20 Questions: Gary Flashner, MD [Family Medicine]

 
Dr. Gary Flashner, MS, MD, ABFP is an emergency physician and Vice President of Medical Content for ExitCare, LLC.    He completed his undergraduate work at Muhlenberg College (Allentown, PA), Masters work at Penn State, medical school at Thomas Jefferson University, and residency in Family Medicine at Sacred Heart Hospital (Allentown, PA).    His 20 years of clinical practice and teaching endeavors (including 13 years of full-time work in hospital-based emergency medicine) were split between the eastern U.S. (Pennsylvania and Ohio) and California, including working at Yosemite National Park.
Dr. Flashner has been involved in medical informatics for 15 years with previous work that focused on the research and development of emergency department physician documentation systems and end-user screen design.    As an IBM Business Partner, he pursued a special interest in the use of computerized speech recognition as a data input method for physician charting, and he continues to provide guidance in the use of this technology.   After retiring from clinical practice, he worked for Eclipsys Corporation for four years.  That work included a focus on the development of their first software offering for hospital-based emergency departments.   At the beginning of 2009, Dr. Flashner accepted the position of VP of Medical Content at ExitCare with a focus on the research, development, and updating of patient education materials.
Dr. Flashner lives in Orange County, California.  He recently took the time to speak to the Student Doctor Network about his experiences.
Why did you choose to become a physician?
I recall declaring this as my “designated profession” from the time I was age 8.   During all of my pre-medical school years, the driving idea was “helping people”.
If you had it to do all over again, would you still become a physician? (Why or why not? What would you have done instead?)
With some hesitation, I would say “Yes”, if I had it to do all over again, I still would have pursued medicine as a career.   I experienced too many positives in the process of working with patients, families, etc.  Those positives included the challenges of the “detective work” of medicine, the joys of seeing improvement and/or control of numerous medical and surgical problems, helping to relieve pain (both physical and psychological), and the opportunity to truly “fix” problems that were fixable either by my own hands or through the referral to a subspecialist.
Tell us what it was like serving as the physician in Yosemite National Park.  What was unique about that environment?  What was it like to practice medicine there?
This was a very unique environment from a medical, social, and environmental point of view.    My family and I felt very lucky to be able to live and work in the one of the most beautiful places on the face of the earth.   We also felt very lucky to have our children spend their earliest years in that environment, and now that they are adults, the personal “connection” to Yosemite remains.   The local community was small, compact, tight knit, and retained many of the positive parts of “small town life”.
As a staff physician at the Yosemite Medical Clinic, I was joined by two other physicians (three during the summer months) and a staff focused on primary care services for the local community.   In doing so, we “knew everyone” in the local community – something that I found to be very enjoyable (although it also had its challenges!).   The community was also remote and isolated – the closest hospital and “urban” medical community was 85 miles west in a town of 50,000 people.   This presented challenges associated with medical “isolation” and the inability to conveniently discuss various aspects of patient care with colleagues.
The greatest challenges came mostly in the summer when the Park was jammed full of visitors.   The volume of patients coming to the Clinic for care predictably increased dramatically, and the Clinic functioned more as an emergency department than a primary care practice.   A significant volume of seriously injured multiple trauma patients were brought to the Clinic for initial stabilization, and there were numerous challenges associated with the logistics of transporting these patients to area trauma receiving facilities in Fresno or Modesto.   On site, we had to do everything ourselves with no backup from subspecialists – because there were no subspecialists.   There was no opportunity to call upon anesthesia, surgery, orthopedics, cardiology, ophthalmology, etc. to assist with problems that clearly required subspecialist/surgical intervention and critical care services.   The staff had to be very independent, creative, and resourceful.
What did you like most and least about being a physician and interacting with patients?
What I liked most:

• Collaboration on an intended goal of managing a problem, health maintenance, etc.
• Fixing a problem that can be fixed (broken bone, laceration, etc.).
• Providing reassurance.
• “Being there” during very difficult times.
• The adrenaline rush of a successful resuscitation.

