A DAY FLYING HOBBY ROCKETS - IS LIKE NO OTH ER - Metro Omaha Medical Society
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VOL. 43
NO. 6
NOVEMBER/DECEMBER 2022
USA $1.95
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A DAY
FLYING
HOBBY
ROCKETS
IS LIKE
N O OT H E R
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wellness center courtesy of the
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and safe space just for physicians.
Email cwang@omahamedical.com
or call (402) 393-1415 for
the access code.
November/December 2022 • Physicians Bulletin 5
6 THIS ISSUE November/December 2022
16 FE ATURES
14 SOME ADVICE ABOUT 11 NMA MESSAGE
PREPARING FOR RETIREMENT Looking Ahead at 2023
16 ADVOCACY RESOURCES: 12 RISK MANAGEMENT
A MOMS Member Benefit IT Security: Why Should You
Care About Endpoint
19 A DAY FLYING HOBBY
Detection Response?
ROCKETS IS LIKE NO OTHER
24 24 MAKING A CASE ABOUT
THE IMPORTANCE OF
13 FINANCIAL COLUMN
Residency to Retirement
19
IMMUNIZATIONS: 26 MOMS EVENT RECAP
More than a Primary
Care Discussion 27 MEMBER NEWS
28 NEW MEMBERS/
D EPARTMENTS CAMPUS & HEALTH
SYSTEMS UPDATES
9 EDITOR’S DESK
Don’t Give Up Your Hobbies
10 MOMS LEADERSHIP
In Gratitude for a
Memorable Year
Thanks Omaha for over 45
11
Years!
A LWA Y S
L O C A L,
A LWA Y S
B E A U T I F U L.
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Specialized Estate and
Asset Protection VOLUME 43, NUMBER 6
A PUBLICATION OF THE
Planning for Physicians
As a physician, your strategies for earning, wealth accumulation and
preservation are different. Your estate planning should reect these
METRO OMAHA MEDICAL SOCIETY
differences. Vandenack Weaver Truhlsen specializes in estate and asset 7906 Davenport St. | Omaha, NE 68114
protection planning for physicians. Our expertise weaves together legal (402) 393-1415 | www.omahamedical.com
expertise and high-end tax acumen to ensure security and nancial OFFICERS
President | Tina Scott-Mordhorst, M.D.
stability – today and well into the future.
President-Elect | Maria Michaelis, M.D.
Secretary-Treasurer | Travis Teetor, M.D.
Contact us today to discuss your needs and preferences. Past President | Richard Lund, M.D.
Executive Director | Carol Wang
EXECUTIVE BOARD
Tina Scott-Mordhorst, M.D.
Maria Michaelis, M.D.
Travis Teetor, M.D.
Richard Lund, M.D.
402-426-8877 402-504-1300 Alëna Balasanova, M.D.
1650 Washington Street 17007 Marcy Street, Suite 3
Robert Cochran, M.D.
Blair, Nebraska 68008 vwattys.com • 888-232-1000 Omaha, Nebraska 68118
Andrew Coughlin, M.D.
Gina DiRenzo-Coffey, M.D.
Gary Gorby, M.D.
Kathleen Grier, M.D.
Courtney Hellman, M.D.
Sara May, M.D.
Cori McBride, M.D.
Anne O’Keefe, M.D.
John Peters, M.D.
Randy Pritza, M.D.
Tiffany Tanner, M.D.
Steven Wengel, M.D.
Rowen Zetterman, M.D.
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November/December 2022 • Physicians Bulletin 7
STRATEGIC PARTNERS
The Metro Omaha Medical Society Strategic
Partners offer a variety of expertise, products
and services to assist physicians and practices in
addressing their needs and achieving success.
We encourage you to talk with our
Strategic Partners when making decisions for
yourself or your practice.
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8 Physicians Bulletin • November/December 2022
Physicians Bulletin • November/December 2022 EDITOR’S DESK 9
DON’T GIVE UP Four activities are routinely recom-
mended as hobbies to physicians. Those
The hobby is intergenerational, as he has
built rockets for himself, with his son, and
YOUR HOBBIES activities, shown to decrease burnout,
include reading, writing, meditation and
now his grandsons. He has participated in
STEM outreach, instructing school groups
exercise. While I accept that these are in model rocketry. He has flexibility in this
good recommendations, I have found hobby, some days working hours on rock-
these four activities can sometimes feel ets, and then, at times, leaving them unat-
too much like work. tended on the workbench for months at
a time.
Reading medical books and journals has
left me little enthusiasm for additional lei- Model rocketry represents things to buy,
sure reading. Writing, often known in medi- problems to solve and kits to build. It is
cine as “completing charts,” has little room hours of construction, sanding, testing,
AUDREY PAULMAN, M.D. for creativity. While relaxation is always my and painting. In the end, there is the joy of
Editor goal in meditation, too often it leads me a clean launch with a good recovery. Like
Physicians Bulletin to unplanned prolonged napping. As for golf, it is best enjoyed in the company of
regular exercise, I find it neither enjoyable others—in this case, the comradery of the
Iwas given this advice upon admission to
medical school. I think most medical stu-
dents still hear that phrase.
nor relaxing, one of the hallmarks of the
definition of a hobby.
Heartland Organization of Rocketry, where
he is a member.
As people work from home, time avail- Don’t give up your hobbies, and if you
Hobbies? “Does studying count as a able for hobbies has increased. Nearly 40% want, start a new one.
hobby?” I asked myself. Through high school have taken up cooking and baking, accord-
and undergraduate school, my days were ing to Statista, as published on the inter- After more than 40 years of going with
spent studying. Medical school increased net. The baking hobby has led to shortages my husband, Paul, to launch his own hobby
the required study hours in a week. of flour and yeast. Pets, outdoor activities model rockets, I finally built and launched a
and video gaming are listed as hobbies rocket of my own. It was a snap together kit
I laughed and mentally listed “surviving by about a third of people. Arts and crafts, with minimal assembly required, and it flew
medical school” as my hobby. gardening, and travel appeal to a quarter with the smallest engine available. It didn’t
of people as a hobby. go high, and it didn’t go far, but it flew.
