July 13, 2015

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POLITICAL PULSE: Legislature Returns This Thursday; Constitutional Question May Go to the Law Court

The session-long tension between Governor LePage and the legislative leadership will continue to the very end of the First Regular Session as the two branches of government disagree on the timing of the Governor's opportunity to act upon bills enacted by the legislature and sent to him for signature.  The outcome of some 70 bills depends on whether Executive branch's or Legislative branch's interpretation of the Maine Constitution is correct, an interpretation that may have to be made by the Maine Supreme Judicial Court.

The latest controversy arising out of Maine's divided government came to light on or about July 10th when the Legislature's Office of the Revisor of Statutes began "chaptering" or putting in a format to become law without the Governor's signature, some 19 bills held by the Governor's Office beyond the 10 days he had to act upon them.  The Governor's legal counsel issued an opinion that the Governor was entitled to hold on to the bills because the Legislature had finally adjourned.  Attorney General Janet Mills responded to a bipartisan inquiry from the Senate that the bills had become law because the Legislature had not finally adjourned.  Final adjournment of a legislative session traditionally is known as "adjournment sine die," or adjournment with no specified date of return.  When the Legislature left Augusta on June 30th, leaders planned to return on July 16th to finish their business, including further vetoes anticipated from Governor LePage.  The Governor continues to hold another 50 or so bills.  Today, he announced that he has not decided whether to ask for an opinion from the Law Court this week or wait until January.  The Legislature also could request an opinion.  

 Several bills of interest to MMA appear to be caught up in the controversy.  Among those being "chaptered" and becoming law are LDs 1307 (diversion alert), 1145 (involuntary commitment), 1013 (shackling pregnant prisoners), 1108 (protect children from e-cigarette vapor), 1391 (treatment of forensic patients), and 91 (prescribing by dental hygienists).  Among the bills that may be held by the Governor are LDs 140 (access to naloxone), 787 (adult day care/respite care), 831 (targeted prevention services), 905 (Fund for a Healthy Maine study), and 1350 (reimbursement of direct care workers).

In the coming weeks MMA advocacy staff will prepare a summary of all the legislative action impacting physician practices and will make it available to all MMA members.

A special thank you is due to the many physicians who joined staff in the weekly conference calls of the Legislative Committee and to those who came to the State House to serve as Doctor of the Day.  Also a shout out to those MMA members who testified on the many bills impacting on the practice of medicine.  The Association ultimately reviewed and monitored more than two hundred of the approximately 1750 bills printed.


Medicare to Pay for Counseling on End-of-Life Care, Effective January 1, 2016

On Wednesday, July 8th, the Centers for Medicare and Medicaid Services announced plans to pay physicians to counsel patients about end-of-life care, effective January 1, 2016.  The decision was announced by Patrick Conway, Medicare's chief medical officer who stated, "As a practicing physician, and a son, and someone who has dealt with this in his own family, I would say these are discussions . . . that are critical to high-quality care.   I would want any American who wanted to have this conversation with their clinician to have the opportunity to do so."

Medicare will use the term "advanced care planning" for the new benefit aimed to discern the type of treatment patients want in their last days, with options ranging from care that's more focused on comfort than extending life to all-out medical efforts to resuscitate a dying patient.

Last week's announcement did not elicit accusations of "death panels" that arose when a similar provision was included in the Affordable Care Act.  Ultimately, that provision was removed from the ACA.  

This provision is part of the proposed 2016 physician payment rule that is set to be published in the Federal Register this Wednesday, July 15th with comments due on September 8th and anticipated publication of a final rule on November 1st.  

This rule institutes the Merit-Based Incentive Payment System (MIPS), the new physician payment system to replace the SGR enacted through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

You can view the CMS news release with links to a rulemaking fact sheet and the rule here.

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Fore! Join MMA at Augusta Country Club on Monday, July 20th for Scholarship Golf Tournament

 The MMA's 12th Annual Golf Tournament to benefit the Maine Medical Education Trust Scholarship Fund (providing scholarships to medical students from Maine) will take place at the beautiful Augusta Country Club on Monday, July 20th.  Tournament Chair Brian Jumper, M.D. invites all friends of MMA to join us for this event.  

