Physician Stories

Favourites and must-do's for alla y'all wanting to visit New Zealand

kchen — Mon, 12 Nov 2007 08:36:24 -0700

After a year in locum tenens assignments in New Zealand—hers in family medicine in Otautau, his in psychiatry in Invercargill—Kimball Chen and Amy Mullen have scoped out the highlights of what they call the sweetest place on the planet. From the best half-day hike to optimal weather conditions for a helicopter glacier tour to glow-worms dangling from the walls of a cave, they have made the most of their work and play time. And through the glory that is Google, they have created a detailed map with photos, directions, commentary, and unbridled enthusiasm that is sure to increase tourism in the south island. Ha! Be careful what you wish for, for you may get it!
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After a quick vacation (vacation?) they have returned to work another year in their respective assignments. Click here to view their map and share the adventure.
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ALASKA IN THE SPRING Well…it was supposed to be…

kgudiksen — Mon, 12 May 2008 00:00:00 -0600

I went off to Anchorage to work for three weeks and to find out what spring was like in Alaska. I had been there twice before in August and September and had seen late summer and early fall and had watched the snowline gradually move down the Chugach Mountains. Yes, break-up is over and spring will be getting going, they assured me. Well…

The last 20-30 minutes of the late afternoon flight into Anchorage were past range on range of rugged snow-covered mountains. There was still lots of snow around on the ground, including those dirty late season heaps piled along the roads and at the edges of parking lots. The woman who let me into my apartment, when I made some comment about it looked like a lot of winter was still around, said, “At least the light is back…”

As the days went by things gradually got warmer. The first nights were nearly in the teens but some of the days were getting well into the 50’s. I am still amazed how quickly the days lengthen – more than 5 min. 30 seconds each day. You can notice from day to day. I am also amazed how warm 40-50 can feel. I never would think of walking around here when it is in the 40s with my jacket unzipped. And locals would be appearing in T-shirts and shorts exposing very white legs. Last Thursday I thought I saw the first sprigs of green along the road as I drove home after work.

Then Friday, April 25th dawned. There were a few flakes of snow beginning to come down as I drove to work. It was hovering just about at freezing. They were those big, fat, sloppy flakes we are all familiar with from western Washington. And they kept falling and they kept falling and they kept falling …They stuck to the bushes and the trees and the cars and everything. The parking lot looked like a lot of overstuffed marshmallows when I went out to drive home. I’m not used to driving in snow and ice. We don’t go off to the mountains in the winter here. It was 40+ years ago we moved to California. And, in fact, I had never driven in that much snow. I was scared – even for the 3 or so miles I had to drive to get home. It still was not freezing so there was not any ice down on the road surface. Lots of slush. All seemed to be driving slower and I did get home uneventfully.

Turns out that all this snow is not at all the Anchorage-rule. It kept snowing until there was 15-16 inches in the bowl where most of the city of Anchorage is located It was the most snow ever to fall in an April day and the third most snow to fall in Anchorage in a single day ever in the nearly 100 years they have been keeping track of such things. And it was late. The snow plows had been put in the yard for the summer. They got them out and went to work. Not surprisingly my week-end plans were cancelled. I got my exercise by leaping over ankle deep and more slushy curbside puddles. The days and nights kept warming, most of the snow is now melted and I think that I saw those blades of grass again as I drove home my last afternoon...

And, so it went for another short stay working in Alaska. Thought you might be interested. I certainly find it interesting. Alaska is a different place. They say the rest of us live Outside. We do.

I was sure we were missing something!

jpoole — Mon, 05 May 2008 00:00:00 -0600

I am excited about my future. I will be starting as a hospitalist with Southwestern Vermont Health Care in July. Currently a 3rd year Internal Medicine Resident, and chief resident, at Stamford Hospital in Stamford, Connecticut, I started considering positions last summer. I was considering a fellowship and other hospitalist positions when I received an email from VISTA’s Search and Consulting division about an opportunity in Bennington, Vermont. The opportunity appealed to me because of its location and the drastic change of pace from Fairfield County and I am looking forward to the challenges of a rural hospital, working in an area in need of physicians, and being in a nice community to raise a family.

