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Two decades ago, neurologist Marilyn Rymer was included in the first class of Ingram’s Top Doctors program, and she’s been a part of the program most every year since, with influential nominations of strong players in the provider space. She knows a Top Doctor when she sees one.
“We are very fortunate in Kansas City to have access to very high-quality health care,” says Rymer, who is on the medical staff at the University of Kansas Hospital.
Hers is the kind of talent that could have ended up in most any major metropolitan area in the nation, but she staked out her career in Kansas City and never looked back. “I had great experiences training and practicing medicine in several parts of the country,” she said, but “I enjoy the camaraderie and relationships one builds in the Midwest, where I find colleagues are more interested in the best outcome for the patient rather than competing with one another.”
You’ll find a great many of those relationships at work in the market here, and
especially among the more than 225 surviving members of those classes over the years. This year’s 21 honorees bring to 249 the number of physicians recognized across almost every conceivable medical discipline and specialty.
More than just providing care, Kansas City’s physician community, and the region’s ability to attract and retain so many talented health-care providers, has become a business consideration. It helps companies recruiting talent from outside to sell this community, not just the job.
But without question, it is a profession in transition. It’s worth noting that while hands-on technologies, patient-records digitalization, changes in the insurance sector, demographics and other mega-factors have affected physician practices individually, the changes in their daily routines are taking place in a marketplace that is fundamentally different than that of the late 1990s. Take a look:
Opthalmologist Dan Durrie, another member of that first Top Doctors class, sees consolidation in medicine as perhaps the biggest change in the game.
“Twenty years ago, more than 50 percent of physicians were independent, in their own practices or group practices, but that number nationally has dropped to a little below 30 percent,” he said. “That’s a significant change—that now, over 70 percent of doctors are working within health systems or large commercial groups.”
In response, Durrie said, “physicians need to be very mindful these days of their interaction with patients. It’s all about the pateint and patient-driven relationship. Anybody who is a physician needs to realize the importance of looking out for patients and getting the absolute best care they can. Kansas City has done a marvelous job of that. We’re going through the consolidations as all metro areas are, but the quality of care is still among the best in the country, and patients appreciate that.”
Rymer sees another mega-trend at work with the delivery model’s embrace of team-based care, particularly in her area of specialization with stroke treatment. In addition, she said, “the team approach is also a big advance for cancer, cardiac and transplant cases. The other change is the emphasis on involving the patient and family in decision-making so that we ensure they receive the treatment they need and want.”
The challenges of keeping a top-tier physician community in place are many and varied. Given the mega trends in U.S. health care today, they are also outside the control of local hospitals, practice owners and other providers. One key, though, will be an organizational shift to that continues to place a high value on work-life balance for doctors.
“I think the emphasis on work/life balance is good,” Rymer said. “As a female physician with a family, I always kept that balance in mind and was lucky to have a very supportive family. Our daughter is a pediatrician in Alaska with a husband and three children. She does a great job at balancing her career and her home. I am happy to see more male physicians seeing the importance of that balance, as well.”
Overall, said Durrie, medicine today “is all about patient-reported outcomes, not clinical outcomes as defined in the past: Do patients perceive value, appreciate the care they are getting? In our practice, we don’t have a waiting room—that was once the biggest complaint of patients, so we redid our systems to immediately take patients into the back.”
That he said, is “the type of thing people need to look at, is what the patient desires in health care that goes beyond the clinical to the quality of health care overall. That’s what makes the practice of medicine really fun.”
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Ahmed Abdelmoity, Children’s Mercy Kansas City
Over the course of thousands of patient interactions in a medical career, successful outcomes are so plentiful that they can make it impossible to single out one that is career-defining. Unless the physician doing the recollecting is Ahmed Abdelmoity. A specialist in neurophysiology and epilepsy, he immediately thinks of a young patient from Egypt who was suffering from up to 150 seizures a day—with virtually no hope for successful treatment in his own country. Abdelmoity worked with the leadership of Children’s Mercy to arrange the boy’s flight to Kansas City, oversee the treatment, and return him to his homeland, free of seizures and moving on with a normal life. “I still get goosebumps when I think of that,” says Abdelmoity, who chose neurology as a specialty because of his fascination with the brain and all its complexities. He earned his medical degree at Cairo University Medical School in 1995, then came to the U.S. and did his residency at Texas Southwestern Medical Center in Dallas, where he was also chief resident, before finishing with a fellowship in clinical neurophysiology at Baylor College of Medicine. Abdelmoity came to Children’s Mercy in 2008 to build its level-4 comprehensive epilepsy center as director, and he’s also section chief for the neurophysiology and epilepsy center at the hospital, in addition to directing its division of neurology. On the academic side, he is a professor of pediatrics at UMKC’s School of Medicine, and director of the neurodiagnostic program for Johnson County Community College. On his watch, the hospital’s neurology department has ranked on U.S. News & World Report’s rankings of the nation’s top pediatric programs. He leads a team of more than 100 staff members including pediatric doctors, nurses, imaging specialists and others who are experts in the development of brains and nervous systems of children, and hospital officials say his leadership, dedication and enthusiasm for his field translate into everything he does.
