Please Save the Date For Our Upcoming WA-ACEP CME Events!

2009 Emergency Medicine Leadership Summit
Who’s Invited: ED Directors and Emergency Medicine Leaders
November 4, 2009
SeaTac Hilton Hotel & Conference Center

Mountains to Sea – Northwest Emergency Medicine Assembly
(Formally Emergency Medicine Without Borders)
May 19-21, 2010
Bell Harbor International Conference Center
Symposiums this year will consist of cardiology, trauma, infectious disease and critical care. Our pre-conference workshops offered include ultrasound guided IV placement, regional anesthesia blocks, and EKG & pacemakers.  All emergency medicine providers are encouraged to attend!

For more information, please contact the chapter at smc@wsma.org, 206-956-3648.

EMTALA and Options for Hospitals in a Disaster
Below is a link to a new CMS memo and fact sheet regarding existing flexibility in EMTALA requirements (as well as information on the EMTALA waiver process) that could be utilized in the event of a surge of demand for emergency services due to an H1N1 flu outbreak. 

CMS memo and fact sheet

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H1N1 Influenza Adds Wrinkle to Preparations for Flu Season
Washington state is eligible to receive an extra $7.3 million this fall for swine flu and seasonal flu prevention efforts, U.S. Health and Human Services Secretary Kathleen Sebelius announced. About $5.4 million will go for public health emergency response programs, including preparations for vaccination campaigns, reducing swine flu virus exposure, and improving flu monitoring and investigations. About $1.9 million could help hospitals and other health care facilities plan for flu-related emergencies.

Gov. Gregoire has also announced that she has authorized emergency funding to prepare the state for the regular flu season and the possibility of H1N1 influenza. Included is $700,000 to buy additional antiviral medications to go with the supplies that the DoH has already received from the federal Strategic National Stockpile.

In related news, the CDC recently announced that antiviral treatment of H1N1 infection is not where it should be. It is urging early, empiric antiviral treatment for hospitalized patients and high-risk outpatients with suspected or probable H1N1 infection. Current CDC guidelines do not require physicians to perform confirmatory testing for influenza infection before treating high-risk patients who are suspected to have H1N1 virus infections. For more information go to www.doh.wa.gov/swineflu/.

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Zero Tolerance for ED Assaults
by Bill Briggs, RN, ENA President

A disturbing online survey released last week of 3,465 emergency nurses found that more than half of them say they've been "spit on," "hit," "pushed or shoved," "scratched," and "kicked" while on the job. What's even more disturbing, the nurses say, is the culture of acceptance for violent behavior in the ED that exists nowhere else in the hospital, or in decent society.

One in four of the emergency nurses surveyed for the ENA's Violence Against Nurses Working in U.S. Emergency Departments has been assaulted more than 20 times in the past three years, and one in five nurses has been verbally abused more than 200 times during the same period.

As troubling as those responses are, it's a wonder there isn't more violence in the ED. All the ingredients are in place for violence and abuse by a small percentage of the volumes of people that use the ED. Injured, sick people and their relatives enter an intimidating ED environment afraid, confused, and in pain. Some are drunk, drugged out, mentally ill, or all three. Often they face long waits for treatment. Given the increasingly important and growing role that the ED is playing as a healthcare entry point for many Americans, however, hospitals must adopt a Zero Tolerance policy toward ED violence.

No hospital would tolerate verbal or physical abuse or assault in the ICU, maternity, oncology, or in the gift shop. For whatever reason, the ED is held to a lower standard. This needs to change.

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Ibuprofen Best for Injured Kids
Kids with a broken arm do better on a simple over-the-counter painkiller than on a more powerful prescription combination that includes a narcotic, a recent study has found.

It tested ibuprofen, sold as Advil, Motrin and other brands, against acetaminophen plus codeine—a combo called Tylenol No. 3 that is also sold in generic form.

