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December 8, 2015

Live & Practice: Sports Towns 2015

Hershey’s Chocolate World

Photo by Bill Cress

When Lilia Reyes, M.D., left New York City last year to move to Hershey, Pennsylvania, she didn’t anticipate the cultural and linguistic diversity she would encounter. Now as she nears her first full year as a pediatric emergency medical specialist at Penn State Hershey Emergency Medicine, Reyes describes herself as "happy" and "grateful." She says Penn State Hershey has given her a valuable and well-rounded experience. "It’s been amazingly busy," she says. "It really benefits my clinical acumen."

Reyes focused on general pediatrics in medical school and then trained at the Jacobi Medical Center at the Albert Einstein College of Medicine in the Bronx. There she treated trauma patients, including many with stab wounds and gunshots, and felt a call to treat children with traumatic injuries. She honed her expertise during a fellowship at Yale University and then returned to New York City to practice.

Interesting medical cases in Hershey

Reyes doesn’t see many stab wounds in Hershey, but she does treat patients who have had major ATV accidents, farming accidents, car accidents and severe bicycle falls. "When I interviewed, they told me I’d have some interesting cases."

They were right. Reyes deals with a diverse patient base, including many children from the large Amish population in nearby Lancaster County. "They come in with either major injuries or chronic illnesses. We want to provide the best quality of care for them while also doing the minimum number of tests. The families are paying out of pocket because they don’t have health insurance." Reyes enjoys working with them. "They are so grateful and humble," she says. The children speak Pennsylvania Dutch to their parents, and their parents translate into English for Reyes.

Hershey’s diverse patient base

Penn State Hershey’s diverse patient base also includes many Spanish-speaking migrant farm workers. As a second generation Colombian-American, Reyes is able to serve these patients in their native Spanish. Her Colombian-born parents raised their daughter in suburban central New Jersey, and Reyes went on to attend Rutgers University.

Now Reyes is thrilled to have landed at Penn State Hershey. "We have all the resources of a major hospital," she says. "I have every specialty to consult with." What she appreciates most is her colleagues’ commitment to teamwork. For example, once as she was sedating one patient so the EMT could do stitches, she was called away to resuscitate a second patient. Another physician quickly stepped in to help. "It’s so great to have that collaborative help between the nurses, the techs and the EMTs. Hospitals strive for that level of collaboration. It should be the norm, but that’s not always the case. So I feel very grateful to be here."

Others who move to Hershey have their own reasons to be grateful. Mary Smith, president and CEO of Hershey Harrisburg Regional Visitors Bureau, sees more and more young professionals coming to the area and finding their niches. "Hershey-Harrisburg has intrigue for the Millennial group," she explains. "We always say, ’You may be familiar with Hersheypark, and you may have even visited as a child. But there are more areas to discover.’"

A great place for people in different stages of life

Smith explains that the Hershey-Harrisburg region is a good fit for people in several different stages of life. She describes the area as having three pillars: "There’s family fun, there is life for couples without kids, and there is the outdoor component. If you come here for the eclectic urban life, you can stay here and grow into a family."

Also important is Hershey’s sports scene. "There is an awesome following of hockey in the area. The Bears are our team, and they are the affiliate of the Washington Capitals," says Smith. "The people here really follow sports and the minor league teams, whether it’s the Bears [hockey], the Senators [baseball] or the Islanders [soccer]. We are definitely known as a minor league sports destination. In 2009 and 2011, we were rated the number-one minor league sports city by Street and Smith’s SportsBusiness Journal."

People come to Hershey for its hiking trails, its farm-to-table restaurants (enabled by Lancaster County farms), and of course its chocolate. But for physicians, Hershey’s draw is professional. It provides an opportunity for a high-level medical career at a large-scale hospital without the intense competition, stress and expense of a major metropolis.

"Residents and fellows are generally only accustomed to working in large state-of-the-art hospitals in major metropolitan cities," says Jessica Mullany, MHA, associate director of physician recruitment at Penn State Milton S. Hershey Medical Center. "But patients who otherwise would need to go to Philadelphia or Pittsburgh for care can come here."

