gaining acceptance in other parts of the country. ■

Is the Cost Curve

bendIng? by Dave Hewett , President/CEO, SDAHO

Source: U.S. Bureau of Labor Statistics, Percent change from previous December

4.2

4.9

4.5

4.1

5.9

3.0

3.4 3.4 3.6

3.5

1.9

3.3 3.4

2.5

4.1

0.1

2.7

1.5

3.0 2.7

2003 2004 2005 2006 2007 2008 2009 2010 2011 Mar-12

Inflation: CPI-U vs. Medical Care Services Medical Care Services CPI-U

Source: U.S. Bureau of Labor Statistics, Percent change from previous December

4.2

4.9

4.5

4.1

5.9

3.0

3.4 3.4 3.6

3.5

1.9

3.3 3.4

2.5

4.1

0.1

2.7

1.5

3.0 2.7

2003 2004 2005 2006 2007 2008 2009 2010 2011 Mar-12

Inflation: CPI-U vs. Medical Care Services Medical Care Services CPI-U

June 2012 7MidwestMedicaledition.com

Skilled in matters of the heart

More than 1,000 professionals skilled in heart care. A life-saving network that spans four states. Sanford Heart partners with South Dakota physicians to help them improve patient outcomes.

Meet Sanford Heart’s skilled professionals. Hear how they stay inspired to connect, heal and protect.

Your heart. Our hands. Connected. Visit heart.sanfordhealth.org

100-

1139

5-34

35 3

/12

PEOPLE WHO SUFFEr cardiac arrest in the Sioux Falls area have a much better chance of survival than they do in many other com-

munities across the country, thanks to a strong EMS System.

Once again, the community’s EMS System has scored high marks from the Cardiac Arrest Registry to Enhance Survival (CARES), the national organization that compiles and releases regular performance reports for emergency response systems nationwide. The 2011 CARES annual report showed the EMS System in Sioux Falls with a neurologically intact cardiac arrest survival rate of 18.5%–more than twice as high as the national average of 7.7%.

“I think it speaks greatly to the entire chain that makes up the EMS System in the community,” says Mike Deitschman, Quality

Assurance Coordinator for Sioux Falls ambu-lance service, Rural Metro. “These statistics reflect on the work across the entire spec-trum, starting with the dispatch center and the first responders, including the Sioux Falls Fire Rescue and the Sioux Falls Police Department, and all three of the local hospitals that receive cardiac arrest patients.”

Between dispatch and hospital care, Deitschman says the third link in the chain is the advanced life support care provided on the scene by Rural Metro personnel. “If any one of these links breaks down,” he says, “we could not continually earn such high marks.”

CARES statistics bear that out. Accord-ing to a 2011 CARES weekly Morbidity and Mortality report, “Provision of optimal care at the scene is essential to survival. If a pulse is not restored before EMS transport,

additional efforts at the receiving hospital almost invariably fail.”

“I think that part of our success lies in the size of the community,” says Deitschman, who says Sioux Falls’ EMS System has con-sistently scored high among participating CARES communities nationwide. “We are big enough and have enough calls that we have been able to get good at responding to cardiac arrest. But we are still small enough to control and know what’s going on in the community. Sometimes in larger communi-ties that have more cardiac arrests, it is more difficult to correct errors and make adjust-ments to improve your system.”

CARES statistics are based on an esti-mated 30,000 cardiac arrests annually in 45 communities. About a hundred of those cases occur in the Sioux Falls area. Data from every cardiac arrest call in each participating

8

Beating the oddsSIoux FaLLS’ CardIaC arreSt StatS better than the natIonaL average

LoCaL ParamedICS teSt heart attaCk treatment For Jama StudySIOux FAllS eMergeNcy

perSONNel are helping to

advance understanding of

treatment for patients with

heart attack symptoms. Sioux

falls was one of 13 communi-

ties nationwide to participate

in an innovative national study

of a glucose-insulin-potassium

(GiK) solution for patients

experiencing symptoms such

as chest pains.

according to the study

published recently in the

Journal of the american

Medical association (JaMa),

GiK was not only capable of

reducing the size of a heart

attack (2% of heart muscle

versus 10%) but the rate of

cardiac arrests or death was

50 percent lower among

patients who received GiK

versus placebo. The GiK treat-

ment was administered in the

ambulance and continued

during the hospitalization for

12 hours. The cost of the treat-

ment is about $50 dollars.

“There is a dearth of

research in eMS in part

because it is very difficult to

follow study protocols when

you are in the midst of an

emergency situation,” says

Mike Deitschman of rural

Metro in Sioux falls, local

director of the study along

with Dr. Donald Kosiak of

avera Medical Group.

another roadblock to the

study of GiK was money. “GiK

is common and inexpensive,

but no one had ever done a

double blind placebo controlled

study on it for heart attack

symptoms,” says Deitschman.

“what drug company would

want to fund this?”

instead, the $35 million

dollar study was supported by

the NiH’s National Heart, Lung

and Blood institute. it included

rural Metro ambulance and

35 other eMS agencies around

the country that together

enrolled 911 patients. avera

McKennan Hospital, avera

Heart Hospital, and Sanford

USD Medical Center were also

involved.

“Hundreds of thousands

of patients across the nation

die from heart attacks each

year,” says Dr. Kosiak. “our

community was part of an

important investigation that

yielded promising results for

patients locally and across

the country.”

The findings of the study

were presented at the

american College of

Cardiology annual meeting in

Chicago in March. ■

community is transmitted to the CARES database at Emory University, which compiles and produces regular reports. CARES is jointly funded by the Ameri-can Heart Association and the Centers for Disease Control and Prevention.

“Prior to CARES, we did not really have this data available to us,” says Deitschman. “So it wasn’t really possible to see how we were doing compared to other communities.”

In addition to the skill of Sioux Falls’ emergency personnel and their ability to work seamlessly together, Deitschman says the community’s success in cardiac arrest is also a reflection on their Mid-western values. “I really do think it speaks to the kind of people we have in this community. This entire EMS System is made up of people who truly care and want to do their jobs well.” ■


Beating the odds

Midwest Medical edition 10 Midwest Medical edition 10

Sd in top 5 for ehr growthACCOrDiNG TO A rECENT rEPOrT bY SK&A, A NATiONAL healthcare data research firm, physician office usage of electronic health records software on a national scale is at 45.6%, up 5% from July 2011 compared to January 2012. Out of all states surveyed, South Dakota is ahead of that national trend and now ranks fifth overall with 57.2%.

Electronic health record software has been around for many years, but recent years have seen tremendous growth thanks to federal mandates, patient demand, and a greater understanding of its potential to impact healthcare quality.

“We see technology impacting the nation every day and in every form of daily life. The same is not true for all of healthcare,” said Holly Arends, Clinical IT Manage for Dakota State University-based Health-POINT, the state’s regional extension service for healthcare EHR adoption. “It is a fact that as a nation, we are behind other countries in EHR adoption but now is the opportunity for us to raise the bar.”