The results, published online by the Annals of Emergency Medicine, don't mean that ibuprofen beats acetaminophen for everyday pain relief. The study tested pain in the first three days after a broken arm and the acetaminophen was combined with the narcotic codeine, not tested alone. Researchers randomly assigned 336 children ages 4 to 18 to go home with liquid versions of either ibuprofen or the acetaminophen-codeine combo after being treated for a broken arm at Children's Hospital of Wisconsin. Neither the children, parents nor the doctors knew who received what treatment until the study ended. Full results were available on 244 children. The portion who failed to get relief from their assigned medicine was roughly the same. However, half of those on the combo medicine reported side effects—mostly nausea and drowsiness that can occur with narcotics like codeine—versus 30% of those given ibuprofen. The ibuprofen users also had fewer problems eating, playing, going to school or sleeping. They and their parents reported more satisfaction with the treatment.

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Health Care Reform Update
HHS Secretary Sebelius had the task of publicly breaking the news that the administration may back off its insistence that a public option be part of any reform bill. 

The U.S. House and Senate have recessed until after Labor Day, leaving a complicated mess of healthcare reform proposals unfinished.  All three House committees that share jurisdiction over the bill (HR 3200, "America's Affordable Health Choices Act") finished debating and amending the bill, but created two very different approaches to implementing changes in the U.S. health care delivery system.  Meanwhile, only one of the two Senate committees with jurisdiction over healthcare issues approved a version of the "Affordable Health Choices Act."

During the congressional August recess, ACEP expects key members of the House leadership and three committees to work on combining the different proposals into one bill that will likely reach the House floor by mid-September.  The small group of bi-partisan negotiators on the Senate Finance Committee, which has yet to introduce its legislation, has announced they will continue their discussions during the August recess.

Many members of Congress will be conducting Town Hall meetings in person or via conference call with their constituents during the August recess.  Click here to see the list of Town Hall meetings compiled by ACEP.  We urge you to review the list and attend a meeting in your area, if possible, as this may present you with an opportunity to not only hear from your federal lawmaker about his/her ideas for health care reform, but also to urge their support for proposals that will improve access to emergency care for their constituents.

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ACEP & Health Care Reform
Thanks to your hard work and support, ACEP has been successful in advancing several emergency medicine priorities and securing these provisions in various sections of the House and Senate health care reform legislation currently on the table.  These measures include:

• Identification of ED services as part of the essential health care benefits package;
• Medicare physician payment reforms (addressing the underlying problems of the sustainable growth rate (SGR) including resetting the budget baseline for the Medicare payment system, eliminating the current debt accrued under the SGR, removing physician-administered drugs from the SGR, and providing increased payments for physicians who provide E&M services);
• Emphasis on ED patient through-put as a measure used to determine quality improvement;
• Authorization of the Emergency Care Coordination Center (ECCC) within the HHS Office of the Assistant Secretary of Preparedness and Response (ASPR), as well as the ECCC Council on Emergency Medicine and a requirement that the ECCC provide an annual report to Congress on its programs (with a focus on ED crowding and boarding);
• Grants to conduct at least four emergency care/trauma regionalization pilot projects;
• Grants for economically troubled trauma centers;
• HHS incentive payments to states that establish medical liability reforms, such as Certificate of Merit and/or "early offer;" and
• HHS demonstration project to reimburse privately owned psychiatric hospitals that provide EMTALA services to Medicaid beneficiaries.

ACEP continues to work with Senator Debbie Stabenow (D-MI), to ensure these initiatives and the provisions of the "Access to Emergency Medical Services Act of 2009" (S. 468/H.R. 1188) are included in the Senate Finance Committee legislation.

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Effective Now – All Hospital Charges to be Disclosed
HB 1869, Disclosure of Estimated Health Care Costs, is now in effect.  The intent is to educate the consumer as to the “cost” of care – no matter that there is a bit of a gap between what is charged and what is paid under the contract provisions with public and private payers. 

At any rate, all fees and charges for health care services by health care providers and licensed facilities must now be disclosed at the request of the patient.  A sign advising patients of this availability must be posted in patient registration areas. 

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Red Flag Rule Delay
The Federal Trade Commission (FTC) has announced it again will delay enforcement of its “Red Flags” Rule, this time until November 1.  The rule is an anti-fraud regulation, requiring “creditors” and “financial institutions” with covered accounts to implement programs to identify, detect, and respond to the warning signs, or “red flags,” that could indicate identity theft.  The FTC considers your practice covered under the rule.

The WSMA has a Policy & Procedures document for Identity Theft Detection and Prevention for your office and is now available as a “members only” item on the WSMA Practice Resource Center.

