April 29, 2013

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Busy Legislative Session Continues: Get Engaged

The 126th Legislature continues to consider legislation at a frenetic pace with nearly 1450 bills printed.  This coming week MMA lobbyists will be working on bills ranging from physician-assisted death to collaborative practice with pharmacists.  The Veterans and Legal Affairs Committee will hold another work session on the bill to restructure the state's liquor contract in hopes that the increased revenue can be used to pay the MaineCare debt to Maine's hospitals.

Readers are encouraged to click on the accompanying articles entitled Political Pulse and Legislative Committee to learn about additional bills impacting on medicine, professional practice or public health.  Members are also invited to join the Legislative Committee on its weekly conference call held at 8:00pm every Tuesday night while the Legislature is in session. Instructions are included in the article on the Committee.

The statutory deadline for adjournment of the session is June 19.

POLITICAL PULSE: Legislative Highlights from the Week

Here are some highlights of what MMA's advocacy team followed at the State House the week of April 22nd.  It was an extremely busy week for Committees as they rush to meet a May 17th deadline for voting on all bills.  


The Health and Human Services Committee reported their budget recommendations to the Appropriations Committee last Monday and the Appropriations Committee has now begun their deliberations on the Budget.  Appropriations also received a report from DHHS last week on various enrollment and systems issues and, at the end of the week, an updated revenue forecast from the Revenue Forecasting Commission.  For FY 2013 revenues are actually expected to exceed estimates by $44 million, however they are projected to be lower than estimates by $35 million in FY 2014 and $24 million in FY 2015.  The administration will soon be releasing a revised proposed biennial budget that takes into account many of these updates.  The Legislature has until June 30 to pass a budget. To avoid a state-government shutdown, the spending plan would have to garner support from at least two-thirds of the Legislature. 


An MMA-written bill on step therapy received a public hearing in the Insurance and Financial Services Committee last Wednesday.  Senator Geoffrey Gratwick sponsored the bill (LD 984), which would: prohibit step-therapy protocols from requiring off-label use of a drug; prohibit step-therapy protocols from requiring a patient to fail more than one time on a drug during the course of coverage by that carrier; make it clear that a patient who successfully follows a step-therapy protocol will pay the same co-payment he or she would have if a drug on the insurance carriers preferred drug list (PDL) worked for the patient; and amend the response time for insurance carriers to respond to prior authorization requests for non-emergency services within 24 hours rather than 2 business days as required by current law. MMA Deputy EVP, Andrew MacLean, Esq., testified in favor of the bill, along with representatives of the American Cancer Society Cancer Action Network, NAMI Maine, the American Lung Association and Consumers for Affordable Health Care.  Harvard Pilgrim Healthcare opposed the bill.   The Committee also held work sessions on a number of bills being followed by the MMA, including bills related to a health insurance exchange, the Maine Guaranteed Access Reinsurance Association and coverage for oral chemotherapy. 


The Labor, Commerce, Research and Economic Development Committee started off the week with a hearing last Monday on compounding pharmacies (LD 1315).   The bill, sponsored by Representative Sharon Treat, would strengthen Maine's laws on compounding pharmacies and they would become some of the toughest in the nation.  The Board of Pharmacy, Maine Pharmacy Association and Hannaford Pharmacies testified in opposition and stated that the Board of Pharmacy is in the process of rulemaking on compounding pharmacies.  Gordon Smith, Esq., MMA EVP, testified neither for nor against the bill, but cautioned not to limit access to important medications. 


The Judiciary Committee held public hearings last week on several bills of interest to the MMA.  First up was LD 1046, An Act To Provide Immunity for Prescribing and Dispensing Intranasal Naloxone Kits. This bill would provide immunity for both health care professionals and other individuals who assist a person who is experiencing or likely to experience an opiate-related drug overdose with intranasal naloxone. MMA testified in favor of the bill.  MMA EVP Gordon Smith, Esq., also testified in support of LD 1200, An Act To Impose a Duty To Warn and Protect on Mental Health Professionals, on behalf of the Maine Association of Psychiatric Physicians.  The law would codify the "Tarasoff" duty-to-warn provision into Maine law. Mr. Smith was in support of codifying the duty to warn a potential victim or law enforcement officer of imminent harm to self or others, though opposed the provision of the bill that would create a duty to warn for harm to property.  The law would apply to all physicians.  The Committee also heard LD 744, which would change the traditional 3 year statue of limitations for professional negligence suits to 10 years in the case of sexual misconduct.  MMA is monitoring this bill. 


