July 5, 2016

 
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Caring for ME: Learning Session July 14th on New Opioid Law

The Maine Medical Association and Quality Counts will present a full day of education on the new state law limiting the prescribing of opioid medication on July 14th at Maple Hill Farm in Hallowell.   As space is limited, sign up today!  The initial elements of the law go into effect on July 29, 2016.

Successfully Implementing LD 1646/Chapter 488:

 An Act to Prevent Opiate Abuse by 

Strengthening the Controlled Substances Prescription Monitoring Program

Thursday, July 14, 2016  

8:00 AM - 4:00 PM

Maple Hill Farm, Hallowell ME 


Please join the Maine Medical Association and Maine Quality Counts for an educational Learning Session designed for providers to gain practical information on key issues related to implementing Maine's new law limiting opioid prescribing. The session is designed to provide training for clinician leaders in your organization and prepare them to train and support practice teams in complying with the new law.

Please note that space for this event is limited to the first 100 registrants. In order to allow for statewide participation, we are asking organizations to limit their initial registration to 6-8 clinical leaders. Should you have additional people who would like to register, please have them contact Linda Leighton to be added to the waiting list.

In order to cover costs of this event, there is a charge of $50 per person to attend.

Register by clicking here.

 

 Featured Presenters:

 Lisa Letourneau, Maine Quality Counts

 Gordon Smith, Maine Medical Association

 Heather Skolfield, ME Prescription Monitoring Program

 Clare Desrosiers, ME Diversion Alert Program

 Noah Nesin, Penobscot Community Health Center 

 Jessica Bates, Penobscot Community Health Center

 Eva Quirion, St. Joseph Internal Medicine

 Stephen Hull, Mercy Pain Center

 Elisabeth Fowlie Mock, Eastern Maine Medical Center

 Peter Leighton, Bridgton Internal Medicine

 

 Learning Objectives: Participants will....

  • Increase their understanding of the current status of Maine's opioid epidemic and the key components of LD 1646/PL Chapter 488.
  • Learn an approach to balancing the quality of patient care while complying with the updated prescribing regulations included in LD 1646/PL Chapter 488.
  • Gain knowledge and skills on how to reduce misuse, abuse and diversion of prescription drugs.
  • Learn how to implement a team based approach to safe prescribing, including opioid dosing, compassionate tapering, and appropriate diagnosis.
  • Develop skills to facilitate difficult patient conversation and the use of functional assessments.
  • Share knowledge and skills gained throughout the day to help build competency in safe opioid prescribing within their practice setting.

To learn more about this upcoming event, please click here to review the draft agenda.

 Continuing Medical Education (CME) credit is available for this learning session. For American Disabilities Act (ADA) services, if special arrangements are required for an individual to attend this course please see contact provided below.

Contact Information:

Administrative Coordinator: 

Linda Leighton

Office: (207) 620-8526, ext. 1016

E-mail: lleighton@mainequalitycounts.org 

Hector Tarraza, M.D. and Gordon Smith, J.D., Two of 50 Mainers Charting State's Future

Maine Medical Association Executive Vice President Gordon Smith, Esq. was named in Maine Magazine's July 2016 edition as one of 50 Mainers charting the State's future.  The article pointed out Gordon's advocacy for Maine physicians and public health, particularly in the area of smoking prevention.  "One of his proudest accomplishments is the work done by Maine Medical Association and its partners in forming the Maine Coalition on Smoking or Health in 1980 and proceeding to pass more than 20 laws over the next three decades, cleaning up the indoor air in the state from second-hand tobacco smoke."

Gordon was lauded for his collaborative work in a variety of areas, not the least of which is his recent work on licensing and regulating midwives' practice to protect the health of mothers and babies.  “I have an opportunity every day to be engaged in some of the most challenging issues of our time," Gordon is quoted as saying, "to build collaborative relationships, and to improve both the health and healthcare of Mainers.”