Erin Stahl, Children’s Mercy Kansas City
Medicine itself isn’t just a family affair with Erin Stahl—medicine at the highest level is. She earns recognition as one of the region’s most gifted physicians two decades after her father, Dan Durrie, was cited as a Top Doctor in Ingram’s inaugural class. And just two years after her husband, Jason, was similarly recognized. The common thread for all: Ophthalmology. In her case, pediatric eye surgery and care at Children’s Mercy. “I was clearly influenced by my ophthalmologist father from an early age,” she says. “His passion for taking care of people and advancing the field of medicine was an ever-present part of my childhood.” That included joining him on his weekend rounds to visit surgical patients, traveling to the airport to collect corneal tissue and even making—remember these?—house calls. Even in her youth, she says, surgery was calling, given her interest in building small models and working with electronics. “As much as I entertained other specialties, in the end I decided on ophthalmology because it gives a unique ability to fix problems and return people to normal lives,” she says. The pediatric spin on that came from “inspirational role models at Children’s Mercy and my desire to tackle small eyes with big problems.” She says she’s lucky to be able to practice in an environment where the focus on taking good care of patients is paramount. Among the toughest challenges in that respect are cases of uveitis, a rare, autoimmune eye disease that, untreated, can lead to blindness. “Parents often have a difficult time understanding the condition and accepting the treatments which include regular injections of immunosuppressive medications,” Stahl says. “Many of our families struggle with the conversations surrounding starting immunosuppressive therapy and it brings me great satisfaction to walk through these decisions with a family.” That therapy is the gateway to care throughout childhood. Says Stahl: “I love watching our kids play sports, go to college and transition to happy and successful young adults thanks to advances in medications and improved understanding of autoimmune diseases
David Clymer, Apex Orthopedics & Sports Medicine
His is a world of medicine and art, engineering and mechanics. David Clymer draws on elements from each in his role at Apex and his affiliation with St. Joseph Medical Center, where he’s a bit of a vanishing breed within his area of specialization: The generalist. While many have staked out reputations in knee or hip replacements, Clymer has a hand in most every moving joint in the human body. “It was more of an avocation,” during his youth in Salina, he says, “I was kind of a mechanic and a carpenter—I liked to make things, and to make them work.” He sandwiched his medical-degree pursuits at Vanderbilt around his undergrad years at the University of Kansas and his internship and residency at KU Med before joining Carondelet Orthopaedic Surgeons, now Apex, and became a highly respected figure in the orthopedic community, serving a term as president of the Kansas City Orthopedic Society. His work has been greatly influenced by advances in medical devices to replace worn-out and broken joints, in some cases now entailing plasma and stem cell applications. “But I’m still interested in the mechanical nature,” he says, “getting the joint in, the back stabilized, the sports injury stable, and I see those as important developing areas in orthopedics. What really makes me feel good is when that artistry works out.” The field, he says, is not for the faint of heart. Much has changed in the world of medicine overall, but if he had to do it all again, he’s confident he would have made the same choices. “I still love the biology and the artistry and mechanics—I don’t think there could be a better match for me.” Like many physicians, he’s concerned and frustrated by the demands placed on providers with technology and regulation. “But what I’m inclined to emphasize most is patient education,” Clymer says. “I think we’re better at medicine and the economics of it if the patient has a better understanding of what their own health care involves, and can make the best decision for themselves.” The advent of digital information and easy access to it, he says, is redefining the relationship between physician and patient—within limits. “In my discussions with patients, a fair amount is debunking digital information they’ve seen that isn’t mainstream.”
Carolyn Davis, Pediatric Care Specialists
Perhaps one day we’ll see a demographic study of health care that can quantify the influence of family relationships on providers, but until then, we’re pretty sure that any physician parent has a solid chance of producing at least one other doctor. We see that a lot, and again with Carolyn Davis of Pediatric Care Specialists. The practice, an affiliate of Children’s Mercy Kansas City, has been her work home for nearly 30 years, and the medical staff also has privileges at Shawnee Mission Medical Center, Saint Luke’s South and Overland Park Regional Medical Center. She started at PCS after wrapping up her advanced training at Children’s, following her undergrad work at the University of Kansas School of Medicine. That line of care called to her for the people aspect as well as its intellectual challenge. Think about it: A child, especially a young one, has little comprehension of how the human body is supposed to work. How, then, can little ones accurately convey to their doctors any real sense of what might be wrong? “I love the critical-thinking of it, and the attention to detail,” says Davis. But her work also evokes memories of childhood with five siblings in Concordia, Kan. “Dad was a physician and a great role model,” she says. “He encouraged me do anything I wanted, and said I could, provided I was willing to do the work.” That started with a collegiate focus on chemistry, earning her degree at K-State. But “I missed the people contact,” Davis says, so it was off to KU for medical school. “This is the right thing for me. I love it.” Over the years, she says, she considers herself blessed to have been part of the lives of many wonderful families. “And I’ve been doing it long enough, some former patients who are now adults are bringing their kids to see me,” she says. “There’s a positive influence in helping kids have a happy and healthy life.” A winner of multiple career recognitions for her skill as a provider, she also won the Clark W. Seeley Award for Excellence in Primary Care while training at Children’s Mercy, and eventually took her place on the hospital’s board of directors. I do what I do every day for the kids, especially the younger ones who can’t speak out,” Davis says. “You’re an advocate for them, and I really enjoy that.”