Tuesday was public health day in the Education Committee.  MMA testified in favor of LD 1160, An Act To Reduce Obesity among Schoolchildren, which would require schools to provide 30 minutes of physical activity each day and prohibit the use of food as a reward.   MMA testified neither for nor against LD 1241, An Act To Protect School Athletes from Head Injuries.  Jessa Barnard, MMA Associate General Counsel, stated that while MMA is concerned about head injuries in school athletics, data does not support the provision of the bill that would require helmets for field hockey and girls lacrosse.  MMA is monitoring several of the other bills that received public hearings on Tuesday, including LD 1366, An Act To Require Students To Receive Instruction in Cardiopulmonary Resuscitation and the Use of an Automated External Defibrillator prior to Graduation, and LD 1394, An Act To Make Parents More Aware of Eating Disorders. 


The Health and Human Services Committee had an extremely busy week, holding a number of hearings and work sessions of priority to MMA.  The following were of particular interest to MMA: 

  • LD 716, An Act Regarding Prescription Medications for Children under the MaineCare Program.  This bill as drafted would have created a PA process and additional hurdles for prescribing stimulant medication to children. MMA is working with the sponsor to turn the bill into a study of appropriate prescribing practices for stimulant medications. Dr. Sandra Fritsch, president of the Maine Council of Child and Adolescent Psychiatry, testified in opposition to the bill.
  • LD 1247, An Act To Expand Coverage of Family Planning Services.  This bill expands Medicaid coverage for family planning services to adults and adolescents who have incomes less than or equal to 200% of the official poverty line, funded with 90% federal dollars.  MMA testified in favor of the bill. 
  • LD 1024, An Act To Enhance Enforcement of the Mandatory Reporting of Abuse and Neglect.  The bill would require the Department of Health and Human Services to make a report, which may include confidential child protection information, to the licensing board of a professional who appears to have violated the mandatory reporting law.  MMA EVP Gordon Smith, Esq., testified in opposition to the bill, stating that current law already allows DHHS to make reports to licensing boards and it is unclear why the bill is necessary. 
  • LD 1294, An Act To Increase the Penalty for Smoking in a Motor Vehicle When a Child Is Present.  MMA testified neither for nor against the bill, supporting the concept of keeping kids away from secondhand smoke but questioning the approach of increasing fines or reporting parents to child protective services. 


The Criminal Justice and Public Safety Committee has continued to hold hearings and work sessions on a number of gun-related bills.  Of most interest to the MMA, last Monday the Committee held a work session on LD 1240, Representative Mark Dion's bill that would increase background checks along with other gun safety measures.  Dr. Jim Maier attended the work session on behalf of MMA and the Maine Association of Psychiatric Physicians and cautioned that a provision of the bill to prohibit all individuals who have been involuntarily committed on an emergency basis ("blue papered") from possessing a weapon may be overly restrictive.   Other bills addressed this week related to whether an employee can store a weapons in their car on an employer's property and increasing funding to Maine courts to allow them to more efficiently transfer information to the National Instant Criminal Background Check System (LD 888).   [return to top]

MMA Legislative Committee Conference Call, Tuesday, April 30th, 8 p.m.

The MMA Legislative Committee weekly phone calls will continue tomorrow, Tuesday, April 30th at 8 p.m..  They will be held every Tuesday at 8 pm through the session. 

Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate.  Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate.  It is not necessary to RSVP for the calls.

Please use the following conference call number and passcode.  These will remain the same for every weekly call during the session:

Conference call number:  1-877-669-3239

Passcode:  23045263

The following are bills of interest to the physician community printed last week.  We will discuss the priority bills marked with an asterisk (*) first:

LD 1431, An Act To Support School Nutrition and Expand the Local Foods Economy (monitor or support; pediatricians; Public Health Committee)

LD 1433, An Act To Amend the Laws Governing Mental Responsibility for Criminal Conduct (monitor; psychiatrists)*

LD 1437, An Act To Amend the Laws Regarding Licensure of Physicians and Physician Assistants (BOLIM bill; monitor)*

