December 12, 2016

 
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Information Needed to Prepare for Jan. 1 Prescription Monitoring Program (PMP) Mandate

Prescribers of opioid medication prescribed for pain and of benzodiazepines or their delegates must check the PMP prior to writing such scripts, effective Jan. 1, 2017. In addition, the ability to override Chapter 488 by utilizing the medical necessity exception expires Jan. 1 and the 7 day and 30 day limits on scripts for acute pain and chronic pain respectively take effect on the same day.

As a reminder, the maximum daily dose provision (100 MME) took effect on July 29, 2016, but patients who were on 100 or more MME of opioid medication on that day can receive up to 300 MME until July 1, 2017. If a patient exceeds 100 MME and does not qualify for the 300 MME exception (until July 1, 2017), the only exceptions available are:

Cancer pain

Hospice care

End of Life care

Palliative Care

However, the Department of Health and Human Services is preparing an emergency rule, as called for in the law, which will likely authorize some additional exceptions, including exceeding the limit to allow for post-op care in cases where the patient may already be receiving pain medication for one or more chronic conditions and for patients who are undergoing an active taper. At the final Stakeholders' meeting held last Wednesday, HHS staff stated that the emergency rule will be emailed to PMP registrants on January 1, the effective date of the rule. Under the state Administrative Procedures Act, an emergency rule can take effect immediately and then the public comment period begins. While MMA staff and several physicians, pharmacists and other health professionals have provided information to HHS and commented on draft exceptions language, we have not had an opportunity to see the final rule and have been told it will not be public until its effective date (Jan. 1, 2017). As it will take some time to educate prescribers regarding the emergency rule, MMA has asked HHS to provide for a grace period of 30 to 60 days prior to enforcing the new rule.

Stephen Hull, M.D., Director of Medical Pain Management at Mercy Hospital, attended the Stakeholders' meeting this past week, along with MMA Associate General Counsel Peter Michaud, J.D., RN, and prepared a summary of the discussion. We very much appreciate the effort that Dr. Hull and several other physicians have made to provide clinical input into the emergency rule.

MMA is pleased to share Dr. Hull's comments below:

Policy Update

As it stands, the statutory exceptions of inpatient, residential treatment (i.e. nursing home), cancer pain, end of life, palliative care, and medically assisted treatment (methadone and Suboxone for substance use disorder) will all remain. In addition, I am expecting an exception for postponing active taper during pregnancy, a total dosage "pursuing active taper" exception that will likely be limited to no more that 6 months (though it will apply to current patients, it is not proposed specifically for those providers who have been delaying implementation of a taper in hopes of an exception that would apply for their patient(s), but instead is intended for that patient moving into the state and coming under our care on large doses after implementation of the new rules). Though there was not any discussion in relationship to the many particulars, we also expect an exception for patients who have failed an active taper, likely requiring some documentation of substantive decline in function that was subsequently recovered on reengagement of doses >100 MME. This last exception has tons of complicating issues: how long was the patient at a dose below 100 MME, what measure and documentation of function will be required, etc.

The DHHS staff at the meeting, while not committing to any position about this, did seem to understand that they should allow some grace period to allow education of prescribers
, since the new rules will not be published before we are expected to be accountable for them. I am expecting more about this and some, though not extensive, leniency on enforcement during the first weeks to a month.

Dr. John Pier has reminded me of an additional anticipated important exemption, the acute on chronic pain circumstance. This could be any acute on chronic pain, particularly post surgical pain. I am anticipating that the rules will include the capacity for a prescriber presented with a patient who has an acute on chronic pain to be allowed an exemption to exceed the 100 MME aggregate limit with renewable 7 day prescriptions for acute on chronic pain. The rule making discussions did not address at what point it is appropriate to convert an acute patient to chronic and at that time it would be likely that a "pursuing active taper" exception would apply as the patient was again returned to a dose less than 100 MME.