Also featured in the same article is MMA member Dr. Hector Tarraza, chair of the Obstetrics and Gynecology Department at Maine Medical Center.  Dr. Tarraza has participated in over 100 medical mission trips to various parts of the world over the last 20 years.  Dr. Tarraza says of this work, “We immerse ourselves within the community and learn from them where the gaps exist.  We embrace their culture, with respect, and build on their knowledge.  ”He focuses on improving surgical practices in the countries he visits, as well as on improving the knowledge and skills of the OB/GYN resident physicians who accompany him on the trips. 

All of us at the MMA are very proud to work with Gordon and Dr. Tarraza, and we are pleased that their work is being recognized in this way. [return to top]

CMS Publishes 2015 Open Payments Data

The Affordable Care Act requires CMS to collect information from applicable manufacturers and group purchasing organizations (GPOs) in order to report information about their financial relationships with physicians and hospitals.

CMS recently has published the 2015 data for the Open Payments Program and you can find more information about the data on the CMS web site here.
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Highlights from the 2016 Annual Meeting of the American Medical Association

Another successful AMA Annual Meeting has come to a close.  From the Zika virus to the opioid overdose epidemic to gun violence, physicians adopted policy to improve the health of the nation.

Here are some of the top stories:

  • Payment model design
    As new payment models become a reality, physicians know that they are best poised to balance the goal of reducing costs while delivering high quality care.  Physicians passed new policy to ensure that those payment models are physician-led to allow for the resources and flexibility needed to implement their own solutions for improving care for patients, rather than letting regulators dictate the way care should be delivered. Read more at AMA Wire®.

  • Opioid overdose epidemic
    The physician role in reducing opioid medication misuse, overdose and death is an important one.  Several new policies were put into place by physicians regarding the importance and effectiveness of prescription drug monitoring programs, increasing access to naloxone, the establishment of addiction medicine as a subspecialty and the development and use of guidelines.  Read more at AMA Wire.

  • Gun violence
    Calling gun violence a "public health crisis," the AMA is urging background checks and a waiting period for all firearms purchasers and will lobby Congress to provide funding for the Centers for Disease Control and Prevention to conduct gun violence research.  Read more at AMA Wire.

  • Zika virus
    As mosquito season escalates in many states, physicians and others are sounding the alarm that the United States needs to act quickly to control the Zika virus, particularly when it comes to pregnant women for whom the virus could mean devastating consequences for their unborn babies.  Read more at AMA Wire.

  • Water purity
    The AMA took vigorous action in response to lead contamination in the water in Flint, Mich., with extensive policy intended to promote public health and safety not only in that city but across the nation. Read more at AMA Wire.

Visit AMA Wire to read additional coverage of new policy adopted by physician delegates at the 2016 AMA Annual Meeting.

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From the MMA Archives: Fifty Years Ago this Month

From time to time in this e-newsletter, your editors enjoy reviewing the issues of the Journal of the Maine Medical Association which was published from 1910 until 1979.  Earlier records of the Association go back to 1853 when MMA was founded (April 28, 1853 at the Tontine Hotel in Brunswick).

At the 113th Annual Session held on June 13, 1966, George E. Sullivan, M.D. of Fairfield assumed his duties as President of the Association.  Dr. Sullivan went on to become the Executive Secretary of the Maine Board of Licensure in Medicine.  The meeting was held at the Samoset and the House of Delegates was presided over by Linus J. Stitham, M.D., who would also go on to become President.  Sixty-three delegates and alternates registered for the meeting, including many physicians who would remain active in MMA for many years, including Brinton T. Darlington, M.D. (Dr. Darlington is retired and living with his wife Alice in Tucson, AZ), and Richard C. Dillihunt, M.D. of Portland who received the Mean Johnson Laboratories' Aeesculappius Award for the Outstanding Scientific Exhibit.  Dr. Dillihunt still resides in Portland and has been working actively with MMA in its response to the opioid and heroin epidemic.