LD 1439, An Act To Repeal Certain Maine Criminal Code Provisions Addressing So-called Bath Salts Containing Synthetic Hallucinogenic Drugs and Instead To Define Them as Schedule W Drugs (monitor; psychiatrists; addiction specialists; Public Health Committee)

LD 1445, An Act To Facilitate Children's Testimony (monitor or support; pediatricians; psychiatrists)*

LD 1449, An Act To Amend the Composition and Duties of the Maine Children's Growth Council (monitor or support; pediatricians)*

LD 1453, An Act To Increase the Transparency of Charges and Expenses of Hospitals That Receive State Funding (check with MHA on position)*

LD 1460, An Act To Update and Clarify the Laws Governing the Operation of Bicycles on Public Roadways (monitor; pediatricians; Public Health Committee)*

LD 1462, An Act To Clarify and Correct Provisions of the Maine Medical Use of Marijuana Act (monitor)

LD 1466, An Act To Amend the Law Governing Provider Contracts with Insurance Companies (support)*

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MMA Board of Directors to Meet Wednesday

The Maine Medical Association Board of Directors will be holding a regularly scheduled meeting this Wednesday, May 1st, at the MMA Headquarters in Manchester from 4-6pm.  Priority topics for discussion will include the joint meeting held with the Maine Hospital Association Board, key legislative issues currently pending in Augusta, and a matrix ranking MMA service areas. The Board will also discuss whether to take a position on a tar sands pipeline in Maine, review work of the Member and Member Benefits Committee with independent primary care practices and receive an update on MMA's peer review program.   The Board next meets June 5th.  [return to top]

Maine Democrats Say They'll Support Hospital Payment if Medicaid is Expanded

Courtesy of Bangor Daily News, April 26, 2013, Matthew Stone, BDN Staff 

Democratic legislative leaders are proposing a deal that would tie the payback of Maine’s $484 million hospital debt to an expansion of the state’s Medicaid program under the federal Affordable Care Act.

The party’s legislative leaders briefed Gov. Paul LePage on the plan in a meeting Thursday, the latest development in a debate over paying back Maine’s hospitals and expanding Medicaid coverage.

House Speaker Mark Eves, D-North Berwick, said Democrats want to tie the debt payback to health care system reforms that could control costs in the long run.

“Democrats are going to repay the hospitals. It’s a top priority of ours,” he said. “As we make that final payment on our hospital debt, we’re also going to do things that address cost drivers in our health care system.”

LePage, who has made paying back the state’s 39 hospitals a top priority this legislative session and has been reluctant to support Medicaid expansion, accused Democrats on Friday of continuing to stall on the hospital debt payback.

“Maine expanded welfare 10 years ago, and we still haven’t paid that debt,” the governor said. “They know that paying our bills is the right thing to do. So why are Democrats still refusing to pay the hospitals?”

LePage unveiled his plan in January to pay off the state’s hospital debt by taking out a revenue bond backed by the state’s future liquor profits. He said he would release $105 million in voter-approved bonds he has so far refused to issue once lawmakers sign off on his debt repayment plan. The hospital debt has accrued since 2009 for services hospitals provided to Medicaid patients but for which they haven’t been reimbursed by the state.

Democratic leaders initially resisted the plan, saying the hospital debt payback and liquor contract shouldn’t be considered as part of the same bill. The party’s leaders later proposed an alternative plan tying the hospital debt payback to a renegotiation of the liquor contract. However, that plan, sponsored by Senate Democratic Leader Seth Goodall, proposed demanding an upfront payment from the winning liquor vendor rather than having the state take out a revenue bond.

In recent weeks, consensus has emerged around using a revenue bond to pay back the debt as Attorney General Janet Mills has said the approach meets constitutional muster and a nonpartisan analysis has shown the approach would also direct more revenue to state coffers than having a private company secure the capital needed to make a $200 million upfront payment.

Eves said Democratic leaders are crafting a bill that ties together a renegotiation of the state’s wholesale liquor contract, a revenue bond to repay the hospital debt and the Medicaid expansion, which has been proposed in a separate bill by Rep. Linda Sanborn, D-Gorham.

Expanding Medicaid “addresses one of the cost drivers in our health care system, which is charity care,” Eves said, referring to care hospitals provide for free to low-income patients without health insurance. “The hospitals want Medicaid expansion, and they know it would address a cost driver within their system. We really feel it’s the responsible thing to do.”