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Proposed Rules for 2010 Medicare Physician Fee Schedule and Hospital Outpatient Department Payment (OPPS) Released July 1, 2009

Medicare Physician Fee Schedule

• Pay Cut:  Unless Congress acts, a -21.5% cut will be imposed across the board on January 1, 2010.
• SGR:  CMS is finally proposing to take drugs out of the SGR pool retroactive to 1996/97 which will greatly decrease the cost of replacing the SGR with another way to update physician payment.
• Practice expense:  Results of the AMA-coordinated practice expense survey have been incorporated by CMS and emergency medicine has realized a slight (2%) increase in practice expenses and small increase in levels 4 and 5 and larger increases in levels 1, 2 and 3.
• Consults:  CMS also proposes to do away with physician consultative fees and replace them with “initial hospital visit or office visit” codes which pay less.  The savings generated from the high volume of these visits will be used to increase payment to primary care office visit payments and be budget neutral within the fee schedule.  (It appears that fees to on-call physicians who come to the ED will depend on whether the patient is admitted or not.)
• Imaging:  CMS also plans to increase estimates of the time complex imaging machines are used in practices from 50% of the time to 90%.  This will affect the technical component only but will significantly reduce practice expense for many physicians who perform complex imaging services in their offices. 
• RUC:  CMS is still considering a group to provide oversight to the work valuations currently done by the AMA RUC, citing greater need to address over-valued codes.
•  PQRI:  The PQRI program will continue to provide a 2% bonus to successfully participating physicians through 2010.  Legislation is required to continue bonus payments beyond 2010.
• Physician groups of 200 or more would be permitted to submit data on selected quality measures if all the physicians reassigned benefits to the group.
• Rules for reporting have not changed from 2009 but the rule contains much more discussion of reporting using registries and EHRs as well as claims-based.
• Measures must be NQF-endorsed by July 1, 2009 in order to be considered for inclusion in the 2010 PQRI quality measure set and there are 168 possible measures.
• CMS intends to publicize the names of eligible professionals and group practices that satisfactorily submit quality data for the 2010 PQRI.

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Medicare Outpatient Hospital Payment Draft Rule
Hospital OPDs will get an average of 2.1 % annual inflation update from Medicare.  Expenditures are estimated at $31.5 billion, compared with projected payments of $28.7 billion in CY 2008.  ACEP will be submitting comments on the proposed rule before the August 31, 2009 deadline.

• Payment:  APC Codes for Hospital ED visits show slight increase with two exceptions:
• Type A ED facility payments grew between 1-3 percent
• For 2010, CMS is adding a Level V Type B APC, which is $82 less than the Type A level V payment. (Last year, Level V Type B was paid at the same level as Type A)
• CMS is reducing payment for trauma response with critical care.  (While the - $132 is a significant reduction, payment from 08 to 09 increased by over $600.  CMS has more claims data to review and adjusted median costs accordingly.)

• Quality Reporting Measures:  OPPS payment inflation update is reduced by 2.0 percentage points for hospitals that do not meet quality reporting requirements starting from 2008. 
• No new quality measures are proposed for 2010
• Hospitals will continue to report data on seven quality measures of emergency department and peri-operative surgical care. 
• CMS is considering an ED throughput measure for 2012 that would track median time from ED arrival to departure for treat and release patients
  
  
• Healthcare Acquired Conditions:  As we requested, CMS has not proposed any measures for 2010 acknowledging the complexity of implementation in the outpatient setting as well as lack of analysis of the current data from the inpatient hospital acquired conditions initiative started in 2008.
  
  
• Facility Coding for ED Visits: CMS is content to allow hospitals to use their own coding guidelines, again citing stability of claims distribution over the past several years.

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ACEP's State Legislative Updates
ACEP’s State Legislative/Regulatory Committee recently surveyed state chapters to collect information on state and local initiatives that have been developed to alleviate boarding and crowding.  The results of that survey are summarized in a new information paper available on the ACEP web site.  The paper highlights legislative, regulatory and other approaches that chapters may want to consider in their states.  Chapter leaders interested in pursuing state advocacy efforts can also access legislative language introduced in other states, talking points and other resources that are also available on the web site.

