The LPMR Times

Updates and News from the D-H LPMR program

Letter from Tina

Greetings from a snowy Upper Valley! We’re delighted to get this first DHLPMR Newsletter out to the friends of our program, and hope we can convince many of you to become contributors. It’s hard to believe that Steve Liu became the first LPM graduate ten years ago – and that he was the first in a group that now numbers over 50. Some quick calculations a couple years ago showed that we have doubled the number of physicians board-certified in Preventive Medicine in the state of NH. We have also bolstered the faculty ranks at Dartmouth-Hitchcock and in Concord, and are making a difference (literally) around the world. You’ll learn more about that here and in future editions.

It’s hard to know where to start or how to limit what I talk about here; there’s been so much good work, and many more great ideas in progress. For those of you who may not have heard much from us recently, I’ll paint a little picture of what LPM looks like today… We now have XX faculty coaches between D-H and Concord and for the last few years have about 15-18 residents/fellows in the program at any given time. Over the years, we’ve had YY different specialty combinations, and we have two more “in the pipeline” with Nephrology (approved) and Hospice and Palliative Medicine (pending). Coaches now work “across specialty lines” and most appreciate the opportunity to work with a resident in another discipline. While some coaches (Kathy Kirkland, Bill Nugent, Gautham S, XXX) have moved on to other things, we’ve also added some new coaches (John M, John T, Alicia Z, Chris A, etc –fill in). While no longer serving as a coach, Carolyn Murray continues her important work with the American Board of Preventive Medicine and in TDI and LPM teaching. In addition to Karen Homa’s fine ongoing work with us, we’ve grown our non-coach faculty. We benefitted for years from David Stevens’ work in the Writing Collaborative, which then transitioned to Gautham Suresh’s leadership. Jon Huntington has worked with us this year on Person/Family-centered care, and Nan Cochran and Cathy Pipas have contributed to this year’s Leadership sessions.

For the real “old-timers” who recall once a month evening seminars, we now have a robust series of educational events every Friday afternoon, along with a well-attended Grand Rounds series. We just received our notice of Continued Accreditation from the ACGME, and will be preparing for a self-study/site visit in a couple years. We will be one of the earlier programs to experience this new accreditation model. Serving as the hub and connector for all of this is our Kris Briand, our program coordinator, who brings wonderful enthusiasm and musicality to what we do. We held our annual program retreat yesterday, and as always came away with some excellent and actionable ideas for program improvement.

But the real joy of the program comes from our residents and fellows! We have new 8 residents and fellows joining us in July. Our current group continues to do incredible work as reflected by their scholarly and other activities: Lu’aie Kailani was able to travel to Liberia late last year to help with Ebola response, Cole Zanetti received the XXX prize, and our LPM2’s are weighing the merits of various job offers.

Our Residency Advisory Council will next meet in early April under the exceptional leadership of Paul Batalden. We have an amazing RAC (see XXX for a listing of all members) and while I can still hear George Anderson’s voice in the background, I am getting equally attuned to the wisdom of Mark Johnson, Jim Vanderpfloeg, Rosemary Caron, Evie Alessandrini, Pippa Shulman and others! We are sad that Jim Heimarck will be stepping down from his role on the RAC, and are searching for an equally passionate, skilled, articulate, and provocative community representative.

Our Practicum Review Board (see membership on p.,) works hard to assure that our residents and fellows work on practicums that have real meaning to patients and the institution, as well as educational value. We are delighted to welcome Gay Landstrom, our Chief Nursing Officer, as co-chair this year, along with new members Dan Jantzen and Brian Sites. Concord’s Practicum Review Committee, chaired by XXX, is getting back into gear after a rare year with no Concord residents, and looking forward to hearing about Cole Zanetti’s practicum proposal.

Our Governmental Public Health experiences continue to grow, with ongoing work in New Hampshire (mostly at the state level, aided and abetted by Jose Montero and his team, including Ben Chan, who has followed in Sharon Alroy-Price’s footsteps as state epidemiologist) and now a solid connection with the Green Mountain Care Board in Vermont.