Arends says EHR systems can help eliminate duplicate informa-tion, improve patient safety, and allow patients and providers to more easily collaborate on their care plans. “We fully expect these numbers to increase,” she says. ■SK&a’S DaTa iS BaSeD oN TeLepHoNe SUrVeYS To oVer 240,000 U.S. MeDiCaL SiTeS.

SanFord CLoSer to bISmark mergerSANFOrD HEALTH HAS MOVED A STEP CLOSEr to a merger with Bismark-based Medcenter One health system. The two have signed a letter of intent and agreed to a memorandum of under-standing (MOU) and are moving forward with discussions. Both agreements are non-binding. The MOU defines what the future organization would look like in the event of a merger. Regulatory filings with the Federal Trade Commission and North Dakota Office of the Attorney General are moving forward, as well.

In a press release on the potential merger, Medcenter One and Sanford Health say they have a similar integrated model, similar culture and a long-standing history of working together. In addition to serving patients along North Dakota’s Interstate 94 corridor, the combined system would likely expand services into underserved central and western North Dakota.

“Together, as one of the largest healthcare providers in the Midwest and in the country, the organizations would have an even greater voice on the national level in order to help shape the future of healthcare delivery for the people of the Midwest,” says Dr. Craig Lambrecht, Medcenter One President/CEO.

The boards of Medcenter One and Sanford Health will make a final determination about a merger this summer with a possible effective date later in the year. ■

The less cancer there is, the more birthdays there will be. Patients count on you to remind them of what they can do to prevent cancer. Remind your patients of appropriate screenings and healthy lifestyle choices.

You can help create a world with more birthdays. Visit morebirthdays.com.Or call 1-800-227-2345. Together we’ll stay well,get well, fi nd cures and fi ght back.

© 2

010

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an C

ance

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Update Your Crisis Communication plan

to avoid a Pr disasterby Tana Tipton

MOTHEr NATUrE is a pow-erful force. Last year alone, severe weather events cost the United States $35 billion

in damages and killed more than 700 people.As a Midwest healthcare organization,

you likely have a crisis communication plan in place to deal with the consequences. But if you can’t recall the last time the plan was updated, you could be in trouble.

According to a recent report published by the Institute of Medicine, most U.S. health systems are unprepared for catastrophic disasters, noting, “Even prepared communi-ties can be overwhelmed.”

Crises can happen to any organization, large or small. With the recent high fre-quency of natural and manmade disasters, it’s time for a plan refresher.

ASk yOurSelF THeSe QueSTIONS AS yOu upDATe yOur plAN:

WHere IS IT lOcATeD? In an emergency, not everyone will have access to a com-puter. Paper can be carried and copied, so

require crisis team members to keep a hard copy at their desk and home residence.

WHO IS ON THe TeAM? Identify members of the crisis team and describe their roles in writing. Include contact info for all team members, including cell numbers. Assign one dedicated spokesperson, one employee to field media calls and one to handle internal communication. Determine back-ups for each role.

WHAT Are yOur key MeSSAgeS? Have messaging ready for the most common types of crises:

✔ Natural disasters (floods, tornadoes, blizzards)

✔ External emergencies (bombs, chemical exposure, multiple victim accidents)

✔ Business scandals (fraud, theft of medical data, equipment recalls)

✔ Workplace violence (shootings, child abductions)

IS IT SIMple? During times of crisis, people need a document that is easily

understood, so address only the critical issues. If your crisis plan has appendices, put them in standalone documents.

What is your social media strategy? Here’s yet another reason to have an active Facebook and Twitter presence. If you have a good following, you can quickly update your employees, patients, families and the media during an emergency. There’s no need to create a new page for a specific crisis; experts recommend using existing pages. People will respond at all hours, so have a 24/7 dedicated social media team member, too.

WHeN DO yOu upDATe THe plAN? After your initial update, plan to revisit at least once a quarter. ■

for further tips, visit www.prsa.org and search crisis plans.

TAnA TipTon is a marketing specialist at

Cassling, a Midwest health-care company

that provides local imaging equipment sales

and service, and marketing and professional

services.

it has the makings of a perfect healthcare storm. as the number of babies continues

to rise, so does the number of baby boomers with age-related health issues. at the

same time, the number of medical students choosing careers in primary care – the

gatekeepers with the expertise to care for patients on both ends of the spectrum

– has been steadily declining. The american academy of family physicians warns that

the combination could result in critical primary care shortages nationwide by 2020.

“It has gotten increasingly difficult to find primary care physicians to join our practice,” says David Barnes, MD, of Yankton Medical Clinic, PC. Dr. Barnes, who has been with the clinic since 1993, has seen the problem firsthand. He is one of four family physicians – a number that hasn’t budged for four years, despite a steadily growing patient base.

“My partners and I are getting pretty tired of taking every fourth call,” says Dr. Barnes. “We have been trying to find someone for a long time. We do have someone coming in a year from now, but there are no other applicants on the horizon.” Had his own daughter not pursued a career in medicine and joined the clinic as an Internist last year, Dr. Barnes says that department would likely still be looking for another doctor, too.

“Probably once a day I have an email in my inbox from a recruiting company,” says Krista Hoyme, DO, a third year resident with the Sioux Falls Family Medicine Residency Program. “The need is huge. You could probably pick any city, anywhere, and find a job.”

Unfortunately, that kind of demand also means that less desirable cities and towns are losing out. “I think we are definitely seeing a shortage, especially in the rural areas,” agrees former USD Med School

the Fate of Primary Careby Alex Strauss

ABOVe

DO’s Dr. Chris boschee and Dr. Myles Zephier,

former Sioux Falls Family Medicine residents

Dr. David barnes, family practitioner,

Yankton

rIgHT

Dr. roberto “bob” Anel, family practitioner, Salem

We do have someone coming in a year from now, but there are no other applicants on the horizon.

We need more people, but we are asking them to work harder for less money. A lot of people wonder if that is really something they want to do.

“

“ ”

”

leFT

Dr. Wallace “Skipper” Fritz, family practitioner, Sioux Falls

rIgHT

Dr. David barnes, family practitioner,

Yankton

12

dean Rodney Parry, who recently retired after 36 years. The school has a stated goal of turning out more primary care doctors, especially those willing to serve underserved areas. Although their number of primary care graduates this year was just under the national average (37% vs. 39%), 12% of USDSM graduates did choose family medicine. Nationally, the number is just 8%.

Primary vs. SubSPeCialty Care

The American Academy of Family Physicians defines a primary care physician as “a gen-eralist physician who provides definitive care to the undifferenti-ated patient at the point of first contact and takes continuing responsibility for providing the patient’s care”.

The idea of continuing or longitudinal care sets primary care apart from other specialties. It is also why a growing number of primary care clinics are positioning themselves as a

‘”Medical Home” for patients throughout their lives.

