June 29, 2015

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Supreme Court Upholds Subsidies in King v. Burwell; Insurance Preserved for More than 60,000

On Thursday, June 25th, The United States Supreme Court issued its much anticipated decision in the case of King v. Burwell which had challenged the tax credits granted to marketplace enrollees in states that had not established their own exchanges, including Maine.  In a 6 to 3 decision written by Chief Justice John Roberts, the Court ruled that Congress had intended for the subsidies to apply in states with either their own exchange or used a federally facilitated exchange.

Writing that the Congress passed the Affordable Care Act "to improve health insurance markets, not to destroy them," the Chief Justice noted some examples of inartful drafting, but concluded that "the context and structure" of the ACA led the justices to conclude that the Congress intended the result that occurred when several states, including Maine, refused to establish their own exchange or marketplace.  

Writing for the dissent, Justice Antonin Scalia said, "We should start calling this law SCOTUScare," suggesting that the Supreme Court has twice saved the ACA a/k/a Obamacare. 

In Maine, more than 70,000 people enrolled in health plans through the exchange-marketplace with more than 60,000 of them receiving subsidies averaging $4,250 each.  Some studies leading up to the Supreme Court decision concluded that as many as 50,000 of these individuals may have given up the insurance if the subsidies had been denied.

POLITICAL PULSE: Legislature Returns Tomorrow to Consider Gubernatorial Vetoes of a Number of Bills, Including the Biennial Budget

Tomorrow morning, the 186 members of the 127th Maine Legislature will return to the State House in Augusta to address Governor LePage's vetoes of the entire biennial budget, L.D. 1019 (in addition to the numerous line item vetoes of budget lines issued and overturned last week), and a number of other bills.  The legislature still has some tabled business to address, too, so they may have to return again for another veto session perhaps in July.  

The MMA staff probably will be engaged in some legislative work on interim studies and/or carry over bills during the Summer and Fall.  The MMA Legislative Committee will hold an organizational meeting for the Second Regular Session some time in late November or early December.  The legislature will return for their Second Regular Session on the first Wednesday after New Year's Day in 2016.  Look for information about this meeting, as well as the process for legislators to submit bill requests for the second session in the Maine Medicine Weekly Upate.

During this first session of the 127th Legislature, the Association through its Legislative Committee has monitored more than two hundred legislative proposals of some interest to physicians.  Many involved public health or professional regulation.  Many thanks to the numerous MMA members who joined the weekly conference calls or came to the State House to serve as Doctor of the Day.  And a special thanks to Legislative Committee Chair Amy Madden, M.D.  Dr. Madden practices family medicine at the Belgrade Health Center.

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Maine Medical Education Foundation Awards $351,000 in Loans to Medical Students from Maine

MMA's Committee on Loan and Trust met last week and considered the applications for low interest loans from the Maine Medical Education Trust from 43 MD students and 13 DO students.  All the students were residents of Maine.  Committee members voted to loan a total of $351,000 to the students and no application was denied.  First year students were loaned $4,000, 2nd year students $5,000, 3rd year students $8,000, and 4th year students $10,000.  $4,000 was set aside for any late applications.  Of the loans granted, 36 went to students in the Tufts University School of Medicine - Maine Medical Center Track and 9 went to students at the University of New England College of Osteopathic Medicine.  A list of all the recipients and their school affiliations will be included in the summer issue of Maine Medicine.

The Committee is chaired by Mark Bolduc, M.D., a general surgeon practicing in Waterville and Augusta.  

The Committee also reviewed policies regarding collection and recent development activities. 

The loan fund that makes up the Foundation was established in 1962 and the funds may only be used for loans to medical students from Maine.  The MMA Board of Directors serve as the Trustees of the Foundation.

Information on eligibility for the loans is available on the MMA website at www.mainemed.com.  



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U.S. House Votes to Repeal ACA Independent Payment Advisory Board

Last week, the U.S. House of Representatives voted 244-154 to repeal the Independent Payment Advisory Board (IPAB) which is a provision within the Affordable Care Act (ACA).  First District Congressman Chellie Pingree voted against the repeal bill and Second District Congressman Bruce Poliquin voted in favor.  The American Medical Association and most of the national specialty societies opposed the IPAB believing that it would have too much authority and power to change Medicare policy without oversight from the President, the courts, or the Congress.

