Do you still perform COLPOSCOPIES?

Hello Alumni. Which of you still perform colposcopies in your office? Dr. Keehbauch has some suspicions that the ASCCP guidelines on resident competency may have impacted the number of colposcopies that family doctors perform. Could you please e-mail us if you still perform colposcopies and the year that your graduated? Thanks so much.

Here our study proposal...

Background and Objectives: The study objective was to determine the influence of the 2001 and 2006, American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines changes on colposcopy training at one family medicine residency.

Methods: We conducted a retrospective chart review from 1/1/2000 to 10/31/2009.  The 2001 ASCCP guidelines were fully implemented into our practice in June 2002 and the 2006 guidelines in June 2008.
Data were extracted with from our electronic medical records and sorted into three groups:  2000-2002 (pre-2001 guideline changes), 2003-2007 (post 2001 and pre-2006 update), and 2008-2009 (post 2006 changes) for total female patient visits aged 18-75 years, pap smears, and colposcopies. An ANOVA post-hoc comparison test was performed on the 3 data groups to test significance.

Results: After the 2001 guidelines; there was a 28.6% significant decrease in colposcopies (CI 0.20-0.37). An additional, 16.5% significant decrease occurred post the 2006 revisions (CI 0.06-0.28). Consequently, residents performed 45.1% fewer colposcopies. The total number of pap smears remained relatively unchanged.

Conclusion: Implementation of the 2001 and 2006 ASCCP guidelines significantly reduced the number colposcopies performed, resulting in greater difficulty training competent Family Medicine residents in colposcopy.

FEATURED ALUMNI: Jason Salagubang

Jason, thanks so much for taking the time from your busy schedule to do this interview and to be the our very first victim "Featured Alumni". We obviously have some questions that we want to grill you with ask. First off, what are you doing now? What are some of the joys and challenges of your current practice? 

      Well, right now, I just finished having lunch, so I feel pretty good. But in regards to my practice, I am doing a wide spectrum of family medicine things. I see newborns, children, adolescents, adults, and geriatric folk. Unfortunately, I no longer do any OB. I also do a lot of sports physicals and plan to be involved in some clinical research regarding concussions.
      Some of the joys I've experienced in solo practice include building a practice that reflects who I am. From the moment you enter my office, I want people to feel relaxed and comfortable. I also have great staff members who reflect that same sentiment and I truly believe our patients leave our office with a positive attitude because of that.
      Some of the challenges I've faced is having to replace some of those staff members who leave for various reasons (i.e. caring for sick family members, going back to school, etc,). In the last 2-3 years, I have had to replace my medical assistant twice. But thanks be to God, He always hooks us up with the right person.

So what do you do for fun or to unwind after a busy day?

      Believe it or not, but I enjoy doing yard work! Now don't ask me to mow your lawn, but I get great exercise and blow off a lot of steam when I work outdoors (besides, I save extra money when I don't have to hire anyone to do my landscaping!) I also have a pitbull/boxer mix who has a lot of energy so I have to run him daily or else he goes crazy! In addition, my wife and I raise two other dogs----these guys are like hairy little humans! Reading my Bible and meditating on God's blessings also energizes me and provides peace in my life. And of course, the 2nd greatest gift God has ever given me (Jesus giving his life to me is my #1 gift), is my wife. She is so patient and loving with me. I love her with all my heart and enjoy any time I can spend with her.

That's wonderful! It's so easy for medicine to "take over" a person's life. Thanks so much for sharing. So, knowing what you do now about the "real world", what advice would you give to our current residents?

      This is a good question.
      My advice: take advantage of your experience during your geriatric rotation. Even if you don't do the fellowship, if you plan to do family medicine in the United States, you will take care of old folk!
      Also, learn to treat your nursing/administrative/support staff with respect. Give them plenty of praise when they do something right. When they do something wrong, point it out immediately (but respectfully), then show them how to do it right. You might be the head of the medical team, but your staff constitute the NECK—meaning they can influence whether or not you have good/bad day or they could give you a bad/good name, etc.
      In addition, don't sweat the small stuff. So you might not score >90% on your shelf exams or your ranked the lowest in your class. So what?! Just pass your tests...but still try your hardest! Your patients just care if YOU CARE to keep/make them well. Finally, integrate healthful habits now while you have more time! This includes finding balance with your family, God, personal time, professional pursuits, etc.

