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Melanie Cole, MS (Host):   Welcome to Checkup Chat with Evergreen Health. I'm Melanie Cole, and today we’re talking about the Evergreen Health Medical Group. Joining me is Dr. Aileen Mickey, she’s the chief medical officer at Evergreen Health Medial Group; and Dr. Mark Freeborn, he’s chief surgeon with Evergreen Health Medical Group and an orthopedic spine surgeon at Evergreen Health Spine and Neurosurgical Care. It’s a pleasure to have you join us both today. Dr. Mickey, I’d like to start with you. Tell us a little bit about how the Evergreen Health Medical Group was formed, how it came about, and what is it’s function?

Aileen Mickey, MD (Guest):   Sure, I'm happy too. So Evergreen Health Medical Group was really formed over time. Evergreen Health started as a relatively small district hospital in Kirkland and since has grown into really a tertiary referral center in the area. As part of that growth, the hospital needed to fill care gaps so that we could take care of the community. It also received requests from physicians who wanted to work more closely with the hospital and perhaps become employed. So overtime the hospital acquired physician practices and hired physicians and gradually grew the medical group. When I arrived in 2009, there were about 50 employed physicians. We now have over 320 employed physicians and providers in our medical group. So quite a bit of growth in a short period of time. A lot of our work over recent years has really been the development of a true multi-specialty group that includes a very solid foundation of primary care and then a wide variety of specialists who practice both ambulatory medicine and hospital medicine. Really working together as a group to take care of patients and to take care of the community.  

Host:   Dr. Freeborn, I’d like you tell us what a medical group really is. Kind of define it for the listeners. As an orthopedic spine surgeon, tell us what does it mean to be an Evergreen Health Medical Group physician? How is that working out for you?

Mark Freeborn, MD (Guest):    Well, it’s a multifaceted question and a good one. So I consider a medical group to be a partnership in it’s both basic form. As physicians, the days of physicians hanging up a shingle as a solo practitioner, medicine has evolved a lot in the last 10/20/50 years. While historically speaking doctors could practice as solo practitioners and provide a broad spectrum of care, the way that medicine works now is it works best in partnership. So having a multidisciplinary group of partners—and I’ll use that word over and over again—really promotes best practices. Our skillsets overlap one another, our knowledge base overlaps ne another. The medical group, in it’s advanced form, is a group of highly educated culturally aligned providers who are partners and view each other as equals who combine together for the betterment of the patient. It is also very professionally satisfying for us to be surrounded by the best and brightest in the area. The medical group has evolved over the last decade or so, really attracting, hiring, and retaining people who could work anywhere that they want but they choose to work here at Evergreen Health as part of our medical group because they're surrounded by excellence on both sides. So as an orthopedic spine surgeon, I'm the end of the road for spine care for many patients. To have that solid foundation of primary care, to have non-surgical musculoskeletal specialists, to have neurologists and neurosurgeons and critical care doctors and anesthesiologists who all help participate in the care of my patients, to me that’s the best of the best. It’s very satisfying professionally.

Dr. Mickey:   I’d like to add just a little bit to what Dr. Freeborn said. I think the multidisciplinary piece of this is extremely important, especially from the patient standpoint and also the feeling that we are truly partners whether we are a neurosurgeon or a primary care physician or pulmonologist, which is my training background. We all work together to take care of the patient so that the patient feels it’s seamless care. They see their primary care physician for backpain. They're not really sure why they have the backpain. The primary care evaluates them and thinks that they need another evaluation, but they're not sure. Does the patient need surgery? Do they need physical therapy? What kind of treatment is best for that patient? We make it easy to transition that care because we can just refer to our spine center.

The patient can go and see a multidisciplinary team who then can decide what is best for this patient and feed that information back to the primary care physician who really follows the care of that patient throughout the continuum. By doing this, we have multiple eyes on the patient. We have multiple very educated physicians looking to see what is best for this particular patient so that we have an overall care pathway that tells us okay for this type of backpain, here is usually the best plan of care. However we then take that and individualize it to each patient to make sure that what we’re doing is right for them. You can really say that across the medical group with all of our specialists. The primary care sees a diabetic patient who they're caring for. They're having difficulty controlling their blood sugars. They have then the expertise of the endocrinologist and the diabetic nutritionist who are then giving that information back to the primary care so that the patient feels that the care is really in a continuum and it’s connected and that their physicians are speaking to each other and also respect each other as partners.

Host:   Well thank you so much, both of you, for those comprehensive answers. Dr. Mickey, as you're telling us a little bit more about the diverse breadth and depth of specialties and services, you mentioned a few. Expand on it for us just a little bit as far as what testing capabilities that you have there at the medical group, how you all work together in this multidisciplinary way for a multimodal approach for your patients. Tell us about some of the other services. Expand a little.  

Dr. Mickey:   Well, we have 13 primary care clinics. We have over 30 distinct specialty clinics. So we really have the full breadth of medical and surgical specialties in addition to our primary care. Since I'm a pulmonologist, I will give you an example through the pulmonary clinic. We have grown the pulmonary service from three physicians in 2009 to over 10 now. What we realized is that there is a need in the community to do lung cancer screening. After the lung cancer screening data came out in 2011, we developed our own comprehensive program. That really required a multidisciplinary approach so that the primary care physician would see someone who is at risk for lung cancer because of a history of smoking. They would refer the patient to the pulmonary clinic to see if they qualify for lung cancer screening. There they would be seen by our physician’s assistant who would go through a shared decision making process with the patient to see do they require lung cancer screening. If they did, they order the CAT scan which is done. They get called with the results that also goes back to the primary care. If that patient then has a lung nodule, they're seen by one of our pulmonary physicians and they are discussed at a multidisciplinary nodule board that includes pulmonary, thoracic surgery, radiology, oncology, radiation oncology so that every case is reviewed by a multidisciplinary team to make sure that the right path forward is chosen. The patient then undergoes diagnostic test. If they do end up having a lung cancer, then they are plugged in with a surgeon, an oncologist, a radiation oncologist, and we follow their care continuously and then hand them back to primary care as well who’s involved throughout this.