A similar bill is likely to pass the Senate, but the President is likely to veto any effort to repeal this provision in the ACA.

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Apply for Meaningful Use Hardship Exemptions by June 30th

Physicians can apply for a meaningful use hardship exemption by 11:59 p.m. Eastern time June 30th to avoid a 2016 penalty.  Some of the hardship exemptions require physicians to file accompanying documentation that may be hard to compile in a single day, so it is important not to wait until the last day to file.

Certain types of physicians designated by their Medicare Provider Enrollment, Chain and Ownership System (PECOS) code are not required to file for a hardship.  Instead, Medicare will automatically grant a hardship exemption to the following specialties:

  • Anesthesiology
  • Diagnostic radiology
  • Interventional radiology
  • Nuclear Medicine
  • Pathology

Get more information and instructions.

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Sunshine Act Payment Data to be Released June 30th

Physicians' 2014 financial data under the Physician Payments Sunshine Act, also known as the Open Payments program, will be released to the public June 30th.  You have just a few hours left to review and dispute errors that will be reflected in the next scheduled update of the database.

Even though CMS overrode the AMA and other medical associations' calls to delay the release of 2013 payment data in light of all the problems, the AMA was able to head off much of the anticipated interpretation troubles by educating reporters about issues with the data, guiding physicians through the review and dispute process and providing talking points to explain the data to inquiring patients. [return to top]

How Real Physicians are Making Their Practices Thrive

Physicians have found a way to minimize stress and overcome barriers to providing the best care:  A free online series of proven solutions developed by physicians that can make your practice thrive.

The AMA's newly launched STEPS Forward website offers a collection of interactive educational modules that help physicians address common practice challenges while earning continuing medical education credit.  The modules include steps for implementation, case studies, and downloadable tools and resources.

Read more at AMA Wire®.

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Considering a Run for Office: Sign Up for AMPAC's 2016 Political Education Programs

AMA members and their spouses who are interested in politics should check out two workshops offered by AMPAC in Arlington, Va.  More than 30 past participants currently hold public office, including five members of the U.S. Congress.

Those considering a run for public office should attend AMPAC's Candidate Workshop Feb. 19-21.  The workshop includes training on campaign strategy and media advertising, as well as hands-on sessions in public speaking and fundraising.

The 2016 Campaign School, April 13-17, is for AMA members who wish to become involved in the political process as advocates and volunteers for medicine-friendly candidates. The school is organized around a simulated congressional campaign, where participants are put on campaign "staff" teams and attend daily lectures on campaign strategy, media advertising and political fundraising.  Each team participates in nightly exercises such as creating a campaign strategy, taping a radio commercial and writing a political fundraising letter.

For both programs, AMPAC covers all costs for AMA members except transportation to the Washington, D.C. metro area.  For more information on these programs or an application, please see the online registration form or email Jim Wilson of the AMA.
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Make Plans Now to Attend 162nd MMA Annual Meeting, September 11-13, 2015 in Bar Harbor

Registration material for MMA's upcoming Annual Session in Bar Harbor, from September 11-13, 2015 is in the mail to each MMA member this week.  The meeting once again will be at the Harborside Hotel & Marina and opens with a reception on Friday evening, September 11th.  Three hours of category one CME has been applied for and the focus of the meeting will be "Advocating for the Profession."  Please make plans soon to join your professional colleagues to discuss issues of common interest and to conduct the annual business of your association.  Anyone wishing to submit a Resolution for consideration should send it to EVP Gordon Smith via e-mail to gsmith@mainemed.com no later than August 15th.

On Saturday evening, September 12th, MMA President Lisa Ryan, D.O. will pass the President's gavel to Brian Pierce, M.D.  Dr. Pierce is a family physician practicing in Rockport.

Any questions about the meeting may be directed to Diane McMahon in the MMA office.  Her phone number is 207-622-3374, ext. 216 and her e-mail address is dmcmahon@mainemed.com.   Potential exhibitors and sponsors should contact Lisa Martin at 622-3374, ext. 221 or via e-mail to lmartin@mainemedcom.