Residency, practicing medicine and
motherhood increased my time commit- As hobbying has increased, the public If you had one and quit, or if you never
ments. There was limited free time to be discussion of hobbies has increased as had one, now is a good time to get a hobby.
idle, let alone time to develop a pastime well. For example, the online magazine, Here’s how to start:
or hobby. Neurology Today, features a regular col-
umn, entitled “Off the Clock.” In that col- • Ask yourself what you have always
For clarity, Webster defines a pastime umn, individual neurologists are featured wanted to do.
as “something that amuses and serves to with their hobbies, which include driving
make time pass agreeably.” Pastimes don’t fast cars, painting, playing musical instru- • Remember and restart your childhood
have to be healthy, beneficial or intellec- ments, writing novels, singing, and doing hobbies.
tual. While baseball has claimed the title of stand-up comedy. These neurologists
“America’s pastime,” few physicians have seem just like us, the members of Metro • Take a class.
the 400 hours it takes to watch a whole sea- Omaha Medical Society, where in this mag-
son of games. Less time-consuming, more azine we have featured drivers, farmers, • Look at what you are already doing and
common pastimes include weekly golf musicians and beekeepers as examples take it a step further.
games, streaming videos, playing video of hobbies.
games, doodling or working on hobbies. Chances are you will find someone at
In this edition, the cover story is that of a MOMS with similar interests.
Pastimes are differentiated from hobbies physician who didn’t give up his hobby. His
by Webster’s dictionary. Rather than just lifelong hobby has been building model
making the time pass agreeably, a hobby is rockets. Beginning in elementary school,
defined as a “pursuit outside one’s regular Paul Paulman has built model rockets, fly-
occupation engaged in especially for relax- ing them in parks, fields, and pasture land.
ation.” It is an activity that specifically is not Over the years, he has launched rockets in
supposed to feel like work. Nebraska, Iowa, Kansas, South Dakota and
the Bonneville Salt Flats in Utah.
10 MOMS LEADERSHIP
IN GRATITUDE Back in January, I started my presidency
with a Zoom inauguration. Happily, we are “For most of us, the
FOR A now doing in-person events and activities.
I have had the good fortune to meet many
days of spending time
in the doctors’ lounges
MEMORABLE of our members at events throughout
the year. I popped in on a retired physi- visiting with friends and
YEAR cian’s coffee at the R+R Physician Wellness
Center, made charcuterie with the Women
colleagues have passed,
in Medicine group, and listened to Dr. but now the wellness
Heather Forkey speak on burnout and sec- center is a place we can
ondary traumatic stress (something that we
entertain and learn from
are all too familiar with over the last few
years). In addition to the amazing oppor- each other, which is
tunities I have had to spend time with our integral to our mental and
members, I had the ability to work with
professional well-being.”
MOMS and NMA to update the bylaws for
both organizations. Through these activi- — TINA SCOTT-MORDHORST, M.D.
TINA SCOTT-MORDHORST, M.D. ties and others, I was able to collaborate
President with so many of you. I’ve made new friends My year as MOMS president has given
Metro Omaha Medical Society and strengthened my relationship with me experiences and opportunities that I
existing friends. am so grateful for. Most of all, I am grate-
W hen I began my year as president of
MOMS, I committed my tenure to
connection, education, and advocacy. I
The R+R Physician Wellness Center has
been a wonderful addition to an already
ful for the time I have spent working with
the incredible MOMS staff and getting to
know and connect with so many of you.
wanted these things not only for all of you fantastic organization. It provides a space
as MOMS members, but also to strive to and opportunity for all of us, regardless Although my year as president is com-
embody these philosophies myself. With of specialty or age, to come together in ing to an end, the commitment I made in
the commitment of the MOMS commu- ways that have not been possible over the January remains the same. I will continue
nity, there have been many opportunities last few years. to embrace the chances I have to connect
to further these things in the last several and work with all of you. I will continue to
months, and with the commitment of the For most of us, the days of spending learn through, and about, MOMS, and I
MOMS community, there are many more time in the doctors’ lounges visiting with will continue to advocate for MOMS, and
opportunities yet to come as I complete friends and colleagues have passed, but our members and our community. I sin-
my term and beyond. This is just one of the now the wellness center is a place we cerely thank each and every one of you
many reasons why this organization means can entertain and learn from each other, for everything you have done to support
so much to me and why I am so grateful which is integral to our mental and pro- me during my presidency, and for what I
and honored to have served as president fessional well-being. know you will continue to contribute to
of MOMS. MOMS and each other in the exciting next
chapter to come.Physicians Bulletin • November/December 2022 NMA MESSAGE 11
LOOKING After several meetings with physicians,
defense attorneys, insurance carriers and
This site will be updated regularly after the
start of the legislative session to keep you
AHEAD AT 2023 agents, health systems, the Nebraska
Hospital Association, and the Certified
all informed and engaged.
Registered Nurse Anesthetists, we believe DID YOU KNOW?
it is evident that the amount of risk to the Did you know that as a member of the
fund needs to be reduced to ensure that the NMA you and your staff can reach out to our
fund remains solvent. The NMA will be work- office anytime for assistance? You may ask
ing with our stakeholders to address this in yourself what constitutes a reason to reach out.
the upcoming legislative session. Below is a list of common examples of how the
NMA has supported members recently.