William Gabrielli, Jr., University of Kansas Health System
For young William Gabrielli, a career in medicine would be a commitment to making a difference in the world “by doing medical research, pushing back the frontiers of knowledge. That is what got me started.” Then came medical school itself, and the laying on of hands with patients. “I discovered my passion in taking care of people,” he says. “I began to appreciate the importance of patient care—and I needed to find a way to do that too.” Those impulses, and memories of his own unpleasant experience with medicine as a child, launched a career in medicine and his lifelong passion for teaching medical students, he says. Gabrielli has two practice areas, psychiatry and internal medicine, with interests built on a background in psychology and behavioral-genetics research. “As I expanded from a primary focus on medical research to include the clinical practice of medicine, I understood the integrated value of primary care and mental health,” he says. “This allowed me to channel my skills and understanding of real disease in a way that optimizes clinical outcomes.” At the same time, new challenges have arisen that complicate the care process. “The mechanics of health-care finance and access to care, prior authorizations, lack of physician autonomy for patient benefit, and insurance company interference, instead of advancing quality, have greatly diminished quality health care—and, paradoxically, increased the cost of health care,” he says. Any medical career will be packed with many successes and occasional disappointments, and Gabrielli believes that “some of the situations where others saw no hope and you were able to make a difference are the most indelible ones.” Focusing on the successes, he said that “the string of positive interactions that merge together into a common positive memory, really define a satisfactory clinical career.” A perfect day in his world, he said, “is about making a difference for the patients, the ones for whom we help today, the ones that will be helped by our trainees down the way, the ones that are helped by the discoveries we make, the ones for whom we advocate, and the ones helped by the programs we design and lead. Any day we make a difference for someone is a good day.”
Stan Hoehn, The Bariatric Center of Kansas City
Want to know about the depth of passion Stan Hoehn brings to his work? Just spend five minutes with him, and you’ll feel it radiating from every word as he speaks about the health challenges America faces with its obesity epidemic, the effectiveness of weight-loss surgery, a food pyramid he believes was built upside-down (and the corporate influences behind that construct), the poisonous influence of fad diets and supplemental treatments, insurance decisions he believes are both short-sighted and fraught with long-term higher costs for health care—you get the picture. All of that, and more, inspired him to leave general surgery behind after launching the Bariatric Center of KC in 2002. Today, the straight-talking Hoehn, through his private practice, is medical director of Shawnee Mission Health’s weight-loss surgery program. He’s a veteran of more 15,000 surgeries overall, with more than 5,000 of them being highly successful weight-loss operations. The life-changing aspects of what he does are a constant part of his work. “When you treat somebody with this, they get results, and you’ve got a friend for life,” Hoehn says. He got into medicine after earning his bachelor’s degree in biology from Union College in Lincoln, Neb., then his M.D. from Southern California’s Loma Linda University, wrapping up his surgical residency and at the University of Kansas Hospital nearly two decades ago. At Shawnee Mission Health, officials say Hoehn and his team are performing more weight-loss surgeries than any other facility nationwide, with some of the best quality outcomes. Because of his pioneering work in the field, manufacturers of bariatric surgery instrumentation and devices send surgeons from aro-und the country to train with him. More than any other factor contributing to health challenges, obesity creates what Hoehn calls “halo conditions” of diabetes, stroke, heart attack, sleep apnea and circulatory illness. “And yet, the one surgery that could correct all of those,” he says, “remains an elective procedure in the eyes of insurance. The return on health-care savings after surgery is about 18 months, by which time, many patients have changed jobs and moved on to other carriers. “If that insurance were portable,” Hoehn says, “we could address an incredible amount of our health-care spending.”
Craig Satterlee, Drisko, Fee & Parkins
Back at Rockhurst High School, Craig Satterlee settled on a senior project that brought him to the old General Hospital, forerunner of today’s Truman Medical Center. “I was really at the low end of it, but it piqued my interest,” he recalls. Biology and chemistry classes at MU compounded that interest and took the Kansas City native into med school in Columbia, and he was pretty sure that after working his way to an M.D., a career as a primary-care physician was in the cards. Then came a rotation in orthopedic surgery, dealing with “all kinds of car wrecks and accidents,” he says. “I enjoyed it, and when the chief resident asked me what I wanted to do, I told him. He said, ‘Primary care? Heck, you are a natural at this.” Upon further review, Satterlee realized that he had the interest and, in a sense, the background: His father was a plumber, and young Craig had worked with him to learn how systems come together and function properly. After medical school, he landed one of two positions available to graduates nationwide, working with the renowned Charles Neer at Columbia University in New York. “That,” says Satterlee, “was the stepping stone to orthopedics and my involvement in national teaching, running courses, and becoming involved in governance.” That includes his current stint as secretary of the American Association of Orthopedic Surgeons’ board of surgeons, representing 39,000 physicians in every state and 100 other countries. While the current expansion in robotics is changing the field, the defining technological advances during his career entail arthroscopic surgery in all its applications, he says. It has helped him find the high points in his work. “Almost daily in the office, patients thank you for taking care of them, especially for helping them with pain,” Satterlee says. “They’ve had some kind of injury, or arthritic condition that caused great pain for a long time, and they’re very grateful—that’s one of the most satisfying things, about this work, especially with shoulder replacement.” Harkening back to his work with Neer, he says he was fortunate to have trained under the man credited with inventing modern shoulder replacement. “We stand,” Satterlee says, “on the shoulders of giants.”