PMP Update

The Department has selected a vendor to replace the current PMP vendor, Appriss (see below) to provide the upgrade of the PMP. They currently have a portfolio of 28 state PMPs they host/serve and provided a demo. The "go live" for the upgrade will be December 20th. Appriss is sending a guidebook to how to use this upgrade to the Maine PMP, which in turn will be sent out to registrants via email or snail mail on December 19th. Those registrants, and presumably their delegates, who have provided email addresses (are currently receiving emails from the PMP) are being migrated over from the current vendor to the Appriss product. Those current registrants who do not have an email address registered with the current vendor will need to reregister with the Appriss product. This appeared from the demo to be an easy process that will be hastened somewhat by entering their NPI, which will be in the system with a limited amount of data that will populate the registration page. When a delegate first registers they will identify prescribers under whom they are requesting delegate status, and an invitation will be sent to the prescriber to accept the delegate.

Appriss PMP Demo

I believe that most registrants will be pleased with the upgrade. It seems more user friendly. I won't provide a detailed description of the product but instead this PDF: http://www.appriss.com/static/sitedocs/PMPAWARE_ProductSheet.pdf. I believe the most useful feature will be the ability for delegates to batch search the database on behalf of a provider. In our clinic I would anticipate our delegates to upload the day's schedule in a PDF or CSV format to the PMP and then be able to rapidly produce a report for the prescribers patients for the day. Additionally, I was told that there would be a way for us to all save some trees by uploading these reports to our EHRs, though they did not demonstrate this function. My recommendation to medical directors would be that they alert their IT department to the implementation on December 20th and, though clearly short notice, have them provide instructions to the prescribers, or more correctly, their clinic managers, on how to create a PDF or CSV formatted report of a day's scheduled patients. The data points that will be required will be Last Name, First Name and Date of Birth. Including Zip Code will allow the program to use some fuzzy logic to search for aliases that may be in the system, i.e. misspellings of the patient's name of incorrect dates of birth, allowing the delegates to accept or reject close matches as their patient.

Again, we want to express our tremendous gratitude to Dr. Hull both for his dedicated participation in the stakeholder process and for his excellent summary of the PMP and rule status.

 

Evelyn Sharkey Named New PMP Coordinator

Evelyn Sharkey, BS, MPH, MSW, has been named coordinator of Maine's Prescription Monitoring Program (PMP). The program had been without a coordinator for a few months until Ms. Sharkey was hired in November 2016.

Ms. Sharkey is a graduate of Tufts University and holds advanced degrees in public health and social work from the Brown School of Washington University in St. Louis. Most recently she has been employed as a global migration epidemiologist in the Maryland Department of Health and Mental Hygiene.

The Maine Medical Association welcomes Ms. Sharkey to Maine, and our staff looks forward to working with her.

In other PMP news, the program is in the process of making a shift to a new PMP platform, Appriss Clearinghouse. Registration is now open for data submitters (pharmacies and other dispensers) only, with registration for prescribers and pharmacists scheduled to be available following the Dec. 20 conversion date.
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MMA Blog Invites Discussion of Price Nomination to DHHS

On November 29, 2016, President-elect Donald Trump named Rep. Tom Price, MD (D-GA) as his nominee for Secretary of Health and Human Services. There have been varied reactions to this news from the medical community, from the public, and from organized medicine. This blog post is an opportunity for MMA members and others to discuss this appointment. - See more at: https://www.mainemed.com/blog/blog/detail/2016/12/08/dr-tom-price-a-good-or-bad-choice-for-secretary-of-us-dhhs.html#sthash.s0prpL8d.dpuf

On November 29, 2016, President-elect Donald Trump named Rep. Tom Price, MD (D-GA) as his nominee for Secretary of Health and Human Services. There have been varied reactions to this news from the medical community, from the public, and from organized medicine. MMA's newest blog post is an opportunity for MMA members and others to discuss this appointment.

Dr. Price is an orthopedic surgeon and has been very active in the AMA House of Delegates dating back to a period before his election to Congress in 2004. He was reelected to Congress on November 8, 2016 to serve his 7th term prior to his being named as Secretary-designate of HHS. His appointment is subject to confirmation by the United State Senate.