Additional legislative topics being dis-
cussed include prior authorization “gold • Providing assistance navigating payer
card” regulation, extending Medicaid post- related issues such as prior authorizations,
AMY REYNOLDSON
partum coverage, potential scope expan- reimbursements or credentialing. Don’t
Executive Vice President
sion efforts, and physician wellness safe wait to reach out for assistance on payer
Nebraska Medical Association
haven, just to name a few. related issues. We know you and your
staff only have so much bandwidth to work
A s we approach 2023, the NMA is focus-
ing on our legislative priorities and
preparing for what we anticipate to be a
Once bill introductions have concluded in
mid-January, we will review the introduced
legislation and meet with the Legislative
these cases. Often, when you are strug-
gling with prior authorization on a specific
procedure, someone else is in the same sit-
very busy session. With the start of a new Committee to discuss and formulate the uation. It is important for me to know what
year comes the start of a new legislative NMA priorities and approach. We will also you are struggling with so we can work col-
session, and 2023 will be a new opportu- focus on connecting with and educating lectively with the payers.
nity as over one-third of the body is join- the newly elected senators about these
ing as freshmen state senators. After the topics. With the election of new senators, • Connecting you and your staff to impor-
recent election in November, we now know there historically has been a shuffle of com- tant information and resources to ensure
who will join the Legislature in January. mittee members and committee chairs. compliance is met for CME requirements
Many of the races were highly contested Anticipating the coming year will be no dif- for physician’s license renewal.
and it was unpredictable who would be ferent, we will continue to monitor these
the front runners to win their districts. changes closely to ensure that we are well • Keeping you up to date on changes
This uncertainty kept us busy networking connected with the new committee mem- regarding prescribing requirements,
with many of the candidates to learn more bers and their respective chairs, specifically such as CMSs requirements for providers
about their priorities and approach in mak- in Health and Human Services, Banking, when prescribing a controlled substance.
ing good healthcare policy. Commerce and Insurance, and Judiciary. Recently, CMS instituted their Medicare
Promoting Interoperability Program that
Throughout this past summer and fall, We will undoubtedly need your assistance includes CMS eligible providers and hos-
the NMA staff and contracted lobbyists this coming year as we navigate through the pitals must query the Prescription Drug
have been busy meeting with health care session advocating for physicians and the Monitoring Program prior to prescribing
organizations and stakeholders discussing health of all Nebraskans. As we prepare for a Schedule II drug for Medicare patients.
legislative topics for this coming year. Our legislative hearings, not only does the NMA
primary focus has been researching and coordinate testimony with identified physi- • Providing practice management resources
studying the sustainability of the Excess cians speaking on our behalf, but we also to help relieve the burden on staff to ulti-
Liability Fund. In summary, data indicate often ask you to connect with your senator mately provide a better experience and
that the five-year average for paid loss ratio to discuss and educate them on the specific outcomes for your patients. The NMA
is nearly 90%, and the incurred loss ratio is topics to encourage them to do what is in offers a variety of resources, including
more than 110%. Both averages have been the best interest of medicine and patients. member benefit opportunities, to help
trending upward over the last decade. We Our collective, respected voice can bring reduce costs and streamline processes
also know the average severity of claims has about measurable change to our patients, internally to function more efficiently.
seen a sharp rise since 2012. Between 2016 our profession, and our communities.
and 2020, Nebraska’s indemnity severity I encourage you to connect with us sooner
loss ratio is four times higher than the rest To stay engaged and connec ted rather than later when you have identified a
of the country, according to the National with our work at the legislature, NMA situation you want us to know about some-
Practitioner Data Bank. All of these data members can access detailed infor- thing specific or need our assistance. The
points make it difficult to sustain the fund. mation regarding the bills we will be sooner we know about it, the sooner we can
tracking by logging into our secured begin working to get it resolved and hope-
member portal at member.nebmed.org. fully save everyone some time and energy
better focused elsewhere.12 RISK MANAGEMENT
IT SECURITY: A behavior-based component is critical
considering how quickly malware spreads.
Consider the questions that arise when a
virus detection occurs. Where did it come
WHY SHOULD Traditional antivirus was definition-based,
and those definitions changed every couple
from? Where is it now? Did it encrypt any
files? Did it write any new files? Is it config-
YOU CARE ABOUT of days. Zero-day is a term that indicates ured to run on startup after a reboot? What
threats are released and exploited the same do we do next?
ENDPOINT day. A definition does no good in that case.
DETECTION
Rather than definitions, the behavior-based Endpoint Detection Response (EDR)
component learns expected historical continually collects the information about
RESPONSE? activity and blocks processes with activity
the system classifies as suspicious.
processes and files so that when an active
exploit or virus is discovered, a report can
be generated answering all the questions
In addition to file protection, Next- needed to identify the root cause and defin-
Generation Antivirus should protect system ing a plan of action.
files in a manner that protects Windows sys-
tem files from most applications. It should Extending EDR beyond the windows end-
also block USB storage and other remov- point continues with eXtended Detection
able storage. These features improve ran- Response (XDR). XDR is similar, but extends
somware protection. the collection to servers, cloud services,
and network activity to further assist in
BRANDON GORDON Next-generation antivirus continues its cleanup efforts.
President protection to web protection and network
RUN Networks traffic. Web protection is not just a web fil- Even with EDR and XDR, the monitoring
ter. It protects against malicious compo- of these alerts can be overwhelming, which
E ven with good endpoint protection,
the discovery of a threat needs to be
addressed. Is the threat active? Was it
nents involved in an exploit that begins with
a web site. A vulnerability affecting a web
site can quickly lead to pushing the exploit
is where the last two acronyms come in,
MDR and MTR are both managed by a ser-
vice. Managed Detection Response (MDR)
stopped and deleted? These are ques- to Windows workstations. The speed of should involve a human element which
tions that need to be answered to deter- zero-day attacks is why web protection allows for deeper investigation of alerts and
mine if further cleanup needs to happen. against traffic unrelated to the local net- more targeted actions related to cleanup.