Jeff Luerding, Meritas Gashland Clinic
He’s about as affable a person as you could hope to meet, but Jeff Luerding can recall a moment when he was truly … chagrined. “I had a specialist in medical school, and when I said I wanted to go into family practice, he said ‘You’re too smart’ because I needed to specialize. That really pissed me off.” Family medicine, Luerding believes, needs people who are compassionate, caring and want to provide a continuity of care. “I didn’t want to see somebody for an Xray one time and never again,” he says. “I wanted to take care of families, children, multiple generations, and to really impact people’s lives.” Yes, he could have made a lot more money doing specialty medical work, “but that’s not what I enjoy,” says the St. Charles native, who has spent 31 years in family medicine here. Luerding came to this area as a college student at William Jewell, and immediately fell in love with the place. When he finished medical school and moved to Minnesota, he found out that a colleague was taking a job here, and Luerding sounded him out about a job. U-Haul time. His work today at Meritas, an affiliate of North Kansas City Hospital, is in-formed by childhood recollections of “the coolest pediatrician,” he says. “I thought, if a guy this cool does this for a living, it’s got to be a great job. Any time I saw him, he always made it comfortable, even if I had to get a shot.” After 31 years, he has realized his goal of treating multiple generations—in some cases, families four generations deep. The distractions of dealing with insurance, regulatory mandates and the business side of medicine, he says, are just that: Distractions. They are not insurmountable. “Anyone successful has hassles, they have them in law, or if they’re teachers, but those who excel look at all that stuff and remember how to focus.” After seeing so many patients for so many years, the names start to fade away, but he still encounters people he’s treated who will stop to thank him for making a referral that confirmed a cancer case, or led to heart surgery of other life-saving treatment. “I can’t fix everything,” Luerding says, “but I can help them deal with things in ways that makes their lives better.”
Scott Luallin, Truman Medical Centers
The successful outcomes that come to mind for Scott Luallin are a tale of haves and have-nots. One involved a professional soccer player who had a potentially career-ending multi-ligament knee injury. “After a successful reconstructive surgery and months of rehabilitation, this player was able to return to his previous level of performance and continues to play professionally today,” Luallin says. The less fortunate of the two involved a young man in the Dominican Republic, where Luallin was on a medical mission trip. “This young man had spent six months in bed with fractures of his femur, lower leg and humerus. He had no treatment options until our team arrived.” But they were able to repair those fractures and allow the man to return to work and take care of his family. As that trip was ending, the patient returned to the hospital and tearfully told the crew that they had given him back his life. “This was one of the most moving and gratifying outcomes that I can recall, and reinforced for me why I went into medicine,” Luallin says. That journey started with a school-age interest in science and how the body works, and a family tie helped. “My older brother was in medical school while I was in high school,” he says, “and I was able to shadow him and became very interested in medicine during that time.” One of the rewards of his work in the orthopedic applications of sports medicine is returning athletes to high levels of performance, and he’s been medical director for Sporting KC for 23 years. “This has enabled me to work with these high-level athletes and help them return to play after injuries,” he says. The advent of minimally invasive methods of performing surgery has been the most exciting technological advancement in orthopedic surgery, he says, and “performing surgery arthroscopically enables me to perform surgery with greater precision and allows a more rapid recovery.” With luck, there is more to come in his field. “Treatment of cartilage injuries is a rapidly evolving area of orthopedic surgery,” Luallin says. “We have a number of treatments for cartilage injuries, but there is still room for more technological advances in this area.”