Dr. Price has been chairman of the Committee on the Budget in the House of Representatives and has also served on the House Ways and Means Committee - including the subcommittee on Health.

 

On November 29, 2016, President-elect Donald Trump named Rep. Tom Price, MD (D-GA) as his nominee for Secretary of Health and Human Services. There have been varied reactions to this news from the medical community, from the public, and from organized medicine. This blog post is an opportunity for MMA members and others to discuss this appointment. - See more at: https://www.mainemed.com/blog/blog/detail/2016/12/08/dr-tom-price-a-good-or-bad-choice-for-secretary-of-us-dhhs.html#sthash.s0prpL8d.dpuf
On November 29, 2016, President-elect Donald Trump named Rep. Tom Price, MD (D-GA) as his nominee for Secretary of Health and Human Services. There have been varied reactions to this news from the medical community, from the public, and from organized medicine. This blog post is an opportunity for MMA members and others to discuss this appointment. - See more at: https://www.mainemed.com/blog/blog/detail/2016/12/08/dr-tom-price-a-good-or-bad-choice-for-secretary-of-us-dhhs.html#sthash.s0prpL8d.dpuf
On November 29, 2016, President-elect Donald Trump named Rep. Tom Price, MD (D-GA) as his nominee for Secretary of Health and Human Services. There have been varied reactions to this news from the medical community, from the public, and from organized medicine. This blog post is an opportunity for MMA members and others to discuss this appointment. - See more at: https://www.mainemed.com/blog/blog/detail/2016/12/08/dr-tom-price-a-good-or-bad-choice-for-secretary-of-us-dhhs.html#sthash.s0prpL8d.dpuf
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SIM annual conference lauds program accomplishments

[Content from, and thanks to, Maine Hospital Association]

At the State Innovation Model (SIM) annual conference held this week in Augusta, officials highlighted what they said were the program’s accomplishments.

Specifically, the program:

·        Strengthened Primary Care:

o    By implementing Health Homes and Behavioral Health Homes, the following was accomplished:

§  MaineCare Stage A Health Homes generated a savings for three years of $224 per member, per month over a control group;

§  MaineCare members who were served by a Stage A Health Home within an Accountable Community had a 69.3 percent increase in primary care physician follow-up visits after hospitalization for a mental health condition;

§  Health Home members’ use of the Emergency Department for non-emergencies declined by more than 24 percent compared to a 14 percent decline in the control group; and

§  Behavioral Health integration scores improved by 27 percent in part because of the implementation of the 10 MaineCare Health Home Core Expectations and Home Health required screenings.

o    Implementation of data analytics allowed MaineCare managers to identify high-risk and high-cost members and collaborate with primary care providers to provide appropriate healthcare services; and

o    By giving providers training about how non-verbal intellectually/developmentally disabled patients communicate pain, the rate of anti-psychotic medication prescribing was reduced.

·        Integrated Physical and Behavioral Health:  By providing 20 behavioral health organizations access to the Statewide Health Information Exchange (HIE), providers were able to share health records and coordinate physical and behavioral health needs.  Behavioral health providers reported on quality metrics.

·        Centralized Data and Analysis: 

o    SIM enabled the integration of monthly MaineCare claims into the HIE medication history list, important for care management and medication reconciliation; 

o    SIM is providing future risk prediction of Emergency Department visits and re-admissions; and

o    A common set of 27 quality measures for payment purposes and 17 measures for monitoring performance was established.

·        Increased Alternative Payment Models:

o    Mainecare’s Accountable Communities initiative has grown to more than 53,000 enrolled members;

o    One in four eligible MaineCare members are enrolled in a non-fee-for-service payment model;

o    The National Diabetes Prevention Program has expanded and trained more than 150 lifestyle coaches; and

o    The Value-Based Insurance Design workgroup aligned benefit coverage across payers.