As for my experience with VISTA, it was so easy, I was sure we were missing something! From the beginning, I was partnered with a dedicated recruiter, Kelley Hekowczyk, who walked me through every step. Kelley helped me prepare for interviews by briefing me on what to expect so there were no surprises. I appreciated Kelley’s knowledge of the job, position, and hospital and I felt that her relationship with the hospital was almost as if she were one of their employees. Her knowledge and the fact that she kept in constant contact with me made the interview and hiring process an easy and pleasant one.

Bennington, here I come!

Musings of a Physician -- Roots

sembury — Sun, 02 Mar 2008 23:00:00 -0700

The bush pilot gunned the engine of the DeHaviland Beaver float plane as it glided across the bay. We gently lifted off from Ketchikan, Alaska, on the final leg of a journey taking me to a five-week locum tenens job in Klawock, Alaska. During the 45-minute flight, I surveyed the stunning scenery of the vast Southeast Alaska wilderness, which spread out in all directions.

Klawock is located on the Prince of Wales Island, which is the third largest island in the US. The island is accessible only via float plane or a once daily three-hour ferry ride from Ketchikan. During the winter months there are many days when the float planes can’t fly due to weather. The island gets 120” of rain yearly, and it has rained nearly every day. The temperature however, is in the low 40s, and we haven’t had any snow yet.

After my first few days of work at the Alisha Roberts Medical Clinic, I discovered that the pace of life in Alaska is much slower than I had anticipated. My wife Lynn came for a visit during my third week. She enjoyed the slower pace which gave her time to reflect after her father’s recent death.

On Saturday, we travelled 30 miles on gravel roads to the village of Kasaan to see the totem park. We hiked through the rainy woods to the park where we encountered more than a dozen antique totem poles, and an old clan house. It was a marvelous experience!

The next day, we went hiking on Cemetery Island. Southeast Alaska is a rain forest so the forest is very damp, and everything is covered with lichen and moss. Along the trail we encountered several large trees that had been toppled. I was struck by the lack of deep roots, which is due to the abundant rainfall, making it unnecessary for the trees to sink deeper roots. The huge uprooted trunks were lying at crazy angles with their flat roots ripped from the earth. It was so striking that I took several pictures of the trees.

During the ensuing week, the sight of those fallen trees kept coming back to me. They could be used as a metaphor of human life. When I was born, my only “root” was the umbilical cord. Then during my childhood and early life my parents and wonderful grandmother Amanda helped me to form some first tentative roots. Then teachers, neighbors, pastors, Sunday school teachers, and other numerous mentors helped those roots to multiply, and sink deeper. These roots gave me a strong foundation to begin medical school where other positive influences continued to strengthen them.

After medical school and internship, my roots continued to be nourished by my lovely wife Lynn, practice partners, colleagues, and other friends and family. Now unlike those toppled trees in the forest, I feel “firmly rooted”, and hopefully I can withstand almost any wind of adversity. Our deep roots make us truly blessed.

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Note: Stuart Embury, MD, has been writing columns for the Cornhusker Family Physician for nearly 20 years. To read more of his work, visit www.nebrafp.org/online/ne/home/publications.html. This article is scheduled to appear in the Spring 2008 issue.

Oh, the places you’ll go (and stay)

bwalklett — Mon, 18 Feb 2008 00:00:00 -0700

One of the most memorable places I have stayed during a locum tenens radiology assignment was a converted carriage house behind the home of a radiologist I was helping out. It was restored with such attention to detail, charming, with a spiral wrought iron staircase. And it was within walking distance of the hospital.

Another time my wife came with me and we stayed in a lovely two-bedroom condo in Vermont. It was winter and it just snowed and snowed. Maybe because we live in Florida, we found it fascinating to watch the snow pile up higher and higher on the railing around our little balcony. It was this narrow strip of snow, growing taller and taller. It seemed to defy gravity. Then the wind picked up and we watched it gradually tilt, like someone pulling on a coat and walking into the wind.