Penn State Hershey not only offers varied and exciting cases, but also the opportunity to learn about all areas of treatment. "We’re an academic medical center," Mullany says. She echoes Reyes’ experience in the ER. "Physicians want to teach the clinical passions they pursued. The hospital takes a very collaboration-oriented approach between the doctors, the nursing staff and the technicians. We try to be on the cutting edge in terms of cross-collaborations in our institute."

Work/life balance in Hershey

"People like the work/life balance that our system and our community provide," says Mullany. "It’s very rewarding work, and we operate like most of the facilities in a major metro area would. But we have this nice work/life balance. This makes us unique and desirable as an employer."

"It’s a great place to raise a family. Our location is very central to getting to the bigger cities, but the cost of living is lower," notes Linda Campbell, manager of physician recruitment for PinnacleHealth in nearby Harrisburg, Pennsylvania’s capital city.

PinnacleHealth’s CardioVascular Institute, Cancer Institute, and Weight Loss Center are among the system’s most well-known offerings.

"For our women and children’s services, in addition to deliveries, we have maternal fetal medicine and reproductive services," Campbell adds.

PinnacleHealth was recently named among the top 10 Pennsylvania Hospitals by U.S. News & World Report, and is ranked in the top 5 percent of the state for major joint replacements, open heart and spine/back surgery and heart catheterization and stenting. The 636-bed system has more than 6,000 employees.

Chris Scheid, D.O., is one of PinnacleHealth’s newer employees, having moved to Harrisburg in July after finishing medical school at the Philadelphia College of Osteopathic Medicine and residency at UPMC Altoona, about two hours away.

"I would say that there’s a little bit greater patient diversity," he says of his new location. "And as far as living here, a little bit more convenience to getting to things."

He picked PinnacleHealth thanks in part to the hospitality toward physicians he witnessed during the interview, compensation levels for the region - and location to family.

"The best part’s been the way that they treat physicians," he says.

For Reyes, Hershey is a place where she can "enjoy her work, enjoy her life and have a leadership position at the medical school." She marvels at her progress. "In one short year, I was able to get there. This is really a place where you can advance."

She and her husband are also first-time homeowners. In New York, they had to rent, but after just one year in Hershey, they saved enough to buy a house. Reyes believes that would not have been the case had they stayed in New York. "We could have eventually bought an apartment, but it would have taken much longer."

Like so many others, Reyes has found life in Hershey as sweet as the chocolate.

Freedom Lake Park

Freedom Lake Park in Charlotte

Professional admiration attracted James Rachal, M.D., to Charlotte, North Carolina. Rachal had heard of John Santopietro, M.D., FAPA, chief clinical officer at Carolinas HealthCare System, and admired his work. "He was changing psychiatry and telepsychiatry," Rachal says.

Telepsychiatry in Charlotte

Santopietro practices telepsychiatry, in which psychological professionals treat patients via teleconferencing. This allows them to treat more patients and reach underserved populations in remote areas. And in Rachal’s new role as the medical director of Behavioral Health Center Charlotte for Carolinas HealthCare System, he reports to Santopietro.

But Rachal’s interest in Charlotte wasn’t just professional. The city was also appealing. "The draw was multifactorial," he says. "It was a beautiful city,"

In this, Rachal is like many who move to Charlotte for work, according to Ryan Knox, a recruiter for Carolinas HealthCare System and a 17-year Charlotte resident. Knox says, "Once they come to interview, it’s usually a done deal. I’m lucky Charlotte is such an easy place to sell."

Before moving to Charlotte, Rachal spent time in Ohio and near D.C. and served in the Air Force. He attended Ohio’s Miami University for undergrad and graduated from medical school at the University of Cincinnati.

Rachal then did his residency in Bethesda, Maryland, at the National Capital Consortium at Walter Reed National Military Medical Center. While working in the psychiatry and family residency program, he worked with the center’s large number of trauma patients. "I saw several hundred returning veterans that had been traumatized by the war," he says. "I was also involved in the trauma services provided to Pentagon workers the day of and the day after September 11th."