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VA Announces Information about the Veterans Choice Program

                          DEPARTMENT OF VETERANS AFFAIRS

VA Maine Healthcare System

1 VA Center

Augusta, Maine 04330


                                                                                                                   January 10, 1996

In Reply Refer To:  BSL4B

Dear Community Medical Care Provider,

On August 7, 2014, the President and Congress enacted the Veterans Access, Choice, and Accountability Act of 2014, which established the Veterans Choice Program (Choice) to improve access to care for our nation’s Veterans by allowing Veterans who qualify for this program to receive health care in their communities rather than waiting for a Department of Veterans Affairs (VA) appointment or traveling to a VA facility.

VA is pleased to let you know that we have partnered with Health Net Federal Services to serve Veterans who qualify for the Choice program.  Health Net is working with providers to establish network capacity to provide eligible Veterans access to covered medical care when the local VA medical facility cannot readily provide the care due to lack of available specialists, long wait times, geographic inaccessibility, or other factors.  

I realize that you provide non-VA medical care to Veterans through programs other than our Choice network arrangement with Health Net and I greatly appreciate your willingness to provide medical services to our nation’s Veterans.  Moving forward, VA asks you to join the Health Net network to continue to provide services covered under the Choice Act.  In the future these networks will be the primary vehicle through which VA will authorize and pay for care for services covered under Choice.  

Reimbursement for medical services provided under the Choice program is 100% of Medicare rates. Claims and reimbursement are handled by Health Net and will be processed within 30 calendar days of receipt of claim and medical documentation per the agreement.

If you are a Medicare provider, it is easy to become a network provider for the VA Choice program. Simply go to Health Net’s website at: https://www.hnfs.com/content/hnfs/home/va/home/provider/options-for-providers/become-a-veterans-choice-participating-provider.html to complete and submit the provider agreement template found on the website.  If you have any additional questions for Health Net, please visit the website above or call 1-866-606-8198 and select option 2. 

I appreciate your support of our mission and look forward to continuing our relationship through these arrangements.


Ryan S. Lilly, Director, VA Maine Healthcare System

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Save the Date: MMA's 25th Annual Practice Education Seminar, November 18th in South Portland

The Double Tree Hotel across from the Maine Mall will be the site of this year's Annual Practice Education Seminar on Wednesday, November 18, 2015.  This year's program will be the 25th annual educational program that the Maine Medical Association has presented for the benefit of physicians and practice managers.  This year's program will include presentations from experts on the following topics:

  • Medicare in the post-SGR era
  • Payment models beyond fee for service
  • New laws from the 127th Legislature
  • Current issues in regulatory compliance 
  • Prescribing for pain while being cognizant of the state's opiate problems
  • Enhancements to the Prescription Monitoring Program
  • New obligations regarding Child Abuse reporting
  • Update on State Innovation Model (SIM) grant
  • Medicaid and Medicare update
  • Quality Improvement Initiatives for the Private Practice
Other topics may be added between now and the date of the program.  Registration materials for the conference will be available later this summer.  Information for interested attendees or exhibitors/sponsors are available from Gail Begin, Lisa Martin, or Gordon Smith at MMA.
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Job Openings

Medical Director - Physician III - Maine Office of Child & Family Services  (click to link to full job description)

Recruitment efforts are underway for the position of Medical Director/Physician III within the Office of Child and Family Services at the Maine Department of Health & Human Services. 

Description:  As the Medical Director you will be part of a talented team responsible for behavioral health services in Maine. The Medical Director is the liaison that provides oversight and technical assistance in the area of behavioral health services for children to the Office of Child and Family Services, the Office of MaineCare Services and other DHHS Offices, as well as statewide contractors, acute psychiatric hospitals, residential treatment centers, and crisis centers. As Medical Director you will evaluate and assist in determining policy criteria for the eligibility of services for those who have behavioral health needs; oversee the provision of services and second level reviews regarding the provision of services; oversee and provide consultation related to the delivery of home and community based treatment, Early Childhood Autism Specialized Habilitation Services and Habilitation Consultation Services. You will also evaluate and approve out-of-home placements for members under 18 years old and perform utilization and review of out-of-state placements in Residential Treatment Centers; and develop and implement Clinical Guidance documents, policies, procedures and plans. 