That's great advise. I can remember having to buy my staff lots of pizzas to apologize for treating them unkindly! I can attest that treating staff well also helps to save on pizza money! So here is our next questions: if you could go back in time, what would you have done differently during your residency days? 

 I guess I would've spent more time poking fun at Dr. Gui. LOL! Just kidding!!!! [EDITOR: I agree that poking fun at Dr. Gui is a excellent ambition]. Nothing really, except maybe marry my wife sooner (I married her after I completed my geriatric fellowship).

Since you have been married, how do you maintain balance in your life between work and marriage? 

      I want to say leave work at work, but because I'm in solo practice, I'm on call pretty much 24 hours a day. It's important to actually set aside time for your family, schedule it on your calendar if you have to! Just be sure to take time out for your loved ones. When everything is said and then, they are the ones who matter the most in life (in addition to your relationship with God).
      I also try not to over-extend myself. My problem is that I like to be involved in a variety of things, i.e. b-ball games, medical volunteering, med staff leadership, etc., and I can still do those things, but I need to remember that my family should still be a top priority. One thing that has helped me in my practice is that I close up shop early on Friday afternoons. Unless there is a medical emergency or hospital/nursing home admission, I use this time to get home early and prepare for the Sabbath. When she can, my wife also tries to get home on Friday afternoons. We may not do anything spectacular, but at least we are home together during those times.

Again, that is great advice! I agree that going on "date nights" with my wife has been very important for a marriage. It's so encouraging to see how you have made your wife and faith a priority over medicine. Speaking of your faith, how has your faith influenced your practice? 

 My faith plays a tremendous role in how I practice medicine. In fact, as much as I loved being an attending at the residency, I truly felt called by the Lord to start a practice at Florida Hospital Apopka. My staff and I see our clinic as a type of ministry. Yes, we still need to make enough money to pay the bills. Yes, we sometimes get overwhelmingly busy with our work. And yes, we can get frustrated at times. I am not perfect. But by the grace of God, He still uses me to reach out to those who are in need. I am very grateful for the many, many, many blessings that I have received from God and I pray that I can be a good steward of those blessings as I seek to extend the healing ministry of Jesus Christ to those who walk through our office doors.

Jason, thank you again for taking the time for this interview. It has been a true pleasure for me as one of the new faculty here at Florida Hospital to get to know you. And I pray that this interview will encourage past alumni and current residents as we all face the many challenges of being family doctors. God bless! —David Koo

In Memory of Dr. Orris O. Rollie

It is with great sadness and honor that we announce the passing of Dr. Orris Rollie. He served at the residency for more than 20 years and his life has made a tremendous impact for many practicing family doctors. He retired as faculty around 1997. His wife commented, "He loved Florida Hospital and he was always talking about it, even after he retired." Our thoughts and prayers are with the family.

OBITUARY:

Orris O Rollie, MD, 89, DeBary, FL died Sunday, April 17, 2011.

Orris was born in Grand Forks, North Dakota. He attended University of Minnesota and received his doctorate from University of Illinois Medical School in June 1946. He served his internship at Bethesda Hospital in St Paul, MN, Surgical Residency at Midway Hospital in St Paul and Orthopedic Surgery Residency at Brooke Army Hospital. While serving in the US Army he was with the 24th Infantry in Japan as the Regimental Surgeon.

During his career he held memberships in Florida Medical Association, Florida Academy of Family Physicians and American Academy of Family Practice. During his career he also served as Ship’s Physician for about seven years.