Among the actions taken at the meeting was approval of a dues increase from $55.00 to $65.00.  Issues discussed included the presentation of a report concerning the Medical School for Maine Feasibility Study and passage of a Resolution calling for action on the "dire need of beds for chronic care patients requiring hospitalizations from six to twelve months."

Other physicians active in the activities of MMA at that time included Charles Glassmire, M.D. of Portland, Charles F. Branch, M.D. of Lewiston,  Asa C. Adams, M.D. of Orono, Harry Brinkman, M.D. of Farmington, Lawrence Cutler, M.D. of Bangor, and, of course, Daniel Hanley, M.D. of Brunswick, the MMA Executive Director from 1955-1979.  While all of these physicians are now deceased, much of their legacy has lived on through the next generation of physicians which included David and Marvin Adams, Carl and Paul Brinkman (all now deceased)  and Josh and Joel Cutler (and daughter in law Melanie Cutler) and Sean, Sharon, and Daniel Hanley, Jr. (all very much alive).  The Adams connection has continued into a third generation through the work of Neil Korsen, M.D., son-in-law of David Adams, only recently deceased.  And, the Brinkman connection carries on through the work of Erik Steele, D.O., Paul's son-in-law.   MMA is very grateful for the many contributions of these medical families.

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HHS Announces $100 Million to Support Small Practices

The Medicare Access and Chip Reauthorization Act of 2015 (MACRA) contained a provision to fund on-the-ground training and education for Medicare clinicians in solo or small group practices of 15 clinicians or fewer.  The U.S. Department of Health and Human Services (HHS) is required to award $20 million each year over the next five years for a total of $100 million to support small practices transitioning to the quality payment program.

The funds will help provide technical assistance to small practices—especially those in rural and medically underserved areas, as well as those in areas with health professional shortages.  The AMA has been pressing HHS to release these funds.

Organizations can apply to receive funding for our efforts to support physicians in this process.  To be eligible, organizations must be able to tailor training to clinicians and provide this education to them free of charge.

Learn more about the recent announcement and how to apply.
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AMA Provides Comment on MACRA Proposed Rule; MACRA Resources Available

In a letter dated June 27, 2016, the AMA provided extensive comments on the proposed rule, Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models (CMS-5517-P).  

The AMA also has a page on its web site dedicated to helping physicians understand the Medicare Access & CHIP Reauthorization Act (MACRA).
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Tax Credits for Primary Care Professionals: Instructions and Applications Are Now Available

Primary care professionals who are paying outstanding student loans may now apply for an income tax credit. To download the application and instruction forms please click HERE. You may submit an application for either the 2014 tax year or the 2015 tax year. Applications must be postmarked on or before July 22, 2016.   Applications postmarked after July 22, 2016 will not be considered.

Applications are subject to a competitive order of receipt process (so called “first-come first served”) as set out in the rules at Section 4.11. Apply today.

Up to five primary care professionals will be certified to receive an income tax credit for each tax year (2014 and 2015). To determine if you are eligible to be certified for an income tax credit, carefully read the statute and rules that are posted here:  STATUTE and RULES.

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MHMC/MMA Annual Symposium to Feature Keynote Address by David Blumenthal, M.D.

The Maine Health Management Coalition and Maine Medical Association 2016 Annual Symposium is scheduled for Thursday, October 27, 2016 at the Holiday Inn by the Bay in Portland.

For this year’s symposium we will be continuing to highlight and explore actionable strategies that each of us can take to help improve health and lower costs.  Our keynote speaker, David Blumenthal, MD, President of The Commonwealth Fund, will share examples of how organizations around the country are getting more value from their health care dollars, and breakout sessions will dive into the details to highlight invidual efforts that organizations in our state can emulate.  There will be presentations on tackling prescription drug abuse for providers and employers, alternative payment arrangements being tested through employer/provider partnerships, an overview of how MACRA will impact the payment landscape in our state, and more!  