I also have a particular bond with Wyoming. I can’t explain it, but I have a sense that I lived there at one time (and I was raised in Ohio; figure that one out). I was working in Sheridan, a great town, and staying in a guest house. There was a crab apple tree in the yard and every morning a small herd of deer would wander into the yard to eat the windfall apples. I got the bright idea to take a broom and knock down a bunch of apples. The deer came as usual, and then ate so many apples they were all foaming at the mouth. They just plopped down in the yard, so stuffed they were immobilized. I am not sure whether you should mess with nature like that.

The memories go on and on—a bed-and-breakfast apartment in Ketchikan, right on the water. The sunsets were just amazing. I guess I linger on the cozy places like this and try to forget the crazy little hotels I end up in once in a while. But sometimes that’s all there is in a small town and you make do. The rewards of getting to know a new part of the country, filling these radiology jobs and helping out a colleague, always make it worthwhile.

Locum tenens keeps me young

bwalklett — Sun, 10 Feb 2008 23:00:00 -0700

After my internship, I was a Navy flight surgeon for three years. Then I took a Navy residency at Bethesda Naval Hospital and practiced for several years at the Naval Hospital in Portsmouth, VA. I left active duty in 1969 to become chairman of the radiology department at University Hospital in Jacksonville, FL, where I worked with a five-person group for many years. Eventually the group fell victim to political dealings that lead to our break up.

You know, a practice break up is a lot like a divorce. You feel guilty. You have to split up friends and redefine loyalties. But like a divorce, things usually end up much better.

Instead of getting into another permanent radiology job, I decided to try locum tenens. It wasn’t as well known back then—I’ve worked locums assignments for 20 years! But it did more for me than I ever expected.

You don’t always realize how much you are giving up to run a practice—how much time you are spending away from home, how many hours you have to work to cover your overhead. Locum tenens radiology jobs get you back to what you enjoy—pure medicine. Your hours are set and you know what to expect up front from each job. Your professional liability insurance, travel, housing, and rental car are paid for, so what you earn is essentially free and clear. About the only thing you pay for is meals and calling home.

I’ve learned a lot about myself too. Until I started working locum tenens, all of my radiology jobs had been in large hospitals. Through locums I found that my place really is in smaller hospitals and smaller towns. The people are friendly. You don’t fight traffic to get there every day. And they appreciate the help so much. You know you are making a contribution to the community or to the other radiologists who are working there.

At last count I have worked in 42 hospitals and 21 clinics. (It’s important to get new licenses because it really opens up new opportunities. At my peak, I had 19 state licenses.) I do a lot of return engagements, because I make friends and feel responsible for helping them out, for keeping them going. But I always try to mix in a few new jobs to keep things fresh. I don’t really consider it a career. It’s fun. It keeps me young.

Change, opportunity, and the chance to pursue our passions (locum tenens, education, activism, and photography)

psilverstein — Mon, 17 Dec 2007 00:00:00 -0700

I remind myself frequently that change is good. This year the community hospital at which I practiced emergency medicine for more than a decade relocated. Patient volumes dropped dramatically. Ironically, in this world of physician shortages and long emergency department waits, I found myself working fewer shifts than I wanted.

But here’s the part where change is good. My wife and I started thinking about options. We thought about going to interesting locations where she could pursue her passions—she’s an activist and a photographer –while I practiced medicine and developed my other passion—science education. Locum tenens offered us the chance to at least try to have it all.

I’m now working emergency medicine assignments with VISTA and finding more time to present and refine the first module of an educational program I developed that is called Inner World Discovery (IWD).

IWD Part 1- The Immune System /HIV is a multimedia presentation that begins with professionally-created animation on CD-ROM that deconstructs complex human biology through the use of metaphor, which makes learning both engaging and accessible to a variety of audiences. I included dozens of unique graphics, illustrations, and cases from the emergency room. (Find out more at www.innerworlddiscovery.com.)

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For the past three years, I’ve been presenting the program to high school students nationwide through a powerful internet architecture known as the MAGPI network, a division of the University of Pennsylvania. And now I am able to present it to nurses, lab personnel, medical students, residents, and others at the hospitals I work in through VISTA. The first hospital applied for and received CME for the nursing staff. A bonus!

I am excited about the future of IWD and our new locum tenens lifestyle. I recently partnered with Penn State University on a grant submission to develop four more programs over the next five years.