The schedule for the day of the tournament follows:

  • 11:00 a.m., Registration and lunch on the ACC deck
  • 12:00 p.m., Tournament begins; shotgun start
  • 5:30 p.m., Hors d'oeuvres, cash bar, networking, and awards ceremony

The registration fees and sponsorship opportunities follow:

  • Individual player registration:  $125
  • Foursome registration:  $500
  • Hole sponsorship and foursome:  $1000
  • Hole sponsorship:  $500

Tournament prizes include:

  • Top 3 net scores
  • Top 3 gross scores
  • Men's and women's long drive
  • Men's and women's closest to pin on Par 3s

You can find online registration information on the MMA website, www.mainemed.com here

For more information, please contact Lisa Martin, Membership Coordinator, at 622-3374, ext. 221 or lmartin@mainemed.com.


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Workers' Comp Proposes Medical Fee Schedule Changes

On July 9th  the MMA staff submitted comments on the Maine Workers’ Compensation Board’s proposed rule changes relating to the medical fee schedule. Among the changes the Association supports are clarifications of the rules regarding patient authorizations (they are not required) and records (they are to be sent with each bill and paid for by the insurer/employer). The MMA also supports the change from a reimbursement formula to a fee schedule for durable medical equipment. We asked for clarification of references to such items as post-surgical care, which has no definition or time frame, whether “any visit” includes diagnostic testing, and whether a diagnostic code reference will be considered a sufficient “description of the injury” on requests for payment for services. The proposed rules also refer to ICD codes without any discussion about how the change from ICD-9 to ICD-10 will be handled by the agency.

Finally, the proposed rules have two fee reduction sections which the MMA opposes. The fee for the first page of copies is reduced from $10 to $5, although the per-page amount is increased from $0.35 to $0.45. More significantly, the facility base rates for ambulatory surgical units are proposed to be reduced over three years from the current $81.32 to $78.53. In comparison, the rates for acute care hospitals will rise from $108.42 to $143.59 and the rates for critical access hospitals will rise from $132.53 to $166.50 during that same time frame. The MMA voiced its strong objection to these changes, particularly since our members are prevented by contract from revealing what they are paid by commercial insurers and the Workers’ Compensation Board does not appear to have asked the insurers for that information before relying on demonstrably poor quality data upon which their consultant based its recommendations. We will continue to monitor and report on these proposed changes.

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How Physicians are Helping Rethink EHRs

Physician involvement in a special group of health IT leaders could help solve the electronic health record (EHR) system problem.

With its recent involvement in the Substitutable Medical Applications and Reusable Technology (SMART) Platforms project, the AMA is embedding the voice of physicians in efforts to make EHRs work better for physicians and patients.  A key component of the SMART project is the development of an infrastructure that allows for free, open development of plug-and-play apps.  Such apps are intended to increase cost-effective interoperability between health technology, including EHRs.  Jesse M. Ehrenfeld, MD, member of the AMA Board of Trustees, will lend the physician voice to project.

The AMA continues to advocate for better EHRs and views the SMART project as a vital component in improving physicians’ satisfaction with the use of health information technology in patient care.

Learn more at AMA Wire®.
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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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President Appoints Acting CMS Head Slavitt to be Administrator

On July 9th, President Obama announced his formal appointment of Andy Slavitt, principal deputy administrator at the Centers for Medicare & Medicaid Services (CMS), to be the Administrator of the agency.  Slavitt has been acting Administrator since the departure of Marilyn Tavenner.  Before joining the government in 2014, Slavitt was an executive at Optum, a clinical, technological, and operations solutions-focused part of UnitedHealth Group.  The position requires Senate confirmation where he is likely to face tough questions from Republicans about the ACA and his former employer. [return to top]

Advocate for Your Profession! MMA Nominations Committee is Looking for Volunteers

The MMA Nominating Committee is meeting regularly to review candidates for open positions on the MMA Board of Directors and all of its committees.  The Committee's charge is to:

  • Consider the needs of the Association and its members;

  • Ensure that the Board of Directors has the necessary balance of skills, talent, and representation to fulfill its mission; and

  • Nominate members for the Board of Directors, the Officers, AMA Representatives, and other committee leadership positions.

Nominations must be made by August 7th in order to be considered at the Annual Meeting in Bar Harbor on September 12th.  If you would like to be considered for a Board or committee position, please send your CV to Gordon Smith, Executive Vice President at gsmith@mainemed.com.   Any questions may also be directed to Mr. Smith at 215-7461 (cell) or to the Chair of the Nominations Committee Kenneth Christian, M.D. at 949-5700. Information on all the MMA Committees is also available on the MMA website at www.mainemed.com.