Eric Voth, Stormont Vail Health
There are bright shining sides of medicine, and there are some that aren’t so alluring. Eric Voth knows both. Himself the son of a physician, Voth is vice president for clinical care at Stormont Vail, the largest hospital in Topeka—and a health system serving much of northeast Kansas. As such, he’s in a position to influence the care of tens of thousands of patients, many of whom are immersed in an avalanche of information that is unprecedented in world history. Because of that, practicing medicine today in many ways is far more challenging, than ever, he says. “The most incredible change is information management, the Internet, cell phones, texting and texting with patients, electronic-health records, telehealth visits—there’ a lot of good in that, but it takes a lot of time and pulls physicians away from interactions with patients,” he says. “The key is finding the right balance, particularly in primary care.” That information flow to patients, he says, can sometimes be frustrating (But Doctor, I read on WebMD that …”) but Voth has another view: “It keeps physicians honest,” he says. “If it’s good, legitimate, scientific-based stuff, we should know it and be able to carry on that conversation.” The darker side of medicine that Voth knows deals with the opioid abuse that has reached epidemic lev-els in America. In that capacity, Voth plays on bigger stages, as he lectures at venues nationwide on drug-policy issues and is recognized as an international authority on drug use. During his career, he has serviced as an adviser to three presidential administrations—under Ronald Reagan, George Bush and Bill Clinton—and has routinely testified on drug-related issues before Congress. He’s also a past recipient of the Director’s Award from the director of the Office of National Drug Control Policy, given for outstanding achievement on combating drug use in the U.S. And he’s on the governor’s task force on opiates, addressing the current challenges. “I think we’ll get a handle on it,” he says, hopefully, “but it’s a complex issue.”’
Melissa Mitchell, University of Kansas Health System
It started early for Melissa Mitchell: “As a child, if someone got hurt, I always wanted to be the one to bandage their wounds,” she recalls. “My mother was a nurse and received many compliments for her outstanding care, and I knew I wanted to be like her.” But this self-described “nerdy kid” also had a strong scientific bent. “I asked for a microscope for Christmas when I was 8 years old and loved reading about the human body,” Mitchell says. “The challenge was deciding whether to be in medicine or science.” Then came college, and the realization that she could train in a dual program to become both a physician and a scientist. “I knew instantly that was the path for me,” she says. And so it was. After earning twin degrees in biology and integrated science from Northwestern University, she earned a doctorate in pharmacology, then picked up her medical degree at the University of Colorado Health Sciences Center. Her fellowship in advanced radiation oncology was at the prestigious M.D. Anderson Cancer Center in Houston, and she came back from there to the KU Med Center campus, where she’d done her residency. She’s a radiation oncologist for the health system, where “I get to use all of the math and physics skills that I learned during high school and college and merge those with my passion for medicine, all while conquering cancer.” That’s a noble goal, but one inspired by more than pure altruism: It’s personal, too. “I’ve had numerous family members that have taken this rough path through cancer treatment, and I have always had a passion for oncology for this reason,” Mitchell says. “I know how a diagnosis of cancer can completely change everything in your life in an instant, and my goal is to figure out how to help patients through this time as easily as possible and help them to move forward.” Bringing patients back from the depths of diagnosis is her calling. “I love seeing how medicine continually evolves in the world of breast cancer,” she says. “From new drugs that were not available five years ago, to new ways of operating on patients and new ways to do breast reconstruction, there is a strong movement to improve outcomes while simultaneously reducing
toxicity right now in our field.”
Ajay Nangia, University of Kansas Health System
The practice of medicine is invariably personal, but it doesn’t get much more personal than you’ll find in the reproductive aspects of urology. The very ability to sire children is a biological imperative, and Ajay Nangia works to help patients overcome the bad hand that life can deal with it. In part, his work there is an extension of what he and his wife had to overcome. While still in urology residency at the University of Pittsburgh, he recalls, “my wife and I were having trouble having kids, too. That led to his interest in reproductive medicine and infertility procedures while at the Cleveland Clinic before he joined the faculty of Dartmouth College. A native of London who came to the U.S. in 1991, he was eventually attracted to the health system here because of its burgeoning reputation. “The department here was up and coming in the world of urology,” Nangia says, particularly with male reproductivity. That work draws on his early life interest in biology, working with his hands, teaching and looking after people—especially with cases of infertility. “When you’re young, you think you’re indestructible,” he says. “But if you have a diagnosis of infertility, it can be devastating, almost like cancer.” His field is changing in many ways, but he celebrates the advance of the information age and the way it has changed the nature of discussions with patients. “It leads to better conversations when I try to have them absorb the complexities of what I do,” he says, and that awareness leads to both better access to care and more informed access. “The reasons we want children are deep, personal and multifactorial,” Nangia says. “The beauty of treatment is, when it actually happens, you have extended the life of that family by an addition 70 years with a new generation. What this gives is priceless. It is a gift.” To this day, he’ll receive Christmas cards from former patients, showing their kids enjoying Santa’s bounty. “I run into people all the time with kids around town, and to know I had something, to do with that, hopefully with a positive influence, is amazing.”