Fur ther cleanup might even include work is so important in endpoint protection. This service assumes a Security Operations
restoring from backup, or formatting and Web protection scans the internet traffic Center (SOC) is involved on the backend
reinstalling the machine which can have and another feature sometimes referred which is why outsourcing this service makes
an impact on business. to as simply “Network Traffic Protection” the most sense. Even further extending
scans mainly local traffic. Local network these services is Managed Threat Response
With EDR (Endpoint Detection and scans, printer exploits, trusted folders, even (MTR), which not only responds to the
Response)/XDR (eXtended Detection credential theft are the types of activity that alerts giving direction back to your IT, MTR
Response), answering the questions network traffic protection features watches responds and takes the required cleanup
becomes much simpler with little effort and protects against. action on your behalf.
required. EDR/XDR can be a huge time sav-
ings leading to a huge decrease in downtime. Lastly, endpoint protection should SUMMARY
be able to isolate a machine with active Since the threat landscape and related
Also, cyber insurance companies are exploits. If malicious activity occurs at 2 services change so frequently, keeping
increasingly expecting EDR and other secu- a.m., endpoint protection should be able up on these services has become a chal-
rity services. Lack of EDR might be a deter- to prevent the machine from spreading that lenge. Software and IT vendors refer to
mining factor in whether the carrier will attack to the rest of the network. these services interchangeably so drilling
provide insurance or what rate they assign. into the services the product provides is
EDR/XDR/MDR/MTR ACRONYMS important. Defining what the protection
ENDPOINT PROTECTION While next-generation antivirus and covers is important and vendor trust is
The security landscape is changing, and endpoint protection is good and is greatly important. But most important is accurate
so is the terminology. Let’s start with Next- improved from traditional definition-based statements on compliance reporting and
Generation Antivirus, which is part of the antivirus, the plan of action in responding cyber insurance forms.
Endpoint Protection category. Antivirus to an alert is not clearly defined. EDR/XDR
alone is not enough any longer, so Next provides the information needed to create
Gen Antivirus now includes other features, a plan of action.
and these features should be required in
any business setting.Physicians Bulletin • November/December 2022 FINANCIAL COLUMN 13
RESIDENCY TO checking, or savings account can provide
some financial protection by quickly earn-
RETIREMENT
As physicians think forward, it’s impera-
RETIREMENT ing interest. Some financial institutions
are more flexible in their consideration of
tive to understand the options available to
monetize their initial investment into their
student loans in the debt-to-income ratio, practice and ensure continue financial sta-
making it easier to qualify for loans, espe- bility upon retirement. When planning for
cially for a mortgage. retirement, the two most common options
to consider are practice acquisition and
PRACTICING PHYSICIAN partner buy-in.
Post residency, it’s most common for
new physicians to seek employment within Partner buy-in is essentially a buy-sell
a health care system to establish them- agreement that details the ownership
selves with physicians and patients instead equity after a partner retires or leaves
MARKIE LOWRY of taking the leap directly into private prac- the practice. With this option, other part-
Assistant Vice President, tice. It can take several years to build a ners can buy out the equity of the retiring
Healthcare Relationship Manager patient portfolio and without established physician and those physicians who are
Core Bank patients, the work can be made more diffi- not currently partners, have the option to
cult and stressful than necessary. However, become a partner by buying in. Most pri-
T he road from residency to retirement
can be long and complicated, but it
doesn’t have to be. When planning for the
beginning your career as a new physician
comes with great potential, a long run-
way, and the need to start thinking about
vate practices generally employ physicians
for several years prior to offering partner-
ship opportunities.
future, it’s important to build a team of investing and saving if you haven’t done
industry experts early on to help navigate so already. Practice acquisition is another option
those financial woes. From the stress of and generally occurs when a physician
being a resident to the daily challenges of With physicians retiring in droves post retires, and an existing practice or health
patient care, the last thing you – as a physi- COVID, there is a high need for primary system purchases the practice. This is one
cian – need to worry about is your financial care physicians and health care organiza- of the most challenging business deals
health, both now and in the future. tions are willing to pay. In 2019 the aver- to execute and if not done properly, can
age starting salary for a first year, full-time have lasting legal ramifications including
RESIDENCY primary care physician was $180,000 and patient abandonment. During a practice
As if residency wasn’t taxing enough, in 2021, this number jumped significantly acquisition, it’s important to work with the
student loans and financial planning can to $225,000. Established primary care right financial partners such as a health
make it seem even more complicated. physicians can expect to make upward of care attorney or accountant who can
With the rising costs of education, it’s $278,000 in base compensation but also advise on legal and financial decisions.
not unusual for young physicians to begin receive additional benefits such as PTO
their careers with six figure debt. In 2020, and retirement. Specialty groups have Retirement doesn’t happen overnight
the average resident salary was $64,000 also seen large jumps in compensation and generally buy-ins and practice acqui-
while student loan debt well exceeded with COVID. A first-year orthopedic sur- sitions take years to properly execute.
$250,000; add in the compounding inter- geon could expect to make an average Having your team of experts to help pre-
est from student loans, and it can seem of $370,000 in 2019, however the first-year pare for the future and to be ready when
almost impossible to pay off. Luckily there salary now sits around $400,000. the time comes is imperative to being
are many ways to pay off student loans financially successful starting in residency
and industry experts who work with you Financial planning early on is especially and following through to retirement.
to fit your needs. important because physicians, when com-
pared to other professions, take years Sources:
longer to reach their full income poten- Provider Placement 2017-2021. (2022).
Another big financial decision to con-
tial. Private prac tice physicians also MGMA DataDive.
sider is the purchase of your first home.
face additional challenges as they take
It’s beneficial to seek out a financial insti-
on extra debt to front the initial capital Physician Compensation 2017-2021. (2022).
tution with a physician program as there
investment it takes to become a practice MGMA DataDive.
are often many benefits including lower
owner. Despite the costs however, there
interest rates on loans, mortgages that
are many benefits to private practice own-
require little to no money down, and high
ership that can pay out in the long run,
interest accounts. As a resident beginning
especially near retirement.
their professional journey, a high interest14 FEATURE
SOME ADVICE
ABOUT PREPARING
FOR RETIREMENT
A lan Thorson, M.D., has a message for
those who want to know whether he’s
enjoying being retired: “It’s awesome. It is
over during COVID,” he said. Previously, chil-
dren could stretch IRA beneficiaries over
their lifetime. No more. Now, they have 10
Some people find they just can’t retire.