I’ve asked Karen Tombs to provide a brief update on what’s up at the Center for Education at TDI – big changes are underway, but being undertaken in a thoughtful and inclusive manner that will result in a stronger curriculum. We are also looking forward to the opening of the Williamson Building on the D-H campus which will move TDI researchers and faculty adjacent to the medical center. In addition to these (literally) closer relations with TDI/TDC, we continue to work to understand how LPM can best support our institutional efforts at both DHMC and Concord to address the needs of the populations we serve – a big thanks to Rob Greene, DHMC’s new Executive VP for Population Health for his February Grand Rounds which clearly showed why LPM is the place to be!

Finally, a word on Boards. It is impressive that so many of our graduates sit for (and pass!) the Preventive Medicine Board exams –even though these are at least their second (and sometimes their 4th!) set of Boards to maintain. However, the cost is considerable for new grads with big loans, growing families, and other needs. We do have a small fund intended to provide no-interest loans to help grads cover Board expenses, and we would welcome donations. If you’re interested, please contact Kris Briand.

I have been reminded daily over the last 18 months or so (as my responsibilities expanded unexpectedly in other areas) of what an amazing team we have at LPM. Beginning with the residents and fellows brave enough to undertake this difficult but deeply satisfying work, extending to our D-H, Concord, TDI, and GPHE faculty, and reaching our external and internal advisors on the PRB and RAC and friends in the world of Preventive Medicine and GME – I experience abundance every day. Please enjoy these updates on the program and the people affiliated with it – and keep in touch!

With heartfelt gratitude,

Tina

Current RAC Members

Evaline Alessandrini, MD, MSCE

Professor of Pediatrics at the University of Cincinnati College of Medicine

Director of the Quality Scholars Program in Health Care Transformation, James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Dawn Barclay, MD

Year 1 Resident– Leadership Preventive Medicine residency program at Dartmouth Hitchcock Medical Center, Lebanon, NH

Paul Batalden, MD

Chair, Residency Advisory Committee, DHLPMR

Senior Fellow, Institute for Healthcare Improvement

Adjunct Professor, Jönköping Academy for the Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden

Marc Bertrand MD

Associate Dean for Graduate Medical Education, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Rosemary Caron, PHD, MPH

Associate Professor - Department of Health Management and Policy

College of Health and Human Services - University of New Hampshire

Doug Dreffer, MD

Program Director, NH Dartmouth Family Medicine Residency, Concord NH

Paul B. Gardent, MBA, CPA

Senior Faculty Associate, Health Care Improvement Leadership Development Unit, Dartmouth Medical School, Hanover, NH

Rob Green, MD, MHCDS, FACP

Executive Vice President and Chief Population Health Management Officer for Dartmouth-Hitchcock Health

James Heimarck, MHA

Community Member

Asim Jani, MD, MPH

Branch Chief, Preventive Medicine Residency and Fellowship

Center for Disease Control, Atlanta, Georgia

Mark Johnson, MD, MPH

Executive Director – Johnson County Public Health
Lakewood, CO

Jose T. Montero, MD, MHCDS

Director, NH – Division of Public Health Services

Concord, NH

Alina Robert, MD

Year 2 Resident– Leadership Preventive Medicine residency program at Dartmouth Hitchcock Medical Center, Lebanon, NH

Eliza “Pippa” Shulman, DO, MPH

Alumna of the Leadership Preventive Medicine Program

Harvard Vanguard Medical Associates

Karen Tombs, Ed.D

Director of Educational Programs, The Dartmouth Institute

James Vanderploeg, MD, MPH

Professor, Aerospace Medicine

Director, clinical Preventive Medicine Division, Preventive Medicine and community health department

Galveston, TX

John Wuchenich, MD

Year 2 Resident– Leadership Preventive Medicine residency program at Dartmouth Hitchcock Medical Center Lebanon, NH