This was good training because as Rachal explains, "A large percentage of behavioral health patients have experienced trauma." He finds psychiatry rewarding because he can help these patients and others. "You’re making an impact, working with someone who was going to harm themselves."

Rachal believes other physicians can do the same. "A lot of mental health is performed in primary care with psychiatry in consultation," he explains. "I always felt a fusion of the two was important." And when it comes to physical and mental health, Rachal teaches his patients to be proactive, not reactive.

Excellence and innovation in North Carolina

Rachal’s happy to be helping patients become more active and informed, and he’s happy doing it in Charlotte. He explains, "I was attracted to the commitment to excellence and innovation that seems to be across the entire hospital system [at Carolinas HealthCare System]."

It’s no wonder Rachal enjoys Charlotte. As Laura White, director of communications at Charlotte Regional Visitors Authority, explains, "Charlotte is the perfect blend of big city with small-town charm and Southern hospitality." But don’t let that small-town charm fool you. Residents still shout and scream for their favorite teams. "Charlotte is a huge sports town," White affirms. "We calculated that in a year [on] 200 days or nights, there was a major sporting event."

Hockey is especially popular. "Our AHL team is the Charlotte Checkers," White says. "The community around the Checkers is so enthusiastic that there was recently a big effort to move them to a renovated historic coliseum, the Bojangles Coliseum. This was a major renovation to bring the Checkers home." Charlotte’s other sports venues include the Bank of America Stadium and the Time Warner Cable Arena.

Charlotte, the fifth fastest-growing city in the U.S.

Charlotte is experiencing huge growth. Forbes magazine ranked it the fifth fastest-growing city in the U.S., citing 32.8 percent population growth since 2000. This rapid growth makes getting connected easy. "People who are new here have the opportunity to get involved in and be embraced by the community," says White. "Right now, we’re seeing new people moving into new neighborhoods and a lot of growth and change in these neighborhoods. When you’re living there, you feel invested in the growth of these places."

According to White, popular and up-and-coming neighborhoods include South End, Plaza Midwood, Dilworth, SouthPark and "NoDa" (short for North Davidson). And in Charlotte, downtown and uptown are reversed. Uptown has the city’s highest point of elevation, so the city planners centered city attractions there instead of downtown.

"Uptown is where there are a lot of new buildings and high-rise condos," says Knox. "They are good for doctors who are younger and right out of residency to rent or buy, if that’s their goal. Downtown is where there are older homes, historic ones that have been updated and remodeled."

Many physicians buy homes in the Myers Park neighborhood, an area that Knox says is "cozy, chic and very livable," and it’s close to a cluster of hospitals. These include Carolinas Medical Center’s F.H. "Sammy" Ross, Jr. Center and Carolinas Medical Center-Mercy. Thanks to its livability, Knox says Charlotte attracts many young families. "Sometimes doctors will do their first few years in a bigger city and come here once their kids are ready to start kindergarten," she explains. "They move for the school system and all the family options."

White agrees: "Charlotte is a desirable place to live and settle down." In addition to its family friendliness, Charlotte has excellent weather. Even in fall, it’s warm enough for outdoor activities, and golfers can play year-round.

Rachal has lived in Charlotte since May. He and his wife bought a house for themselves and their three children, and they are enjoying exploring nearby neighborhoods. "Right now, finding restaurants and cultural activities is important," he says.

Chances are that won’t be much of a struggle in Charlotte.

Karen Kennedy

Karen Kennedy, M.D., moved to Grand Rapids from New York City. "As much as I love New York, I think the size of Grand Rapids has helped me progress faster," she says.

Out of the 8 million people in New York City, I found a Michigan man to fall in love with," marvels Karen Kennedy, M.D. So the native Brooklynite moved to Grand Rapids, Michigan. She not only fell in love with the city but also found professional opportunities there. She says the Grand Rapids medical community accelerated her career in a way New York City could not have.

Opportunities in Grand Rapids

"As much as I love New York, I think the size of Grand Rapids has helped me progress faster," she explains. "New opportunities are easier to access. In New York, if you want something, there may be 20 people with similar experience and the same idea up against you. I had eight years of experience under my belt when I moved to Grand Rapids. I was a board-certified physician, and I became lead physician within one year."