Volunteer for a nonprofit or community
agency to fill your days. “Walk before you
incredibly freeing to have control over your years to do so. Yes, that’s your child’s issue, run.” Consider going into semi-retirement,
schedule. My schedule is full, but I control it.” he said, but being aware of the change can working 20 hours and devoting 20 hours to
help them maximize their inheritance. “That personal pursuits. Then, transition to work-
Dr. Thorson, who retired Dec. 31, 2019, was a biggie. Not everyone is aware of it ing 10 hours and spending 30 hours on hob-
after 35 years of practicing medicine, said from a generational planning perspective.” bies and volunteering.
he began preparing for retirement on his
first day on the job. He saved for retirement OTHER PIECES OF ADVICE Dr. Thorson said he still begins his days
and lived below his means—so he could From Mary Vandenack on the timing of early (4:30 a.m.) with an emphasis on physi-
retire on his own terms. When asked now, your retirement: Pick your retirement date cal fitness, including swimming, weight train-
he tells people to think about their “exit wisely and make sure you have your bases ing and yoga. His many hobbies include
strategy” early on because you never know covered. Some employment contracts auto- landscaping, gardening, volunteering,
when you may need to “exit,” by choice or renew. Are you responsible for training your and painting landscapes using oils. He still
otherwise. That includes financial as well as successor? Retirement plans may stipulate serves medical specialty groups on the local,
vocational. It’s one piece of advice he’s will- that you must work on the last day of the plan regional and national levels. As he said, his
ing to share with anyone about how best to year to receive a contribution for a particular schedule is busy, but on his own terms.
prepare for retirement. year. One physician retired a month early—
only to realize the early retirement meant From Mary Vandenack about medical
Mary Vandenack, founder and CEO of the $20,000 less in the physician’s tax deferred licenses: As retirement approaches, decide
law firm Vandenack Weaver Truhlsen; Chad plan. Make sure the definition of retirement whether you want to retain your medical
Rutar, a financial adviser and shareholder is stated in your employment contract and license, and for how long. Many keep it for
at Renaissance Financial; and Dr. Thorson research any stipulations in the summary several years in case they decide to prac-
offered advice—some legal, some finan- plan description of any retirement plan in tice again or if they are asked to consult. “It’s
cial and some personal—to physicians with which you participate. something to look at and consider.”
retirement on their minds.
From Chad Rutar about easing into From Mary Vandenack about medi-
First things first: Rutar pointed out that retirement: Have a plan—a purpose—for cal records: Make arrangements for them.
the IRS Secure Act of 2019 changes how IRA your time in retirement. “Don’t go from If you’re working for a hospital, you may
beneficiaries are handled. “It got glossed working 50 to 60 hours to doing nothing.” not need to worry. Still, ask your employer15
EARLY EXI T S T R AT EGY
IR A BEN E F ICIAR I ES
CON SI DER S EMI-
RE T IREM EN T
K NOW YOUR CON T R ACT ’ S
RE T IREM EN T PLAN
CON SI DER LOCAT ION
& COS T OF HOBBI ES
for assurance by letter that your records a trustee.” This is a better approach than hav- From Chad Rutar on seeking guidance
will be maintained and that you will have ing a power of attorney. (A trustee with finan- about retirement: “Hire the team and have
access to them in the event of a lawsuit cial responsibility to you means the funds are the team work together.” Your professional
after your retirement. If you are a solo prac- guaranteed and if trustee is incapacitated or team—accountant, attorney and financial
titioner, determine who will be responsi- dies, a replacement will be designated. If you adviser—should work together and know
ble for the ongoing management of your don’t have successors in a power of attor- one another.
patients’ records. ney, a court proceeding may be required to
appoint a conservator or guardian.) From Chad Rutar about involving your
From Chad Rutar on having funds children in your retirement plans: When
lined up for your initial retirement years: From Dr. Thorson on announcing retire- the time is right, talk to your children about
Have three or four years of funds ready and ment plans: He notified his partners at your money. “At some point, it’s going to
available from low-yielding sources. If your Colorectal Surgery Inc. about three years be their money and they may be taking care
annual need is $100,000, have $300,000 to earlier that he was looking to retire—but of you.” Share your financial information as
$400,000 available in CDs, money market wasn’t sure exactly when. Then, he gave time passes. Be sure one child (or heir) is
accounts or treasurer bonds—rather than actual notice one year prior. Giving them ready to handle your responsibilities when
dipping into your equities or other higher- a heads up, followed by his actual timeline you no longer are able. “Make sure they’re
yielding assets. Save those for your later allowed his partners to prepare for his retire- not scrambling to find the paperwork about
years in retirement. If that’s not possible, an ment—just as he was. your care.”
IRA can provide those funds. Say your IRA
sits at $2 million, use the initial $400,000 for From Mary Vandenack about having A repeat piece of advice from Dr.
the first years of retirement—“the remaining proper insurance: Do a complete evaluation Thorson about the importance of start-
$1.6 million needs to be your inflation fighter.” of your insurance coverage. Take into consid- ing early to save for retirement. “The first
eration how you plan to live—and where—in dollar you save during that first year is the
From Mary Vandenack on planning for retirement. Will your insurance cover you one that’s going to have the best chance to
worst case scenarios: What happens if properly if you live in several states? What if grow. If you wait until you’re 50 to start saving,
you become incapacitated and can no lon- Florida is your new residence and Nebraska you’ve lost 25 years of growth.”
ger care for yourself? Consider establish- becomes your vacation home? If you plan
ing a trust to cover incapacity. You should to start collecting artwork, cars, firearms—
title your assets in your trust during life to make sure your insurance covers those new-
simplify fiduciary handling of incapacity if it found interests.
occurs. “A trust never fails for the absence of
November/December 2022 • Physicians Bulletin 15Jane Raybould, Nebraska Senator-Elect District
28 (left) and husband Jose Herrero speak with
John Peters, M.D., co-chair MOMS Legislative
Committee; and Joshua Mammen, M.D. (back right).
ADVOCACY RESOURCES:
A MOMS Member Benefit
Juan Santamaria,
M.D. (right) shares
his thoughts with
Senator Patty
Pansing-Brooks
(left) and Alex
Dworak, M.D.Physicians Bulletin • November/December 2022 FEATURE 17
T here’s something necessary about MOMS
members raising issues important to
themselves, their medical practices and,
Some issues identified at the Precaucus
forum and later discussed at Caucus are state
matters. Others have a more national reach
most of all, their patients. and could be forwarded to the American
Medical Association for consideration.