A multi-year state advocacy effort by the Arizona chapter paid off with the passage of special liability protection for emergency care providers. The new law increases the burden of proof that must be met in emergency care cases.  Clear and convincing evidence is now required to prove negligence by emergency providers. 

Several state chapters have been working to enact or protect motorcycle helmet laws in their states. The Maine chapter was successful in leading the effort for a new mandatory helmet law for minors. At least seven other states have actively considered repealing their helmet laws. Missouri’s governor vetoed a bill that would have repealed that state’s law and legislative testimony by Louisiana chapter members helped fend off another helmet law repeal effort. Meanwhile, Arkansas, Florida, and Minnesota have enacted primary seat belt enforcement laws this year.

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ACEP Foundation to Become Dormant For Now
The ACEP Foundation Board of Directors voted in late June to suspend activity for Foundation activities, including the direct mail campaign and the publication of Vital Care for ED waiting rooms. In this economy, it is virtually impossible to meet the advertising goals to maintain Vital Care, despite its popularity.  As the economic climate changes over the next few years, the Board will consider bringing back the magazine and other activities. The Web site, www.EmergencyCareForYou.org, will be maintained, however, during the dormancy.

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Please welcome our new members to the Chapter
Juan F Acosta, DO, FACEP – Yakima
Jameel Ali, MD – Seattle
Amy E Betz, MD – Seattle
Robert A Bessler, MD – Tacoma
Suzanne Bigelow, MD – Seattle
Eric T Brown, MD – Walla Walla
Joel Edminster, MD – Spokane
George M Elliott, MD – Puyallup
Elizabeth Gray, MD – Silverdale
Shamik Kumar Jain, MD – Auburn
Robert William Jensen, MD – Seattle
Aaron Bruce Jones, MD – Walla Walla
Richard D King, MD – Bellevue

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JOB POSTINGS

Northwest Emergency Physicians, TeamHealth has the following EM Opportunity in Eastern Washington: Kadlec Medical Center - KMC had the largest growth percentage of any hospital in Washington last year, and now captures 40% of hospital admissions in the Tri-Cities.   Kadlec was the first hospital in Washington to be designated an accredited chest pain center and is currently the only hospital in the area to be designated as a chest pain center with PCI capability.  Kadlec is home to the region's only Neonatal Intensive Care Unit, treating high risk newborns needing specialized care.  Hospital facilities include a new, technologically-advanced 20 bed CCU, a 19 bed immediate care unit, a 12 bed short stay unit, a new open heart surgery suite, an additional cardiac catheterization lab and new outpatient imaging center.   In the summer of 2008, Kadlec opened a new 71.8 million, six-story building which included new operating rooms, a clinical decision unit and a floor of private patient rooms. Emergency Department is a 28 bed, plus 6 bed fast-track Emergency Department with an annual patient volume of 50,000 patients.  Kadlec's ED patient volume has grown approximately 9% year for the last 10 years.  The ED recently opened an additional 8 bed section staffed by ED physicians.  The ED coverage is 67 hours daily with 9 hr. shifts.  For more information about this opportunity and other EM opportunities in Washington, please contact: Emily Enck (800) 336-8614 x 2115 or emily_enck@teamhealth.com     

Central Washington, ED Physician Openings
Emergency Medicine Physicians needed for three hospitals located in Yakima County, WA.  Looking BE/BC EM or BC/FP or IM with significant ED experience.  All three locations have generous hourly rates and physicians enjoy Independent Contractor Status with many tax saving advantages.  “A” rated malpractice insurance program with no tail obligation upon departure. 

• Yakima Regional Medical Center
• 214 Bed Hospital/21-bed ED including 10-bed Fast Track and designated trauma bays
• Estimated Annual Volume of 32K
• 12 hr shifts with 24 hrs of physician coverage + 10 hrs MLP coverage in Fast Track

• Sunnyside Community Hospital
• 38 Bed Hospital / 8 Bed ED
• Estimated Annual Volume of 17K
• 12 Hour Shifts - 24 hour physician coverage + 12 hrs per day of MLP coverage

• Toppenish Community Hospital
• 64 Bed Hospital / 8 Bed ED with 3 Fast Track Beds
• Estimated Annual Volume of 25K
• 12 Hour Physician Shifts with 24 hours of physician coverage (7 days/week) + 10 hours of MLP coverage (4 days/week)