“We can take care of a large percentage of problems that come in,” says Dr. Barnes. “Especially if it is a patient that I have had for several years, I might be able to make a decision without having to run a lot of tests. It is more efficient and cheaper for me to rule out things before they get to the specialist. Then by the time they get to the specialist, they probably really do need more extensive testing. And the spe-cialist can concentrate on what he or she went to school for.”

“A lot of specialists are over-whelmed and overworked,” adds Dr. Hoyme. “Primary care pro-viders should be the first in line because so many things can be taken care of by us.”

Many health plans do require patients to start with a primary care provider, but that can be easier said than done. According to a 2011 study in the Archives of Internal Medicine, only 264 U.S. medical students chose residency training in internal medicine (which make up about

half of the country’s primary care providers) compared to 575 in 1999. Which means that, instead of finding a medical ‘home’, many patients are likely to find themselves ‘homeless’.

Why the Shortage?

Not surprisingly, one of the major reasons cited for the decline in primary care is money. With the average medical student leaving school with a debt in excess of $156,000 (according to the AMA) and the income gap between primary care and subspecialists widening, some students feel they don’t have much choice. Medicare reim-bursements will likely continue to be reduced and insurance companies will follow suit with decreases of their own, making the prospect of paying off debt, while simultaneously trying to start a life, daunting.

“As student debt goes up, due to increased tuition and other costs, the student’s ability to choose primary care declines,” says Dr. Parry. “Even if they

I think we are definitely seeing a shortage, especially in the rural area.

“ ”

Part i

Dr. Sam Schimelpfenig

leFT

Dr. Angela Meyer, family practitioner, Sioux Falls

leFT

Dr. Pastel Fligge, former Sioux Falls Family Medicine resident.

rIgHT

Dr. rick Kooima, pediatrician, Sioux falls

Learn what is being done to protect and preserve primary

care and why it matters in Part II of our series,

The Fate of Primary Care, in the July/August issue

of MED.

rodney Parry, MD, retired dean, USD Sanford School of Medicine

rIgHT

Dr. Chris bell and Dr. Earl Kemp,

family practitioners, Sioux Falls

Midwest Medical edition

want to, they may not be able to afford it.”“We need more people, but we are asking them to

work harder for less money,” says Sioux Falls pediatri-cian Sam Schimelpfenig, whose patient base – like that of all pediatricians – is growing rapidly. “A lot of people wonder if that is really something they want to do. So it becomes harder and harder to attract good people.”

The body of knowledge needed to practice primary care, the long hours (Barnes often doesn’t get home until 9 pm) and the fear of being sued, can also be deterrents.

“It is difficult to stay up on so many things,” acknowledges Dr. Barnes, who keeps himself up to date in part through regular interaction with specialist colleagues. “There are just not enough hours in the day to keep up on everything.”

“Students often like the idea of being an expert in something,” adds Sioux Falls Family Practitioner Scott Boyens. “But it is very hard to feel like an expert in family medicine. We have to know a little bit about a lot of things and we have to know when to call for help. Specialists sometimes end up being the heroes. But because there is so much to it, family medicine needs to attract some of the smartest students.”

But those students may have to cope with the per-ception among their peers that primary care is somehow ‘lesser’, lacking not only the salary but also the prestige of a subspecialty.

“It is not something that is really talked about, but I think there is an attitude that is ingrained in some of the training programs that primary care is somehow second rate,” says Dr. Barnes. “It gives the impression that you are more important to the medical profession if you specialize.”

Dr. Hoyme agrees. “There is somewhat of an atti-tude like ‘Oh, you’re just going into primary care.’”

PreServing the ProFeSSionAs physician shortages and rising healthcare costs

make the ‘gatekeeping’ function of primary care more critical than ever, what can be done to preserve it? The Sanford School of Medicine is addressing the problem from several angles. The curriculum has been revamped to give more students experience with ‘longitudinal care’, the kind often delivered by primary care providers over the course of a patient’s life, earlier in their medical school career.

“Many, many students make their decision based on their role models,” says Dr. Parry. “This is part of why we are trying to introduce the clinical com-ponent early, so that they can establish those relationships.”

Another way the school tries to boost the number of primary care graduates is by selecting those whose personality type makes them more suited to it. Students who have diverse interests and those who embrace volunteerism are often good bets. And every USDSM student spends a month in a primary care setting, usually in a smaller community.

“I always tell students, choose a specialty where you fit, personality wise,” says Dr. Boyens. “Because those are the people you are going to have to work with every day. . . I am with family docs all day – They are my people.”

Most primary care physicians tend to talk with passion about the diversity of their daily experience and the satisfaction of getting to know patients well and partnering with them over the long haul to preserve and improve their health.

“At least I know that I’m guaranteed a job,” says Dr. Hoyme, who remains positive about her prospects. “If it truly is where your passion is, you have to do it and not worry about the financial side.” ■

It is very hard to feel like an expert in primary care. You have to know a little bit about a lot of things . . .

“ ”

Dr. Scott boyens

ABOVe

Dr. Courtney Moose, family practitioner, Sioux Falls

The need is huge. You could probably pick any city, anywhere, and find a job. – Dr. Krista Hoyme, resident

“ ”

BelOW

Dr. Shawn Culey, family practitioner,

Sioux Falls

leFT

Dr. Heidi Feistner, family practitioner, Sioux Falls14


Sanford Children’s team is a family of pediatric specialists who offer additional expertise to physicians in need of compassionate, partnered care for their

patients with ear, nose and throat conditions.

Dr. Patrick Munson is the only fellowship-trained pediatric ENT physician in the region. He specializes in treatment of cleft lip and palate, birthmarks and vascular anomalies.

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It’s hIt or mIss when you refer your patIents to a famIly practIce clInIc — sometimes they can get an appointment that same day, other times they have to wait a week or two before they can be seen.

At Midwest Family Care, a division of Sioux Falls Specialty Hospital, we’re focused on providing innovative and per-sonalized care for every member of the family. And, when it comes to care, we want to make it convenient. That means your patients can call us and get same-day appointments — and we even have extended hours upon request. Our specialists provide primary care, prevention and disease man-agement to ensure your patients receive comprehensive care when they come in for

a visit. If they do need further care, we can refer them to Sioux Falls Specialty Hospital for any surgery, pain management or imag-ing needs.

It isn’t our intention to be the biggest healthcare facility, but we do want to be the best. What that means for your patients is more time with a provider. By the end of the appointment, our providers really know their patients because they’re not rushed and have more time to make an informed diagnosis.