“Personally, I like the concept of people
who are MOMS members bringing forth The Precaucus is more of the information-
issues important to them and helping solve gathering portion of the process. Topics
these challenges. The advocacy resources suggested for consideration are shared with
MOMS provides its members can be of tre- members of the Legislative Committee and
mendous value to our physicians—if they uti- the membership at large. The
lize them,” said John Peters, M.D. Peters
Added Rowen Zetterman, M.D.: “Our
“If you see a problem and no one is doing
anything about it, this is your opportunity,”
File
members have a voice. We have a mission Dr. Peters said. Hometown
to listen to everyone’s voice, to make sure Lincoln, Nebraska
everyone is heard and their needs are being Several months after Precaucus, the
Undergraduate Degree
met about the issues important to them and Legislative Committee hosts the annual Creighton University
their work.” Caucus where issues are discussed and in biology
options for solutions identified. A typical
Drs. Peters and Zetterman, who serve Caucus may include a half-dozen topics dis- Medical Degree
Creighton University
as co-chairs of the MOMS Legislative cussed during a two- to three-hour session. School of Medicine
Commit tee, ex plained the advocac y
resources available to MOMS members, The discussion is lively, Drs. Peters and Residency
which they described as a membership ben- Zetterman said. The goal is to draft a rea- UNMC in ophthalmology
efit. The first, they said, is the Precaucus/ sonable and tenable solution to an issue Fellowship
Caucus process for identifying issues that brought before attendees that can be pre- Cornea and external
could ultimately be considered as legislative sented to the NMA in the form of Resolution. disease, University of
priorities. Another is the annual Policymaker These resolutions are then voted upon by Florida Medical Center
Meet-and-Greet forum with lawmakers cur- the membership at the annual NMA House Specialty
rently in office and candidates for state and of Delegates meeting. Those passed then Ophthalmology
federal. And as a final suggestion, Drs. Peters go to the NMA leadership for review of the
Titles
and Zetterman invited MOMS members to offering and consideration as a potential leg-
Adjunct Clinical Professor,
get involved in their medical society. islative bill or for policy discussion. UNMC Department
of Ophthalmology
First, they want MOMS members to “It’s a way to get from nothing happening—
Clinic
understand the purpose of the Legislative to a solution,” Dr. Peters said.
Omaha Center for Sight
Committee. “Our mission is to work to
improve the capacity of physicians to take Dr. Peters has participated in nearly a dozen Hobbies
care of their patients,” Dr. Zetterman said. Precaucus sessions, while Dr. Zetterman has Physical fitness, cycling,
hiking, landscaping
about three dozen. Each session is differ-
and reading
ent and typically includes lively debate and
PRECAUCUS/CAUCUS impactful conversations, they said. Why He Joined MOMS
Each summer, MOMS members are invited “I joined MOMS to be
to attend the Precaucus forum where attend- This year’s Precaucus/Caucus process part of an organization
that facilitates advocacy,
ees are encouraged to suggest issues that are included an issue relating to organ tissue use education and cooperation
affecting their practices and their patients— brought forward by medical students. “The in the medical community.”
while suggesting potential solutions. students represented themselves extremely
well in the process”, Dr. Peters said, and
Why bring issues that are important to us prompted discussion and feedback before
in Omaha to all physicians? “To see if they their issue was forwarded to the NMA for
will join us within the state and send to the consideration.
Nebraska Medical Association for consider-
ation as a priority for legislative attention,” CONT. PAGE 18
Dr. Zetterman said.18 FEATURE
The
Zetterman
File
Hometown Rick Holdcroft, Nebraska
Shickley, Nebraska Senator-Elect District 36,
Jillyn Kratochvil, M.D., and
Undergraduate Degree Brett Kettelhut, M.D.
Nebraska Wesleyan
University in biology
Medical Degree FROM PAGE 17
University of Nebraska
Medical Center
POLICYMAKER MEET-AND GREET one venue. “It gives our members the oppor-
Residency The annual gathering typically draws a tunity to meet with more than just their indi-
University Hospital in crowd, Dr. Zetterman said, because sit- vidual legislator.”
Omaha in internal medicine
ting lawmakers and candidates for legis-
Fellowship lative office at the state and federal levels Dr. Peters said he has come to appreciate
UNMC in gastroenterology understand the value of discussing issues the give-and-take that results at the meet-
and New Jersey College related to health care with the people who and-greets. He said he generally stays current
of Medicine at Newark in
provide it. with candidates’ stances on issues, so though
hepatology and nutrition
it may not be common for him to change his
Title Previously, MOMS leadership invited support from one to another, it often rein-
Interim dean lawmakers and candidates for individual forces his support for his candidates of choice.
Institution conversations about where they stood on
UNMC College of Dentistry issues. That approach evolved into a recep- “It’s a back-and-forth environment. It’s nice
tion where all candidates could attend and to get to know our candidates so they remem-
Hobbies
meet MOMS members at one gathering. ber us and the challenges we face. We can
Fishing, woodworking
and collecting— help each other. This event creates familiarity
especially clocks Typically held between the primary and when issues arise. It builds trust and valida-
general elections, the reception allows tion between physicians and the people who
Family MOMS members to not only talk with law- represent us in government.”
Wife, Joanie Zetterman;
three sons and seven makers and candidates from their legislative
grandchildren and congressional districts, but also those
who want to represent nearby districts. ANOTHER OPPORTUNITY
Why He Joined MOMS Drs. Peters and Zetterman said the Legislative
“I joined MOMS because
Both groups of attendees seem to Committee, as well as other MOMS committees,
I wanted to be a part of
a group of people who appreciate the opportunity for interac- are always looking for new members, especially
worked on issues in tion, Dr. Zetterman said. “The fact that those who enjoy being part of the policymak-
health care to improve candidates show up tells us they believe ing process.
patient care.” it is important to them to listen about the
issues affecting health care.” “This is your avenue to see that everyday
problems are addressed,” Dr. Peters said.
In return, Dr. Zetterman said, MOMS “That’s why we’re here—to help our members,
members are appreciative of the oppor- their practices and most of all our patients.”
tunity to visit with multiple candidates atPhysicians Bulletin • November/December 2022 COVER FEATURE 19
A DAY FLYING A third is a production manager at Lozier.