Beautiful Yakima County, WA is well known for its picturesque fruit orchards and award winning wineries.  Outdoor enthusiasts will enjoy blue ribbon trout fishing, cross country and downhill skiing, hiking, and bicycling. For more information, or to submit your CV, please contact:
John Torres, EmCare Physician Consultant
(800) 230-5160, ext. 3025
Fax 805-564-5087
John.Torres@EmCare.com
www.EmCare.com

Urgent Care/Emergency Services Line Chief Opportunity, Seattle, WA
Group Health Permanente, the Pacific Northwest's premier multi-specialty group, is currently seeking a BC/BP Emergency Medicine Physician.  Group Health is dedicated to providing comprehensive, innovative, and patient-centered care and leads the nation in EMR integration.

For additional information regarding this position or to submit your CV, please contact Kelly Pedrini, GHP Physician Recruiter, at pedrini.k@ghc.org or 206/448-2947.

Yakima, Wa.  Single hospital democratic group looking to add a partner. Shift equity from the start, finantial equity and parternership in one year. Excellent compensation. mklivingston@charter.net

EDMONDS, WA:  CEP America is seeking BC/BP emergency physicians for its newest contract at Stevens Hospital in Edmonds.  Located 15 minutes from Seattle, Edmonds is one of Washington’s most picturesque waterfront communities offering an appealing, small-town quality of life.  Enjoy the mountains, sea and Seattle life that this opportunity has to offer.  Stevens is a 217 bed hospital that has an ED volume of 42,000 patient visits a year.  CEP America is a true democratic partnership where each physician is a partner from the day he or she works their first clinical shift.  All Partners collectively own their contracts in CEP America, and every Partner has an opportunity to gain equal ownership with other long-term Partners.  We offer excellent compensation with annual profit sharing as well as health, disability and retirement programs.  For immediate consideration please contact Kelly Moore at 800-842-2619 or e-mail moorek@medamerica.com.

Isn’t it Time for Something Better? Group Health Permanente, the Northwest’s premier multi specialty group, is currently seeking a BC/BE Emergency or Family Medicine Physician to join our Urgent Care Center located at our Capitol Hill campus in Seattle, WA. Group Health is dedicated to providing comprehensive, innovative and patient-centered care to communities throughout Washington.

• Candidates should have a full range of urgent care skills & an interest in working with an innovative group
• Affordable housing, highly rated schools & pleasant neighborhoods, an unparalleled place to raise a family
• A flexible schedule, generous benefits and competitive salaries make this an opportunity worth exploring

For Additional information or to submit your CV please contact Josie Lavin at 206-448-6132 or lavin.j@ghc.org

Seattle - Highline Emergency Physicians is democratic independent group of physicians currently seeking full-time ABEM prepared/certified physician. We are a one hospital, two-facility group with 8-hour shifts triple coverage in our high volume facility (45 K visits annually) and single coverage in our low volume facility (15 K visits annually). Friendly work environment with rapid patient turnaround and a anticipated completion of a new department on the March 2010 and EMR Mar 2009. Flexible scheduling allows for ample free time to enjoy the Northwest's abundant opportunities for outdoor recreation. Great nurses! We provide competitive compensation and paid malpractice, health and dental. We are a well-established group (contract held for 30 years), respected by the medical staff and community. Send CV to Carter Hill MD; e-mail: carterhill@comcast.net or Fax 206-236-8063, Mobile # 206-409-7598. Position is available summer of 2009 for qualified and credentialed candidate!

Needed-a physician to work at Pasco Worker Care, an Occ Med Clinic providing care to injured workers.This is a full time job with competitive salary and benefits. No weekends, nights or major holidays. Experience in EM preferred. Send a resume to drted@yakimaworkercare.com.