So it’s a very good example of how we've built services that involve multidisciplinary teams to make sure that the patients pass through their diseases as seamless as possible. We have all the major medical specialties. We have a very large cardiology group who also works with a team at Overlake Hospital for cardiac surgery, but our cardiology team is excellent and provides excellent care in the community. They were actually one of our first group of employed physicians. We have diabetes and endocrinology. We have a relationship with nephrology. We have a new bariatric surgery team and a medical weight loss center that’s housed in diabetes and endocrine, which is a new service line for us. We have general surgery with an excellent group that has been in the community for many years, and now the development of a lot of the surgical subspecialties. We have a very large spine center, as you can tell from Dr. Freeborn’s experience. We are building a larger neurosurgical presence on the east side, again in collaboration with Overlake. So most of the medical specialties and the surgery and surgical subspecialties are really represented at Evergreen.

Host:   Thank you so much Dr. Mickey for telling us about the diverse breadth and depth of specialties and services. It really is incredible. Dr. Freeborn, please tell us how you all work together? Dr. Mickey mentioned group discussions and conferences. Please tell us how you work together, how you collaborate so that you can make the best decisions for your patients?

Dr. Freeborn:   Sure. I frequently like to say to patients in colleagues when we walk in the door as a physician, whether it’s a surgeon or a pulmonologist or a primary care doctor, we should really check our ego at the door. The concept of competition for medicine to be practiced in its best form, which is one of our underlying principles within the medical group and Evergreen Health in general, competition shouldn’t be an issue. If you really just stop and focus on the patient, then getting a group of people together and hearing differing opinions and talking through those opinions and getting the collective wisdom of the group is absolutely for the betterment of the patient. I would argue there's an educational component there for the physicians as well. We have a variety of physicians in terms of experience and background in training in our medical group. If we can overlap each other’s training and wisdom onto a conference, let’s say, the physician can become a better physician because the patient gets a more comprehensive diagnosis. So we are focused in a laser like way. Within the spine world, we have an indications conference at 6:00 a.m. So we get everybody together at 6:00 a.m. every other Wednesday. That is community based doctors. Any doctor within our area that wants to come to our spine indication conference is invited to bring a case. So if they just want to hear our group of expert’s opinion, we’re happy to provide that. Anybody within our system can obviously add a patient onto that conference as well. So the collaborative nature of the conference really serves many purposes. It helps bind the medical community together. Again, whether it’s a community based doctor who’s in private practice or an employed physician within the medical group or somebody else that works within the hospital that might share a patient with one of our experts. That conference is designed to be all inclusive, everyone’s invited, and the discussion is really centered around education and developing the plan that’s best for the patient. So for me, I started that conference about 12 years ago when I came on campus. It started with three to five people that showed up every other Wednesday and we now have routinely 30 people in the room. So it’s really been rewarding to sit back and watch the conference evolve and see how people are benefiting from it.

Host:   Wow. It really is incredible. Dr. Mickey, if you would wrap up for us by giving us the best information you would like listeners to know about the uniqueness of Evergreen Health Medical Group, why it’s so important, and really what questions you would like listeners and patients coming there to ask so that they know that you're keeping the community safe and they know they are well taken care of.

Dr. Mickey:   I think the most important thing to understand about Evergreen Health Medical Group is that it is really dedicated to the patient. We have the benefit of being a public hospital district. What that means is that we really support the community with our services. We look to the community to see what do you need; how can we serve you? So it really is all about service to the patient. We put the patient first. The patient’s care comes first. I can even tell you that on an administrative level when we make decisions—because sometimes we sometimes have to make difficult decisions—the first and foremost is how will this effect patient care because that is our mission is to provide excellent patient care. As Dr. Freeborn said, it has been amazing for me to see the quality of physicians that have flocked to Evergreen. These are physicians who have trained in superb academic institutions who don’t want to do research. They want to be at the patient bedside. They want to care for patients. They want those relationships, and they want to practice in a place where they can practice at such a high level of quality and have the surrounding physicians be at the same level of quality as they are and be able to do what they feel is right for the patient. It is a physician driven medical group. It’s a physician lead medical group. I think that’s so important because we really need to focus, again, on the patient and the quality of that care and the multidisciplinary approach.

What I would like patients to ask when they come in is really how are you going to interact with my other physicians? How do you make sure that my care for all of my problems—not just the one thing you're looking at as the specialist but everything—how are you going to make sure that I am getting cared for as an entire person and not just by COPD or my back pain or my diabetes but me as the person? So we can help figure out how to best guide them through the system and take care of them.

Host:  It’s great information. Thank you doctors so much for joining us and telling us about Evergreen Health Medical Group. To learn more about Evergreen Health Medical Group, please visit www.evergreenhealth.com/ehmg. That concludes this episode of Checkup Chat with Evergreen Health. Please also remember to subscribe, rate, and review this podcast and all the other Evergreen Health podcasts. I'm Melanie Cole.