Kennedy is the medical director of Mercy Health St. Mary’s Hospital Browning Claytor Health Center, a family practice clinic that provides care to underserved community members. She says helping these patients requires understanding and motivational interviewing.

"As doctors, we can all have this high level of information, but it’s not helpful if you can’t get to the core of the issue," Kennedy explains. "When you treat a patient with diabetes, you can take some extra time to connect with them, and then you can get them on the right path. For example, do they feel that this is a family curse and that there isn’t anything they can do about it? Then that’s a new conversation, and you try to have them walk away with an attitude of, ’You do as much as you can do anyway.’"

James Lebolt, D.O.

As medical director of sports medicine at Spectrum Health Medical Group, James Lebolt, D.O., appreciates how motivated athletes can be to get back to their sports. In Grand Rapids, that includes a fair share of hockey-related accidents.

Although Kennedy loves working with patients, she decided she also wanted a voice in hospital administration. "There is a beauty to the trenches, but I was also interested in how we orchestrated and managed patient care," she says. Being in Grand Rapids instead of New York helped her make the shift quickly. "All I had to do was voice an interest, and here I am."

Spectrum Health Medical Group

Like Kennedy, James Lebolt, D.O., came to Grand Rapids for love. His wife grew up there, and Lebolt had lived in Michigan during his residency at Sparrow Hospital-Michigan State University. So when his wife wanted to move to Grand Rapids to be closer to her family, he says, "It didn’t take much convincing." He is now medical director of sports medicine at Spectrum Health Medical Group in Grand Rapids.

A lifelong athlete, Lebolt played on his high school and college baseball teams. In college, he realized that although sports were his passion, he probably wouldn’t make it to the MLB. "I wanted to be in a sports environment and be active with great teams and also make a living. I realized that the way to make that transition was to become an orthopedic surgeon."

Lebolt completed his fellowship at the American Sports Medicine Institute in Birmingham, Alabama. "I didn’t realize how motivated people could be to get back to their sport. Some people had had devastating injuries, but they had this drive to get better."

That’s Lebolt’s favorite part of his job: "People get better," he says. "In other specialties, you’re dealing with chronic illnesses, and you’re helping people live with their illness and deal with it. It’s very gratifying for me to see my patients recovered, such as when I see a high school sports player on the news, back on the court, or I read in the paper that a former patient was recruited to play at a college."

Treating hockey players in Michigan

Practicing in Grand Rapids means Lebolt sees his fair share of hockey accidents. He treats a lot of junior players, including high school students and adult league players. Raised mostly in the South, Lebolt didn’t have much exposure to hockey as a young athlete, but he says, "I’ve learned to appreciate the sport through my patients, and I’m growing to love it because of my patients’ passion for it."

The town’s love of hockey is great not only for sports medicine but also for sports fans. "We have a more active community of younger residents than people realize," says Janet Korn, senior vice president of Experience Grand Rapids. "If you are a hockey fan, watching a hockey game is one of the go-to activities."

"The Grand Rapids Griffins have a real connection to the NHL," she adds. "Frequently, the players will trade to the Red Wings or go back and forth. There are some times when a weekend player for the Red Wings will come play with the Griffins. The Griffins games offer a fun family atmosphere. But they also market the games as a fun thing to do on a Friday night, with college student night or Friday night specials like $2 for a beer and a hot dog."

"Hockey is really special to our community," says Beth Brackenridge, FASPR, a physician recruiter with Spectrum Health. The city has a traveling youth hockey team, and most schools partner with the Grand Rapids Griffins. Brackenridge adds, "There are a lot of ways people can participate in the local hockey community as a spectator, as a participant or parent of a participant," she says.

Spectrum Health System, which operates 14 centers and employs 1,300 providers in Grand Rapids, is a sponsor of the Grand Rapids Griffins. They give away tickets and offer special ticket prices to support the Griffins while raising awareness of their facilities and their city wellness initiatives.