In a news release and on social media, LePage accused Democrats of “reneging” on plans to pay back the hospitals. House Republican Leader Ken Fredette also said the Democrats’ proposal “raises serious concerns.”

Eves said Democrats want to move quickly on the hospital debt repayment so Maine can pay it off before its federal Medicaid match rate drops on Oct. 1. Currently, Maine would owe $181 million, and the federal government would kick in the remainder in order to pay off the full $484 million debt. On Oct. 1, however, the federal Medicaid funding rate for Maine is expected to drop a percentage point, meaning the state would have to pay $186 million to trigger a federal match of about $298 million.

Under the Affordable Care Act, President Barack Obama’s 2010 health care reform law, Maine has the option of expanding Medicaid. Under the law, the federal government will cover 100 percent of costs for newly eligible Medicaid recipients for three years. The 100 percent funding will gradually drop to 90 percent in 2020, and states will have to make up the remaining share.

Since Maine is one of a handful of states that have already expanded Medicaid to many of the people who would be newly eligible in most other states, the state can qualify for an increased matching rate for some of the residents it’s already covering, about 10,000 adults without children.

As a result of this increased federal funding rate, a recent Kaiser Family Foundation analysis projected that Maine would be one of 10 states to see the amount of state funds it spends on Medicaid actually drop over the next decade — by $570 million, or 3.8 percent — while the federal share of Medicaid expenses would rise by $3.1 billion, or 11.4 percent.

“We have an opportunity to do something that is in the best interests of Maine people,” Eves said. “We can’t miss this opportunity, and I think to do anything other than that would be irresponsible.”

While LePage has generally opposed expanding Medicaid, his administration began discussing the possibility with federal officials after a number of other Republican governors said they would accept the federal Medicaid funds in their states.

Health and Human Services Commissioner Mary Mayhew last month sent a letter to U.S. Health and Human Services Secretary Kathleen Sebelius requesting more flexibility and more funding — 10 years of full federal expansion funding rather than the three prescribed in law — as a condition for Maine to expand Medicaid.

Adrienne Bennett, a LePage spokeswoman, said Friday the administration hasn’t yet received answers from the federal government regarding those requests. [return to top]

Request for Information: Health Homes "Stage B"

Request for Information (RFI)

Maine Department of Health and Human Services’ “Stage B” Health Homes for Adults with Serious Mental Illness and Children with Serious Emotional Disturbance

The Office of MaineCare Services is seeking information and comments regarding certain aspects of the Maine Department of Health and Human Services’ (the Department’s) Value Based Purchasing (VBP) Strategy focusing on Section 2703 of the Affordable Care Act, establishing Health Homes to serve MaineCare and Medicare-Medicaid dual enrollees (both children and adults) with significant mental health and co-occurring needs.  The State is seeking information that it may use for future policy development regarding Health Homes, including information on how best to structure a Medicaid State Plan Amendment to support integrated and coordinated care for adults and children with mental health needs.   Any individual or entity may respond to the Request For Information (RFI), including, but not limited to individuals, social service organizations, advocacy organizations, mental health providers, primary care providers, hospitals and health systems.  This RFI, and responses to it, does not in any way obligate the State, nor will it provide any advantage or disadvantage to respondents in potential future applications or Requests for Proposals for competitive procurement.  All responses to this RFI are public.

A copy of the RFI may be accessed on the Health Homes Stage B webpage.  Please contact Kitty Purington if you need assistance in obtaining a copy of the RFI.

For more information on the Department’s Value Based Purchasing Strategy, visit the VBP website.

Notice Date:  April 25, 2013

Deadline for Questions: 5:00 PM Eastern Standard Time, May 3, 2013

Answers Published: 5:00 PM Eastern Standard Time, May 17, 2013

Final RFI Submission Date: 5:00 PM Eastern Standard Time, June 14, 2013 [return to top]

Medicaid Primary Care Payment Increase - Physician Self-Attestation

As reported in previous issues of the Update, the Office MaineCare Services (OMS) is implementing Section 1202 of the Affordable Care Act,  which requires Medicaid programs to pay for select primary care services and vaccine administration at rates equal to Medicare for 2013 and 2014.  