When you want innovative and personal-ized care for your patients, think Midwest Family Care. We’re at 719 East 19th Street in Sioux Falls. We’re open Monday through Friday, 8 a.m. to 5 p.m. with extended hours available upon request. ■

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Nursing News from around the region

The Nurses’ Station

SOuTH DAkOTA STATe uNIVerSITy grADuATeD 251 NurSINg STuDeNTS – A recOrD NuMBer – AT VAriOUS LEVELS iN brOOKiNGS AND rAPiD CiTY MAY 5. The previous record for SDSU nursing graduates in a single year had been 250 set in 2010. This spring’s graduates total 80 from the traditional Brookings program and another 42 at Rapid City. In addition, another 79 students earned their bachelor’s degree through RN Upward Mobility, an online program that allows practicing nurses to gain their four-year degree. Another 40 received master’s degrees while seven earned a Doctor of Nursing Practice and three received a Doctorate of Philosophy (PhD) in nursing. After earning their undergraduate degrees, about 93 percent of SDSU nursing students pass the national licensure exam on the first try. A hundred percent of graduates pass on the second or third attempt. ■

raPId CIty nurSe reCognIzed

For 20 yearS oF CertIFICatIongleNDA VIce, A clINIcAl reSOurce NurSe in the Intensive Care Unit at Rapid City Regional Hospital (RCRH), recently received national recognition for consistently main-taining Critical Care Registered Nurse Certification through the

American Association of Critical Care Nurses (AACN) for the past 20 years.Vice has been employed at RCRH for 31 years. She is one of only 1,611 nurses in the

country being honored this year by the AACN for having 20 years of certification.“Glenda exemplifies a strong dedication to nursing,” said Rita Haxton, Vice President of

Patient Care at RCRH. “She provides excellent care to every patient she comes into contact with and is highly respected by her peers.”

CCRN designation indicates advanced knowledge and clinical expertise in the care of acutely and critically ill patients and their families. Vice was also the 2009 recipient of the George S. Mickelson Award to recognize nursing excellence. ■

year oF the nurSe MOre THAN 2000 peOple ATTeNDeD A “yeAr OF THe NurSe” celeBrATION AT THE WASHiNGTON PAViLiON iN SiOUx FALLS ON MAY 3., just three days before the kickoff of National Nurses Week. Sanford Health honored its nursing staff with awards and presented its annual ‘Friend of Nursing’ awards to those throughout the region who help support nursing excellence. Among them were SDSU College of Nursing administrators roBerTa oLSoN and SaNDra BUNKerS. Olson, the college dean, and Bunkers, the head of graduate nursing, were among nine educa-tors to receive awards. More than 50 nurses were honored at the Sanford nurse appreciation event, where Captain Chesley ‘Sully’ Sullenberger, the pilot who landed a jetliner in the Hudson river, was the great speaker. National Nursing Week culminated on May 12, the birthday of Florence Nightingale. ■

rObErTA OLSON SANDrA bUNKErS

IN recOgNITION OF NATIONAl NurSeS Week, May 6th–May 12th, HCPro is offering nurses a special white paper examining the image of Nursing and practical strategies nurses can employ to elevate their image and dis-play their professionalism and clinical excellence. The white paper is compiled from the book, The image of Nursing: Perspectives on Shaping, Empowering and Elevating the Nursing Profession by Shelley Cohen, rN, MS, CEN, and Kathleen bartholomew, rN, MN, with contributions from nursing experts in the field and comes with a free Con-tinuing Education (CE) unit. To access

the white paper, nurses may visit http://www.hcpro.com/register/sEO110189. ■


PAUL CArPENTEr, MD, of North Central Heart Institute in Sioux Falls has been recognized for his work as a professor at the University of South Dakota’s Sanford School of Medicine as the 2012 recipient of the school’s Clinical Faculty Award.

Dr. Carpenter is a clinical professor in the Department of Internal Medicine, and has been a faculty member for 30 years. His colleagues respect his commitment to teaching future physicians.

“When I was a medical student at USD, Dr. Carpenter continuously demonstrated professionalism, respect for the patient and excellence in teaching, which played an

important role in my decision to pursue cardiology training,” says cardiologist Elden Rand, MD, who joined North Central Heart last year. “He continues to be an excellent role model for physicians and physicians-to-be.”

Dr. Carpenter is one of the founding phy-sicians at North Central Heart Institute, where he has worked since it opened in 1981. A graduate of the University of Minnesota, Dr. Carpenter completed residencies in inter-nal medicine and cardiology at Northwestern Hospital in Minneapolis. He is a fellow with the American College of Cardiology and the American College of Chest Physicians. ■

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UbM MEDiCA’S PHYSiCiAN’S PrACTiCE 2012 Staff Salary Survey reveals that with nurses in high demand, America’s medi-cal practices started paying a premium for their services last year, even as pay for most other clinical and administrative support staff stagnated or declined.

Nurses and nurse managers saw average salary increases of 4 percent and 12 percent according to the survey, for which results were released in print and online this month in Physicians Practice and PhysiciansPrac-tice.com. More than 1,260 medical practices around the country provided compensation data during the fourth quarter of 2011 on nine specific clinical and administrative support job titles.

Some interesting trends concerning non-physician providers are seen in the latest salary data:

♦ The highest-paid non physicians on staff are physician assistants, earning an average $84,000, followed by nurse practitioners, at $83,000.

♦ Nurse practitioners enjoy more opportunities, with 35 percent of practices employing one compared with only 25 percent of practices who employ a physician assistant.

The Staff Salary Survey provides data nationally and in six individual regions on compensation for nurses, nurse managers, nurse practitioners, physician assistants, medical assistants, front-desk staff, medical billers, bill-ing managers, and medical records clerks. The Survey also details salary levels for each posi-tion at five discrete levels of experience. ■

Sioux falls Doctor receives Med School Awarduniversity recognizes paul carpenter, MD,

for excellence in TeachingSurvey reveals nursing Salary Increase


Dr. leylAND-JONeS

Bryan Leyland-Jones, MB BS,

phD, most recently served as

the associate vice president

and director of the emory

einship Cancer institute. Before

joining emory in November

2006, Dr. Leyland-Jones was

the Minda de Gunzberg Chair

in oncology and professor of

medicine at McGill University

in Montreal, Canada.

Dr. Leyland-Jones holds bio-

chemistry, medical and doctoral

degrees from the University of

London. following residency

training at Hammersmith,

Brompton, St. Bartholomew’s

and London hospitals, he com-

pleted a clinical pharmacology

fellowship at Cornell University

and a medical oncology fellow-

ship at Memorial Sloan-Kettering

Cancer Center. He then joined

the academic staff at Memorial

Sloan-Kettering Cancer Center

and New York Hospitals with a

special research interest in

early clinical evaluation of new

anti-cancer compounds.

He has authored more than

150 peer-reviewed articles and

book contributions, 200

abstracts and 34 patents.

New Director sAys genome Sequencing next for breast Cancer AboutTHe NeWly-HIreD DIrecTOr OF THe eDITH SANFOrD BreAST cANcer ceNTer,

A cANcer geNOMIc reSeArcH prOgrAM AND STATe-OF-THe-ArT cANcer

ceNTer, SAyS BreAST cANcer TreATMeNT IN SIOux FAllS IS ABOuT TO

uNDergO A SeA cHANge.

BriAN LEYLAND-JONES, Mb bS, PHD has done groundbreaking work as a breast cancer researcher and clinician and is internationally known for his leadership in the development of novel clinical trials and the role of genomics in individualizing breast cancer therapies.