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Court to Weigh Physicians’ Right to Payments, Recourse

Should physicians be left holding the bag when a private insurer retroactively denies a medical claim or recoups a payment?  A federal appeals court is considering a case that could determine whether medical providers have recourse in such situations to ensure that their practices remain financially stable so they can continue caring for their patients.

At issue in Pennsylvania Chiropractic Association v. Independence Hospital Indemnity Plan, Inc., is the payer retroactively denying benefits or taking back payments without explaining why the action was taken or how the medical provider can appeal the decision.

“The decades-long dispute continues between medical providers and the … third-party payers … of Employee Retirement Income Security Act (ERISA)-regulated health plans over whether providers should be paid for their services, and how providers can assert their right to receive payment,” the Litigation Center of the AMA and State Medical Societies and the Illinois State Medical Society said in an amicus brief recently filed with the court.

“Unsurprisingly, the position Independence Hospital Indemnity Plan takes would result in … medical professionals performing necessary medical services and then being left ‘holding the bag,’” the brief states.

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NCOIL to Consider Model Bills on Provider Directories, Telemedicine

State legislators who are responsible for insurance legislation will consider AMA model bills on provider directories and telemedicine.

The National Conference of Insurance Legislators (NCOIL) will consider:

  • Model Act to Ensure Meaningful Access to Accurate Provider Directories.  Sponsored by Arkansas Rep. Deborah Ferguson, this model would require insurance department approval of insurance company provider directories, as well as of annual updates.  It also would identify various contact and other information that must be included in a directory, including whether physicians are accepting new patients and set rules for publishing and updating directories.  Finally, it would lay out rules for enforcement and allow for private rights of action.
  • Model Telemedicine Reimbursement Act.  Sponsored by Rhode Island Rep. Brian Kennedy, this model would require coverage for telemedicine services that would be on par with coverage for in-person treatments.  It also would, among other things, prohibit insurers from excluding coverage for a service solely because it is provided through telemedicine.
  • Model Telemedicine Licensure Act.  Also sponsored by Rep. Kennedy, this model would require physicians treating patients to be licensed in the state in which the patient receives care, as well as to be regulated by that state’s board of medicine.

For more information about the accurate provider directory bill, email Emily Carroll or Daniel Blaney-Koen of the AMA.  For more on the telemedicine model bills, email Kristin Schleiter of the AMA.

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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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Job Openings

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 Director/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

Falmouth Orthopaedic Center - Falmouth, Maine

Seeking a BE/BC general or fellowship trained surgeon to join our expanding group.  Falmouth Orthopaedic Center is a well respected private practice in a vibrant orthopedic community. You will be partnering with 3 experienced surgeons each with an outstanding reputation in the area.

Located in Falmouth Maine (approximately 10 minutes from Portland, 2 hours from Boston) we pride ourselves on our four beautiful seasons, unlimited recreation, and top-ranking schools all within 10 minutes of the magnificent Maine coast. Falmouth is an excellent place to raise a family and offers a great quality of life with easy access to all the cultural amenities of the city of Portland.

This opportunity offers minimal ER call at a Level 2 community hospital with a competitive compensation package.  Our ideal candidate is a well trained general orthopedist or an orthopedist who is fellowship trained in foot and ankle, hand, pediatrics, sports medicine or adult reconstructive surgery.

Please send cover letter, CV, and inquiries to: hsgentile@maine.rr.com.


Emergency Medicine Physician at Sebasticook Valley Health in Pittsfield, Maine

Sebasticook Valley Hospital (SVH) is a 25-bed modern critical access hospital located in Pittsfield which is 20 minutes north of Waterville, and 40 minutes south of Bangor, Maine’s second largest city. The hospital serves a population of 30,000 in this central Maine area.

An excellent opportunity is available for a full time Emergency Medicine Physician.  The Emergency Medicine Physician is responsible for the evaluation and management of patients who seek emergency care for a broad range of illnesses and injuries. 

This is an experienced ED staff treating approximately 13,000 patients annually. Flexible schedule working 12-14 12-hr shifts. We are seeking either an MD/DO board certified/eligible emergency medicine trained physician, or board certified/eligible 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.  SVH serves has a wide range of outpatient services, including over 20 specialty services.

For more information, please contact Sherry Tardy, PHR, AASPR, at 207-487-4085 or stardy@emh.org.





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