Cole Zanetti, MD

Year 1 Resident– Leadership Preventive Medicine residency program at Concord Hospital

Concord, NH

Michael Zubkoff, PhD

Chair of Community and Family Medicine at Dartmouth Medical School; Hanover, NH

Ex-officio – Residency Program Director; Associate Program Directors; Improvement/Data Specialist; Residency Coordinator [Tina Foster, MD, MPH, MS; Carolyn Murray, MD, MPH; Stephen Liu, MD, MPH; Dominic Geffken, MD, MPH; Gautham Suresh, MD; Karen Homa, PhD; Kris Briand, BM]

Residency Coordinator Corner - Meet Kris Briand

I came to LPM in June of 2014, from the HR Development department, at Dartmouth Hitchcock.

Previous to D-H, I taught vocal and instrumental music for 15 years both publically and privately – clarinet being my specialty and then I spent 5 years as an elementary classroom educator. I am passionate about learning and being an effective, positive member of a team.

Along with my education interests, my husband Jeff and I, have two boys; Ian 15 and Logan 12. They keep us busy with sports games, music activities, Boy Scouts and I enjoy volunteering for school events when possible.

My LPM goals for this upcoming academic year are to help redesign the 2015 orientation by incorporating more detailed information on the ACGME/GME responsibilities which impact our accreditation and create more relationship building experiences. I am also interested in learning more about the TDI classes our residents take and hope to have an opportunity to observe some starting this summer. I will continue to provide high quality, prompt service for our residents and faculty while learning the ongoing different aspects of the program. This year has been a steep learning curve for me as there are so many different layers of the residency that are unique to other programs. I am excited to continue learning and to develop new ideas with the residency.

I welcome any thoughts or ideas you would like to share, feel free to send them my way!

“Green Mountain Care Board: Despite changes and challenges, the work goes on” By John Matulis, DO (LPM-2, Internal Medicine-LPM resident)

Vermont’s movement towards a state run, single payer health system took a dramatically altered course on December 17th. Governor Shumlin, citing daunting fiscal realities, placed future plans for a state administered, unified healthcare budget on hold for the foreseeable future. Although a surprise to many, insiders were able to see that the money being counted on for implementation just wouldn’t be there. When the choice came to moving forward with his centerpiece healthcare plan, or imposing double digit tax increases on Vermont businesses, the governor flinched. Stated Shumlin, “It became clear that risk of economic shock is too high at this time to offer a plan that I can responsibly support for passage.” I guess that sums it up pretty well- if the money isn’t there it can’t work. While the ramifications related to this seed change and lessons learned from this experiment have yet to reveal themselves, my most immediate question is what does this mean for my Governmental Public health Experience?

As a second year LPM beginning my GPHE this past summer I was thrilled when Tina was able to pair me up with the Green Mountain Care Board. The Green Mountain Care Board was created in early 2011, immediately following passage of The Affordable Care Act by the Vermont legislature after many years of careful planning. GMCB was charged with varied tasks related to healthcare regulation and planning with an ultimate goal of shepherding the state towards a first of its kind single payer healthcare financing system. When asked what I could do to help their mission, I thought my perspective as a fledgling primary care internist seeking my first job could be helpful in looking at some of their work-force planning issues. Like many QI projects, I quickly realized the need to limit the scope of my undertaking and to focus more carefully on the final deliverables- a white paper and presentation to the board with recommendations on steps GMCB can take to sustain an adequate primary care work-force. The topic itself, as well as the plethora of changes affecting the workforce have been truly fascinating.

Fortunately, I have learned that the GMCB will continue to function, and in fact many of their short term goals and projects will be unchanged by the governor’s recent announcement. I am in the process of surveying a variety of different primary care practices within the state, learning what primary care actually looks like. Although what direction healthcare takes in Vermont remains uncertain, I am confident that there will be plenty of work to do.