Family Medicine and Outpatient Internal Medicine Physicians

Katahdin Valley Health Center is recruiting dedicated Family Medicine and Outpatient Internal Medicine Physicians that are committed to providing quality health care services to the people in Central/Northern Maine.  KVHC has sites in Ashland, Houlton, Island Falls, Patten and Millinocket.  Join our practice in one of the newly expanded facilities.  We are seeking physicians for all of our outpatient only practices.  KVHC is a fully electronic medical record site and offers a Four day work week with a competitive salary ($170,000 to $190,000 annual) and benefit package which includes: a 10% of first year salary sign on bonus, generous amounts of paid time off and $2500 annually toward CME.  The call schedule is 1 in 9 with additional coverage from the Open Access Clinic.  Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.  HPSA scores at the KVHC sites increased in 2015.

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.


Department of Psychiatry Faculty Position

The Geisel School of Medicine at Dartmouth, Department of Psychiatry, in a productive collaboration with the State of Maine, is seeking psychiatrists to join our faculty for inpatient responsibilities at the Riverview Psychiatric Center.

Riverview Psychiatric Center is a 92-bed acute psychiatric facility located in Augusta, ME and is the flagship inpatient treatment center for Maine’s public mental health system.  Psychiatrists with expertise in general inpatient psychiatry or forensic psychiatry are encouraged to apply.

Academic duties can include teaching and supervision of medical students and residents. Research opportunities available and encouraged.

Candidates should be board certified or eligible in Psychiatry. This position will include a faculty appointment at The Geisel School of Medicine at Dartmouth at a rank and salary commensurate with experience. Curriculum vitae and three letters of reference, addressed to Dr. William Torrey, Search Chair, should be e-mailed to psychiatry.jobs@dartmouth.edu.  Please reference search number PS0314D.

Dartmouth College/Dartmouth Hitchcock Clinic/Geisel School of Medicine is an equal opportunity/ affirmative action employer with a strong commitment to diversity. In that spirit, we are particularly interested in receiving applications from a broad spectrum of people, including women, persons of color, persons with disabilities, veterans or any other legally protected group.


Waterville Pediatrics - Waterville, ME

Seeking both a Pediatrician and Pediatric Nurse Practitioner to join our expanding practice.  We provide pediatric care to thousands of Maine children of all ages.

Waterville Pediatrics is a well established practice with locations in Waterville and Madison.

Minimal call, competitive salary and benefits.

Please send letter of interest and CV to hsgentile@maine.rr.com


Winthrop Family Medicine Family Practitioner

MaineGeneral Medical Center in Augusta, Maine is seeking a full-time, outpatient BC Family Practitioner to join our nationally recognized Advanced Medical Home practice that delivers care in a team model. Join a collaborative group made up of 11 MDs, DOs, NPs and PAs and practice in an “Open Access” model of scheduling. Provide a full range of care including: OB, newborn and pediatric care, adult medicine, gynecology, geriatric and nursing home care. Technology includes an electronic medical record, online digital radiology program, and online hospital records and ordering. MaineGeneral offers a comprehensive benefits package. The brand new, state-of-the-art, 192-bed MaineGeneral Medical Center at the Alfond Center for Health offers comprehensive inpatient and outpatient services for the surrounding communities. We’re located just an hour north of Portland, Maine’s largest city, and three hours from Boston. Contact Tiffiny Lamarre, Physician Recruiter at tiffiny.lamarre@mainegeneral.org.


Family Medicine Physician

Oakland Family Medicine, a hospital-employed outpatient Family Medicine practice located in Oakland, Maine, is recruiting for an experienced Family Medicine Physician to join our growing team. Responsible for providing care for pediatric through adult patients while working in collaboration with our practice administrator, providers and senior management team as Oakland continues the transition to Patient Centered Medical Home. Join our team of four family medicine physicians and one physician assistant and collaborate with a unique mix of seasoned physicians who have practiced in the area over 10 years, and new team members who have recently joined our group. Weekly schedule will be 32 hours of patient contact time and up to 8 hours of administrative time. MaineGeneral offers a comprehensive benefits package. We’re located just an hour north of Portland, Maine’s largest city, and three hours from Boston. Contact Tiffiny Lamarre, Physician Recruiter at tiffiny.lamarre@mainegeneral.org.