Michigan’s Metro Health

Another major healthcare player in the area is Metro Health. Its 208-bed general acute care teaching hospital has been named one of the country’s Top 20 Most Beautiful Hospitals five times. Metro Health Village combines restaurants, retail and Metro Health Hospital on one unique 170-acre campus.

Also in town is Michigan State University College of Human Medicine.

"Michigan State University Medical School opened a campus in downtown Grand Rapids just a few years ago. It is a wonderful addition for physicians who are interested in teaching," Korn says. Korn explains that Grand Rapids is making a great effort to intertwine its economic development with its healthcare systems. "We are trying to build the city as an anchor for the health sciences," she says.

The city’s other anchor is its breweries, which have earned the city the affectionate nickname "Beer City, USA." Korn says, "There are over two dozen craft breweries in the area. The community is very engaged with the craft brewing culture, and people usually have a favorite brewery. They get to know the brewer, and many of the breweries have a Cheers-like feeling."

Grand Rapids’ eclectic restaurant scene

There’s plenty to eat as well as drink. The Grand Rapids restaurant scene is eclectic enough to entertain any palate. A self-described foodie, Lebolt raves, "The restaurants here, just fantastic food. Grand Rapids’ restaurant scene has a big-city feel. There is a plethora of choices." Lebolt’s recommendation for the best meal around? Fish tacos from Donkey Taqueria, a trendy Mexican restaurant.

But the metropolitan flavors don’t come at the cost of small-town friendliness. Brackenridge says, "Grand Rapids is the second-largest city in the state, but it has a small-town feel. You get a little of both. We’re near Lake Michigan, so we have beautiful beaches. We’re rated number one in Forbes to raise a family."

Jenna Thayer, a physician recruiter for Mercy Health, agrees. "People live in Grand Rapids for the exceptional quality of life," she says. This includes not only the city’s offerings but also its people. "Grand Rapids fosters a dynamic environment with increasing diversity and a growing population. …People notice the sincere kindness and generosity that radiates throughout the city."

No wonder they call it grand.

Matt Snodgrass, M.D.
Matt Snodgrass, M.D., hung up his white coat a few months into residency. "The patient population (in Portland) doesn’t think you need to have a white coat in clinic," he says.

Born and raised in suburban Portland, Oregon, Matt Snodgrass, M.D., credits the Oregon wilderness with sparking his interest in medicine. He went to college at Willamette University in nearby Salem, where he originally planned to study psychology. "I thought I might even want to be a Ph.D. or Psy.D. therapist," he says.

From the wilderness to medicine

But before his junior year, Snodgrass led a week-long wilderness program for incoming freshman. To prepare, he and the other leaders took a training course that changed his career path. "We basically had to train to become first responders," he says. "I took the course, and I was really impressed and thought, ’Man, maybe medicine . . . is what I want to do.’"

Snodgrass has traveled extensively, but he’s found nothing compares to his lush native city of Portland. Now a family medicine physician, he is putting down roots and plans to stay. He recently began a new job, and he bought a house close to his work. Snodgrass embodies the city’s cultured, laid-back vibe - one of the reasons it’s growing so rapidly - and he believes this down-to-earth attitude makes him a better physician. He listens to patients, makes himself approachable and provides thorough care.

Patient-centered care in Oregon

While job hunting, Snodgrass looked for a group practice and an established health system, one that could support a patient-centered medical home. "The residency where I trained was a patient-centered medical home," he says. "Practically speaking, it meant I had a lot of backup. It allowed patients to have a lot more points of contact. My numbers were much better. Clinical pharmacists can help, we have on-site behavioral health, and it’s all the same co-pay to see me."

He considered Providence Health & Services, Kaiser Permanente and Legacy Health, and found his fit at Providence Medical Group-Tanasbourne, a small primary care practice within a large health care system. He says he likes the teamwork he sees there. "I am such a team fan. Maybe it’s because I’m a team-oriented thinker that I’m drawn to the way these practices are organized."

Hockey in Portland

But although Snodgrass loves teamwork and athletic activity, he doesn’t follow Portland hockey and can’t play himself: "I can’t skate worth a darn, and my son knows it. I’ve tried to skate with him, and it’s embarrassing."