·        Developed New Workforce Models: The SIM Community Health Workers’ pilot program hired 37 workers and 19 supervisors to complete core competency training that included focus on Maine disparities, chronic conditions and population health. More than 1,700 patients have been matched with a health worker through SIM.  Also, the Behavioral Health Home Learning Collaborative was launched to provide technical assistance to Behavioral Health Homes.

·        Engaged Patients and Consumers:

o    As of October, 1,246 program-eligible Mainers have participated in the National Diabetes Prevention Program and are no longer at risk for Type 2 diabetes; and

o    Ten practices implemented shared decision-making tools and decision aids into their workflows.

A report from the Lewin group made some recommendations for further refinements to Maine’s healthcare system now that the SIM project has ended.  It called for further analysis of high-cost patients, especially those with behavioral health issues, a closer look at the reasons that child health-related quality measures underperformed and identifying best practices relating to the integration of behavioral and physical health, among other suggestions. [return to top]

Congress passes 21st Century Cures bill

The Senate this week completed consideration of the "21st Century Cures Act," approving the bill by a vote of 94 to 5. The House last week passed the bill 392 to 26. After several years of hearings, meetings and negotiations, and with bipartisan support from Congress and the White House, the $6.3 billion medical innovation package is intended to accelerate the discovery, development and delivery of new therapies, including $1 billion to assist states in addressing the opioid epidemic.

As with any legislative package of this size, there are provisions which have the support of physicians and provisions that raise some concerns. However, in the interest of advancing the many positive elements of the final bill, the AMA is in support of the final product.

One AMA-supported provision that would have clarified Sunshine Act reporting obligations for medical reprints and continuing medical education, for example, was struck during final negotiations.

Supported provisions
Some of the elements in the bill are supported by AMA policy. It includes $4.8 billion in funding for the National Institutes of Health (NIH) and additional funding for Vice President Biden's Cancer Moonshot initiative. The Precision Medicine Initiative and the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) programs also received funding in the wide-ranging package.

Importantly, $1 billion will be distributed to states over two years to assist in addressing the epidemic of opioid misuse and abuse. Significant funding is also included for many elements of the Helping Families in Mental Health Crisis Act, intended to make improvements to the nation's mental health system.

Other provisions in the bill include:

  • Funding for the U.S. Food and Drug Administration (FDA) to meet its various priorities and obligations.

  • More protections for human participants in clinical research and provisions to streamline and simplify Institutional Review Board (IRB) requirements.

  • Requiring that Medicare Advantage and Medicare Part D plans provide beneficiaries with an option to change plans during the first three months of the benefit year.

  • New authority for the U.S. Department of Health and Human Services (HHS) Office of the Inspector General to investigate and penalize acts of information blocking—the first financial penalties that can be directed at electronic health record (EHR) developers and vendors.

Reporting burdens
The AMA supports a provision excluding those who furnish most of their Medicare services at ambulatory surgical centers from penalties under the EHR Meaningful Use program and from the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program.

Addressing physician reporting burdens, the bill also allows physicians to delegate certain EHR documentation requirements to non-physician staff. Key interoperability problems were also tackled in the bill by establishing a directory of health professionals so that physicians can easily contact each other.
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Physicians Needed for Medical Advisory Board

The Maine Secretary of State’s office is asking for physicians to fill vacancies on the office’s Medical Advisory Board. This is a compensated position.

The Medical Advisory Board is a professional unit composed of physicians and motor vehicle staff to advise the Secretary of State’s office on medical criteria and vision standards for licensing drivers. The board consists of at least seven members who have expertise in matters concerning health or medicine. By statute the board must include licensed physicians representing the specialties of cardiology, gerontology, internal medicine, neurology or neurological surgery, ophthalmology, psychiatry, family practice and rehabilitative medicine and may include additional members who are professionals in relevant medical fields. The board advises the Secretary of State on matters relating to medical conditions and vision standards relating to driver’s licenses.

In addition, the board collectively or any individual member of the board will, from time to time, evaluate reports submitted by healthcare professionals to advise the Secretary of State on whether a person is medically competent to operate a motor vehicle on public roads.