HOBBY ROCKETS
Several are retired. He’s the only retired phy-
sician in the group.
Is Like No Other On this Sunday, Dr. Paulman didn’t have
the best of luck. Two of his glider rock-
ets failed to launch on the first attempt
I
and they lagged in lift-off on the second
t’s mid-morning on a sunny
attempt and spent just seconds airborne
Sunday in September and Paul
before angling violently to the ground.
Paulman, M.D., is exactly where
he wants to be. He moves back
The two gliders, he explained, were
and forth along the sidelines of a
damaged beyond repair. “I thinned the
freshly manicured sod farm west
herd today,” referring to his stable of
of Plattsmouth and south of the
more than 20 rockets kept in the base-
Platte River as he readies his rock-
ment of his home. “Recovery has been
ets for launch.
an issue today. They all come down,
but maybe not the way you would like.”
Dr. Paulman is surrounded by other
Another rocket—a low-power rocket
rocketeers—many of them members
designed for a slow-motion liftoff “a
of the Hear tland Organization of
crowd-pleaser”—did well on its launch
Rocketry—who share a passion for his
and was considered the success of his
hobby. One is a pilot by profes-
day. This particular launch had moments
sion, another a machinist.
of glory, he explained, as the parachute
spun on the rocket’s return to the
ground—a technique Dr. Paulman
is working to perfect. “I had a
bit of success today.”
CONT. PAGE 21
Paul Paulman, M.D.20 Physicians Bulletin • November/December 2022
Physicians Bulletin • November/December 2022 COVER FEATURE 21
FROM PAGE 19
Despite the mishaps with his pair of glid- He reconnected with his hobby when
ers, Dr. Paulman said, there was no place their two children (now grown) were grow-
he’d rather be, because he was launch- ing up and became interested in rockets.
ing rockets. The weather conditions were He also connected with the rocket club and
perfect—sunny skies and winds under 20 kept his hobby going. The
mph. Temperatures in the 70s didn’t hurt,
he said, noting that club members launch
Paulman
every month of the year, even the cold-
Why rockets? He likes File
temperature ones. the problem-solving Hometown
that goes with them— Sutherland, Nebraska
Dr. Paulman spends at least one day
each month launching his rockets—and the worrying, for example, Undergraduate Degree
Attended Kearney
time in between preparing them for their about propulsion and State College, now
moments of glory. During the cold-weather
months, club members launch from a field the balance points of known as University of
Nebraska Kearney
north of Wayne, Nebraska. During warmer- the rocket and selecting
weather months, they launch from a field Medical Degree
closer to Omaha. (Permission from the FAA
the appropriate engine University of Nebraska
Medical Center
is needed to launch rockets with higher- for each.
powered engines.) Residency
Why rockets? He likes the problem- Broadlawns Medical
Center in Des Moines
Dr. Paulman’s passion for hobby rock- solving that goes with them—worrying,
in family medicine
etry started as a youngster when adver- for example, about propulsion and the
tisements for rocket kits found in Popular balance points of the rocket and select- Title
Science and Popular Mechanics maga- ing the appropriate engine for each. He Professor emeritus of
family medicine
zines caught his eye. He bought an Estes also appreciates the flexibility his hobby
Industries (estesrockets.com) rocket and offers. You can focus on building rockets Institution
launched it on the high school football for a time, he explained, then spend time UNMC
field with partial success. flying what you’ve built.
Hobbies
Besides hobby rocketry,
“It went OK except the parachute didn’t Dr. Paulman discussed some aspects of yardwork, cycling
come out. It became a missile on the way rocketry that those considering the hobby and boating
down, but it didn’t hurt anything.” should know before getting involved:
Family
Wife, Audrey Paulman,
He was hooked. While in high school, he The cost—smaller rockets generally cost M.D.; two grown children,
said, he always had a rocket he was flying about $50 for the kit and launch equipment, Roger Paulman, M.D.;
or building. He had little time for hobby which can be purchased at hobby shops. and Kate Crowley
rocketry in college and medical school, but Larger and more powerful ones cost $150
Why He Joined MOMS
returned to his hobby on a limited basis and their engines about $50—and must be “I joined because the
during his medical residency at Broadlawns purchased from select mail-order compa- organization supports
Medical Center in Des Moines. nies. “You can spend as much as you have— physicians.”
if you want.”
“We lived in kind of a commune—so it was
a nice hobby,” he recalled. “It was mostly CONT. PAGE 23
me—Audrey (his wife, Audrey Paulman,
M.D.) was involved by diffusion.”When he retired from
medicine in 2020, Dr.
Paulman didn’t need to go
looking for a hobby. He
already had one. Building
and launching rockets
make for great days...
22 Physicians Bulletin • November/December 2022COVER FEATURE 23
FROM PAGE 21
SAFETY
Hobby rocketry comes with a series of Club members meet monthly with Dr. Paulman plans to continue his hobby
safety rules. “Rocketry is inherently a guests welcome. Members and guests until mobility becomes an issue—and
dangerous hobby. Our safety rules discuss their current challenges with their even then, he said, he could just launch
are non-negotiable.” The club car- rockets and ask for advice. Everyone is smaller rockets—the type described as
ries its own insurance policy for its welcome, Dr. Paulman said. Visit www. “line of sight—then don’t venture far from
members, but has had few claims nebraskarocketry.com for launch and their launching point.” Mobility is an
over the years. meeting dates. issue when rockets with higher-powered
engines go astray—like his two gliders
CERTIFICATION When he retired from medicine in 2020, did that day. Retrieving rockets that had
Rockets engines H and I (anyone Dr. Paulman didn’t need to go looking for less-than perfect launches is a moment
can launch rockets with engines A a hobby. He already had one. Building all hobbyists experience. “We call it the
through G) require a Level 1 certi- and launching rockets make for great walk of shame.”
fication. Rockets with more pow- days, he said, as do days when club mem-
erful engines (J, K and L) require bers visit with students about their hobby. Why does he keep coming back? Think
Level 2 certification and launch- They have visited with members of 4-H of it this way, Dr. Paulman said: Even the
ing rocket s with M engines clubs and school children. He always best golfers have shots that go astray. A
require Level 3. Dr. Paulman enjoys those times, but admits that club day when your rockets fail to launch or
holds a Level 3 cer tification, members have an ulterior motive when are damaged beyond repair, he said, still
which, he said, took time, effort they talk about their rockets. “We need deserves high marks, including this one. “I
and practice to earn. to get kids fired up about rocketry. The would give my day a high B because I was
hobby will fade away if we don’t. I’m not out flying. A day flying is like no other.”
young. Most of the fliers are not young.”24 FEATURE
MAKING A CASE
ABOUT THE
IMPORTANCE OF
IMMUNIZATIONS:
More than a Primary
Care Discussion
Andrew Coughlin, M.D.