Time flies. Keep up.

gkitching — Wed, 21 Nov 2007 15:25:09 -0700

It is not easy—when you have been in medicine for a long time and worked in a lot of places—to get through all the documentation material and pick up a new license or two when you decide to sign up to work with locum tenens staffing agencies. But (VISTAites) Bessie Thornton, Chris Taylor and Sean Clark have been very good to me and have found me good situations to work in. It does take some focus and attention to keep the work situation going while making sure you have the time you need to climb, hike, fish, ski, play tennis, golf and keep the house from falling apart. My move to Colorado has accentuated the way time flies with the change of seasons vs. living in California where there is little change of season. Makes it more important to keep your scheduling skills sharp and VISTA has been a big help to me.
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My daughter and I climbed Capitol Peak August 2007.

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Climbing Mt. Elbert, October 2007.

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Aspen glow in the Andes, from our skiing trip to Portillo, Chile.

A Great Way to Put Your Toe in the Water

jbrennan — Mon, 22 Oct 2007 14:00:00 -0600

I just completed a very positive locum tenens assignment with VISTA and—because it offers a bit of a twist on the standard—I wanted to share it.

My family and I decided to relocate from Tucson to Sacramento and I found a great new job there. My California license was taking forever, however. I decided to work as a locum tenens while I waited for the license.

I accepted an assignment through VISTA in the VA in Sacramento. (Many federal facilities accept any state license, so my Arizona license was just fine.) The assignment turned out to be a perfect entre into the community for the entire family. Instead of the standard hotel or corporate apartment, VISTA worked with me to find a rental house, which makes sense for longer term assignments. I was able to bring my family out and get them settled. We were able to check out the area and explore. It helped us make a smooth transition.

I also really enjoyed working at the VA. The IT systems were good and the staff was involved with the patients. They are sorry to see me go they tell me and I am sorry too. I had a good time there and it was a perfect temporary placement for me.

I would strongly recommend using locum tenens to put your toe in the water when you are considering a move to a new community. I had a great experience working with VISTA. They shared my sense of urgency and had a number of jobs to choose from. When you call them, they call you back!

Should You Work Locum Tenens In New Zealand?

yasufuke — Mon, 24 Sep 2007 10:50:28 -0600

Simple answer … Absolutely!

I must admit that my main reason initially for going to New Zealand was not for work. I’ve thought for a long time that New Zealand would be an awesome place to visit, so I thought why not work and travel at the same time? This allows you to spend more time in New Zealand and the experiences you get working and living there are so much more rewarding than if you just travel there as a tourist. Obviously, most people will have some trepidation about working in a different country in a foreign medical environment on the other side of the globe but hopefully, as you read my postings, I can allay those fears and convince you to go have the experience of a lifetime.

Let me share with you my typical day, working as a consultant (attending physician) in a New Zealand hospital. The house surgeon (intern) usually comes in at 7:30-8am so rounds usually can start around 8:30-9am. They do not pre-round on all patients and therefore do not know every detail about the patient. As you see the patient, they will have the patient’s chart and will be writing the day’s progress note while in the patient’s room. They will write what you find on exam and what you decide (or what you decide together) is the assessment and plan. Any medication changes will be changed directly on the med chart and any nursing orders will be told to the nurses. There is no ‘ORDERS’ section in the chart like in the U.S. The house surgeon’s progress note counts as your note. You do not need to write a note or even co-sign their note. Sweetness!

Tea time is at 10am and if you are not busy, take tea.

I would usually go see the radiologist or pathologist to review diagnostic data after tea time around 10:30am if needed. We finish off any hospital rounds left during the rest of the morning. Lab results usually aren’t available until about 11am or later. These need to be followed up and appropriate changes to the plan made. This was initially frustrating for me but you get used to it. The afternoon is spent carrying out the plans you made.

There are some differences in the medical staff, medical practice, and patient management between NZ and the US. The majority of stuff is the same whether you work in NZ or the US, it’s just some little differences. Some of the more difficult things I had to adjust to were related more to small town medicine vs. larger city medicine. I was trained in a large city so it took me a bit of time to adjust to small town medicine.

More about my adventures in another post.

Read more about VISTA's International Opportunities.