Maine rules relating to drivers’ license medical standards have recently undergone a significant redrafting process, and the new rules go into effect December 31, 2016. A summary of the rules may be found at www.maine.gov/sos/bmv/licenses/Medical/FAP%20Summary%20of%20Changes%2011.02.16rev.doc .

By law the board must meet once every two years, but by custom it meets twice per year. Its next meeting is April 21, 2017.

At the moment there are board vacancies in the following specialty areas:

·        Gerontology

·        Internal medicine

·        Family practice

Any interested physicians wishing more information should contact, or send their CVs to:

Barbara A. Redmond, Chief Deputy Secretary of State

Office of the Secretary of State

148 State House Station

Augusta, ME 04333-0148

Tel: 207-626-8400 | Fax:  207-287-8598

The MMA urges its members to consider seriously serving on this board which performs an essential and important public health and safety function.


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Health Insurance Marketplace 2017 Open Enrollment goes through January 31, 2017

Need affordable health insurance? Mark your calendar.  The Health Insurance Marketplace Open Enrollment period for 2017 began on November 1 and goes through January 31, 2017.  

Get Ready to Apply for 2017 Coverage

December 15 is the last day to sign up or update your current Marketplace health insurance plan for coverage to take effect on January 1, 2017.   

Many people who apply will qualify for some kind of savings. Depending on household income, you may be able to get lower costs on monthly Marketplace health insurance premiums and out-of-pocket costs.

Already Have Marketplace Coverage? Anyone who has a 2016 health insurance plan through the Marketplace should review their current plan, update their healthcare.gov account, and either renew coverage or select another plan for 2017.  5 Steps to Staying Covered Through the Marketplace

After January 31, you can enroll in or change a plan only if you qualify for a Special Enrollment Period. 

Health Insurance Marketplace assistance is available:

  • Call the Consumers for Affordable Health Care HelpLine at 1-800-965-7476
  • Find local help at www.enroll207.com.  Navigators and assisters are available throughout Maine.
  • Call the Health Insurance Marketplace at 1-800-318-2596
  • Medical practices: order patient brochures about the Health Insurance Marketplace at enroll207
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Diversion Alert Program Seeks Contributions

The Diversion Alert staff has been working hard to sustain Diversion Alert's free services which assist Maine medical professionals in identifying patients at risk for overdose or in need of addiction treatment. Although many efforts were made to procure state funds through both the Maine legislature and the Governor's Office, the program was not able to obtain funds for this state fiscal year.

They are reaching out to ask for a tax-deductible donation of $25 to support Diversion Alert. This program is truly improving patient care in Maine as evidenced by our recent publication in the CDC's Chronic Disease Prevention journal. MMA urges its members to support this program, which is doing so much to assist with Maine's opioid crisis.

You may click here to make a tax deductible donation through the Diversion Alert fundraising page.

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Upcoming Events

 

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Caring for ME Leadership Meeting

Supporting Maine Clinicians in Responding to the Opioid Epidemic

December 14, 2016

8:00 am - 12:00 pm

Maine Medical Association - Manchester, ME

 

QC is expanding our December Caring for ME Leadership Meeting to hold a half-day strategy session to focus on planning and alignment efforts in support of our Caring for ME initiatives. 

This meeting will give special emphasis to updates on the implementation of PL Chapter 488, including rule-making and exceptions, as well as to fostering a dialogue around Medication Assisted Treatment (MAT). Specifically, what is the current MAT landscape in Maine, and how do we improve and expand access to this critically important treatment? 

Registration is encouraged, but not required, for in-person attendance so that we may get an accurate headcount. A light breakfast will be provided.

For anyone that is unable to attend in person, remote attendance is possible. Please email Lizzy White to request the web-conference log in. 

Featured Presentations

This meeting will feature both structured presentations and facilitated group discussions designed to share knowledge and resources, and increase alignment across the programs currently underway around the state.  