Rhea Pimentel, University of Kansas Health System
“When I was going through medical school, I never thought of cardiology. It seemed too complex and intimidating.” So says Rhea Pimentel, who is—as you might have guessed—a cardiac electrophysiologist. Her patients today can thank an enthusiastic senior she knew during her rotations after med school. “He would pull me aside from other rotations and show me fascinating EKGs and then take me to the EP lab to see what those EKGs meant,” she recalls. “ His energy was infectious and he made it all seem a lot less scary. I owe him a lot.” So do those at the health system, where she’s director of the fellowship program in cardiac electrophysiology. Her path to medicine wasn’t precisely pre-ordained, but neither was it unlikely: Both of her parents were physicians. “They enjoyed the idea of being able to help people,” Pimentel says. “My father led a medical mission every year to the Philippines, where I was born. When I was 14, I came along with him. It was the first time I saw the kind of abject poverty that many people in this world suffer. It was also the first time I was able to see how doctors could change a person’s life. It was at that moment I decided I was going to be a doctor too.” When she was younger, she says, “medicine was all about a doctor helping a patient in the best way they knew how sometimes. …Today, I spend half my time in documentation and discussing cases with insurance companies.” But electronic records have, she says, helped disseminate patient information and improved patient care. “The bottom line,” she says, “is that we have to work harder these days to be the same doctor who spends time with a patient and advocates for them in the best way they know how.” And that “best way” is continually evolving. “There are things I do today that I never thought would be possible to treat when I was training 20 years ago,” she says, providing relief from such disorders as atrial fibrillation and better quality of life with biventricular devices. “Technology continues to focus on improving success rates and decreasing complications in our procedures,” she says. “I am hoping in the future we will be able to offer more noninvasive ways to treat common disorders.”
Jim Kelly, Saint Luke’s Hospital
Yes, Jim Kelly admits when asks, he spends his days knocking people out. “But more importantly,” he says wryly, “we wake them up beautifully.” Kelly is chief of cardiac anesthesia for Saint Luke’s and a key member of the transplant team lead by the renowned heart surgeon Michael Borkon there. “We’ve worked together an awfully long time,” Kelly says. “The better part of 25 years, at least.” Attainment of such an important role surely reflects a lifelong desire to become a physician, right? Not necessarily. “Tell the truth, I was never drawn to medicine,” he confesses. “I always wanted to be a farmer.” Encouraged by his farming family to go to college first, Kelly still didn’t start on a medical pathway. “I was pre-vet, and was accepted into vet school, but I took the MCAT (the medical-entrance exam) on a dare from a frat brother.” To the surprise of no one who knows him, he did well, switched from vet school to medical school, and was on his way. But why anesthesia? “That seemed to be where the most normal people in medicine were,” he says. “They seemed to be happy and content, kind of well-balanced people.” More than one might think anesthesiologists do indeed develop patient relationships that run deeper than “count backwards from 100 for me,” but there is an intensity to it. “We are treating them at some of the most stressful times of a medical encounter,” Kelly says. “It takes a special skill to find a bond or relationship with a person that quickly and assure them you can take good care of them. You don’t often have a long-term relationship, but it’s a very intense, quick relationship.” And, at times, with repeat procedures for certain treatments, there is the opportunity to have multiple encounters. He’s done thousands of these procedures, but when a person is getting a new heart, in particular, the process never grows old. “What we do becomes part of everyday life, but few people are hoping to go to the cardiac operating room more than once,” Kelly says. “If I didn’t have to take that call, I’d be happier, but there’s nothing but excitement about it. There is nothing better than seeing a patient knowing he’s going to get a new heart.”
Steven Marso, HCA Health Midwest
It was Kansas City’s loss in 2014 when Steven Marso moved to Dallas to become medical director of interventional cardiology at the University of Texas Southwestern Medical Center. But HCA Midwest Health brought him back to this region two years later and today, he runs the interventional cardiology program for the health system, working through its six largest medical centers in the Kansas City region. “I am grateful,” Marso says, “to work in a health-care team that offers hope to many patients who have been told there are no options.” Given newer tools and techniques, he says, “we can many times offer these patients the hope to live life with less symptoms of advanced cardiovascular disease.” His work here is the latest step on a path that began in his youth. “My mom was a surgical nurse at a VA hospital in my home town,” he says. “I recall her telling many stories at the dinner table and sharing her opinions and experiences. I believe this affected me in a profound way as a young child. I also was very interested in the biological sciences as a student.” Interventional cardiology came early in my medical training, back when intra-coronary stents were first used in humans. “I was drawn to this strategy as a possible durable and effective treatment for many patients,” Marso says. “At the time, however, I had no idea how much the field of interventional cardiology would expand in my professional career.” That career has seen much in the way of transformative technology and factors that have reshaped the contours of the doctor-patient relationship. “The major distractor for physicians providing quality care to patients is the current burden of health-care documentation and electronic medical records,” Marso says. “While EMRs have helped in many ways to collect and codify the patient’s medical record, they have definitely made health-care practitioners less efficient over time. Physicians really do spend too much time entering information into a computer rather than spending time with patients and their patient’s families.” Distractions aside, though, he says, “I truly believe it is an honor and a privilege to be an interventional cardiologist in the current era of health care.”