W hen discussing the importance of
immunizations, Andrew Coughlin,
M.D., relies on data to do his bidding.
In the case of the HPV vaccine, Dr.
Coughlin said that evidence provides a
strong case for getting children vaccinated.
Dr. Coughlin said conversations about
immunizations typically fall to primary
care, internal medicine and family medi-
Similar assertions, he said, could be made cine physicians. Specialists, however, can
The Head and Neck surgeon with for other childhood immunizations. “It is do their part. “It has to be a team effort
Methodist Health System typically is pro- not uncommon for people to be leery or and communication is key to encouraging
moting the HPV (it stands for human papil- concerned about new vaccines. That is what immunization.”
lomavirus) vaccine, but said this approach we saw when the HPV vaccine came out.
makes a strong case for other immuni- Ultimately it comes down to the patient- Dr. Coughlin looks forward to the day
zations that parents (and grandparents) doctor experience. If I give them GOOD when the HPV vaccine is widely distributed
should consider for their children (and data and they trust me, most patients are to the population at large.
grandchildren). willing to accept that.”Physicians Bulletin • November/December 2022 25
The conversation between a pediatrician He explains that he routinely treats patients
and parents and their children, he said, would with cancerous tumors in the base of tongue
go something like this: “You’re due for your and tonsil region. Those cancers, he said,
vaccines. Let’s get your tetanus and menin- are no longer caused solely from smoking.
gitis shots and, hey, we also have your cancer Rather, they are related to exposure to HPV
vaccine. It’s recommended for kids 10 years several decades past. “It behooves me to get
and older.” the message out and work on the prevention
side, rather than taking care of the tumor as an
When encouraging the HPV vaccine and afterthought.” An additional point he makes is
others, Dr. Coughlin said, physicians have that the vaccine is one that potentially can pro-
built-in credibility. “The good news is that
patients still trust their doctors. And most
tect the person getting the immunization and
those with whom he or she has later contact.
The
doctors trust other doctors. Have a good Coughlin
conversation with your patients and with your What originally was a vaccine targeted for File
colleagues. Patients believe and are willing young girls has extended to boys. Dr. Coughlin
Hometown
to do what their physician suggests. That’s a said he noticed that marketing campaigns for
Council Bluffs, Iowa
good thing.” getting the HPV vaccine in the past few years
have targeted the younger male population Undergraduate Degree
When the HPV vaccine first was introduced as well. Nebraska Wesleyan
in 2006, it caused an uproar among parents University in biochemistry
and molecular biology
who thought their daughters were being If the goal is to achieve herd immunity of
encouraged to have sex, Dr. Coughlin said. 80 percent of the population, as is the goal Medical Degree
“That was unfortunate. It should have been for other vaccines, why eliminate 50 percent University of Nebraska
looked at as a cancer vaccine.” The stigma of the target by not focusing on getting boys Medical Center
has waned, and the vaccine is more readily also vaccinated, he asked. Residency
accepted for boys and girls as a way to pre- University of Texas Medical
vent HPV infections that can cause cancer later While Nebraska and Iowa sport HPV vacci- Branch at Galveston
in life. nation rates that rank among states with the in Otolaryngology
highest percentages, Dr. Coughlin said, just Fellowship
Fifteen years ago, the goal for the vaccine an estimated 60 percent of eligible children Methodist Estabrook
was to get people caught up with their vac- have been vaccinated. “There is still work to Cancer Center, head and
cines, including HPV, especially since we did be done.” neck surgical oncology
and microvascular
not have the ability to start the series at 11
reconstruction
years old for those who were in their late teens Dr. Coughlin said he talks with his patients,
and 20s. Now, and fortunately so, he said, the ages 40 to 60, about the importance of the Specialty
vaccine over time has become accepted as vaccine. While it may be too late for them, he Head and neck surgery
part of the series of vaccines for youngsters said, they have children and grandchildren for Institution
to receive. “Because of this we have seen whom that’s not the case. Methodist Health System
improved numbers with regards to vaccina-
Hobbies
tion, but we still have work to do.” As for adults, he said, most people have
F3 Omaha (men’s
been exposed to HPV by the time they are 30. workout group), running,
As a reminder, according to the CDC, HPV Anyone born in the 1990s or earlier has likely hiking and spending
vaccination is recommended to start at ages 11 been exposed and the vaccine likely would time with his family
to 12 years. HPV vaccines can be given starting have no value.
Family
at age 9 years. All preteens need HPV vaccina- Jennifer Coughlin;
tion so they are protected from HPV infections Still, the FDA two years ago approved the three children, Claire,
that can cause cancer later in life. HPV vaccine for people up to 45 years old, Lucas and Julia
Dr. Coughlin said, and people who are not
Why He Joined MOMS
So why is a head and neck surgeon bang- monogamous or have multiple sex partners
“It is rewarding to have a
ing the drum for parents to have their children should consider receiving it. sense of belonging to the
receive the HPV vaccination? It’s a way to work greater medical community
himself out of a job, he said, only partially in And it starts with a conversation about and to help improve the
jest. “Yes, I am a surgeon, but I would rather the impor tance of getting vaccinated. health of Nebraska.”
people not get cancer and have to see me to “Communication, evidence and trust are all
get treatment.” critical to the conversation.You can also read