“We live at a pivotal moment in cancer research, when the interface of deep genomic profiling and targeted therapies has the potential of transforming breast cancer,” said Dr. Leyland-Jones, who points out that breast cancer is one of the most genetically-driven of all cancers.

“In the past ten to twelve years, we have been able to identify more and more of the genes driving breast cancer,” says Dr. Leyland-Jones. “Our knowledge base has grown, the technology for discovering the genes has grown, and the cost of doing so continues to come down.” Like many of his colleagues, Dr. Leyland-Jones predicts that it will be possible to sequence an indi-vidual’s entire genome for $1000 within the next few years, opening the door to a revolutionary treatment approach for breast cancer at Sanford.

“Our goal is to try to sequence the genes of every patient with metastatic breast cancer,” says Dr. Leyland-Jones. “When we can detect the drivers, the patient can be treated with drugs that specifically target those drivers.” University of Michigan researchers estimate that 60 percent of breast cancer patients whose genome is sequenced have genetic drivers that could benefit from an individualized treatment approach. In explaining the significance of such studies, Dr. Leyland-Jones likes to quote Gabriel Hortobagyi, MD, in a 2005 Editorial in the New England Journal of Medicine:

“ Clearly, the results reported in this issue of the Journal are not evolutionary but revolutionary. The rational development of molecularly targeted therapies points the direction toward continued improvement in breast cancer therapy. Other targets and other agents will follow.”

“We have the knowledge, the techniques, and even the cost-effectiveness,” says Dr. Leyland-Jones, who also hopes to help Sanford achieve NCI Cancer Center designation. “Now, we want to bring this revolutionary approach to breast cancer treatment to patients in this community. We plan to do that not only in Sioux Falls, but throughout the entire Sanford network.” ■

by Alex Strauss

GENETiC rESEArCH CONDUCTED by the Avera Institute for Human Genetics (AIHG) in Sioux Falls in conjunction with the Netherlands Twin Register (NTR) has yielded information that could revolutionize the treatment of ADHD in children.

Genetic analyses at AIHG of identical twins from NTR shows that identical twins can have different DNA, disputing the long-held belief that they are truly the same on the genetic level. The study has been accepted for publication in the European Journal of Human Genetics.

The research focused on DNA copy number variations (CNVs), differences in the number of chromosomal regions in DNA that have been recognized as major contributors to human genetic variability. The research teams at the Avera Institute for Human Genet-ics and the Netherlands Twin Register, in collaboration with colleagues from the University of Vermont, studied CNV differ-ences between identical twins to understand

whether these differences could contribute to attention disorders.

Sets of twins were identified in which one twin has an attention disorder while the other is healthy. Genetic analysis revealed CNV regions that differed between the affected child and the twin sibling.

“These findings may someday enable a means to identify risk for attention problems in children and allow for early environmental intervention, such as music or team sports, to possibly prevent the manifestation of ADHD,” notes Erik Ehli, author of the research results.

Ehli’s colleague in the research, Abdel Abdellaoui, MS, of Vrije University in The Netherlands says further study is need to understand how CNV’s increase the risk of disorders such as ADHD and how common such genetic differences between identical twins are. The article was co-authored by Gareth Davies, PhD, of AIHG, and Dorret Boomsma, PhD, of Vrije University. ■

New regional Breast cancer Network and registryTHE AVERA CANCER INSTITUTE is collaborating with the Eppley Cancer Center at the University of Nebraska Medical Center to form a new regional Breast Cancer Network & Collaborative Registry (BCCR). The network and reg-istry are designed to bring cancer experts together, and gather patient information and tissue samples in order to develop prevention and treatment strategies to combat breast cancer.

Goals of the network and the BCCR are to help researchers and clinicians identify factors that influence breast cancer risk and survival, and provide data for evaluating the impact of the disease and treatments on survivors’ quality of life.

INITIATIVeS OF THe Bccr:✘ Whole genome analysis to assist

physicians in making treatment recommendations for patients

✘ An e-Breast Cancer Registry to provide patients with personalized cancer prevention and control information

✘ An e-Breast Cancer Conference, in which patient cases are reviewed by a multidisciplinary team that collabo-rates on best treatment protocols

✘ e-Breast Cancer Consultation in which breast cancer specialists review cases submitted by oncologists

WOMeN WHO Are AT leAST 19 yeArS OlD AND MeeT ANy ONe OF THe FOllOWINg crITerIA MAy Be ABle TO TAke pArT IN THe regISTry:✘ Have recently been diagnosed

with breast cancer✘ Have a history of breast cancer✘ Are at high risk of developing

breast cancer✘ Have an immediate family member

who has been diagnosed with breast cancer

More information is available at www.AveraResearch.org.


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Quarter Page Horizontal 3.875 x 5.275 MAR 2012 ISSUE - FINAL 2012-02-02_Layout 1 2/2/2012 9:41 AM Page 1

adhd breakthrough?

avera Study reveals Twin DNa

Can Differ

By John Knies

“ I have always done things with numbers in my head…. I love the symmetry, geometry and mathematics of knitting.”

photo by Kristi Shanks24

Medicine&ArtsLife is short but art endures —Hippocrates

&er doctor Artful Knitter

Mary Helen Harris, MD

MAry HeleN HArrIS SAyS SHe doesn’t remember when she learned to knit, but she can’t forget the day she learned to purl.

“I distinctly remember that we were at my grand-ma’s house in Orient, South Dakota,” she recalls. “It must have been a Sunday because we were there for dinner. I had gone to sit through an open archway and I remember getting so frustrated with purling that I just threw a fit. And I remember everyone around the table looking at me.”

The fit notwithstanding, Dr. Harris did learn to purl, (knitting’s trickier sister stitch) in a big way. By junior high school, she’d progressed beyond dish clothes and mittens to making elaborate Barbie-sized garments. (“They were my first ‘real’ garments,” she laughs.) Today, the girl who knit her way through med school, motherhood and a career in Emergency Medi-cine owns her own knit shop – a longtime dream. She remembers her grandma’s cedar chest of yarn scraps as the spark that both ignited her creativity and engaged her mathematical mind.

“I have always done things with numbers in my head. . . . watching for patterns on the odometer, remembering phone numbers,” says Dr. Harris. “So, in addition to the creative side, I love the symmetry, geometry and mathematics of knitting. I’m much more likely to do patterns that I make up myself. And I love the exploratory nature of trying something new to see what’s going to happen.”

As a fashion-savvy co-ed at USD, Harris honed her artistic sensibilities on skirts, scarves and hand-bags, experimenting with novel combinations of colors and fibers.

“Like all art, it is not as much about the object itself as it is about the conversation that people have with it when they look at it, or experience it. Different people are going to experience a knitted object in different ways,” says Dr. Harris. “Art is always interactive.”

Although there may not appear to be much cross-over between knitting and medicine, Harris believes her own interaction with her art may have helped her manage the stress of Emergency Medicine for so many years.