Mike Waxman, Research Medical Center
A pair of close, personal family acquaintances, you might say, influenced Mike Waxman’s decision to go into medicine—his parents. Both of them were doctors. “I used to go to the hospital with them when I was a kid and watch them at work,” says Waxman, medical director of the surgical and intensive-care unit at Research. “I was fascinated at how they could simply talk to a patient and examine them and figure out what was wrong with them and what to do about it. I knew that was what I wanted to do with my life.” A lot of us would think twice about a life decision that leads to work shifts starting at 2 a.m., but that’s the gig he has, and the one that he loves. In that role, he’s supervising treatment of the kinds of patients he first encountered back during his internal residency 40 years ago. “I did a rotation on pulmonary critical care,” he recalls. “The patients in the ICU were so sick with problems that, if not diagnosed and treated quickly, would result in death or disability. I wanted to work with patients who had that intensity of illness, that level of acuity. I wanted to care for the sickest of the sick.” That he does with roughly 50 patients when the critical-care beds are filled at Research. It helps, he says, to be using the kinds of tools available to physicians today. “The use of bedside sonography to image certain body structures to diagnose and guide treatment has been one of the more helpful advances,” he says, but “we have been helped by better medications to treat COPD, asthma and various infections. We have studies that now tell us what works and what doesn’t, such as how we can now screen for lung cancer.” And the technology pays off in instruction, as well, with computer simulations that allow repeated practice to get procedures right. “It is a great way to involve all the medical professions to work together as they would in real life,” Waxman says. “Instead of learning on the job, they learn in a simulated environment where they can practice over and over again. It improves patient safety and patient outcome.”
Atul Patel, Kansas City Bone & Joint Clinic
In addition to the skill set he wields in rehabilitative medicine, Atul Patel brings a world view to his work, and a track record that gave little indication he would one day end up in medicine. Indian by origin, he was born in Kenya, grew up in Zambia and came to the U.S. when he was 18. He attended 10 different grades scho-ols in three countries, missed high school during the emigration process, took his GED and eventually earned a degree in chemical engineering at the University of Houston. But the economic prospects for chemical engineers was not good as graduation loomed. He thought about his options on his daily bus ride, which took him past the campus of the Texas Medical Center, the largest in the world. Call it a light-bulb moment. Following the med school entrance exam, he ended up at Baylor College of Medicine, again exploring his options. “I was very open-minded; I enjoyed every field of medicine, so I started looking into areas I didn’t know much about,” he said. That led to a report on the coming aging of America, and an expected explosion in the numbers of disabled
people. “I realized there would be this huge need,” Patel says. Rehabilitative medicine, he says, differs from most other disciplines in that it is not focused on a specific disease or condition, but on function: How to get a person with a given problem back to his or her life? “Not treating disease, but looking at ways to optimize someone’s function was a completely different view,” he said, “and from an engineering standpoint, you get to work with a team, solve a problem, and every problem is different. I get bored easily, so I thought this is perfect, I get to do all kinds of things.” As a physician today, he sees a challenge for the profession overall. “When I started, the perspective was different; it was more like let’s get the work done, and keep growing,” Patel says. “The biggest thing that has changed is the focus—the incentives are in the wrong place in medicine.” The current cost structure has shifted the focus of too many providers to the business side of things, he says, and away from patients. “I’ve tried to focus on what’s best for the patient, and everything else has fallen into place,” he says.
Kelly Rhodes-Stark, Olathe Health
Something you may not know about radiation oncology: The machines they use to treat patients with cancer are tremendously heavy. You won’t find them on the upper floors of medical centers, with sweeping window views. “We’re basement dwellers,” says Kelly Rhodes-Stark says, describing her colleagues. “Bunch of weirdos, right?” But that field, she says, “is fantastic, because we get all the tech, the science, the patients—it’s the perfect blend.” That combination of care and science is what drew this Louisville native to her field, back in the days when women weren’t typically entering that discipline. “In high school, I was more inclined to math and science, but I realized I was not all left-brain.” While in college, she volunteered at a local hospital, and that work confirmed her instincts. “I didn’t have family members in medicine; I was taking off on my own hunch and going with my gut,” she says. She earned her medical degree and did her internship and internal medicine in residency at the University of Louisville, then her radiation oncology residency at the University of Kansas Hospital. Oncology, and radiation oncology in particular, is not a common pathway. “Most people in medicine don’t want to see people with terminal illnesses, they want to make things better.” The discipline of oncology, followed by advances in treatments, technology and outcomes, is the perfect mix, she says, clicking off the shortened treatment cycles and increased success rates for brain, breast and prostate cancer. With a little notice, she’ll show you a thank-you note from one of those success cases, postmarked Charlotte, N.C., from a woman she treated in 1998 who has lived to see her grandchildren. “That,” Rhodes-Stark says, “is why I do this.” A perfect day in her world, she says, is when she can leverage the talents of her team to achieve each patient’s goals. “A perfect day is when I’ve got good news for every patient,” she says. And now, she gets to pursue those days in the new cancer center Olathe Health recently finished, one that came with all the best technology—and a little something extra. Windows? “Yes!” she beams. “Yes! I do have windows!”