At Florida Hospital he served as Director of Family Practice Residency Geriatrics and Family Medicine. He was also director of CME Florida Medical Center, Physician Consultant on Aging and Adult Division of HRS and consultant Adult Protective Team and Cares Unit of Orlando.

He leaves to cherish his memory his wife of 43 years Carol, sons Bruce (Diane) Rollie of Stillwater, MN, Matthew (Amy) Rollie of Tampa, FL, daughters Jenine (Dean) Selander of Sun City West, AZ, Noelle (Mike) Rowan of New Smyrna Beach FL, brother Robert (Margaret) Rollie of White Bear, MN, sister Shirley (LeRoy) Vossetieg of Fargo, ND,daughter in law Mary Rollie, nine grandchildren and nine great grandchildren. He was preceded in death by a son Michael in 2003.

MEMORIAL:

Memorial donations are requested to Florida Hospital Foundation, 2809 North Orange Avenue Orlando, FL 32804.  In memo section of check please note:  Dr. Orris Rollie/CME. Or you can make your donation directly online at www.foundation.floridahospital.com

Alumni, please update your contact info!

We are planning on putting together an updated Alumni Directory (password protected). Please take a moment to fill in your contact information below so that we can make an updated directory. Thanks so much!

Congratulations Class of 2010!

It gives us great pleasure to announce that all 16 of our residents who sat for the 2010 American Board of Family Medicine’s certification exam were successful! This is spectacular!  When you compare numbers around the state and nationally, having a large program have a 100% pass rate is truly outstanding. GREAT JOB!

Dr. Fishberg Quoted in LA TIMES

Congrats to Dr. Fishberg of our faculty! He was quoted in the LA Times for an article on osteopenia and osteoporosis. Here's the quote in its entirety:

Dr. Alexander Fishberg, medical director at the Center for Family Medicine at Florida Hospital, acknowledges that some physicians have fallen into the trap of treating osteopenia like a disease rather than an increased risk. "I think some women may get treated where the risk of fracture is very low," Fishberg says.

But he says that patients shouldn't shrug off concerns about osteopenia, and he points to evidence that many women in the osteopenia category will get fractures.

Fishberg takes T-scores into consideration but says that the decision about whether to treat osteopenia shouldn't be based on the score alone. Fishberg relies on the WHO calculator called FRAX, which takes into account a woman's age, ethnicity, family health history, lifestyle decisions like smoking and drinking and other risk factors. With all of that information, the FRAX algorithm makes two predictions: the chance that a woman will fracture a hip in the next 10 years, and the chance that she will fracture either her hip, spine, forearm or shoulder in the next 10 years. (Anyone can try FRAX online at http://www.sheffield.ac.uk/FRAX.)

The discussion between a patient and her doctor should involve factors such as lifestyle, exercise, calcium and vitamin D, he says.

"That's how I make my decisions," Fishberg says. "A good old-fashioned discussion with your patient to help form a plan so that both parties agree that the treatment is right for them."

Ultimately, the decision about whether to be treated for osteopenia must be made by the patient and doctor, he says: "In this day and age, our treatment should be individualized. An individual score does not define the woman."

Alumni Reunion 2011

The 2011 alumni reunion at the new Centre for Family Medicine was a great time! It was fun for old friends to catch up, check out the new residency building, see our state-of-the-art sim lab, eat too much appetizers, meet our new Program Director, and reminisce about the old days.  Click here to see (or download) the photos. Enjoy!

Here are some samples...

Meet the Program Director

Our residency warmly welcomes Dr. Eddie Needham as Program Director. He and his family moved here from Atlanta, Georgia and they are enjoying the warmer weather, fishing hotspots, and milder rush hour traffic (at least compared to Atlanta).