“It is unusual for people to stay in it for their whole career. The hours are bad and it’s hard on your health. So anything that lowers your blood pressure and slows your heart rate is a good thing. Maybe knitting is the reason I was able to work in the ER until I was 60,” says Dr. Harris. She now works in acute care two shifts a week, and indulges her passion for knitting by running her eclectic knit shop, Athena Fibers, in Sioux Falls.

“I knit for the shop a lot and I love trying the same pattern with different yarns,” explains Harris. “I’m on a Lintilla scarf kick right now. I first knitted it on some beautiful yarn I found in Seattle, then with a papery Japanese yarn in our shop combined with a fine, nubby wool. Now I’m making it out of sock yarn. I love to explore how it changes.”

But, for Harris, there is even more to knitting than relaxation and creativity. Knitting, she says, also helps her access deep, intuitive parts of her brain. In effect, it makes her smarter.

“When I knit while I am listening to something, I am better able to make connections and see patterns,” says Dr. Harris, who has lately also taken up spinning her own yarn on an old-fashioned ‘Rumpelstiltskin-style’ spinning wheel, a pursuit she finds equally relaxing and creative.

“In The Zen of Knitting, it talks about the fact that people who knit exhibit the same kind of brain changes on EEG as people who are meditating and I can really sense that. I can have a problem that I’m trying to work through and I’ll start a pair of socks. By the time I have finished those socks, I have often figured out an answer!”

Either way, thinking while knitting is a no-fail approach for Harris. If she still doesn’t get an answer, at least she has a great pair of socks. ■

M

25

Geoffrey Tufty, MDPediatric OphthalmologySanford Eye Center and Optical

Sanford Children’s team is a family of pediatric specialists who offer additional expertise to physicians in need of compassionate,

partnered care for their patients with eye conditions.

Dr. Geoffrey Tufty is the only fellowship-trained pediatric ophthalmologist in the region. He specializes in the diagnosis, treatment and management of diseases and infections of the young and developing eye.

For referral information or to refer a family, call (605) 328-9200.

sanfordhealth.org

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MED: The idea of a department focused on integrative therapies was part of the Avera Cancer Institute’s plan for the Prairie Center since the beginning. Why?

MJ: When our body is under stress, such as during cancer treatment, it really goes into fight or flight mode. Over time, we know that the stress hormones released can be damaging

and many illnesses are linked directly to stress. At the very least, stress does nothing to help healing. On the other hand, research continues to show us that, when a body is calm and relaxed, it is more able to focus on healing. That is the main goal of our complementary therapies; to bring people back to a level of balance so that their bodies can do what they are intended to do, naturally.

MED: You offer everything from mind-body movement and massage to art therapy, aromatherapy and acupuncture. How did you choose the services that would be offered at ACI?

MJ: We were looking for things that would not only address stress for our patients, but also things like pain, nausea and insomnia. Everything that we chose to offer here was brought before an integrative medicine committee that included oncologists and other providers and the answer was always the same – if there is some evidence that it might be effective, and it is not going to harm the patients, we are OK with it.

MED: Was there concern about the lack of scientific evidence for some of these services?

MJ: It is true that the amount and quality of scientific research behind some of these things is often not at the level that practitioners would like to see. Unfortunately, there is not a lot of funding available for this kind of research. Thank-fully, the NIH is being proactive about this through the newly formed National Center for Complementary and Alter-native Medicine (NCCAM). This gives providers some tools for learning about these approaches. I think it has helped make more physicians aware that, even though the scientific evidence may not be there yet, there may still be merit to these. Ultimately, they want to do whatever they can to support their patients during their treatment.

MED: What are some examples of specific ways integrative medicine can help cancer patients?

The concept of complementary or alternative

therapies is gaining momentum as patients

search for new ways to maintain or regain health

in the face of rising healthcare costs. As a result,

the number of alternative medicine practitioners

and programs in the South Dakota region has

also grown dramatically. Some are offered

within a traditional healthcare setting, while

others are free-standing businesses. in this new

column, we take a closer look at some of the

new (and sometimes ancient) therapies being

offered in our region and meet the people who

practice them.

Name

Marcia JonesTiTle

Integr atIve MedIcIne SupervISor

BusiNess

Integr atIve MedIcIne at aver a cancer InStItute

Complementary TherapySupporting a Holistic approach


MJ: Hand or foot massage can help reduce anxiety for people receiving chemotherapy. If they are feeling nauseous, we can bring them aromatherapy oil, such as peppermint or ginger, which has been shown to reduce nausea. This has been shown to have an effect on the sympathetic nervous system via the limbic system. We had a patient recently who had radiation for head and neck cancer and had a great deal of tension in the neck. Dr. Dawn Flickema was able to administer acupuncture that greatly reduced the patient’s pain and stiffness. A lot of holistic treatments come down to quality of life. ■

NOTe: Many integrative Medicine services at aCi, such as yoga, tai chi and acupuncture are available to the public. a list of services is available at www.averaCancer.org by clicking on integrative Medicine.

We have South Dakota’s only two fellowship-trained breast radiologists. In July, we welcome a third. Their extensive training and expertise means better care for your patients including earlier detection of cancer, fewer false positives and a more precise diagnosis. We are proud to help patients recognize victories through every stage of their cancer journey.

For mastery, innovation and personalized care.

Breast Health Institute (605) 328-5244cancer.sanfordhealth.org keyword: breast imaging

For all the you seekFellowship-trained breast radiologists at Sanford Cancer

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Melinda Talley, MD and Thomas Cink, MD

29MidwestMedicaledition.com

Grape expectations

a midsummer night’s wineby Heather Taylor boysen

June 2012

THE SUN iS FiNALLY SHiNiNG and the temperature is perfect. I can hear my kids playing down the street at a neighbor’s and

my husband is preparing to grill The fra-grance of Lilacs fills the air and hints at what an amazing summer we have ahead of us. At this very moment it is an ideal existence.

The biggest decision I have to make at this moment is what wine I will have while enjoying a pretty close to perfect evening. The hardest part is getting off my chair and actually pouring myself a glass! It’s not often I have a chance to sit down for very long, so I have a tendency to “camp out” when I have a moment to myself. I have actually stocked up preparing for this moment, knowing that one of my favorite summer whites would be calling my name.

I am a “V” girl when it comes to white wines. Certainly I enjoy a Chardonnay, Pinot Grigio or Sauvignon Blanc, but two of my favorite summer whites are Verdicchio and Vermentino. Maybe I have an old soul, because these two whites are some of the oldest white varietals known to exist, and some of the easiest drinking whites I’ve ever had. Both happen to be Italian.

Verdicchio is an Italian varietal that dates back to the 14th century. It is primarily grown in the Marche region of Italy and in

the 1980’s was actually the 15th most planted varietal in the world ahead, of even Char-donnay! As wine drinkers grew more sophisticated, this very simple grape with very simple flavors fell out of fashion.