 You can find online registration information here! [return to top]

Telemedicine May be Beginning to Transform How Physicians Practice Medicine

In a 2,000-word article, the Wall Street Journal (6/26, Beck) reports that telemedicine is beginning to transform healthcare.  More physicians are beginning to use electronic communication while delivering care.  Additionally, telemedicine is allowing for better care in more remote locations where medical expertise is harder to come by.

This is particularly good news in rural areas of the US and in parts of the world where hundreds of miles may separate medical facilities.  Virtual doctor visits are expected to rise by 20% from 2015 to 2016.  While only 15% of family physicians polled had used telemedicine in their practices, 90% said they would do so if there is appropriate reimbursement.  The definition of "appropriate" in this context continues to be a matter of debate.  Bills to expand Medicare coverage of telemedicine services are working their way through Congress.

This month, the American Medical Association approved new ethical guidelines for telemedicine, calling on physicians using the technology to recognize the limitations of the services they are providing and ensure that they manage to gather sufficient information to make a sound clinical recommendation.


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Medical Boards Propose Rule Governing Telemedicine

The Board of Licensure in Medicine and the Board of Osteopathic Licensure recently released a proposed joint rule governing the use of telemedicine in the state. 

The proposed rule defines terms and sets forth practice guidelines, including provisions regarding establishing a physician-patient relationship in the telemedicine setting, technology requirements for physicians using electronic communications, and maintaining privacy and security.  You can read the proposed rule on the Board's website, here.

Comments on the proposed rules are due by 5:00 pm, Friday, July 15th.  MMA expects to file comments on the rule with the assistance of the AMA.  MMA members with interest in the rule should communicate with EVP Gordon Smith via e-mail to gsmith@mainemed.com.

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Upcoming Events
 

MCMI Training Programs – Level 1 and Level 2

General Information for 2016

When and where held:

                October 25, 2016 in Portland in conjunction with the Maine Brain Injury Conference

                                (Registration and fees will be through the Maine Brain Injury Conference for October 25)

               June and October programs will be Level 1 in the morning and Level 2 in the afternoon.

                               

Training Programs:             

              Level 1 – An Introduction to Concussions and Concussion Management

                            Speaker: Deb Nichols, CPNP or Peter Sedgwick, MD or Bill Heinz, MD

                           Level of Difficulty: beginner

                           Content: The Diagnostic and Return to Play Dilemma

                                           How Concussion Occurs and Pathophysiology            

                                           Concussion Signs and Symptoms

                                           Concussion Evaluation Tools

                                           Concussion Treatment

                                           Recovery Epidemiology

                                           Return to Function – Academics and Play

                                           Risk Factors and Protective Equipment

                                           Short and Long Term Sequelae

                                           Neurocognitive Testing

                                           Concussion Sideline Assessment

                                           Key Points

                                                      

              Level 2 – Advanced Concussion Management (Level 1 is a prerequisite for taking Level 2)

                           Speaker: Mike Rizzo, FNP-C, CIC or Paul Berkner, DO

                           Level of Difficulty: intermediate

                           Content: Updates from Zurich 2012       

                                           Using ImPACT Testing in Concussion Management

                                           Interpreting ImPACT Test Results

                                           Concussion Case Reviews

Schedule:

          

              June – Level 1:

                           7:45am – 8:00am           Registration

                           8:00am – noon               Training Program

                           Level 2:

                           12:15pm-12:30pm          Registration

                           12:30pm – 4:30pm         Training Program

                                                                    

Registration Fee:           

              For morning only training programs: March 11 and April 8

              $100 for Health Care Professionals (MD, DO, NP, PA, Neuropsychologist, AT, 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

             

              For morning and afternoon training program: June 10

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

              $175 for Health Care Professionals taking Level 1 and Level 2 - Only June 10

             

              $40 for school personnel and all other attendees                                                                                                              (School nurses, coaches, athletic directors and administrators, etc.)

              $70 for school personnel taking Level 1 and Level 2 - Only June 10

             

              $20 for students currently enrolled in a college program            

              $35 for students taking Level 1 and Level 2- Only June 10

CME/CEU contact hours: 3.50

Registration Confirmation will be sent by email.