Sterling Healthcare is seeking EM physicians to join a growing group and practice in a beautiful setting in Spokane, WA. This Level III trauma center operates 24/7 and is staffed with more than 40 registered nurses experienced in emergency, trauma, and critical care.  The Emergency Services Department also includes cardiac treatment rooms and a separate Express Care Unit.  Physicians work 8 hour shifts with double coverage by physicians and mid- levels in the main ED.  The Express Care unit is open 16 hours a day and staffed by mid-level providers.  Annual ED volume is 43,000 with 21 beds. Candidates must be BC Emergency Medicine or Primary Care with recent ED experience. ACLS, ATLS, and PALS certification required. Sterling Healthcare offers flexible scheduling, independent contractor status, professional liability insurance, CME, and competitive compensation. Please contact Molly Smith at 1-800-877-5520 ext 1020 or email molly.smith@sterlinghealthcare.com or fax CV to 904-805-1418

Magnificent North Olympic Peninsula of WA State: Emergency Physician Openings.  Waterfront or mountain side living, driving distance to Seattle, ferry boat ride to Victoria, BC! Excellent full and part time opportunities now available in our stable, cohesive and collegial group of practitioners. Offering:  private, stable, single hospital democratic group, equally shared night/weekends, excellent pay/benefits, flexible scheduling, no buy-in, equal partnership, 12 hours shifts with mid-level support, 27k annual volume in expanding dept, Level 3 Trauma Center.  We are located at the foot of the Olympic National Park on the bluffs overlooking the Strait of Juan de Fuca, providing magnificent views everywhere you look!  Port Angeles is in the rain shadow of the Olympic Mountains with wonderful out door activities and a wide range of community attractions.  It is the site of Olympic National Park (a World Heritage Site) and a beautiful salt water location with easy access to Seattle and Victoria, B.C.  Email or send CV to: James Wallace, MD c/o Nancy Buckner, Physician Recruiter, Olympic Medical Center, 939 Caroline Street, Port Angeles, WA  908362, 360 417 7231, nbuckner@olympicmedical.org or James Wallace, 360-417-3281, Jwallace@olympicmedical.org.

Tacoma Emergency Care Physicians (TECP) is a 19 member democratic group of Board Certified/Board Prepared Emergency Physicians staffing two hospitals in Tacoma, WA. We seek a full time emergency physician. Our primary hospital (Tacoma General) is an urban level II trauma facility with high acuity and superb medical staff in all specialties. Shifts are eight hours with excellent compensation. TECP provides malpractice insurance.  Physicians are eligible for partnership after one year. Located on Puget Sound 35 minutes from downtown Seattle and one hour from the Cascade Mountains, recreational and cultural opportunities abound. Visit our website at www.tecp.net.  Contact Heather Marshall, heathermarshallmd@comcast.net, 253-820-6412.

Eastern Washington - Full Time Opportunity. Samaritan Hospital, Moses Lake, has an annual patient volume of 13,000. The shifts are 12 hrs. with 10 hrs. of PA/NP coverage.  The physician will see an average of 1.25 patients per hour with 12% admission rate. Trauma Capabilities and Resources:  Samaritan Healthcare serves a 75,000 population area with 32,000 in the local area.  Patients transferred are sent by ground ambulance to Central Washington Hospital in Wenatchee or by helicopter to Deaconess Medical Center, Sacred Heart Medical Center in Spokane, or Harborview, Seattle. Physical Description of the Emergency Department:  9 rooms and 10 beds.  This ED includes a trauma/cardiac room, 2 cardiac bays, a pediatric room, casting room, OB room, 2 minor medical rooms, a mental health room and a room with an undesignated function. Availability of Ancillary Services:  Radiology – 24/7, Nighthawk:  nights, CT 24/7, Ultra Sound 24/7, MRI off-site, Pharmacy, Pyxis system, Lab, Respiratory Therapy. Brief Description of Community: Moses Lake is the commercial hub of the Columbia Basin in Grant County located at the intersection of Interstate 90 and State Highway 17.  The lake, Moses Lake, is the largest, natural body of fresh water in the county, with over 120 miles of shoreline.  Due to the large number of lakes, streams and the Columbia River this is a fisherman’s paradise, with trout, salmon, bass, spiny ray and walleye pike plentiful. The area is in the path of the Pacific flyway, goose and duck hunting is a sportsmen attraction.  Deer hunting is excellent in nearby Clockum and Blue Mountains which have large elk herds.  Winter sports include an outdoor ice skating rink, downhill skiing at several locations within a few hours drive, as well as cross country skiing and snowmobiling.  The area provides several golf courses, tennis courts, a family aquatic center with water slides and an Olympic size competitive pool.  A large area in nearby sand dunes has been designated for ORV and recreational use. Average annual rainfall is about 8 inches and average snowfall is 15 inches.  For more information about this opportunity, please call: Emily Enck (800) 336-8614 x 2115 or email: emily_enck@teamhealth.com Quality of Care.  Fairness.  Integrity. Professionalism