Rather than let this wonderful wine languish, the winemakers from the D.O.C. Verdicchio dei Castelli di Jesi (denomin-azione di origine controllata) took great care to perfewct their craft and improve grape quality. The end result is a wine with an acidity that will actually improve greatly with age. A young Verdicchio is light, fresh and uncomplicated while an older Verdic-chio can reveal deep stone fruit flavors such as apricots. This wine is a perfect comple-ment to a warm summer day as well as an easy sipper with just about anything.

Another Italian varietal that I love is Vermentino. It is primarily grown in Sardinia and we have been lucky enough in recent years to have begun working with importers who partner with small family vineyards to bring these excellent wines to the United States. I really do think finding some of these wines is like finding trea-sures! The first time I had Vermentino it was like a party in my mouth. Vermentino wines are a pale straw color and relatively low in alcohol, with crisp acids and pro-nounced minerality. The flavors of green apple and lime, heightened by refreshing acidity, good richness and medium body make it a delicious accompaniment to fresh

seafood, oysters on the half shell, or grilled Mediterranean vegetables. Perfect summer fare!

I did bother to get out of my chair and pour myself a glass of wine. The Fazi Batta-glia Verdicchio Classico has gone from refrigerator to glass. The sides of my glass have fogged because I chilled it colder than it should be, but it’s hot out. It will warm up in the glass soon enough. As I sit and lazily swirl the wine in my glass I think of the other “V” wines I must add to my tast-ing list including Verdelho and Viognier. Well, those are for another day. Hopefully one as beautiful as this. ■

“�This�wine�is�a�perfect�complement��to�a�warm�summer�day�as�well�as�an��easy�sipper�with�just�about�anything.”

THE CHiLDrEN’S CArE HOSPiTAL & SCHOOL bOArD of Directors has named former Eide Bailly CPA Dave Timpe as interim Chief Executive Officer following the resignation of former CEO Dianna Rajski. Timpe took over duties on May 10th.

Timpe, a Sioux Falls-area resident for 35 years, has been a member of Children’s Care Hospital & School Board of Directors since 2008. He retired after 37 years of public accounting in 2007 and has acted as interim CEO of several other organizations since his retirement, including Avera Sacred Heart Hospital in Yankton and Brookings Health System in Brookings.

Timpe currently serves on the board of First Bank and Trust NA, on the board and finance committee of Avera Health Plans, and on the Lloyd Companies Advisory Board. He is an active member of the Healthcare Financial Management Association (HFMA)-South Dakota Chapter and is a recipient of the Morgan Award, HFMA’s highest recognition for individual achievement.

Timpe will serve full-time at Children’s Care until a new CEO is hired. ■

ChILdren’S Care names Interim Ceo


REHABILITATION CENTER1020 W. 18th St., Sioux Falls, SD 57104 • www.cchs.org

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News & NotesHappenings around the region

AverAThe marketing department for Avera McKennan Hospital & University Health Center has won six national Aster Awards through an elite competition recognizing the health care marketing professionals for excellence in advertising. Judging criteria includes creativity, layout and design, functionality, message effectiveness, production quality and overall appeal. Avera McKennan received two gold awards and four silvers. The 2012 Aster Awards received approximately 3,000 entries from across the United States as well as Canada and South America.

Dr. Lewis Ofstein, Dr. bruce Watt and registered Nurse Kelli Willging have been named “Guardian Angels” by the Avera McKennan Foundation. The Guardian Angel program allows grateful patients and families to honor health care workers, staff and volunteers. Guardian Angels are outstanding caregivers who made a difference during the patient’s time at Avera.

The McHale institute, led by Hematologist/Oncologist Michael McHale, MD, has joined Avera Medical Group. The

McHale Institute will remain in its current location at 3720 W. 69th Street in Sioux Falls and Dr. McHale will continue his outreach in all existing regional locations. He will also continue his appointed academic position as clinical associate professor of internal medicine and division chief of hematology at the University of South Dakota Sanford School of Medicine.

The Avera brady Health and rehab capital campaign, ‘Connecting the Past to the Future,’ has received a $275,000 pledge from an anonymous local donor whose spouse stayed at Avera Brady Health and Rehab. With the new donation, more than $650,000 has been raised to support a building and remodeling project, which is set to break ground in early fall. The project includes 17 new rooms and remodeling of the smallest existing double rooms into singles. The facility is also adding a pub and parlor, a theatre, a new therapy center, and an updated beauty salon.

regionAl:The regional Sleep Health Center, a department of rapid City regional Hospital, was recently reaccredited by the American Academy of Sleep Medicine. The five-year accreditation is voluntary and promotes the development of best practices in sleep medicine. Standards for Accreditation ensure that sleep medicine providers display and maintain proficiency in areas such as testing procedures and policies, patient safety and follow-up, and physician and staff training.

regional Heart Doctors Cardiologist Jose M. Teixeira, M.D., was recently inducted as a Fellow at a Heart

Rhythm Society special ceremony in Boston, Mass. Fellowship is the highest level of membership in the Heart Rhythm Society. It is bestowed upon the most esteemed members for significant achievements, service and prominence in the field of cardiac arrhythmia. Fellows are elected by vote of the Society’s Membership Committee.The numbers are in. The Hospice Benefit Ball at the Spearfish Convention Center on March 3 raised more than $37,000 for

Hospice of the Northern Hills patients. This year’s theme was “Crystal Ball” and featured live and silent auctions, live music and an elegant four-course dinner. Auction items were donated by nearly 300 area business and individuals and ball expenses were supported by local sponsors. Pictures from this year’s event can be seen at www.RegionalHealth.com/HospiceBall.

rapid City regional Hospital’s Hospice of the Hills program was recently awarded Level One status by the ‘We Honor Veterans’ Partner Program for their end-of-life care to veterans. The National Hospice and Palliative Care Organizations in collaboration with the Department of Veterans Affairs launched ‘We Honor Veterans’, a pioneering campaign to help improve the care veterans receive from hospice and palliative care providers. Twenty-five percent of people who die in the United States are veterans.

rapid City regional Hospital has received the Get with the Guidelines-Stroke bronze Achievement Award and the Get with the Guidelines-Heart Failure Silver Award from the American Heart Association. The recognition signifies Rapid City Regional Hospital has reached an aggressive goal of treating stroke and heart failure patients with 85 percent compliance to core standard levels of care. The different levels reflect the amount of time for which the hospital demonstrates performance. The bronze award recognized performance for 90 consecutive days. The silver award recognized performance for at least a year. Get With the Guidelines is a quality improvement initiative that includes tools such as care maps, discharge protocols, standing orders and measurement tools.

SAnfordSanford USD Medical Center has been named to becker Hospital review’s 2012 list of 100 Great Hospitals to Know. This year’s list features 100 of the country’s most remarkable hospitals that have demonstrated greatness through clinical accolades, innovation, recent capital developments, and new services, specialty programs or technology. To develop this list, the Becker’s Hospital Review editorial team accepted nominations, conducted research and considered other reputable hospital ranking sources such as U.S. News & World Report, Thomson Reuters and HealthGrades. The full list can be found at www.beckershospitalreview.com.