Originally trained as an industrial engineer at GA TECH, Dr. Needham went on to graduate from medical school at Emory. After finishing a residency in Family Practice at Tripler Army Medical Center in Hawaii, he served an additional four years in the US Army at Fort Benning, GA. He returned to Emory as faculty and advanced to Program Director for eight years.  He received the degree of Fellow, American Academy of Family Physicians (AAFP) while at Emory. He has won numerous teaching awards to include the AAFP's Parke-Davis Teaching Award in 1996 and the Georgia Academy of Family Physicians (GAFP) Teacher of the Year Award in 2007.  He has published in the American Family Physician and continues to practice full service Family Medicine.  He has taught at the AAFP's Annual Scientific Assembly as well as numerous engagements with the GAFP.

It is his joy and passion to teach students of medicine the wonders of the human body and spirit. He loves his wife of 23 years, his five children, the rigors of triathlons, the wonder and surprise of fishing, and mountain top experiences with friends.

A Message from Dr. Bob Quigley

Thank you so much for visiting our new alumni website. For many years, we have looked for an avenue to communicate with our past graduates. With this new blog, we are hoping to keep our alumni in touch with each other and with what's new at our residency.

Currently, we are actively working on making an online directory. We want it to be a place where you can find previous graduates with little fuss. But we also want to make the directory secure (since many of you have unlisted phone numbers). Check back on this blog frequently. We will hopefully have a solution very soon.

Every month we want to have a Featured Alumni article. This will be a great chance for you to see what new and interesting things other alumni are doing. Do you have an interesting story from your practice? Have you traveled to someplace fascinating? Do you have an interesting practice model? Do you have a story to share from your residency days? Don't be surprised if a faculty member calls you up for a personal interview!

So enjoy the blog. And if you have any suggestions for this website that would be helpful, please don't hesitate to contact us.

Robert Quigley, MD

Our NEW Centre for Family Medicine!

Because of a generous support from the Winter Park Health Foundation and other patrons, our family residency has a BRAND SPANKING NEW office! It's beautiful! And we are incredibly thankful for the generosity of the people of Winter Park! We moved in around June of 2010, and the transition has gone GREAT. The patients love the new space and we have been busy, busy, busy.

As you can see, Dr. Dumois and his Disney characters have made a smooth transition too. Buzz is a little disappointed that he didn't get a window seat... But some toys you can never make happy.

Jacque and Christine are enthralled with their new space. They said, "The new facilities bring us unmitigated joy! And with this new space, we can press on with our commitment to excellence in training a new generation of family doctor who will epitomize the values of our illustrious profession." Or, something to that effect... They sit in what we affectionately call "command central" and have an eagle eye's view of all the nefarious activities and pranks of the residents (and faculty).

We have a new conference room which is great for lectures, lunch conferences, and team meetings. The AV system is state-of-the-art and we use it frequently to present slide after slide after slide... Each chair has been equipped with an electric prod which sends 200,000,000 volts into any sleeping resident. More voltage is sent to sleeping faculty since they are harder to wake up.

We have two chiefing rooms! We require all residents to sing Hail To The Chief before presenting a history. In the above photo you see Dr. Santizo actively teaching two eager medical students. He was extremely good at saying things like, "That's a very interesting question! Why don't you look that up and give us a brief presentation tomorrow."

Our new facilities also has artwork! Can you imagine that? ARTWORK!!!! A doctor's office that doesn't look like a monotonous study in post-modern minimalism (like Drs. Lee and Zeini's office)! It took a while for some of us to adjust to this. At first, most of us thought the artwork was some kind of phantasm. But after Dr. Bob Vandervoort chipped his left molar on one of the paintings, we knew they were for real! Bob has an appointment with a dentist next week.

The residents even have their own comfy lounge (with a wii player). Please excuse their mess. They haven't transitioned out of their college years yet. 

Dr. Needham (our new Program Director) has a much tidier office. We call him "Mr. Clean". Personally, his attention to detail and cleanliness makes some (well most) of us faculty who are a little less tidy a little bit nervous. Give us time, we're working on him...

And finally, here is our wall of past graduates! In all seriousness, we are very proud of our alumni who have gone out into the world to help the sick, give hope to the mourning, and comfort those who are dying. God bless all of you! And keep doing what you are doing!