Family Practice Physician – Bucksport Regional Health Center                                                                

The Bucksport Regional Health Center, a Federally Qualified Health Center, has a unique opportunity for an experienced Family Practice Physician to work at a small, independent, community-based primary care facility that offers great quality indicators, a team atmosphere, and excellent working conditions.  Responsibilities will include the diagnosis, treatment, coordination of care, preventive care and provision of health maintenance services to patients of all life cycles. 

Candidates must have graduated from an accredited medical school and completed a residency in Family Practice or Med/Peds, have a current State of Maine Medical License and D.E.A Certificate, and at least five years of experience in the practice of family or internal medicine. The successful candidate will be offered a generous compensation package, including a competitive salary and excellent benefits. 

The Bucksport Regional Health Center has been offering easy access to quality, affordable care for persons of all ages since 1974.  Interested applicants should apply with a resume and cover letter to Carol Carew, Executive Director, 110 Broadway, Bucksport, ME 04416 or via email at ccarew@brhc.info (or call 207-469-7371).


Physician/Medical Director – Nasson Health Care

Nasson Health Care is seeking a qualified clinical leader to work collaboratively with a team of health and administrative professionals to provide comprehensive primary care to patients while utilizing the Patient-Centered Medical Home model of care delivery.  

The Physician/Medical Director: 

  • Provides advice and counsel regarding a broad range of clinical, clinical policy, programmatic and strategic issues required to achieve the short and long-term strategies and objectives of Nasson Health Care; 
  • Provides direct clinical services and oversees physicians and advanced practice nurses; works in partnership with members of the practice team to manage the care of patients, assuring a high standard of medical care.

Qualifications include:

  • A minimum of three years’ experience as a Medical Director of a primary care medical practice;  A degree from an accredited medical school in the U.S.,
  • Board certification in Family or Internal Medicine;  An unrestricted Maine license to practice medicine, as well as a U.S. Drug Enforcement Agency license;
  • Working knowledge of the core concepts of evidence-based practice, social and behavioral determinants of health, population-based care, integration of medical, behavioral health and dental care, and Meaningful Use of health information technology.
Visit www.yccac.org for an application. Completed cover letter, resume, and employment application will be accepted until position is filled.


Assistant Medical Director

The Assistant Medical Director is responsible assisting the Chief Medical Officer with all areas of medical and behavioral treatment policy, pharmacy, utilization review and management, disease / case management and quality management and for the medical oversight of daily case management and utilization management activities and decisions.

MD or DO with unrestricted medical license in Maine or New Hampshire required. Board certification in primary or specialty care. 

Minimum of five or more years of direct clinical experience in area of clinical practice, participation in a leadership role in medical staff organization activities, and management experience within a health care delivery system.  Minimum of three years’ experience in medical management in a managed care setting or the equivalent.

Apply online at JobsinME.com or email your information to blovejoy@maineoptions.org


Medical Dierctor/Psychiatrist – Woodfords Family Services

Woodfords Family Services http://www.woodfords.org, a not-for-profit social service agency serving individuals with autism, intellectual and developmental disabilities and mental health diagnoses since 1967 has an immediate opening for a Medical Director/Psychiatrist for 2-3 days/week contractual basis to support a program serving children, adolescents and adults.