Sanford USD Medical Center has been granted three-year term of accreditation in Echocardiography in the areas of Pediatric Transthoracic, Pediatric Transesophageal and Fetal by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). Accreditation requires a thorough review of a program’s operational and technical components, including detailed case study review by a panel of experts. Each year 35,000 babies (nearly 1 in 100) are born in the United Sates with some type of congenital heart defect, making it the most common birth defect in newborns. It is also the most critical, as congenital heart defects cause more deaths during the first year of life than any other birth defect.


News & NotesHappenings around the region


Joseph Segeleon, MD has been appointed Sanford Children’s Hospital Chief

Medical Officer for Sioux Falls. Dr. Segeleon replaces Eugene Hoyme, MD who was recently named president of Sanford Research. Dr. Segeleon has served as the Pediatric Intensive Care Unit director for many years and has been instrumental in the development of the pediatric practice at Sanford Health. Dr. Segeleon worked as an assistant professor of pediatric intensive care at the USD Sanford School of Medicine from 1997 to 2002. He returned to South Dakota in 2005 as associate professor of pediatrics, chief division of pediatric critical care medicine and was promoted to professor in 2011.

Sanford bemidji has broken ground for a new Sanford Orthopedics & Sports Medicine Center. The two-story, 46,385 square foot expansion to the northwest side of the hospital, is expected to open in spring, 2013. Kraus-Anderson Bemidji has been named the general contractor for the approximately $9 million construction project. The Orthopedic & Sports Medicine Center will integrate the services and clinicians from Sanford Bemidji orthopedics, sports medicine and rehab/Peak Performance therapy services to a central location within the hospital.

Sanford breast Health institute has been granted a three-year/full accreditation by the National Accreditation Program for breast Centers (NAPBC), a program administered by the American College of Surgeons. Sanford Breast Health Institute met 27 of 27 standards to receive NAPBC accreditation. The NAPBC is a consortium of professional organizations dedicated to the improvement of

the quality of care and monitoring of outcomes of patients with diseases of the breast. The standards include proficiency in the areas of center leadership, clinical management, research, community outreach, professional education

and quality improvement.

Eva A. May and Chris Orzechowski have been added to the leadership team at Edith Sanford breast Cancer Foundation. May will serve as vice president of marketing and Orzechowski as vice president of branding and communications. May earned her MBA in marketing and finance from Columbia University and a Bachelor of Arts in English from the University of North Carolina, Chapel Hill. Orzechowski holds an MLA from Southern Methodist University and a BFA from the University of North Texas. Edith Sanford Breast Cancer Foundation has a mission to unlock each women’s genetic code, advance today’s prevention and treatment, and eradicate breast cancer.

william James watson md.7/10/1954 to 5/12/2012

MATERNAL FETAL MEDICINE SPECIALIST Bill Watson, MD, died May 12th of pancreatic cancer. Dr. Watson worked for Sioux Valley Clinic Ob/Gyn Ltd. from 1991 and served as Chair of the USDSM Department of Ob/Gyn before moving to Mayo Clinic in 2003. He served as Chair of Maternal Fetal Medicine at Mayo and was director of the May Clinic Family Birth Center. Dr. Watson and his wife moved back to Sioux Falls this year to be near family while battling pancreatic cancer. He was 57.

other

Yankton Medical Clinic, PC, has been awarded three-year accreditation in breast Mri by the American College of radiology. YMC is Yankton’s only facility equipped with Breast MRI. Board certified Radiologist, Will Eidsness, MD, and a fully board certified staff assure patients of quality imaging and the highest possible expertise in reading MRI images. MRI offers valuable information about many breast conditions that may not be obtained by mammography or ultrasound. The ACR accreditation is awarded to facilities meeting ACR Practice Guidelines and Technical Standards.

Also at Yankton Medical Clinic: internal Medicine Physician,

Daniel J. Megard, MD, has been recertified as a Diplomat of the American Board of Internal

Medicine. ABIM Diplomats must continue to demonstrate their competence in the specialty by taking recertification exams every 10 years. Dr. Megard has been in practice at the Yankton Medical Clinic, P.C. since December 1991.

byron S. Nielsen, M.D. has recently become board Certified in Nephrology. Dr. Nielsen is also

Board Certified by the American Board of Internal Medicine. Dr. Nielsen provides the diagnosis and treatment of adult kidney diseases including but not limited to those associated with underlying medical ailments, genetic disorders, autoimmune diseases and vasculitis. He also specializes in the treatment of hypertension, electrolyte disturbances, the medical management of kidney stones, and provides both inpatient and outpatient dialysis.

Steve Gutnik, MD, FACP, board Certified

Gastroenterologist, was recently recognized by Sanford School of Medicine of The University of South Dakota (SSOM) as an Outstanding Faculty member. He has been a faculty member at the SSOM for 25 years and an affiliate of Yankton Medical Clinic since 2000.

The Crohn’s and Colitis Foundation of America, Sioux Falls Chapter, will hold its annual Take Steps Walk-a-Thon on Saturday, June 9th beginning at 4 pm. Registration begins in Falls Park in Sioux Falls at 3:30. Participants can set their own speed and distance around Falls Park. Pre-register online at www.cctakesteps.org.

MED Quotes

I learned a long time ago that minor surgery is when they do the operation on

someone else, not you. ~Bill Walton

Learning opportunities

June 2012

MeD reaches more than 5000 doctors and other healthcare professionals across

our region 8 times a year. if you know of an upcoming class, seminar, webinar,

or other educational event in the region in which these clinicians may want to

participate, help us share it in MeD. Send your submissions for the Learning

opportunities calendar to the editor at [email protected].

June 15 - 16 Black Hills pediatric conference location: The Lodge at Deadwood

registration: childrens.sanfordhealth.org, keyword: BH pediatric Symposium

June 21 Webinar: regulations and risks Inherent in the 12:00 am – 1:00 pm use of Mobile Health Devices and Applications Information: rhonda,[email protected], 605-361-2281 registration: www.SDaHo.org

June 30 Sanford cardiology conference Information: [email protected]

August 13 Avera Behavioral Health Services update9:00 am – 3:00 pm location: avera education Center auditorium Information: www.averaMcKennan.org, click on events Calendar or call 322-8950

September 13 - 14 37th Annual South Dakota perinatal Association conference Location: The Lodge at Deadwood Information & registration: www.sdperinatal.org, 333-5210

September 14 community response to child Abuse Location: Sanford Information: [email protected]

September 21 – 22 Avera cancer Institute Oncology Sumposium Location: avera education Cente Information & registration: www.averaMcKennan.org, click on events Calendar or call 3228950

September 28 Avera Transplant Institute Symposium8:00 am – 2:00 pm Location The prairie Center Information & registration: www.averaMcKennan.org, click on events Calendar or call 322-8950

September, December Sanford perinatal Nurse Fellowship– Multiple Dates Information: 328-6353


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