Refund / Cancellation Policy: If you need to cancel contact Jan Salis, PT, ATC. You can choose to apply your registration fee to another training program or have your check returned.

For more information contact:

              Jan Salis, PT, ATC

              MCMI - Membership and Education Committee - Chair

              jsalis@aol.com

              (207) 577-2018


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Job Openings

Exciting Physician Leadership Opportunity in Maine

The Office of Child and Family Services (OCFS) within Maine’s Department of Health and Human Services (DHHS) is searching for the ideal candidate to be its Medical Director, serving as a senior leader and its clinical representative.

The selected candidate will play key advisory roles in improving the health of some of Maine’s most vulnerable citizens.   You will provide leadership in:

  • Policy development
  • Utilization of resources
  • Clinical practice models the guide the care and treatment of children known to child welfare and at-risk families.

Why Join Our Team?

Maine OCFS is:

  • Committed to reducing the number of youth in out-of-home placements by increasing the effectiveness of community-based services.
  • Working closely with Georgetown University’s Technical Assistance Center to guide us in Evidenced-Based and Promising Practice Models
  • Has multiple agencies and partners collaborating to address the social, medical and behavioral challenges impacting children and families.
  • Intensely focused on complex trauma.
  • Creating  new strategies to decrease the number of youth in custody on Psychotropic medication; 
  • Enhancing its family reunification practices.

Why Maine?

Maine is home to some of the finest beaches, lakes and mountains in the country.  For more information on why Maine is called vacationland all year, please visit the Maine tourism website at http://visitmaine.com/. 

This position is contracted through the University of Maine and the annual salary is $181,800.  

6/9/16

Relocate to Beautiful Southwestern Maine - FAMILY PRACTICE PHYSICIAN

Sacopee Valley Health Center has a position available for a full-time family practice physician for our multi-service, progressive, rural federally qualified community health center located in a medically underserved area. Services on site include integrated primary care, dental services, family planning, mental health counseling, psychiatry, nutritionist, optometry, podiatry, social services support, sliding fee coverage, care management, radiology and lab services. NextGen EMR. Practice is outpatient only with no OB. On-call rotation is 4-5 times per month. NCQA Level III PCMH. Competitive salary and benefits package; physicians are eligible to apply for NHSC loan repayment.  Located in Porter, ME, between Portland and the White Mountains. Area is known for terrific four season recreational activities. Just two and one-half hours from Boston. Submit CV to: Nancy Buck, Human Resources Coordinator, (nbuck@svhc.org), Sacopee Valley Health Center, 70 Main Street, Porter, ME 04068. EOE. www.svhc.org. Sacopee Valley Health Center is an equal opportunity provider and employer. 

7/04/16

HOSPITALIST - Brunswick, Maine

Mid Coast Hospital is seeking a full time Hospitalist to join its established hospitalist service, which is expanding due to growth. The candidate should be BC/BE in Internal Medicine or Family Medicine. Procedures are not required. Excellent Intensivist and subspecialist support is available. New graduates and experienced candidates are encouraged to apply. Part-time and per diem applications will be considered. 

Part of the Mid Coast–Parkview health family of services, Mid Coast Hospital offers competitive benefits and compensation package, along with an excellent work environment. Please send CV to Melanie Crowe, Physician Recruiter, at mcrowe@midcoasthealth.com or call (207) 406-7872, for more information.

6/27/16

OUTPATIENT INTERNAL MEDICINE - Mid Coast Maine

Mid Coast Medical Group is seeking a BC/BE Outpatient Internis to join our multi-specialty group. Admitting is through a high-quality Hospitalist service.

The Coastal location, historic neighborhoods, superior schools, and Bowdoin College campus make this part of Maine a very desirable place to live.  

Part of the Mid Coast–Parkview health family of services, Mid Coast Medical Group offers competitive benefits and compensation package, along with an excellent work environment. Please send CV to Melanie Crowe, Physician Recruiter, at mcrowe@midcoasthealth.com or call (207) 406-7872, for more information.