Featured presentations and discussions will include:

  • Updates on Implementation of Opioid-Related Laws, Gordon Smith
  • Successes & Challenges of Chapter 488 Implementation, Group Discussion
  • Advancing the Broader Agenda: Caring for ME Goals, Group Discussion
  • A Review of Maine's MAT Landscape, Lisa Letourneau
  • Training Providers in MAT, Alane O'Connor
  • Current Statewide MAT Efforts: Successes & Challenges, Group Discussion

 

Click here to see the complete agenda.

Event Contact:

Lizzy White

207-620-8526 ext. 1033

Email Lizzy

For Americans with Disabilities Act (ADA) services, or if special arrangements are required for an individual to attend this course please call or email us directly.

 

 


 

 

 


 

 

 


 


 


 



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Job Openings

NP or PA - Jackman Community Health Center

JCHC is a part of Penobscot Community Health Center which is a nationally recognized health care facility that focuses on patient-centered care, innovation and collaboration. Signing, retention, and relocation bonuses are up for grabs with this position! This site is also loan repayment eligible.

Give yourself the opportunity you deserve, by working for a healthcare facility that always puts the patient first…for you, for your family, for our community.

For more information, please contact Vanessa Sanderson, Recruitment Coordinator, Penobscot Community Health Center at (207) 404-8015 orvsanderson@pchc.com

If you want to enjoy Maine, the way it should be, come and experience the simple pleasures of small town medicine while being surrounded by over 250,000 acres of woodlands. Each season offers something for everyone except a traffic light. Jackman Community Health Center is in need of a full-time NP or PA to work in their highly unique primary care and urgent care facility.

1/2/17

CMHVI IN-PATIENT CARDIOLOGY, NP or PA, Baylor Staffing Plan, Nights, Lewiston, Maine

CMHVI Cardiology, in Lewiston, Maine is seeking an experienced Nurse Practitioner or Physician Assistant, full-time Baylor Staffing Plan, 11pm – 7am, Friday, Saturday and Sunday, to work 24 hours and get paid for 36 hours! This person will perform dedicated in-patient care under the supervision of a CMHVI cardiologist.  Candidate must have (2) or more years as a hospital-based Physician Assistant/Nurse Practitioner experience and at least (1) year cardiovascular experience preferred.

CMMC is proud to offer you a competitive salary and benefit package that includes:  Substantial hiring bonus; all-inclusive relocation packages; generous loan repayment; short term and long term disability insurance; significant time off to complete CME & allowance for paid program; excellent 403B retirement/savings plan; state of the art Fitness Center and Wellness Program.

Contact Donna Lafean, lafeando@cmhc.org; FMI: http://recruitment.cmmc.org/

12/26/16

BC/BE FAMILY MEDICINE PHYSICIAN - FLOAT 

HealthReach Community Health Centers seeks an experienced full-time, part-time or per diem BC/BE Family Medicine Physician to join our team of float providers. The selected candidate will travel to health centers in Central and Western Maine and provide acute, chronic and preventive services to patients of all ages. 

HealthReach has been providing healthcare in rural and medically underserved communities for 41 years. Annually, 28,000 Maine residents access medical, dental and behavioral health services at our facilities, which are located in Albion, Bingham, Belgrade, Bethel, Coopers Mills, Kingfield, Livermore Falls, Madison, Rangeley, Richmond and Strong. 

We offer competitive compensation including a generous float differential and malpractice coverage. Contact Recruiter, HRCHC, 10 Water Street, Suite 305, Waterville, ME  04901. (207) 660-9913 ~ Fax: (207) 660-9901 ~Communications@HealthReach.org ~ www.HealthReachCHC.org

12/5/16

GENERAL SURGEON - Brunswick, ME

Mid Coast Medical Group is seeking a full time General Surgeon. This is a community hospital oriented job with needed skills in all core aspects of general surgery.  The surgeon will be part of a long standing 4-5 provider general surgery group. The office is conveniently located adjacent to Mid Coast Hospital. New graduates and experienced candidates are encouraged to apply.

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.

1/2/17

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) 661-7383 or nathaa@mainehealth.org.

12/12/16

 

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