Full Time Opportunity at Kadlec Medical Center in Richland, Washington a 181 bed acute care facility with a 20 bed CCU, a 19 bed intermediate care unit and a 12 bed short stay unit.  Hospital has a new open-heart surgery suite, an additional cardiac catheterization lab, and new outpatient imaging center.   Summer of 2008, Kadlec will open a new 71.8 million, six story building which will include new operating rooms, a clinical decision unit and a floor of private patient rooms.  Emergency Department consists of 26 beds with state of the art equipment including a robust intranet linked to PC’s throughout the ED and hospital and a separate Fast Track.  Applications include:  MUSE, Micromedex – (Poisondex, drugdex, Emergidex), Web PACS, and internet access, ED includes electronic medical records and Electronic "T" system.  Providers care for 48,000 patients annually with 56 hours of physician and mid level coverage.  Community offers, excellent school systems, golf courses, wineries, and much more.  For more information, please contact: Emily Enck at (800) 336-8614 x 2115 or email: emily_enck@teamhealth.com

Seattle: Academic Pediatric Emergency Medicine (Children's Hospital & Regional Medical Center) The Department of Pediatrics at Children's Hospital and Regional Medical Center/University of Washington School of Medicine is recruiting one or more board certified/eligible Pediatric Emergency Medicine Physician(s) (MD or DO required) at the Assistant/Associate Professor/Professor level. Position(s) may be full-time or part-time. Contact Tony Woodward, MD, MBA, Chief, Division of Emergency Medicine, Children's Hospital and Regional Medical Center, Emergency Medicine B-5519, 4800 Sand Point Way, NE , Seattle, WA 98105, 206-987-1371, Fax 206-729-3072, E-mail: Tony.Woodward@seattlechildrens.org

Seattle: Pediatric Urgent Care and Emergency Medicine (Children's Hospital & Regional Medical Center) The Department of Pediatrics at Children's Hospital and Regional Medical Center/University of Washington School of Medicine is recruiting two board certified/eligible Pediatric Emergency Medicine Physicians ((MD/DO required) at the Assistant/Associate Professor/Professor level. Contact Tony Woodward, MD, MBA, Chief, Division of Emergency Medicine, Children's Hospital and Regional Medical Center, Emergency Medicine B-5519, 4800 Sand Point Way, NE , Seattle, WA 98105, 206-987-1371, Fax 206-729-3072, E-mail: Tony.Woodward@seattlechildrens.org

Washington, Walla Walla:  Independent, democratic group seeking BC/BE emergency physician to join our growing group.  We staff St. Mary Medical Center ED which has a 20k patient volume.  Good specialty backup and hospital administration support.  Both St. Mary Medical Center and our ED physicians are ranked in the top 1% nationally.  Level III trauma center for adults and pediatrics.  State of the art 3 yr old ED. You are equal in terms of shifts, salary and benefits from day one.  Come live and work in the heart of WA wine country at the foot of the Blue Mountains.  Contact Byron Miller, MD at Walla Walla Emergency Physicians 401 W. Poplar Walla Walla, WA 99362 (509) 522-5802 or email your CV to byron.miller@providence.org    