Cheerag Upadhyaya, Saint Luke’s Health System
The influence of his father, an obstetrician-gynecologist, captured the career interests of Cheerag Upadhyaya, who looks back and says that “I always had a desire to work in medicine and to care for patients.” What he drew from his dad, though, was “a great foundation for me with his dedication to his patients and providing them with excellent care.” The path to that care-giving, he decided, would lie with neurosurgery. “Surgery has always been an interest of mine, and I love the intensity of neurosurgery,” says Upadhyaya, director of the spine program and surgical director for the Saint Luke’s Marion Bloch Neuroscience Institute. “Few specialties allow the opportunity to combine surgery and experience the intensity that comes with neurosurgery. I believe neurosurgery had the greatest potential for change, growth and development throughout my career.” A relative newcomer to KC—Saint Luke’s recruited him in May 2014 from his previous work at Kadlac Neuroscience Center in Richland, Washington—Upadhyaya earned his medical degree from the University of Florida, then did his residency in general surgery with the University of Michigan Health System and his fellowship in spinal surgery at the UCSF Medical Center in San Francisco. He has a long roster of contributions to medical journals, books, videos, and industry conferences. As with most physician specialists today, he’s witnessing a technological revolution that is creating new frontiers for treatment. “I am excited for the new and future applications of robotic technology for spine surgeries,” he says. “We are seeing new opportunities for intraoperative navigation, which will bring dramatic change, including allowing more surgeries to become minimally invasive.” And computer technology in neurosurgery will allow providers to interface computers with the brain and spinal cord to enhance function for patients, he says. That technological shift, however, and goes beyond what’s needed to restore a patient’s ability to function. “I believe advances in technology are providing us the ability to change and improve health care overall, especially in our ability to coordinate care in a multidisciplinary environment,” Upadhyaya says, “but also as we develop operational efficiencies, and in communication with patients. It’s important to find ways to balance the costs of health care for our patients, and make the highest quality of care affordable.”
Mark Wiley, University of Kansas Health System
It was late at night, and Mark Wiley was a freshman in college, working as a hospital ward clerk on the evening shift. “There was a patient on the cardiac intensive-care floor doing poorly,” Wiley recalls. “I watched as a cardiologist worked to save the man, and at that moment knew my life was changed. I initially wanted to become an educator in biology, but could now clearly see a path and life dedicated to helping others.” He earned his medical degree from the University of Kansas, and stayed on the med-school campus for the trifecta of internship, residency and fellowship in cardiology. Since then, he says, “I have been fortunate to be involved in the evolution/revolution of minimally invasive valve repairs and replacement.” A decade ago, he began to work on early clinical-device research for both aortic and mitral valve disease. That, he says, led to “participating in a valve team with our cardiothoracic surgeons that brings these new technologies to patients.” And he works with patients who have coronary artery disease and complex blockages requiring revascularization. All along, he said, his work has been framed by only one real concern: Caring for patients. “There was no thought to process, cost or regulatory components,” early in his career, he says, “the focus revolved around providing the highest quality of care.” Over the past decade though, he believes “the time to complete a day’s work has extended with the advent of the electronic record. There are many benefits to our current system, but many new pressures with public reporting of quality metrics and insurance companies adding steps to patient care.” The flip side? The excitement that comes from advances in care, particularly with valve-replacement technologies. His work is a daily reminder of what matters most. He recalled the case of a former patient who was on the road to recovery—and to realizing his dream of hiking in Alaska—before his life was cut down by cancer. “I keep this in my memory to remind me to live every day in the present and push towards dreams today,” Wiley says. “We only get one pass through life with family and friends and we often lose sight of what is truly important.”
Michael Nelson, Shawnee Mission Medical Center
A lot of people might take offense if you were to just doze off in the middle of a conversation. For Mike Nelson, that just might be a success metric. He’s a pulmonologist for Shawnee Mission Health’s pulmonary consultancy practice, and where the mission of treating pulmonary diseases and critical-care cases also covers the challenges of sleep medicine. As the hospital says, a good night’s sleep is not just a luxury; sleep deprivation can reduce your productivity at work and adversely affect relationships at home. Yet millions of Americans are living with an untreated sleep disorder, and a great many of them don’t even know it. They wake up exhausted, even after eight hours in the sack, because those disorders affect your ability to get uninterrupted, quality sleep and can lead to accidents, heart problems and other complications, including heart problems. And given that being more than 20 pounds overweight is a key indicator of a sleep disorder—and that America has a huge challenge dealing with epidemic levels of obesity, Nelson and his team have their hands full. “Mike is great at what he does,” says Scott Cook of Kansas City Orthopedic Institute, a Top Doctor honoree himself. “His critical-care expertise is the reason why I feel comfortable bringing complicated cases to Shawnee Mission Medical Center.” Nelson is also on the medical staff at Saint Luke’s South Hospital in Overland Park. He is also a trustee for the American College of Chest Physicians’ CHEST Foundation. A graduate of the University of Kansas School of Medicine, where he did both his residency in internal medicine and fellowship in pulmonary disease, and is board-certified in each of those disciplines, as well as sleep medicine. Nelson has been affiliated with the American College of Chest Physicians for 27 years in multiple roles. He’s also a member of the American Board of Internal Medicine’s Pulmonary Disease Board.