What I liked least:

• Overly burdensome regulatory, malpractice, and insurance hassles.
• Unreasonable patient demands.
• Refusal to change destructive behaviors despite reasonable patient education.
• Anger in relation to undesirable outcomes out of the control of the medical staff.
• “Entitlement” mentality.

What made you decide to move from patient care into patient information systems?
In 1995, I was found to have a disc herniation in my neck.   That problem has progressed and worsened over the past 14 years, and I now have some problems with my hands that made me decide to work on a career change.   Being a computer nerd and having a passion for technology and information systems, this transition made sense.
Describe a typical day at work.
Currently, here’s what it looks like:

1. Email
2. Conference calls and frequent impromptu calls with our Document Manager
3. Organize the work/tasks for the day
4. Medical literature research, document revision, document review
5. Various other project work which may involve spreadsheets, databases, or both
6. Continued email throughout the day

What do you like most and least about what you are doing now?
What I like most:

• Excellent team of people in my work group.
• Work from home.
• Generally regular hours.
• Minimal work travel.
• Reasonable compensation for what I do.
• My work is valued, and I receive a lot of feedback supporting that.

What I like least:

• Occasional intense stretches of work 7 days a week as our company is undergoing rapid growth.
• Too much time sitting at a computer screen.

Are you satisfied with your income?
Yes.
If you took out educational loans, is/was paying them back a financial strain?
I did take out loans; but the total was relatively low ($25,000), and I was able to pay them off over seven years.  That was not a strain; however, that was also many years ago.
On average: How many hours a week do you work? How many hours do you sleep each night? How many weeks of vacation do you take?
Currently, I work 40-50 hours/week.   I sleep 8 hours a night.   I have 3 weeks vacation allotted per year.
Do you have a family and do you have enough time to spend with them?
“Yes” and “Yes”.
In your position now, knowing what you do – what would you say to yourself ten years ago?
“Keep doing what you are doing”.    Ten years ago, I had a pretty good idea that I would not be able to practice emergency medicine for too many more years because of the progressive orthopedic problems in my neck.   I was already pursuing endeavors in medical informatics, and I would have continued on the same path that I was already on.   Interestingly, 11 years ago, I originally met the founders of the company that I work for now, and that certainly reinforces the notion that I would keep doing what I was doing.
What information/advice do you wish you had known when you were an undergraduate? (What mistakes or experiences have you encountered that you wished you had known about ahead of time so you could have avoided?)
I wish I had had some education as regards interview skills as well as help with organizational skills, time management, and being able to prioritize.
From your perspective, what is the biggest problem in health care today?
The biggest problem today is the way health care is prioritized within society and how it is paid for.
What other types of providers and/or technicians do you work with day-to-day?
Currently, I work with a Document Manager, two Medical Literacy Editors, a Cardiac Nurse, and our Foreign Language Coordinator.
What types of outreach/volunteer work do you do, if any? Any international work?
Nothing formal.   I make it a point to donate blood about four times a year.   I give financial support to a variety of medical organizations that include international relief funds (such as Doctors Without Borders and the International Medical Corps).
What do you like to do for relaxation or stress relief? Can you share any advice on finding a balance between work and life?
For relaxation, nothing beats exercise, including walking on the beach and hiking in the mountains (Sierras and the Sawtooth Mountains in Idaho).    To achieve balance between work and life?    Try to monitor it as closely as you would monitor an unstable cardiac patient in the ER or ICU.   Re-assess, re-assess, re-assess.     Figure out a way to intervene when intervention is appropriate.    Work hard at learning how to say “No” – particularly as regards a variety of material gains and financial burdens.
What would you say to medical or other health professional students that want to mix a business career with health care?  What advice would you give them?
I would ask the student a lot of questions:  “Why do want to do this?    What are your goals in mixing business and medicine?”   I would need to know a whole lot more about what the student wants to do before I could provide any advice.