Portland sign
Local flavor in Portland

In this, Snodgrass differs from the rest of Portland. "Portland is serious about their sports, hockey included," says Megan Conway, vice president of communications and public relations for Travel Portland, the city’s tourism and visitors bureau. "The Winterhawks have sent more than 100 players to the NHL, including hall-of-famers like Mark Messier and Cam Neely." The Winterhawks also won the 2013 WHL Championship.

Portland community

Lucky for Snodgrass, Portland has something for everyone, not just sports fanatics. "Portland is a great community," says Josh Erde-Wollheim, physician recruiter for Providence Physician Services & Development. "You have a lot of open-minded, intelligent, driven people. Portland has a small medical community for a city closing in on 2 million people. It’s really not hard to get established and get your name out there quickly."

The area has four major hospital systems: Legacy, Providence, Kaiser and Oregon Health & Science University. Erde-Wollheim sees an overlap between Portland’s health-consciousness and the state’s health care system. "Oregon as a whole has been really aggressive on accountable care organizations. . . . Health insurance companies are really pushing wellness metrics across the board. I think having the right primary care doctors and right specialists in the area that can help and promote that is important."

The Portland Clinic

At The Portland Clinic, a multispecialty group with seven locations and a 94-year history, 100 providers are committed to the medical home model.

"We have behaviorists, specialists and primary care in our locations," says provider recruiter Jan Reid. "Doctors get to know their MAs, and they get to know their team members. Each site has its own personality, but we’re all a part of The Portland Clinic."

The Portland Clinic is a unique partnership of independent physicians who are self-governed. "Our administrative staff works for the physicians," Reid says. "That’s very different from the other major health systems. We tend to attract physicians who have that independent mind and want to someday have a role in the ownership structure and a voice in how the group is led."

Potential new team members ask a lot of questions about the Clinic’s structure, especially in light of the current climate of smaller groups being acquired by larger systems.

Assures Reid: "Our physicians aren’t just independent - they’re fiercely independent. Together with the administrative team, they’ve implemented measures to assure our longevity over the long term."

When it comes to recruitment and hiring, however, their process take a high-touch, concierge approach.

"From the first time they make contact with our group, they are going to be walked through the process of interviewing, contracting, onboarding, to their first day of practice and beyond," Reid says. "We’re not just looking for clinical skills, but a personality match. They’re not going to be lost here; they’re going to be known here."

Same could be said for Portland as a city.

Portland, Oregon: A healthy place to live

"I think in Portland, a physician will have the opportunity for a very healthy balance of life," Reid says.

"It’s a very healthy place," seconds Erde-Wollheim. "We lead the country in terms of miles of bike lines. When the weather is nice, you see everyone outside, and it inspires you to go outside and be active. It’s really easy to go shopping at a local farmer’s market or get produce delivered from your CSA [community supported agriculture] farm."

Conway agrees. "We’re also pretty enthusiastic about our amazing food and drink options. …Both a cultural and health trend, Portland is big on the farm-to-fork movement of eating local, sustainable food." Conway also adds that Portland doesn’t have sales tax.

Conway says that some people "think the indie music and arts scenes define our particular brand of cool," while others point to Portland’s trees, fresh air and outdoorsy lifestyle. No matter how you define the city’s brand of cool, Portland’s free-spirited atmosphere even extends to doctor-patient interactions.

"I have not worn my white coat since the first few months of my residency [at Providence Milwaukie Hospital]," Snodgrass says. "As an intern, we’d have a month in ICU and a month at a larger hospital near Providence Milwaukie. The month we spent on wards, I was white-coated out. I even had a pocket that was big enough for my iPad. I wanted one specifically designed for my iPad, and let me tell you, I never put my iPad in my white coat ever."

Snodgrass eagerly returned to using his computer on wheels and abandoned his white coat. "Once I had no reason to rock my iPad white coat, I had no reason to wear my white coat at all." He adds, "The patient population here doesn’t think you need to have a white coat in clinic."

How very Portland of them.



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