At Legacy Salmon Creek ED in Vancouver we have two physician openings: 1) BC/BE residency-trained Emergency Physician AND  2) BC/BE Pediatric Emergency Physician.  Legacy Salmon Creek is a 164 bed hospital which is being built out to 220 beds.  The ED saw 48,300 patients in 2007 and about 13,500 are children.  We continue to grow.  We have a separate Pediatric Emergency Department staffed by 3 BC Peds EM physicians, a Peds Critical Care (PICU) physician and Peds-trained and dedicated RNs for 9 to 14 hours/day.  We seek to replace one PEM physician who is returning to Chicago for family reasons and expand our Peds ED hours.  The hospital has an inpatient pediatric service staffed by pediatric hospitalists 24/7, a level 3B NICU and very busy Family Birth Center.  We work closely with Legacy Emanuel Hospital which is a tertiary pediatric Children’s Hospital with PICU.  In 3 years Legacy Children’s Hospital will build a $260 million dollar 7-story Children’s Hospital with 32-bed Pediatric ED.  It is also a Level 1 Trauma Center.  The Legacy Salmon Creek Hospital ED has no trauma designation, but sees trauma, nonetheless. We staff 5 x 8 hour shifts/day (40 hours) in the ED and 2 shifts/day (12 hours) in the ambulatory section of the ED.  The ED and hospital opened just 3 years ago.  The ED is a beautiful, 32-bed state-of-the-art facility.  Due to rising census, a 16 bed extension to the ED is being considered. Our 140 member Emergency, Pediatric Emergency, and Ambulatory physician group ( Northwest Acute Care Specialists (NACS)) staffs the five Legacy Health System Hospital EDs and an Ambulatory Clinic in St. Helens.  NACS is a democratic, independent physician group which contracts exclusively with the Legacy Health System to care for 230,000 patients/year.  We are the largest democratic, independent Emergency Physician Group in the Northwest. Legacy Salmon Creek Hospital is located in a new and growing section of Vancouver, WA with 15 minute access to Portland via I-5.  For more information, contact:
J. Michael Albrich MD FACEP FACP
President, Northwest Acute Care Specialists
Medical Director, Emergency Services
Legacy Salmon Creek Hospital
Vancouver, WA 98686
Office: 360.487.1475
Fax: 360.487.1499

Immediate FT Locum position and PT position available with Associated Emergency Physicians, Inc. at Valley Medical Center. Potential for FT continued employment. Stable independant democratic group, staffing a single hospital with over 72,000 visits. Level III trauma center. New 56-bed ED under construction. Competitive compensation and benefits. Must be residency trained and board eligible or board certified. Send CV or contact Pattie Giuliani:425/228-3440x2975. Fax: 425/656-5016 email: pattie_giuliani@valleymed.org.

Are you considering a change of employment? If so, don't make a move until you give us a call. At any one time we have physician openings across, Washington, Oregon, Idaho, Montana and Wyoming. Northwest Emergency Physicians-TEAMHealth is the largest employer of emergency medicine physicians in the Northwest. Contact: Emily Simpson (800) 336-8614 x 2115 or email: emily_simpson@teamhealth.com or Lynn Benson at (800)336-8614 ex 2123/fax (253)838-6418 or lynn_benson@teamhealth.com


CRAssociates, Inc. (CRA) is a national healthcare management company that is committed to the delivery of high-quality health care services. We have a need for full-time Emergency Medicine Physician to support the Naval Hospital Bremerton. Requirements include:
· Board Certified as an Emergency Medicine Physician
· Min one year exp in last 3 years
CRA is proud to offer you a team environment, excellent compensation and benefits, as well as company-paid professional liability insurance. Please send your resume to Human Resources at one of the following: Fax: 866-550-1476 (Toll Free) Email: ckm@crassoc.com CRA is proud to be an equal opportunity employer.

Immediate Full-Time Position for BC/BE EM Physician with Kennewick Emergency Physicians, a Democratic Group staffing a single hospital, 30,000 annual visits with moderate acquity on the banks of the Columbia River. Generous Competitive Package, Guarantee plus Incentive Compensation, Liability Insurance included, Relocation Expenses included, Full Partnership Tract in 18 months, 8-11hour shifts, Double coverage during peak hours, average 12-14 shifts/month with 3 weeks off/quarter built into schedule. Enjoy a peaceful lifestyle in this friendly community of approximately 200,000. Take advantage of hundreds of miles of waterways- fishing, water sports and beautiful sunsets- all near the mountains, over 300 days of sunshine annually, over 40 local wineries. Contact Louis K. Koussa DO, FACEP; 509-521-3396 or 509-627-1798 and email your CV to loukoussa@yahoo.com

WANTED: Emergency physicians for bipolar company. Quark (www.quarkexpeditions.com) leases Russian Icebreakers for 10 to 25 day voyages to the polar regions. We are in need of ED physicians willing to serve as ship’s doctor. On any ship, there at most 110 passengers and 50 crew members. No dressing up and no night life except the scenery and animals. Contact Dr. Dan Zak at zak38@aol.com. Please let your colleagues know about this as well.

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