To receive the payment increase, however, physicians must act.  Each qualifying physician must complete and submit a Self Attestation form. By completing the form, providers attest that s/he meets the criteria established by the ACA – specifically, that:

  • they are appropriately Board certified; OR 
  • that 60 percent of their Medicaid claims are for evaluation and management (E&M) and vaccine administration codes as specified in the federal rule.  

The Self-Attestation form can be found here (downloadable Word document) and provides detail on each of the above criteria.

Provider files will be updated once OMS has approved your form, and OMS will send you a confirmation via email. Please note that the increase will not occur until OMS has approved your form, and that payments will be retroactive to 1/01/13. 

If you have any questions, please contact Donna Sutter at OMS at (207) 629-4280.

The Centers for Medicare and Medicaid Services (CMS) has also issued a series of Q&As about the payment increase, including which specialties and subspecialties qualify. [return to top]

Accept Federal Funds for Maine’s Health - Action Needed

As a member of the Cover Maine Now! coalition, the Maine Medical Association has been working to bring new federal funds to Maine to cover tens of thousands of uninsured Mainers.  

Accepting these federal dollars, which have already been set aside to cover Maine’s uninsured, will benefit all Maine people and boost Maine’s economy.  

You can help our efforts by signing a petition to your state legislators.  The legislature is considering a plan to accept federal funds, and they need to know that you support it.  

Please send a message to your legislators today. 

Accepting federal funds will save lives and save money.  Please help us keep the momentum going!

Urge your legislators to support accepting the federal money.  

To learn more about our efforts, visit Cover Maine Now. [return to top]

Medicare Enrollment Referring/Ordering Deadline, May 1

As you are probably aware, Medicare is preparing to go live on May 1 with the referring / ordering edits that will result in claims denials unless the referring / ordering physician or other health care provider is enrolled in Medicare (or has a valid opt-out affidavit on file with their local Medicare contractor).  To be clear, it is the billing provider’s claim that is at risk of being denied.  The American Medical Association was instrumental in securing a delay in the implementation of this policy (which was originally scheduled to go into effect in 2010) so that physicians had sufficient time to enroll (or file a valid opt-out affidavit).   The AMA, together with MGMA, have prepared a fact sheet / FAQs which you may find helpful.  To find the fact sheet and for more information on Medicare enrollment please visit the AMA website at http://www.ama-assn.org/go/medicareenrollment. [return to top]

Second Physician Executive Leadership Institute (PELI) Class Begins Thursday

The Daniel Hanley Center for Healthcare Leadership begins its second PELI class on Thursday evening.  The year-long course, offered with the assistance of the Heller School at Brandeis University, is aimed at teaching physicians the skills needed to be successful in the management and operation of complex health care systems. Four MMA leaders are enrolled in the course including President Dieter Kreckel, M.D., Past-Presidents Maroulla Gleaton, M.D. and Brian Jumper, M.D. and Board member Robert Chagrasulis. [return to top]

Upcoming Events

Maine Center for Cancer Medicine Presents Educational Lecture Series:  Screening & Treatment

4th Wednesday of Each Month (with exceptions), 6 pm – 7 pm

100 Campus Drive, Conference Room, Scarborough, Maine

Note: To attend the live presentation or join a lecture via Webex, contact Betsy Chase

at 207-396-7634 or chasee@mccm.org

FREE CME Credit Available

May 22, 2013:  Prostate, Treatment Update  Dr. Aronson

June 26, 2013:  Lung, Screening & Treatment Update  Dr. Thomas

July 24, 2013:  Breast, Screening Update  Dr. Weisberg

August 28, 2013:  Breast, Treatment Update  Dr. Weisberg

September 18, 2013:  GI, Screening Update   Dr. Benton

October 23, 2013:  GI, Treatment Update   Dr. Dugan

November 13, 2013:  Melanoma Review and Update for the PCP   Dr. Aronson

December 18, 2013:  Palliative Care Review  Dr. Keating

January 22, 2014:  Brain, Screening and Treatment Dr. Evans

February 26, 2014:  Clinical Research Overview  Dr. Thomas

March 26, 2014:  Hematologic, Treatment Update  Dr. Ryan


You are cordially invited to attend a MedImmune Speaker Program on: 

FluMist Quadrivalent (Influenza Vaccine Line, Intranasal) 

Tuesday, April 30, 2013 

6:00 pm 

DiMillo's Floating Restaurant, 25 Long Wharf, Portland 

Speaker: Michael Marcus, MD, Dir. of Allergy/Immunology and Ped. Pulmonology, Maimonides Medical CEnter, Staten Island, NY 

Please rsvp by April 25 to demersL@medimmune.com or 508-341-2709


AMDA Maine State Chapter 2013 Medication Safety Conference 

May 17, 2013

11:30 am - 3 pm 

DiMillo’s Floating Restaurant

25 Long Warf Portland, ME 

No cost to Healthcare Professionals

Topics include reducing adverse drug events related to Coumadin and practical approaches to reducing antipsychotic use in dementia. 