The Medical Director/Psychiatrist is responsible for clinical oversight,supervision for a full-time Physician Assistant-C and consultation with Agency programs. Opportunities are available to provide assessment and medication management. Hours are flexible. Some on-call hours may be required. Job/Educational Requirements include:

  • Board Certification and a Maine license to practice medicine
  • DEA registration
  • Professional malpractice insurance certificate
  • Graduation from an accredited program
  • Certificate of completion from an accredited psychiatric residency training program or from a child psychiatry fellowship program

Candidates should mail or e-mail (dpatrick@woodfords.org) a letter of interest/resume to: Woodfords Family Services; P.O. Box 1768; Portland, ME  04104-1768; ATTN: Douglas Patrick; Medical Director/ Psychiatrist Search; EOE 

·      7/27/15

Emergency Room Position at Sebasticook Valley Health in Central Maine

Sebasticook Valley Hospital is a 25-bed modern critical access hospital located in Pittsfield which is 20 minutes north of Waterville, home of Colby College, and 45 minutes south of Bangor, Maine’s second largest city. The hospital serves a population of 30,000 in this central Maine area of beautiful rolling hills. The ER is staffed by an Emergency Medicine trained Director and three other physicians. This is an experienced staff. ER volume is 15,000. Physicians have a flexible schedule working 12 `hr shifts. We are seeking either an emergency residency trained physician, can be resident, or board certified FP with ED experience. The hospital has EMR, and is CPOE. The compensation and fringe benefits package is highly competitive. Sebasticook Valley is an affiliate of Eastern Maine Medical Center, the tertiary care center in Bangor. The hospital has a helipad for transporting trauma cases by Life Flight.  For more information regarding this opportunity, please contact Sherry Tardy, AASPR, 207-487-4085 or email stardy@emhs.org

Sebasticook Valley Health is an integral member of the communities it serves. SVH takes a proactive approach in helping people in the Sebasticook Valley improve the quality of their lives. The hospital works with local businesses, schools, the religious community, other healthcare providers, area organizations, and private individuals to make the Valley a healthy place to live. SVH serves has a wide range of outpatient services, including over 20 specialty services. 





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Upcoming Events


Maine Concussion Management Initiative Training Programs – Level 1 and Level 2

General Information for 2015

When and where held:                           

              October 20, 2015 in Portland in conjunction with the Maine Brain Injury Conference

(Registration and fees will be through the Maine Brain Injury Conference for October 20)

Training Program: Training programs in 2015 will be updated.

              Level 1 - An Introduction to Concussions and Concussion Management

              Level 2 – Interpreting Neurocognitive Testing (Level 1 is a prerequisite for taking Level 2)

              8:00am – 8:15   Registration and Continental Breakfast (Level 1 and Level 2 are run simultaneously)

              8:15am-12:00pm            Level 1 – An Introduction to Concussions and Concussion Management

          • The Diagnostic and Return to Play Dilemma
          • Sport Related Concussion: Short and Long Term Sequelae
          • Concussion Sideline Assessment
          • Concussion Risk Factors, Treatment and Return to Function
          • Tools in Concussion Management
          • Concussion Case Studies
          • Review and Wrap-up

   8:15am-12:00pm            Level 2 – Interpreting Neurocognitive Testing             

          • Using ImPACT Testing in Concussion Management
          • Interpreting ImPACT Test Results
          • Case Reviews
          • Review and Wrap-up

              Registration Fee:

              $100 for Health Care Professionals (MD, DO, NP, PA, Neuropsychologist, ATC, RN, PT, OT, SLP)

              $40 for school personnel and all other attendees

                             (School nurses, coaches, school athletic directors, administrators, parents, etc.)

              $20 for students – currently enrolled in a college program

Registration Fee Includes:

  1. Handouts
  2. Continental Breakfast and mid-morning break
  3. CEU/CME credits for Health Care Professionals

Registration Confirmation will be sent by email and will include:

  1. Directions to training location.            
  2. Training agenda.

For more information contact:

              Jan Salis, PT, ATC

              MCMI - Membership Committee Chair


              (207) 577-2018


6th Annual Patient Safety Academy
Wednesday, September 23, 2015
9:00am - 3:30pm
USM Abromson Center

At the 6th Annual Patient Safety Academy this year, Dr. Bryan Sexton, Director of the Duke Patient Safety Center, will present a 2-part seminar on the science of enhancing resilience. Dr. Sexton's research on safety culture, teamwork, and resilience have resulted in assessment tools used world wide. He will discuss practical strategies to manage stress in the healthcare workplace, cope with change, and manage fatigue.

For more information, visit www.usm.maine.edu/muskie/psa


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For more information or to contact us directly, please visit www.mainemed.com l ©2003, Maine Medical Association