Thursday, January 31, 2008
How to hang on to a doc

By Anthony Policastro, M.D

In any business the terms recruitment and retention go together. That is what we focused on in the Air Force. That is what is focused on in the civilian world. A few weeks ago, I wrote about the recruitment of physicians to rural areas. That is only half the story. Once a physician is recruited to an area, efforts need to be made to retain that physician in the area. The same is true of support staff at the local hospital. You cannot have one with the other. Therefore, retention is a major player in providing adequate patient care to hospitalized patients. In the outpatient arena, enough physicians need to be retained to have an adequate number to see patients when they are not sick enough to be in the hospital. As you can expect, the amount of things that go into retaining a physician can become a real laundry list. It is different for every physician, however, there are some things that are more common than others. The most important one of those is time. There are not enough hours in the day to accomplish all the things that need to be done. That is true for most of us. It is more so for physicians. When I am on call, I am often running between the nursery and the emergency room and seeing sick outpatients. The phone frequently rings with questions that need to be answered. When I am in the office, taking enough time with patients frequently puts me behind. However, in between patients there are phone calls to answer. There are prescription refills to write. There are letters to send. It is important for patients to realize that they have a responsibility for physician retention. For example, I often will return patient phone calls from home. The line may be busy. I may get an answering machine. Then because of caller ID, I will get a call back from the patient at home. When that happens within a few minutes, it is not a problem. When it happens several hours later, it may interrupt something else I am doing. I may be at the hospital. It may now be the middle of the night. The result is that the patient has an expectation that I may not be able to meet in terms of response. Along the same lines, I will sometimes get calls from patients about their sick children. When I try to arrange to see the child the next day, they indicate that they would like to go to the emergency room that night. I tell them that I do not think it is necessary, but it's their prerogative to do so. They then will ask if I will go to the ER to see their child so they will not have to wait that long when they go. That is not a good way to encourage a physician to stay in a small community. There are demands on physicians that hospitals make as well. Some physicians may see these as reasonable. Some may not. That is especially true when the physician is very busy. A surgeon who is busy in his office with patients might want to do urgent surgery after office hours. The hospital may have its OR's closed at that time. It can present a logistical problem for both. The frequency of being on call will vary with the number of people available at the hospital. The physician may see too frequent call as the result of poor recruiting efforts on the part of the hospital. Demands on a physician's time is only one of the many factors that go into physician retention. Those demands can come from the patients. Those demands can come from the hospital. The other issues affecting retention are just as complicated as this one. The bottom line is that each physician is different. Each of them has different desires and expectations. Therefore, whether they stay in one location for their entire career is a very individual decision. It is no wonder that retention is as big, if not a bigger problem than recruitment in the first place.

Virus found on Felton farm
Dr. Sara Busch, Delaware state veterinarian, was informed that a horse in the Felton/Frederica area has tested positive for equine herpesvirus-1 (EHV-1), a highly infectious viral disease of horses. The horse was euthanized on Jan. 17. Clinical signs of the disease include high fever, neurological symptoms and nasal discharge. The virus can spread through the air, contaminated equipment, clothing and hands.

The State Veterinarian's Office and the owners of the horse are implementing immediate biosecurity measures and protocols to prevent the spread of the disease into Delaware's equine community. The horse farm has been placed under quarantine for a minimum of 21 days. In addition to the index farm in Frederica/Felton, Kent County, there are 5 other horse farms under quarantine orders of the Delaware Department of Agriculture (DDA) until February 7. All of the farms are in Kent County. The five additional farms are located in Dover, Hartley, Camden, and two in Clayton. On these 5 farms, there are 9 horses of interest that are being closely monitored by their owners. Samples were taken from 5 additional horses on the index farm on January 25 and sent to a laboratory for PCR testing. As of 11 a.m., Monday, Jan. 28, there are no reports of any new or suspect cases of EHV-1. Equine herpesvirus type 1 (EHV-1) causes a disease of horses called equine rhinopneumonitis. It is found in horses worldwide but does not affect humans. EHV-1 usually causes respiratory symptoms with fever, but it can also cause abortion, nervous system (neurologic) disease or death. EHV-1 has several different strains, and new strains can develop from natural mutations. These strains or mutations are thought to cause outbreaks of the disease. The virus can spread via contact with an infected animal, through the air, via contaminated equipment, or via a handler's clothing and hands. Veterinarians and horse owners should continue to quarantine suspect and diagnosed cases. Using strict biosecurity measures in day-to-day procedures, even when disease is not suspected, is very important in preventing the introduction and spread of infectious diseases. For more information on EHV-1, contact the state veterinarian's office at 800-282-8685 or 302-698-4500.

Cholesterol screenings planned
Nanticoke Memorial Hospital will be offering cholesterol screenings on February 14, 16 and 21, from 7:30 to 10 a.m. at the Seaford Golf & Country Club, located at 1001 W. Locust St., Seaford. The lipid profile test requires a 12-hour fasting and reads the HDL and LDL blood levels. Cost for the lipid profile is $15. No pre-registration is required. In addition to the cholesterol screening free blood pressure checks will be offered as well as information on Nanticoke's Cardiac Rehabilitation services and Cancer Care services. Results from the cholesterol screening will be mailed approximately two weeks after the test is performed. For more information, call 629-6611 ext. 2404.

CPR classes offered at Del Tech
Cardiopulmonary resuscitation (CPR) basic classes for the general public and refresher courses designed for health care professionals are available at Delaware Technical & Community College, Owens Campus. Parents, teachers, coaches and babysitters are just a few of the people who can benefit from these classes. Healthcare providers whose jobs require CPR certification can take the refresher course to meet continuing licensure requirements. Two separate sessions of CPR Heartsaver courses are offered: one teaches adult (one-rescuer) and the other infant and child techniques. Participants may sign up for either or both. Instruction includes video, discussion, demonstration, skills practice and scenarios. After passing the course, participants will receive a two-year course completion card. The Health Care Provider Renewal course is designed for those who need recertification after prior CPR training. Part one is an online assessment from the American Heart Association website; part two requires attending a skills evaluation session at Delaware Tech within 60 days of completing part one. For complete information about these and other prevention and wellness courses, contact Corporate and Community Programs at 854-6966.

Polar Bear Plunge set for Feb. 3
The Lewes Polar Bear Plunge, one of Delaware's largest fundraising events, takes place on Sunday, Feb. 3 at 1 p.m. The Plunge began in 1992 with just 78 plungers raising $7,000. In 2007, 2,692 bears raised over $500,000. Since its inception, the plunge has raised $3.5 million. For more information on the event, contact Jon Buzby at 302-831-3484, or