Attendees may registration online at www.mainemda.com or by contacting Tammy Wing directly at (207) 780-6565 or email thewitt@mainegeriatrics.com


Advancing Change:  Healthcare System Transformation in Northern New England 

Keynote Speaker:  Jay Want, MD, Center for Improving Value in Health Care

May 21, 2013

8:00 am - 5:00 pm

University of New Hampshire, 75 Main Street, Durham, NH

For more information or to register, click here


Save the Date: Enhancing Healthcare for Persons with Intellectual Disabilities

June 11, 2013

Holiday Inn by the Bay, Portland

This one-day program will provide information valuable for improving clinical and systemic capabilities for the effective delivery of healthcare to persons with intellectual disabilities.


Save the Date: 

Maine Public Health Association 29th Annual Meeting 

October 22, 2013 

8:30 am - 4 pm 

Augusta Civic Center 

For more information, click here. 

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Job Openings

FAMILY PRACTICE PHYSICIANS Sought - Katahdin Valley Health Center

Katahdin Valley Health Center is recruiting dedicated Family Practice Physicians that are committed to providing quality health care services to the people in Central/Northern Maine.  Join our practice in one of the newly expanded facilities.  We are seeking physicians for our Millinocket and Patten locations.  KVHC is a fully electronic medical record site and offers a competitive salary and benefits package which includes sign on bonus, generous amounts of paid time off, health insurance, life and disability insurance as well as Federal Torts Claims Act (FTCA) malpractice coverage.  No nights, no weekends, either limited or no inpatient care and limited call coverage.  Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.

Physicians that join KVHC will be providing quality care in a dynamic, cutting edge environment, within a patient focused team of 11 Providers and 90 Staff Members.  As one of New England’s highest performing Federally Qualified Health Centers (FQHC), KVHC has a mission to provide community accessible, quality healthcare with compassion and dignity. 

To learn more about KVHC and Practitioner Opportunities, please contact Michelle LeFay at mlefay@kvhc.org or visit our website at www.kvhc.org.  KVHC is an equal opportunity employer.


INTERNIST - Coastal Maine

Seeking a BC/BE Internist to join a Mid Coast Medical Group practice of seven internists in Bath, Maine.  Mid Coast Medical Group is a department of Mid Coast Hospital and is a NCQA-qualified Patient Centered Medical Home.  It practices high quality internal medicine supported by an excellent EMR.  Our "outpatient only” call is 1 in 7.

Bath is a beautiful, small, historic city on the coast of Maine.  Nearby Mid Coast Hospital, built in 2001, is the newest full-service, stand-alone hospital in New England.  Mid Coast Hospital combines the newest medical technology with skilled medical professionals and Maine’s natural beauty, to meet the psychological as well as the physiological  healing needs of their patients.

This 92-bed hospital has an active medical staff of 160 physicians serving a population of 90,000 area residents.

Mid Coast offers a competitive benefits and compensation package and an excellent work environment.

Contact Jill Rose, Physician Recruiter, at jrose@midcoasthealth.com or call (207) 373-6888.


Emergency Department PA

Full time summer position, mid-May to mid-October.  Emergency Department practitioner.  Primary duties are direct patient care in the emergency room setting; diagnosis and treatment; meeting with physician supervisor in a timely manner.  Graduate of approved Physician Assistant's program.  Certification in BLS, ACLS, PALS, and ATLS or equivalent.   Current Maine licensure.  Medical Practice maturity as evidenced by at least two years of mid-level practitioner experience within an emergency department setting or by completion of an ER specific residency training program.

For more information or to apply please visit us at http://www.mdihospital.org or contact Charlotte Skiff at 207-288-5081, ext. 1165 or Charlotte.Skiff@mdihospital.org


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