6.27/16

FAMILY PRACTICE PHYSICIAN Sought In Oakland Maine!

Inland Hospital Family Practice is seeking a full time Family Medicine Physician without OB to join the employed practice in Oakland.

The practice has been serving the greater Waterville/Oakland area for many years. The practice provides care for infants, pediatrics through geriatric care. A competitive salary with incentives, plus full benefits is offered along with assistance with medical education debt, paid time off, paid CME, and relocation allowance. Qualifications: Board Certified/Eligible in Family Practice. This site is not eligible to sponsor a J-1 waiver.

Inland Hospital is a dynamic healthcare organization that believes in putting the patient first in every way. We are a 48-bed community hospital in Waterville; Lakewood, a 105-bed continuing care center on the hospital campus; 18 primary and specialty care physician offices in Waterville and five surrounding communities. Inland has been a proud member of EMHS since 1998. Inland patients have seamless access to a higher level of care when needed.

For further information, please contact:

Sherry Tardy, Director Business Development/Provider Recruitment, Inland Hospital by email at: stardy@emh.org or by phone at: 207-487-4085.

7/18/16

INTERNAL MEDICINE PHYSICIAN - Maine Medical Partners Internal Medical Clinic

Maine Medical Partners is seeking a PT BC/BE internal medicine physician for their Internal Medicine Outpatient Clinic at Maine Medical Center in Portland, Maine. 

The Clinic is the primary outpatient teaching site for Maine Medical Center’s Internal Medicine Residency Program and is the medical home for a culturally diverse population.  The ideal candidate will have an interest in residency education and international/immigrant patient care.  The clinical portion of the position involves a mix of direct patient care and the precepting of Internal Medicine Residents. 

Maine Medical Center has 637 licensed beds and is the state’s leading tertiary care hospital, with a full complement of residencies and fellowships and an integral part of Tufts University Medical School. 

For more information please contact Alison C. Nathanson, Director, MaineHealth Physician Recruitment Center at (207) 396-8683 or nathaa@mainehealth.org.

7/4/16

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 http://www.nassonhealthcare.org for an application. Completed cover letter, resume, and employment application will be accepted until position is filled.

6/27/16

E.M. BC/BP PHYSICIANS

St. Joseph Hospital is recruiting E.M. BC/BP physicians for its dedicated group.  Collegial, nurturing workplace with latest technology and just-completed expansion.  Members support each other and know patient satisfaction is achieved through staff satisfaction.  Leadership development and participation in policies and direction available. 

Equitable scheduling based on 1440-1472 clinical hours per year; more flexible arrangements available. 

Staffing: 51 hours per day, mostly physicians, for 27,000 visits.  We have great E.D. nurses.   

Area offers many cultural attractions, including the University of Maine, natural and organic food producers, pleasant pace, low crime, friendly people, great public schools and affordable housing.  Acadia National Park, Baxter, scenic towns and harbors, Sugarloaf,  I-95 and Bangor International Airport are right here or close.

Highly competitive package includes relocation, signing bonus, loan repayment, retirement and protected vacation and CME time with allowance.

Contact: Charles F. Pattavina, MD, F.A.C.E.P., Chief, Emergency Medicine at 207.907.3350  or cpattavina@sjhhealth.com

7/18/16

FAMILY MEDICINE/OUTPATIENT INTERNAL MEDICINE PHYSICIAN  

The Maine Highlands offers great outdoor adventures, historic and cultural experiences, many culinary delights and unexpected entertainment opportunities.  KVHC’s newest clinic, Brownville, is located in the Maine Highlands and Katahdin Region.  As a result of this continuous growth, Katahdin Valley Health Center is recruiting a Family Medicine/ Outpatient Internal Medicine Physician that is committed to providing quality health care services to the people in the Brownville/Millinocket Maine regions.   KVHC’s clinics are outpatient only and offers a four day work week with a competitive salary 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. Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.  

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.

8/29/16

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